Electrocochleography-Based Tonotopic Map: II. Frequency-to-Place Mismatch Impacts Speech-Perception Outcomes in Cochlear Implant Recipients

OBJECTIVES

Modern cochlear implants (CIs) use varying-length electrode arrays inserted at varying insertion angles within variably sized cochleae. Thus, there exists an opportunity to enhance CI performance, particularly in postlinguistic adults, by optimizing the frequency-to-place allocation for electrical stimulation, thereby minimizing the need for central adaptation and plasticity. There has been interest in applying Greenwood or Stakhovskaya et al. function (describing the tonotopic map) to postoperative imaging of electrodes to improve frequency allocation and place coding. Acoustically-evoked electrocochleography (ECochG) allows for electrophysiologic best-frequency (BF) determination of CI electrodes and the potential for creating a personalized frequency allocation function. The objective of this study was to investigate the correlation between early speech-perception performance and frequency-to-place mismatch.

DESIGN

This retrospective study included 50 patients who received a slim perimodiolar electrode array. Following electrode insertion, five acoustic pure-tone stimuli ranging from 0.25 to 2 kHz were presented, and electrophysiological measurements were collected across all 22 electrode contacts. Cochlear microphonic tuning curves were subsequently generated for each stimulus frequency to ascertain the BF electrode or the location corresponding to the maximum response amplitude. Subsequently, we calculated the difference between the stimulus frequency and the patient's CI map's actual frequency allocation at each BF electrode, reflecting the frequency-to-place mismatch. BF electrocochleography-total response (BF-ECochG-TR), a measure of cochlear health, was also evaluated for each subject to control for the known impact of this measure on performance.

RESULTS

Our findings showed a moderate correlation (r = 0.51; 95% confidence interval: 0.23 to 0.76) between the cumulative frequency-to-place mismatch, as determined using the ECochG-derived BF map (utilizing 500, 1000, and 2000 Hz), and 3-month performance on consonant-nucleus-consonant words (N = 38). Larger positive mismatches, shifted basal from the BF map, led to enhanced speech perception. Incorporating BF-ECochG-TR, total mismatch, and their interaction in a multivariate model explained 62% of the variance in consonant-nucleus-consonant word scores at 3 months. BF-ECochG-TR as a standalone predictor tended to overestimate performance for subjects with larger negative total mismatches and underestimated the performance for those with larger positive total mismatches. Neither cochlear diameter, number of cochlear turns, nor apical insertion angle accounted for the variability in total mismatch.

CONCLUSIONS

Comparison of ECochG-BF derived tonotopic electrode maps to the frequency allocation tables reveals substantial mismatch, explaining 26.0% of the variability in CI performance in quiet. Closer examination of the mismatch shows that basally shifted maps at high frequencies demonstrate superior performance at 3 months compared with those with apically shifted maps (toward Greenwood and Stakhovskaya et al.). The implications of these results suggest that electrophysiological-based frequency reallocation might lead to enhanced speech-perception performance, especially when compared with conventional manufacturer maps or anatomic-based mapping strategies. Future research, exploring the prospective use of ECochG-based mapping techniques for frequency allocation is underway.

Comparison of Tonotopic and Default Frequency Fitting for Speech Understanding in Noise in New Cochlear Implantees: A Prospective, Randomized, Double-Blind, Cross-Over Study

OBJECTIVES

While cochlear implants (CIs) have provided benefits for speech recognition in quiet for subjects with severe-to-profound hearing loss, speech recognition in noise remains challenging. A body of evidence suggests that reducing frequency-to-place mismatch may positively affect speech perception. Thus, a fitting method based on a tonotopic map may improve speech perception results in quiet and noise. The aim of our study was to assess the impact of a tonotopic map on speech perception in noise and quiet in new CI users.

DESIGN

A prospective, randomized, double-blind, two-period cross-over study in 26 new CI users was performed over a 6-month period. New CI users older than 18 years with bilateral severe-to-profound sensorineural hearing loss or complete hearing loss for less than 5 years were selected in the University Hospital Centre of Rennes in France. An anatomical tonotopic map was created using postoperative flat-panel computed tomography and a reconstruction software based on the Greenwood function. Each participant was randomized to receive a conventional map followed by a tonotopic map or vice versa. Each setting was maintained for 6 weeks, at the end of which participants performed speech perception tasks. The primary outcome measure was speech recognition in noise. Participants were allocated to sequences by block randomization of size two with a ratio 1:1 (CONSORT Guidelines). Participants and those assessing the outcomes were blinded to the intervention.

