Search

Objectives: A method for stimulating the cochlear apex using perimodiolar electrode arrays is described. This method involves implanting an electrode (ECE1) into the helioctrema in addition to standard cochlear implant placement. One objective is to verify a suitable approach for implanting ECE1 in the helicotrema. Another is to determine how placement of ECE1 reshapes electric fields., Design: Two cadaveric half-heads were implanted, and electric voltage tomography was measured with ECE1 placed in many positions., Results: An approach for placing ECE1 was identified. Changes in electric fields were only observed when ECE1 was placed into the fluid in the helicotrema. When inside the helicotrema, electric voltage tomography modeling suggests an increased current flow toward the apex., Conclusions: Placement of ECE1 into the cochlear apex is clinically feasible and has the potential to reshape electric fields to stimulate regions of the cochlea more apical than those represented by the electrode array., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The cochlear implant is one of the most successful medical prostheses, allowing deaf and severely hearing-impaired persons to hear again by electrically stimulating the auditory nerve. A trained audiologist adjusts the stimulation settings for good speech understanding, known as "fitting" the implant. This process is based on subjective feedback from the user, making it time-consuming and challenging, especially in paediatric or communication-impaired populations. Furthermore, fittings only happen during infrequent sessions at a clinic, and therefore cannot take into account variable factors that affect the user's hearing, such as physiological changes and different listening environments. Objective audiometry, in which brain responses evoked by auditory stimulation are collected and analysed, removes the need for active patient participation. However, recording of brain responses still requires expensive equipment that is cumbersome to use. An elegant solution is to record the neural signals using the implant itself. We demonstrate for the first time the recording of continuous electroencephalographic (EEG) signals from the implanted intracochlear electrode array in human subjects, using auditory evoked potentials originating from different brain regions. This was done using a temporary recording set-up with a percutaneous connector used for research purposes. Furthermore, we show that the response morphologies and amplitudes depend crucially on the recording electrode configuration. The integration of an EEG system into cochlear implants paves the way towards chronic neuro-monitoring of hearing-impaired patients in their everyday environment, and neuro-steered hearing prostheses, which can autonomously adjust their output based on neural feedback.

This study looked at different methods to preserve interaural level difference (ILD) cues for bilateral cochlear implant (BiCI) recipients. One possible distortion to ILD is from automatic gain control (AGC). Localization accuracy of BiCI recipients using default versus increased AGC threshold and linked AGCs versus independent AGCs was examined. In addition, speech reception in noise was assessed using linked versus independent AGCs and enabling and disabling Autosensitivity™ Control. Subjective information via a diary and questionnaire was also collected about maps with linked and independent AGCs during a take-home experience. Localization accuracy improved in the increased AGC threshold and the linked AGCs conditions. Increasing the AGC threshold resulted in a 4° improvement in root mean square error averaged across all speaker locations. Using linked AGCs, BiCI participants experienced an 8° improvement for all speaker locations and a 19° improvement at the speaker location most affected by the AGC. Speech reception threshold in noise improved by an average of 2.5 dB when using linked AGCs versus independent AGCs. In addition, the effect of linked AGCs on speech in noise was compared with that of Autosensitivity™ Control. The Speech, Spatial, and Qualities of Hearing Scale-12 question comparative survey showed an improvement when using maps with linked AGCs. These findings support the hypothesis that ILD cues may be preserved by increasing the AGC threshold or linking AGCs.