RESULTS

Thirteen participants were randomized to each sequence. Two of the 26 participants recruited (one in each sequence) had to be excluded due to the COVID-19 pandemic. Twenty-four participants were analyzed. Speech recognition in noise was significantly better with the tonotopic fitting at all signal-to-noise ratio (SNR) levels tested [SNR = +9 dB, p = 0.002, mean effect (ME) = 12.1%, 95% confidence interval (95% CI) = 4.9 to 19.2, standardized effect size (SES) = 0.71; SNR = +6 dB, p < 0.001, ME = 16.3%, 95% CI = 9.8 to 22.7, SES = 1.07; SNR = +3 dB, p < 0.001 ME = 13.8%, 95% CI = 6.9 to 20.6, SES = 0.84; SNR = 0 dB, p = 0.003, ME = 10.8%, 95% CI = 4.1 to 17.6, SES = 0.68]. Neither period nor interaction effects were observed for any signal level. Speech recognition in quiet ( p = 0.66) and tonal audiometry ( p = 0.203) did not significantly differ between the two settings. 92% of the participants kept the tonotopy-based map after the study period. No correlation was found between speech-in-noise perception and age, duration of hearing deprivation, angular insertion depth, or position or width of the frequency filters allocated to the electrodes.

CONCLUSION

For new CI users, tonotopic fitting appears to be more efficient than the default frequency fitting because it allows for better speech recognition in noise without compromising understanding in quiet.

Postoperative Impedance-Based Estimation of Cochlear Implant Electrode Insertion Depth

OBJECTIVES

Reliable determination of cochlear implant electrode positions shows promise for clinical applications, including anatomy-based fitting of audio processors or monitoring of electrode migration during follow-up. Currently, electrode positioning is measured using radiography. The primary objective of this study is to extend and validate an impedance-based method for estimating electrode insertion depths, which could serve as a radiation-free and cost-effective alternative to radiography. The secondary objective is to evaluate the reliability of the estimation method in the postoperative follow-up over several months.

DESIGN

The ground truth insertion depths were measured from postoperative computed tomography scans obtained from the records of 56 cases with an identical lateral wall electrode array. For each of these cases, impedance telemetry records were retrieved starting from the day of implantation up to a maximum observation period of 60 mo. Based on these recordings, the linear and angular electrode insertion depths were estimated using a phenomenological model. The estimates obtained were compared with the ground truth values to calculate the accuracy of the model.

RESULTS

Analysis of the long-term recordings using a linear mixed-effects model showed that postoperative tissue resistances remained stable throughout the follow-up period, except for the two most basal electrodes, which increased significantly over time (electrode 11: ~10 Ω/year, electrode 12: ~30 Ω/year). Inferred phenomenological models from early and late impedance telemetry recordings were not different. The insertion depth of all electrodes was estimated with an absolute error of 0.9 mm ± 0.6 mm or 22° ± 18° angle (mean ± SD).

CONCLUSIONS

Insertion depth estimations of the model were reliable over time when comparing two postoperative computed tomography scans of the same ear. Our results confirm that the impedance-based position estimation method can be applied to postoperative impedance telemetry recordings. Future work needs to address extracochlear electrode detection to increase the performance of the method.

Incomplete Partition Type II Cochlear Malformations: Delineating the Three-Dimensional Structure from Digitized Human Histopathological Specimens

HYPOTHESIS

There are clinically relevant differences in scalae anatomy and spiral ganglion neuron (SGN) quantity between incomplete partition type II (IP-II) and normal cochleae.

BACKGROUND

IP-II is a commonly implanted cochlear malformation. Detailed knowledge of intracochlear three-dimensional (3D) morphology may assist with cochlear implant (CI) electrode selection/design and enable optimization of audiologic programming based on SGN maps.

METHODS

IP-II (n = 11) human temporal bone histological specimens were identified from the National Institute on Deafness and Other Communication Disorders National Temporal Bone Registry and digitized. The cochlear duct, scalae, and surgically relevant anatomy were reconstructed in 3D. A machine learning algorithm was applied to map the location and number of SGNs.

RESULTS

3D scalae morphology of the basal turn was normal. Scala tympani (ST) remained isolated for 540 degrees before fusing with scala vestibuli. Mean ST volume reduced below 1 mm 2 after the first 340 degrees. Scala media was a distinct endolymphatic compartment throughout; mean ± standard deviation cochlear duct length was 28 ± 3 mm. SGNs were reduced compared with age-matched norms (mean, 48%; range, 5-90%). In some cases, SGNs failed to ascend Rosenthal's canal, remaining in an abnormal basalward modiolar location. Two forms of IP-II were seen: type A and type B. A majority (98-100%) of SGNs were located in the basal modiolus in type B IP-II, compared with 76 to 85% in type A.

CONCLUSION

Hallmark features of IP-II cochleae include the following: 1) fusion of the ST and scala vestibuli at a mean of 540 degrees, 2) highly variable and overall reduced SGN quantity compared with normative controls, and 3) abnormal SGN distribution with cell bodies failing to ascend Rosenthal's canal.

Effect of interaural electrode insertion depth difference and independent band selection on sentence recognition in noise and spatial release from masking in simulated bilateral cochlear implant listening

PURPOSE

Inter-aural insertion depth difference (IEDD) in bilateral cochlear implant (BiCI) with continuous interleaved sampling (CIS) processing is known to reduce the recognition of speech in noise and spatial release from masking (SRM). However, the independent channel selection in the 'n-of-m' sound coding strategy might have a different effect on speech recognition and SRM when compared to the effects of IEDD in CIS-based findings. This study aimed to investigate the effect of bilateral 'n-of-m' processing strategy and interaural electrode insertion depth difference on speech recognition in noise and SRM under conditions that simulated bilateral cochlear implant listening.

METHODS

Five young adults with normal hearing sensitivity participated in the study. The target sentences were spatially filtered to originate from 0° and the masker was spatially filtered at 0°, 15°, 37.5°, and 90° using the Oldenburg head-related transfer function database for behind the ear microphone. A 22-channel sine wave vocoder processing based on 'n-of-m' processing was applied to the spatialized target-masker mixture, in each ear. The perceptual experiment involved a test of speech recognition in noise under one co-located condition (target and masker at 0°) and three spatially separated conditions (target at 0°, masker at 15°, 37.5°, or 90° to the right ear).

RESULTS

The results were analyzed using a three-way repeated measure analysis of variance (ANOVA). The effect of interaural insertion depth difference (F (2,8) = 3.145, p = 0.098, ɳ² = 0.007) and spatial separation between target and masker (F (3,12) = 1.239, p = 0.339, ɳ² = 0.004) on speech recognition in noise was not significant.

CONCLUSIONS

Speech recognition in noise and SRM were not affected by IEDD ≤ 3 mm. Bilateral 'n-of-m' processing resulted in reduced speech recognition in noise and SRM.

Evolving a Radiological Protocol for Cochlear Duct Length Measurement: Three Audit Cycles

To develop an accurate protocol for measuring the Cochlear Duct Length (CDL) by using Multi Detector Computerized Tomography (MDCT) imaging of the temporal bones and thereby make the appropriate choice of electrode for cochlear implantation. 79 MED-EL® Cochlear implantees were divided into three cohorts in chronological order of their implantation. CDL was calculated from MDCT images and correlated with the CDL calculated using the existing Jolly's formula. Results of the CDL measured by unfurling the cochlea correlated well with the existing formula. In addition to CDL measurement, measuring diameter of each turn, especially the apical turn, helped in choosing the appropriate electrode for complete cochlear coverage. Having dedicated radiographers and neuro-radiologists can avoid inter-observer variations in CDL measurements. Measuring the CDL and the diameter of each turn helps in choosing an appropriate electrode thus minimizing intra-operative difficulties and achieving complete safe insertion.

Correlation Between Cochlear Length, Insertion Angle, and Tonotopic Mismatch for MED-EL FLEX28 Electrode Arrays

OBJECTIVE

To investigate the relationship between cochlear length, insertion angle, and tonotopic mismatch and to compare the tonotopic mismatches with respect to the spiral ganglion and the organ of Corti.

STUDY DESIGN

Retrospective.

SETTING

Tertiary referral center with cochlear implant program.

PATIENTS

Analyses of patients' computed tomography images after cochlear implant surgery.

INTERVENTION

Cochlear implantation with 28-mm-long straight lateral wall electrode arrays.

MAIN OUTCOME MEASURE

Cochlear length, insertion angle, and insertion depth were assessed using the OTOPLAN software. Tonotopic mismatch for each electrode contact was estimated using the Greenwood (organ of Corti) and the Stakhovskaya (spiral ganglion) maps and compared.

RESULTS

106 cochleae were analyzed. 99% of the electrode arrays were located in the tympanic ramp. The insertion was complete in 96% of cases. The mean cochlear length was 34.5 mm and the mean insertion angle of the apical electrode was 545°. Cochlear length was negatively correlated with the insertion angle of the contacts E1 to E9 (all p < 0.004). The tonotopic mismatch was greater at the organ of Corti than at the spiral ganglion. It was also greater at the organ of Corti in larger cochleae (correlation with mismatch for E1 r = 0.421, p < 0.0001) and in the apical than in the middle and basal regions of the cochlea.

CONCLUSION

Small cochlea size corresponded to higher insertion angle and reduction of tonotopic mismatch on a 28-mm-long straight lateral wall electrode array. Tonotopic mismatch could be minimized preoperatively by choosing electrode arrays according to the individual cochlear morphology and postoperatively by appropriate frequency fitting.