This study examines the relationship between focused-stimulation thresholds, electrode positions, and speech understanding in deaf subjects treated with a cochlear implant (CI). Focused stimulation is more selective than monopolar stimulation, which excites broad regions of the cochlea, so may be more sensitive as a probe of neural survival patterns. Focused thresholds are on average higher and more variable across electrodes than monopolar thresholds. We presume that relatively high focused thresholds are the result of larger distances between the electrodes and the neurons. Two factors are likely to contribute to this distance: (1) the physical position of electrodes relative to the modiolus, where the excitable auditory neurons are normally located, and (2) the pattern of neural survival along the length of the cochlea, since local holes in the neural population will increase the distance between an electrode and the nearest neurons. Electrode-to-modiolus distance was measured from high-resolution CT scans of the cochleae of CI users whose focused-stimulation thresholds were also measured. A hierarchical set of linear models of electrode-to-modiolus distance versus threshold showed a significant increase in threshold with electrode-to-modiolus distance (average slope = 11 dB/mm). The residual of these models was hypothesized to reflect neural survival in each subject. Consonant-Nucleus-Consonant (CNC) word scores were significantly correlated with the within-subject variance of threshold (r(2) = 0.82), but not with within-subject variance of electrode distance (r(2) = 0.03). Speech understanding also significantly correlated with how well distance explained each subject's threshold data (r(2) = 0.63). That is, subjects with focused thresholds that were well described by electrode position had better speech scores. Our results suggest that speech understanding is highly impacted by individual patterns of neural survival and that these patterns manifest themselves in how well (or poorly) electrode position predicts focused thresholds.

Cochlear implants are highly successful neural prostheses that restore hearing in the deaf, often resulting in high levels of speech understanding in quiet listening conditions. In more challenging conditions, however, cochlear implant subjects often score much lower than their normal-hearing peers, possibly reflecting limits of the electrode-neural interface. In this study, we compare monopolar stimulation versus focused stimulation, using multipolar channels, to test if current focusing can increase spectral resolution. Psychophysical results show that current focusing significantly improves subjects' ability to discriminate spectral features and detect dynamic modulations in sound stimuli. These results suggest that focused stimulation can successfully increase the number of effective channels with a cochlear implant and may lead to improved hearing in noisy conditions.

Experiment 1 measured rate discrimination of electric pulse trains by bilateral cochlear implant (CI) users, for standard rates of 100, 200, and 300 pps. In the diotic condition the pulses were presented simultaneously to the two ears. Consistent with previous results with unilateral stimulation, performance deteriorated at higher standard rates. In the signal interval of each trial in the dichotic condition, the standard rate was presented to the left ear and the (higher) signal rate was presented to the right ear; the non-signal intervals were the same as in the diotic condition. Performance in the dichotic condition was better for some listeners than in the diotic condition for standard rates of 100 and 200 pps, but not at 300 pps. It is concluded that the deterioration in rate discrimination observed for CI users at high rates cannot be alleviated by the introduction of a binaural cue, and is unlikely to be limited solely by central pitch processes. Experiment 2 performed an analogous experiment in which 300-pps acoustic pulse trains were bandpass filtered (3900-5400 Hz) and presented in a noise background to normal-hearing listeners. Unlike the results of experiment 1, performance was superior in the dichotic than in the diotic condition.

In the "4-6" condition of experiment 1, normal-hearing (NH) listeners compared the pitch of a bandpass-filtered pulse train, whose inter-pulse intervals (IPIs) alternated between 4 and 6 ms, to that of isochronous pulse trains. Consistent with previous results obtained at a lower signal level, the pitch of the 4-6 stimulus corresponded to that of an isochronous pulse train having a period of 5.7 ms-longer than the mean IPI of 5 ms. In other conditions the IPI alternated between 3.5-5.5 and 4.5-6.5 ms. Experiment 2 was similar but presented electric pulse trains to one channel of a cochlear implant. In both cases, as overall IPI increased, the pitch of the alternating-interval stimulus approached that of an isochronous train having a period equal to the mean IPI. Experiment 3 measured compound action potentials (CAPs) to alternating-interval stimuli in guinea pigs and in NH listeners. The CAPs to pulses occurring after 4-ms intervals were smaller than responses to pulses occurring after 6-ms intervals, resulting in a modulated pattern that was independent of overall level. The results are compared to the predictions of a simple model incorporating auditory-nerve (AN) refractoriness, and where pitch is estimated from first-order intervals in the AN response.