Polarity Sensitivity of Human Auditory Nerve Fibers Based on Pulse Shape, Cochlear Implant Stimulation Strategy and Array

Neural health is of great interest to determine individual degeneration patterns for improving speech perception in cochlear implant (CI) users. Therefore, in recent years, several studies tried to identify and quantify neural survival in CI users. Among all proposed techniques, polarity sensitivity is a promising way to evaluate the neural status of auditory nerve fibers (ANFs) in CI users. Nevertheless, investigating neural health based on polarity sensitivity is a challenging and complicated task that involves various parameters, and the outcomes of many studies show contradictory results of polarity sensitivity behavior. Our computational study benefits from an accurate three-dimensional finite element model of a human cochlea with realistic human ANFs and determined ANF degeneration pattern of peripheral part with a diminishing of axon diameter and myelination thickness based on degeneration levels. In order to see how different parameters may impact the polarity sensitivity behavior of ANFs, we investigated polarity behavior under the application of symmetric and asymmetric pulse shapes, monopolar and multipolar CI stimulation strategies, and a perimodiolar and lateral CI array system. Our main findings are as follows: (1) action potential (AP) initiation sites occurred mainly in the peripheral site in the lateral system regardless of stimulation strategies, pulse polarities, pulse shapes, cochlear turns, and ANF degeneration levels. However, in the perimodiolar system, AP initiation sites varied between peripheral and central processes, depending on stimulation strategies, pulse shapes, and pulse polarities. (2) In perimodiolar array, clusters formed in threshold values based on cochlear turns and degeneration levels for multipolar strategies only when asymmetric pulses were applied. (3) In the perimodiolar array, a declining trend in polarity (anodic threshold/cathodic threshold) with multipolar strategies was observed between intact or slight degenerated cases and more severe degenerated cases, whereas in the lateral array, cathodic sensitivity was noticed for intact and less degenerated cases and anodic sensitivity for cases with high degrees of degeneration. Our results suggest that a combination of asymmetric pulse shapes, focusing more on multipolar stimulation strategies, as well as considering the distances to the modiolus wall, allows us to distinguish the degeneration patterns of ANFs across the cochlea.

Fully Automated Measurement of Cochlear Duct Length From Clinical Temporal Bone Computed Tomography

OBJECTIVES/HYPOTHESIS

To present and validate a novel fully automated method to measure cochlear dimensions, including cochlear duct length (CDL).

STUDY DESIGN

Cross-sectional study.

METHODS

The computational method combined 1) a deep learning (DL) algorithm to segment the cochlea and otic capsule and 2) geometric analysis to measure anti-modiolar distances from the round window to the apex. The algorithm was trained using 165 manually segmented clinical computed tomography (CT). A Testing group of 159 CTs were then measured for cochlear diameter and width (A- and B-values) and CDL using the automated system and compared against manual measurements. The results were also compared with existing approaches and historical data. In addition, pre- and post-implantation scans from 27 cochlear implant recipients were studied to compare predicted versus actual array insertion depth.

RESULTS

Measurements were successfully obtained in 98.1% of scans. The mean CDL to 900° was 35.52 mm (SD, 2.06; range, [30.91-40.50]), the mean A-value was 8.88 mm (0.47; [7.67-10.49]), and mean B-value was 6.38 mm (0.42; [5.16-7.38]). The R² fit of the automated to manual measurements was 0.87 for A-value, 0.70 for B-value, and 0.71 for CDL. For anti-modiolar arrays, the distance between the imaged and predicted array tip location was 0.57 mm (1.25; [0.13-5.28]).

CONCLUSION

Our method provides a fully automated means of cochlear analysis from clinical CTs. The distribution of CDL, dimensions, and cochlear quadrant lengths is similar to those from historical data. This approach requires no radiographic experience and is free from user-related variation.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Frequency-to-Place Mismatch: Characterizing Variability and the Influence on Speech Perception Outcomes in Cochlear Implant Recipients

OBJECTIVES

The spatial position of a cochlear implant (CI) electrode array affects the spectral cues provided to the recipient. Differences in cochlear size and array length lead to substantial variability in angular insertion depth (AID) across and within array types. For CI-alone users, the variability in AID results in varying degrees of frequency-to-place mismatch between the default electric frequency filters and cochlear place of stimulation. For electric-acoustic stimulation (EAS) users, default electric frequency filters also vary as a function of residual acoustic hearing in the implanted ear. The present study aimed to (1) investigate variability in AID associated with lateral wall arrays, (2) determine the subsequent frequency-to-place mismatch for CI-alone and EAS users mapped with default frequency filters, and (3) examine the relationship between early speech perception for CI-alone users and two aspects of electrode position: frequency-to-place mismatch and angular separation between neighboring contacts, a metric associated with spectral selectivity at the periphery.

DESIGN

One hundred one adult CI recipients (111 ears) with MED-EL Flex24 (24 mm), Flex28 (28 mm), and FlexSOFT/Standard (31.5 mm) arrays underwent postoperative computed tomography to determine AID. A subsequent comparison was made between AID, predicted spiral ganglion place frequencies, and the default frequency filters for CI-alone (n = 84) and EAS users (n = 27). For CI-alone users with complete insertions who listened with maps fit with the default frequency filters (n = 48), frequency-to-place mismatch was quantified at 1500 Hz and angular separation between neighboring contacts was determined for electrodes in the 1 to 2 kHz region. Multiple linear regression was used to examine how frequency-to-place mismatch and angular separation of contacts influence consonant-nucleus-consonant (CNC) scores through 6 months postactivation.

RESULTS

For CI recipients with complete insertions (n = 106, 95.5%), the AID (mean ± standard deviation) of the most apical contact was 428° ± 34.3° for Flex24 (n = 11), 558° ± 65.4° for Flex28 (n = 48), and 636° ± 42.9° for FlexSOFT/Standard (n = 47) arrays. For CI-alone users, default frequency filters aligned closely with the spiral ganglion map for deeply inserted lateral wall arrays. For EAS users, default frequency filters produced a range of mismatches; absolute deviations of ≤ 6 semitones occurred in only 37% of cases. Participants with shallow insertions and minimal or no residual hearing experienced the greatest mismatch. For CI-alone users, both smaller frequency-to-place mismatch and greater angular separation between contacts were associated with better CNC scores during the initial 6 months of device use.

CONCLUSIONS

There is significant variability in frequency-to-place mismatch among CI-alone and EAS users with default frequency filters, even between individuals implanted with the same array. When using default frequency filters, mismatch can be minimized with longer lateral wall arrays and insertion depths that meet the edge frequency associated with residual hearing for CI-alone and EAS users, respectively. Smaller degrees of frequency-to-place mismatch and decreased peripheral masking due to more widely spaced contacts may independently support better speech perception with longer lateral wall arrays in CI-alone users.

The smaller the frequency-to-place mismatch the better the hearing outcomes in cochlear implant recipients?

OBJECTIVE

To investigate the effect of frequency-to-place mismatch, i.e. the mismatch between the tonotopic frequency map in the cochlea and the frequency band that is assigned to an electrode contact of a cochlear implant (CI) at the same cochlear location on speech perception outcomes, using postoperative CT images.

STUDY DESIGN

Retrospective observational single-centre study.

METHODS

Retrospective pre- and postoperative clinical CT data of 39 CI recipients with normal cochlear anatomy were analysed in an otological surgical planning software. The tonotopic frequency at each electrode position was estimated using the Greenwood function. For each patient, frequency-to-place mismatch between the tonotopic frequency and the fitted centre frequency for each electrode contact was calculated. The influence of frequency-to-place mismatch on speech perception in noise at 6 and 12 months after CI activation was studied.

RESULTS

A significant linear correlation was found between the frequency-to-place mismatch and speech perception in noise 6 months after cochlear implantation (p < 0.05). The smaller the frequency-to-place mismatch, the better the initial speech perception in noise results of the CI recipients. The significant effect disappeared after 12 months CI experience.

CONCLUSION

The study findings support the idea of minimizing the frequency-to-place mismatch in CI recipients in order to pursue better initial speech perception in noise. Further research is needed to investigate the prospect of tonotopic fitting strategies based upon postoperative CT images of the exact locations of the electrode contacts.

Listening to speech with a guinea pig-to-human brain-to-brain interface

Nicolelis wrote in his 2003 review on brain-machine interfaces (BMIs) that the design of a successful BMI relies on general physiological principles describing how neuronal signals are encoded. Our study explored whether neural information exchanged between brains of different species is possible, similar to the information exchange between computers. We show for the first time that single words processed by the guinea pig auditory system are intelligible to humans who receive the processed information via a cochlear implant. We recorded the neural response patterns to single-spoken words with multi-channel electrodes from the guinea inferior colliculus. The recordings served as a blueprint for trains of biphasic, charge-balanced electrical pulses, which a cochlear implant delivered to the cochlear implant user’s ear. Study participants completed a four-word forced-choice test and identified the correct word in 34.8% of trials. The participants' recognition, defined by the ability to choose the same word twice, whether right or wrong, was 53.6%. For all sessions, the participants received no training and no feedback. The results show that lexical information can be transmitted from an animal to a human auditory system. In the discussion, we will contemplate how learning from the animals might help developing novel coding strategies.

Comparative Performance of Lateral Wall and Perimodiolar Cochlear Implant Arrays

OBJECTIVE

The physical shape of cochlear implant (CI) arrays may impact hearing outcomes. The goal of this study was to compare post-operative speech and melody perception between patients with lateral wall (LW) and perimodiolar (PM) electrode arrays across a range of lengths and manufacturers.

STUDY DESIGN

Retrospective chart review.

SETTING

Tertiary Care Hospital.

PATIENTS

119 adult patients with post-lingual hearing loss who underwent cochlear implantation.

MAIN OUTCOME MEASURES

A total of seven different electrodes were evaluated including 5 different LW electrodes (CI422 [Cochlear American], 1J [Advanced Bionics], Medium [Med El], Standard [Med El], Flex28 [Med El]) and 2 PM electrodes (Contour [Cochlear American], MidScala [Advanced Bionics]). Speech perception outcomes (n = 119 patients) were measured by Consonant-Nucleus-Consonant (CNC) scores collected 3, 6, 12 and 24 months after implantation. Melody perception outcomes (n = 35 CI patients and n = 6 normal hearing patients) were measured by Melodic Contour Identification (MCI).