We investigated potential cues to sound segregation by cochlear implant (CI) and normal-hearing (NH) listeners. In each presentation interval of experiment 1a, CI listeners heard a mixture of four pulse trains applied concurrently to separate electrodes, preceded by a "probe" applied to a single electrode. In one of these two intervals, which the subject had to identify, the probe electrode was the same as a "target" electrode in the mixture. The pulse train on the target electrode had a higher level than the others in the mixture. Additionally, it could be presented either with a 200-ms onset delay, at a lower rate, or with an asynchrony produced by delaying each pulse by about 5 ms re those on the nontarget electrodes. Neither the rate difference nor the asynchrony aided performance over and above the level difference alone, but the onset delay produced a modest improvement. Experiment 1b showed that two subjects could perform the task using the onset delay alone, with no level difference. Experiment 2 used a method similar to that of experiment 1, but investigated the onset cue using NH listeners. In one condition, the mixture consisted of harmonics 5 to 40 of a 100-Hz fundamental, with the onset of either harmonics 13 to 17 or 26 to 30 delayed re the rest. Performance was modest in this condition, but could be improved markedly by using stimuli containing a spectral gap between the target and nontarget harmonics. The results suggest that (a) CI users are unlikely to use temporal pitch differences between adjacent channels to separate concurrent sounds, and that (b) they can use onset differences between channels, but the usefulness of this cue will be compromised by the spread of excitation along the nerve-fiber array. This deleterious effect of spread-of-excitation can also impair the use of onset cues by NH listeners.

Nearly 100,000 deaf patients worldwide have had their hearing restored by a cochlear implant (CI) fitted to one ear. However, although many patients understand speech well in quiet, even the most successful experience difficulty in noisy situations. In contrast, normal-hearing (NH) listeners achieve improved speech understanding in noise by processing the differences between the waveforms reaching the two ears. Here we show that a form of binaural processing can be achieved by patients fitted with an implant in each ear, leading to substantial improvements in signal detection in the presence of competing sounds. The stimulus in each ear consisted of a narrowband noise masker, to which a tonal signal was sometimes added; this mixture was half-wave rectified, lowpass-filtered, and then used to modulate a 1000-pps biphasic pulse train. All four CI users tested showed significantly better signal detection when the signal was presented out of phase at the two ears than when it was in phase. This advantage occurred even though subjects only received information about the slowly varying sound envelope to be presented, contrary to previous reports that waveform fine structure dominates binaural processing. If this advantage generalizes to multichannel situations, it would demonstrate that envelope-based CI speech-processing strategies may allow patients to exploit binaural unmasking in order to improve speech understanding in noise. Furthermore, because the tested patients had been deprived of binaural hearing for eight or more years, our results show that some sensitivity to time-varying interaural cues can persist over extended periods of binaural deprivation.

Human behavioral thresholds for trains of biphasic pulses applied to a single channel of Nucleus CI24 and LAURA cochlear implants were measured as a function of inter-phase gap (IPG). Experiment 1 used bipolar stimulation, a 100-pps pulse rate, and a 400-ms stimulus duration. In one condition, the two phases of each pulse had opposite polarity. Thresholds continued to drop by 9-10 dB as IPG was increased from near zero to the longest value tested (2900 micros for CI24, 4900 micros for LAURA). This time course is much longer than reported for single-cell recordings from animals. In a second condition, the two phases of each pulse had the same polarity, which alternated from pulse to pulse. Thresholds were independent of IPG, and similar to those in condition 1 at IPG=4900 micros. Experiment 2 used monopolar stimulation. One condition was similar to condition 1 of experiment 1, and thresholds also dropped up to the longest IPG studied (2900 micros). This also happened when the pulse rate was reduced to 20 pps, and when only a single pulse was presented on each trial. Keeping IPG constant at 8 micros and adding an extra biphasic pulse x ms into each period produced thresholds that were roughly independent of x, indicating that the effect of IPG in the other conditions was not due to a release from refractoriness at sites central to the auditory nerve. Experiment 3 measured thresholds at three IPGs, which were less than, equal to, and more than one half of the interval between successive pulses. Thresholds were lowest at the intermediate IPG. The results of all experiments could be fit by a linear model consisting of a lowpass filter based on the function relating threshold to the frequency of sinusoidal electrical stimulation. The data and model have implications for reducing the power consumption of cochlear implants.