RESULTS

CNC scores increased over time after implantation across all array designs. PM designs exhibited higher CNC scores compared to LW electrodes, particularly 6-months after implantation. Pre-operative pure tone averages did not correlate with post-operative CNC scores. PM arrays outperformed LW electrodes in terms of MCI scores.

CONCLUSIONS

The physical shape of cochlear implant electrode arrays may impact hearing performance. Compared to LW designs, PM arrays appear to offer superior speech perception during the first 6 months after implantation, with performance equalizing between groups by 24 months. Compared to LW designs, PM arrays also appear to afford superior melody perception.

Semantic influences on the perception of degraded speech by individuals with cochlear implants

This study investigated whether speech intelligibility in cochlear implant (CI) users is affected by semantic context. Three groups participated in two experiments: Two groups of listeners with normal hearing (NH) listened to either full spectrum speech or vocoded speech, and one CI group listened to full spectrum speech. Experiment 1 measured participants' sentence recognition as a function of target-to-masker ratio (four-talker babble masker), and experiment 2 measured perception of interrupted speech as a function of duty cycles (long/short uninterrupted speech). Listeners were presented with both semantic congruent/incongruent targets. Results from the two experiments suggested that NH listeners benefitted more from the semantic cues as the listening conditions became more challenging (lower signal-to-noise ratios and interrupted speech with longer silent intervals). However, the CI group received minimal benefit from context, and therefore performed poorly in such conditions. On the contrary, in the conditions that were less challenging, CI users benefitted greatly from the semantic context, and NH listeners did not rely on such cues. The results also confirmed that such differential use of semantic cues appears to originate from the spectro-temporal degradations experienced by CI users, which could be a contributing factor for their poor performance in suboptimal environments.

High Electrode Impedance Values in Pediatric Cochlear Implant Recipients May Imply Insufficient Auditory and Language Skills Development

Background: Measurements of electrode impedance values are routinely performed after cochlear implantation. The primary objective of the study was to determine if pediatric, prelingually deafened patients with different postoperative performances showed significantly different impedance values one year after implantation. Methods: This study comprised 42 pediatric cochlear implant recipients provided with the device in a single academic tertiary referral center between 1 January 2000, and 31 December 2016. Medical chart analysis was performed in order to assess evolution of impedance values during the first postoperative year on a monthly basis. Electrode impedance values measurements one year postoperatively were compared between children with successful and unsuccessful auditory and language skills development assessed using the EARS protocol (a name of a performance test). Furthermore, values were compared among recipients of different implant types and among different cochlear segments. Results: A gradual rise of average impedance values was found during the first months of implant use (1st month, 7.32 kΩ; 3rd month, 7.86 kΩ) with the peak at the 4th postoperative month (7.96 kΩ), followed by a gradual decrease towards the 12th month (6th month, 7.62 kΩ; 12th month, 6.86 kΩ). Lower values at the 12th postoperative month were observed in recipients with successful development compared to patients presented with unsuccessful development (6.22 kΩ vs. 7.82 kΩ; p = 0.001). Mean impedance values were different when compared among cochlear segments and among different implant types. Conclusion: High electrode impedance values one year after implantation in pediatric patients may imply insufficient auditory and language skills development. Further studies are needed in order to validate our results.

Polarity Sensitivity as a Potential Correlate of Neural Degeneration in Cochlear Implant Users

Cochlear implant (CI) performance varies dramatically between subjects. Although the causes of this variability remain unclear, the electrode-neuron interface is thought to play an important role. Here we evaluate the contribution of two parameters of this interface on the perception of CI listeners: the electrode-to-modiolar wall distance (EMD), estimated from cone-beam computed tomography (CT) scans, and a measure of neural health. Since there is no objective way to quantify neural health in CI users, we measure stimulus polarity sensitivity, which is assumed to be related to neural degeneration, and investigate whether it also correlates with subjects' performance in speech recognition and spectro-temporal modulation detection tasks. Detection thresholds were measured in fifteen CI users (sixteen ears) for partial-tripolar triphasic pulses having an anodic or a cathodic central phase. The polarity effect was defined as the difference in threshold between cathodic and anodic stimuli. Our results show that both the EMD and the polarity effect correlate with detection thresholds, both across and within subjects, although the within-subject correlations were weak. Furthermore, the mean polarity effect, averaged across all electrodes for each subject, was negatively correlated with performance on a spectro-temporal modulation detection task. In other words, lower cathodic thresholds were associated with better spectro-temporal modulation detection performance, which is also consistent with polarity sensitivity being a marker of neural degeneration. Implications for the design of future subject-specific fitting strategies are discussed.

Cochlear duct length along the outer wall vs organ of corti: Which one is relevant for the electrode array length selection and frequency mapping using Greenwood function?