The pitch of stimuli was studied under conditions where place-of-excitation was held constant, and where pitch was therefore derived from "purely temporal" cues. In experiment 1, the acoustical and electrical pulse trains consisted of pulses whose amplitudes alternated between a high and a low value, and whose interpulse intervals alternated between 4 and 6 ms. The attenuated pulses occurred after the 4-ms intervals in condition A, and after the 6-ms intervals in condition B. For both normal-hearing subjects and cochlear implantees, the period of an isochronous pulse train equal in pitch to this "4-6" stimulus increased from near 6 ms at the smallest modulation depth to nearly 10 ms at the largest depth. Additionally, the modulated pulse trains in condition A were perceived as being lower in pitch than those in condition B. Data are interpreted in terms of increased refractoriness in condition A, where the larger pulses are more closely followed by the smaller ones than in condition B. Consistent with this conclusion, the A-B difference was reduced at longer interpulse intervals. These findings provide a measure of supra-threshold effects of refractoriness on pitch perception, and increase our understanding of coding of temporal information in cochlear implant speech processing schemes.

Experiments were conducted with a single, bilateral cochlear implant user to examine interaural level and time-delay cues that putatively underlie the design and efficacy of bilateral implant systems. The subject's two implants were of different types but custom equipment allowed presentation of controlled bilateral stimuli, particularly those with specified interaural time difference (ITD) and interaural level difference (ILD) cues. A lateralization task was used to measure the effect of these cues on the perceived location of the sensations elicited. For trains of fixed-amplitude, biphasic current pulses at 100 pps, the subject demonstrated sensitivity to an ITD of 300 micros, providing evidence of access to binaural information. The choice of bilateral electrode pair greatly influenced ITD sensitivity, suggesting that electrode pairings are likely to be an important consideration in the effort to provide binaural advantages. The selection of bilateral electrode pairs showing sensitivity to ITD was partially aided by comparisons of the pitch elicited by individual electrodes in each ear (when stimulated alone with fixed-amplitude current pulses at 813 pps): specifically, interaural electrodes with similar pitches were more likely (but not certain) to show ITD sensitivity. Significant changes in lateral position occurred with specific electrode pairs. With five bilateral electrode pairs of 14 tested, ITDs of 300 and 600 micros moved an auditory image significantly from right to left. With these same pairs, ILD changes of approximately 11% of the dynamic range (in microApp) moved an auditory image from the far left to the far right-significantly farther than the nine pairs not showing significant ITD sensitivity. However, even these nine pairs did show response changes as a function of the interaural (or confounding monaural) level cue. Overall, insofar as the access to bilateral cues demonstrated herein generalizes to other subjects, it provides hope that the normal binaural advantages for speech recognition and sound localization can be made available to bilateral implant users.