Cochlear duct length (CDL) measurement or estimation is a hot topic for various research groups in the cochlear implant (CI) field as of today. Getting the CDL along the outer wall (LW) and organ of corti (OC) is possible but considering the clinical application especially in the selection of the electrode array length and applying Greenwood's frequency function, we need to have a clear understanding on the CDL in general and as well on the Greenwood's frequency function. It is very clear from the histology images of the cochlea with straight electrode inside, that the electrode locates itself right under the basilar membrane. Also the Greenwood's frequency function involves a variable that corresponds to the CDL at the basilar membrane/organ of corti level. This brings us to conclude that the CDL at the OC is relevant for the selection of electrode array length and in applying Greenwood's frequency function. The ratio between CDL (LW) and CDL (OC) is 0.9 which is a very important number that needs to be remembered when converting CDL (LW) to CDL (OC).

Effect of frequency mismatch and band partitioning on vocal tract length perception in vocoder simulations of cochlear implant processing

The vocal tract length (VTL) of a speaker is an important voice cue that aids speech intelligibility in multi-talker situations. However, cochlear implant (CI) users demonstrate poor VTL sensitivity. This may be partially caused by the mismatch between frequencies received by the implant and those corresponding to places of stimulation along the cochlea. This mismatch can distort formant spacing, where VTL cues are encoded. In this study, the effects of frequency mismatch and band partitioning on VTL sensitivity were investigated in normal hearing listeners with vocoder simulations of CI processing. The hypotheses were that VTL sensitivity may be reduced by increased frequency mismatch and insufficient spectral resolution in how the frequency range is partitioned, specifically where formants lie. Moreover, optimal band partitioning might mitigate the detrimental effects of frequency mismatch on VTL sensitivity. Results showed that VTL sensitivity decreased with increased frequency mismatch and reduced spectral resolution near the low frequencies of the band partitioning map. Band partitioning was independent of mismatch, indicating that if a given partitioning is suboptimal, a better partitioning might improve VTL sensitivity despite the degree of mismatch. These findings suggest that customizing the frequency partitioning map may enhance VTL perception in individual CI users.

Challenging aspects of contemporary cochlear implant electrode array design

Objective

A design comparison of current perimodiolar and lateral wall electrode arrays of the cochlear implant (CI) is provided. The focus is on functional features such as acoustic frequency coverage and tonotopic mapping, battery consumption and dynamic range. A traumacity of their insertion is also evaluated.

Methods

Review of up-to-date literature.

Results

Perimodiolar electrode arrays are positioned in the basal turn of the cochlea near the modiolus. They are designed to initiate the action potential in the proximity to the neural soma located in spiral ganglion. On the other hand, lateral wall electrode arrays can be inserted deeper inside the cochlea, as they are located along the lateral wall and such insertion trajectory is less traumatic. This class of arrays targets primarily surviving neural peripheral processes. Due to their larger insertion depth, lateral wall arrays can deliver lower acoustic frequencies in manner better corresponding to cochlear tonotopicity. In fact, spiral ganglion sections containing auditory nerve fibres tuned to low acoustic frequencies are located deeper than 1 and half turn inside the cochlea. For this reason, a significant frequency mismatch might be occurring for apical electrodes in perimodiolar arrays, detrimental to speech perception. Tonal languages such as Mandarin might be therefore better treated with lateral wall arrays. On the other hand, closer proximity to target tissue results in lower psychophysical threshold levels for perimodiolar arrays. However, the maximal comfort level is also lower, paradoxically resulting in narrower dynamic range than that of lateral wall arrays. Battery consumption is comparable for both types of arrays.

Conclusions

Lateral wall arrays are less likely to cause trauma to cochlear structures. As the current trend in cochlear implantation is the maximal protection of residual acoustic hearing, the lateral wall arrays seem more suitable for hearing preservation CI surgeries. Future development could focus on combining the advantages of both types: perimodiolar location in the basal turn extended to lateral wall location for higher turn locations.

An automated A-value measurement tool for accurate cochlear duct length estimation

BACKGROUND

There has been renewed interest in the cochlear duct length (CDL) for preoperative cochlear implant electrode selection and postoperative generation of patient-specific frequency maps. The CDL can be estimated by measuring the A-value, which is defined as the length between the round window and the furthest point on the basal turn. Unfortunately, there is significant intra- and inter-observer variability when these measurements are made clinically. The objective of this study was to develop an automated A-value measurement algorithm to improve accuracy and eliminate observer variability.

METHOD

Clinical and micro-CT images of 20 cadaveric cochleae specimens were acquired. The micro-CT of one sample was chosen as the atlas, and A-value fiducials were placed onto that image. Image registration (rigid affine and non-rigid B-spline) was applied between the atlas and the 19 remaining clinical CT images. The registration transform was applied to the A-value fiducials, and the A-value was then automatically calculated for each specimen. High resolution micro-CT images of the same 19 specimens were used to measure the gold standard A-values for comparison against the manual and automated methods.

RESULTS

The registration algorithm had excellent qualitative overlap between the atlas and target images. The automated method eliminated the observer variability and the systematic underestimation by experts. Manual measurement of the A-value on clinical CT had a mean error of 9.5 ± 4.3% compared to micro-CT, and this improved to an error of 2.7 ± 2.1% using the automated algorithm. Both the automated and manual methods correlated significantly with the gold standard micro-CT A-values (r = 0.70, p < 0.01 and r = 0.69, p < 0.01, respectively).

CONCLUSION

An automated A-value measurement tool using atlas-based registration methods was successfully developed and validated. The automated method eliminated the observer variability and improved accuracy as compared to manual measurements by experts. This open-source tool has the potential to benefit cochlear implant recipients in the future.

Benefits to Speech Perception in Noise From the Binaural Integration of Electric and Acoustic Signals in Simulated Unilateral Deafness

OBJECTIVES

This study used vocoder simulations with normal-hearing (NH) listeners to (1) measure their ability to integrate speech information from an NH ear and a simulated cochlear implant (CI), and (2) investigate whether binaural integration is disrupted by a mismatch in the delivery of spectral information between the ears arising from a misalignment in the mapping of frequency to place.

DESIGN

Eight NH volunteers participated in the study and listened to sentences embedded in background noise via headphones. Stimuli presented to the left ear were unprocessed. Stimuli presented to the right ear (referred to as the CI-simulation ear) were processed using an eight-channel noise vocoder with one of the three processing strategies. An Ideal strategy simulated a frequency-to-place map across all channels that matched the delivery of spectral information between the ears. A Realistic strategy created a misalignment in the mapping of frequency to place in the CI-simulation ear where the size of the mismatch between the ears varied across channels. Finally, a Shifted strategy imposed a similar degree of misalignment in all channels, resulting in consistent mismatch between the ears across frequency. The ability to report key words in sentences was assessed under monaural and binaural listening conditions and at signal to noise ratios (SNRs) established by estimating speech-reception thresholds in each ear alone. The SNRs ensured that the monaural performance of the left ear never exceeded that of the CI-simulation ear. The advantages of binaural integration were calculated by comparing binaural performance with monaural performance using the CI-simulation ear alone. Thus, these advantages reflected the additional use of the experimentally constrained left ear and were not attributable to better-ear listening.

RESULTS

Binaural performance was as accurate as, or more accurate than, monaural performance with the CI-simulation ear alone. When both ears supported a similar level of monaural performance (50%), binaural integration advantages were found regardless of whether a mismatch was simulated or not. When the CI-simulation ear supported a superior level of monaural performance (71%), evidence of binaural integration was absent when a mismatch was simulated using both the Realistic and the Ideal processing strategies. This absence of integration could not be accounted for by ceiling effects or by changes in SNR.

CONCLUSIONS

If generalizable to unilaterally deaf CI users, the results of the current simulation study would suggest that benefits to speech perception in noise can be obtained by integrating information from an implanted ear and an NH ear. A mismatch in the delivery of spectral information between the ears due to a misalignment in the mapping of frequency to place may disrupt binaural integration in situations where both ears cannot support a similar level of monaural speech understanding. Previous studies that have measured the speech perception of unilaterally deaf individuals after CI but with nonindividualized frequency-to-electrode allocations may therefore have underestimated the potential benefits of providing binaural hearing. However, it remains unclear whether the size and nature of the potential incremental benefits from individualized allocations are sufficient to justify the time and resources required to derive them based on cochlear imaging or pitch-matching tasks.

Measuring Cochlear Duct Length - a historical analysis of methods and results

Background

Cochlear Duct Length (CDL) has been an important measure for the development and advancement of cochlear implants. Emerging literature has shown CDL can be used in preoperative settings to select the proper sized electrode and develop customized frequency maps. In order to improve post-operative outcomes, and develop new electrode technologies, methods of measuring CDL must be validated to allow usage in the clinic.

Purpose

The purpose of this review is to assess the various techniques used to calculate CDL and provide the reader with enough information to make an informed decision on how to conduct future studies measuring the CDL.

Results

The methods to measure CDL, the modality used to capture images, and the location of the measurement have all changed as technology evolved. With recent popularity and advancement in computed tomography (CT) imaging in place of histologic sections, measurements of CDL have been focused at the lateral wall (LW) instead of the organ of Corti (OC), due to the inability of CT to view intracochlear structures. After analyzing results from methods such as directly measuring CDL from histology, indirectly reconstructing the shape of the cochlea, and determining CDL based on spiral coefficients, it was determined the three dimensional (3D) reconstruction method is the most reliable method to measure CDL. 3D reconstruction provides excellent visualization of the cochlea and avoids errors evident in other methods. Due to the number of varying methods with varying accuracies, certain guidelines must be followed in the future to allow direct comparison of CDL values between studies.

Conclusion

After summarizing and analyzing the interesting history of CDL measurements, the use of standardized guidelines and the importance of CDL for future cochlear implant developments is emphasized for future studies.