Two experiments investigated pitch perception for stimuli where the place of excitation was held constant. Experiment 1 used pulse trains in which the interpulse interval alternated between 4 and 6 ms. In experiment 1a these "4-6" pulse trains were bandpass filtered between 3900 and 5300 Hz and presented acoustically against a noise background to normal listeners. The rate of an isochronous pulse train (in which all the interpulse intervals were equal) was adjusted so that its pitch matched that of the "4-6" stimulus. The pitch matches were distributed unimodally, had a mean of 5.7 ms, and never corresponded to either 4 or to 10 ms (the period of the stimulus). In experiment 1b the pulse trains were presented both acoustically to normal listeners and electrically to users of the LAURA cochlear implant, via a single channel of their device. A forced-choice procedure was used to measure psychometric functions, in which subjects judged whether the 4-6 stimulus was higher or lower in pitch than isochronous pulse trains having periods of 3, 4, 5, 6, or 7 ms. For both groups of listeners, the point of subjective equality corresponded to a period of 5.6 to 5.7 ms. Experiment 1c confirmed that these psychometric functions were monotonic over the range 4-12 ms. In experiment 2, normal listeners adjusted the rate of an isochronous filtered pulse train to match the pitch of mixtures of pulse trains having rates of F1 and F2 Hz, passed through the same bandpass filter (3900-5400 Hz). The ratio F2/F1 was 1.29 and F1 was either 70, 92, 109, or 124 Hz. Matches were always close to F2 Hz. It is concluded that the results of both experiments are inconsistent with models of pitch perception which rely on higher-order intervals. Together with those of other published data on purely temporal pitch perception, the data are consistent with a model in which only first-order interpulse intervals contribute to pitch, and in which, over the range 0-12 ms, longer intervals receive higher weights than short intervals.

We investigated potential cues to sound segregation by cochlear implant (CI) and normal-hearing (NH) listeners. In each presentation interval of experiment 1a, CI listeners heard a mixture of four pulse trains applied concurrently to separate electrodes, preceded by a "probe" applied to a single electrode. In one of these two intervals, which the subject had to identify, the probe electrode was the same as a "target" electrode in the mixture. The pulse train on the target electrode had a higher level than the others in the mixture. Additionally, it could be presented either with a 200-ms onset delay, at a lower rate, or with an asynchrony produced by delaying each pulse by about 5 ms re those on the nontarget electrodes. Neither the rate difference nor the asynchrony aided performance over and above the level difference alone, but the onset delay produced a modest improvement. Experiment 1b showed that two subjects could perform the task using the onset delay alone, with no level difference. Experiment 2 used a method similar to that of experiment 1, but investigated the onset cue using NH listeners. In one condition, the mixture consisted of harmonics 5 to 40 of a 100-Hz fundamental, with the onset of either harmonics 13 to 17 or 26 to 30 delayed re the rest. Performance was modest in this condition, but could be improved markedly by using stimuli containing a spectral gap between the target and nontarget harmonics. The results suggest that (a) CI users are unlikely to use temporal pitch differences between adjacent channels to separate concurrent sounds, and that (b) they can use onset differences between channels, but the usefulness of this cue will be compromised by the spread of excitation along the nerve-fiber array. This deleterious effect of spread-of-excitation can also impair the use of onset cues by NH listeners. [ABSTRACT FROM AUTHOR]

Nearly 100,000 deaf patients worldwide have had their hearing restored by a cochlear implant (CI) fitted to one ear. However, although many patients understand speech well in quiet, even the most successful experience difficulty in noisy situations. In contrast, normal-hearing (NH) listeners achieve improved speech understanding in noise by processing the differences between the waveforms reaching the two ears. Here we show that a form of binaural processing can be achieved by patients fitted with an implant in each ear, leading to substantial improvements in signal detection in the presence of competing sounds. The stimulus in each ear consisted of a narrowband noise masker, to which a tonal signal was sometimes added; this mixture was half-wave rectified, lowpass-filtered, and then used to modulate a 1000-pps biphasic pulse train. All four CI users tested showed significantly better signal detection when the signal was presented out of phase at the two ears than when it was in phase. This advantage occurred even though subjects only received information about the slowly varying sound envelope to be presented, contrary to previous reports that waveform fine structure dominates binaural processing. If this advantage generalizes to multichannel situations, it would demonstrate that envelope-based CI speech-processing strategies may allow patients to exploit binaural unmasking in order to improve speech understanding in noise. Furthermore, because the tested patients had been deprived of binaural hearing for eight or more years, our results show that some sensitivity to time-varying interaural cues can persist over extended periods of binaural deprivation. [ABSTRACT FROM AUTHOR]