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Cochlear implant (CI) users often report being unsatisfied by music listening through their hearing device. Vibrotactile stimulation could help alleviate those challenges. Previous research has shown that musical stimuli was given higher preference ratings by normal-hearing listeners when concurrent vibrotactile stimulation was congruent in intensity and timing with the corresponding auditory signal compared to incongruent. However, it is not known whether this is also the case for CI users. Therefore, in this experiment, we presented 18 CI users and 24 normal-hearing listeners with five melodies and five different audio-to-tactile maps. Each map varied the congruence between the audio and tactile signals related to intensity, fundamental frequency, and timing. Participants were asked to rate the maps from zero to 100, based on preference. It was shown that almost all normal-hearing listeners, as well as a subset of the CI users, preferred tactile stimulation, which was congruent with the audio in intensity and timing. However, many CI users had no difference in preference between timing aligned and timing unaligned stimuli. The results provide evidence that vibrotactile music enjoyment enhancement could be a solution for some CI users; however, more research is needed to understand which CI users can benefit from it most., (© 2024 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).)

Background and Objective: Intralabyrinthine schwannomas (ILSs) may have detrimental effects on ipsilateral hearing, commonly leading to single-sided deafness (SSD). Cochlear implantation in patients with ILSs is an option to partly restore ipsilateral hearing; however, the available literature fails to account for the binaural hearing benefits of a cochlear implant (CI) for ILSs., Methods: We prospectively evaluated SSD patients with sporadic ILS undergoing cochlear implantation with simultaneous tumor resection (n = 10) or with tumor observation (n = 1). Patients completed the Speech, Spatial and Qualities Questionnaire (SSQ12) and the Nijmegen Cochlear Implant Questionnaire (NCIQ) pre- and postoperatively, as well as the Bern Benefit in Single-Sided Deafness (BBSSD) questionnaire postoperatively. Patients were also tested postoperatively with and without their CI to measure the effect on localization ability and binaural summation, squelch, and head shadow., Results: Evaluation was completed for nine and six patients (subjective and objective data, respectively). The CI significantly improved the speech reception threshold (SRT) in the head shadow condition where the target signal was presented to the CI side and the noise to the front (SCIN0). On the other hand, the SRTs in the colocated condition (S0N0) and the condition where the target signal was presented to the front and the noise to the CI side (S0NCI) were unaffected by the CI. The mean localization error decreased significantly from 102° to 61° (p = 0.0031) with the addition of a CI. The scores from SSQ12 demonstrated nonsignificant changes. For NCIQ, the self-esteem and the social interaction domains increased significantly but insignificantly for the remaining domains. The BBSSD responses ranged from +0.5 to +3.5 points., Conclusion: After implantation, patients achieved significantly better scores across some of the patient-reported and objective parameters. In addition to reporting on a number of ILS cases where implantation was performed, the study is the first of its kind to document patient-reported and objective binaural hearing improvement after cochlear implantation in patients with ILS and, thereby, lends support to the active management of ILS., (Copyright © 2024, Otology & Neurotology, Inc.)

Vibrotactile stimulation is believed to enhance auditory speech perception, offering potential benefits for cochlear implant (CI) users who may utilize compensatory sensory strategies. Our study advances previous research by directly comparing tactile speech intelligibility enhancements in normal-hearing (NH) and CI participants, using the same paradigm. Moreover, we assessed tactile enhancement considering stimulus non-specific, excitatory effects through an incongruent audio-tactile control condition that did not contain any speech-relevant information. In addition to this incongruent audio-tactile condition, we presented sentences in an auditory only and a congruent audio-tactile condition, with the congruent tactile stimulus providing low-frequency envelope information via a vibrating probe on the index fingertip. The study involved 23 NH listeners and 14 CI users. In both groups, significant tactile enhancements were observed for congruent tactile stimuli (5.3% for NH and 5.4% for CI participants), but not for incongruent tactile stimulation. These findings replicate previously observed tactile enhancement effects. Juxtaposing our study with previous research, the informational content of the tactile stimulus emerges as a modulator of intelligibility: Generally, congruent stimuli enhanced, non-matching tactile stimuli reduced, and neutral stimuli did not change test outcomes. We conclude that the temporal cues provided by congruent vibrotactile stimuli may aid in parsing continuous speech signals into syllables and words, consequently leading to the observed improvements in intelligibility., (© 2023. The Author(s).)

Several studies have established that Cochlear implant (CI) listeners rely on the tempo of music to judge the emotional content of music. However, a re-analysis of a study in which CI listeners judged the emotion conveyed by piano pieces on a scale from happy to sad revealed a weak correlation between tempo and emotion. The present study explored which temporal cues in music influence emotion judgments among normal hearing (NH) listeners, which might provide insights into the cues utilized by CI listeners. Experiment 1 was a replication of the Vannson et al. study with NH listeners using rhythmic patterns of piano created with congas. The temporal cues were preserved while the tonal ones were removed. The results showed (i) tempo was weakly correlated with emotion judgments, (ii) NH listeners' judgments for congas were similar to CI listeners' judgments for piano. In Experiment 2, two tasks were administered with congas played at three different tempi: emotion judgment and a tapping task to record listeners' perceived tempo. Perceived tempo was a better predictor than the tempo, but its physical correlate, mean onset-to-onset difference (MOOD), a measure of the average time between notes, yielded higher correlations with NH listeners' emotion judgments. This result suggests that instead of the tempo, listeners rely on the average time between consecutive notes to judge the emotional content of music. CI listeners could utilize this cue to judge the emotional content of music.

The study tests the hypothesis that vibrotactile stimulation can affect timbre perception. A multidimensional scaling experiment was conducted. Twenty listeners with normal hearing and nine cochlear implant users were asked to judge the dissimilarity of a set of synthetic sounds that varied in attack time and amplitude modulation depth. The listeners were simultaneously presented with vibrotactile stimuli, which varied also in attack time and amplitude modulation depth. The results showed that alterations to the temporal waveform of the tactile stimuli affected the listeners' dissimilarity judgments of the audio. A three-dimensional analysis revealed evidence of crossmodal processing where the audio and tactile equivalents combined accounted for their dissimilarity judgments. For the normal-hearing listeners, 86% of the first dimension was explained by audio impulsiveness and 14% by tactile impulsiveness; 75% of the second dimension was explained by the audio roughness or fast amplitude modulation, while its tactile counterpart explained 25%. Interestingly, the third dimension revealed a combination of 43% of audio impulsiveness and 57% of tactile amplitude modulation. For the CI listeners, the first dimension was mostly accounted for by the tactile roughness and the second by the audio impulsiveness. This experiment shows that the perception of timbre can be affected by tactile input and could lead to the developing of new audio-tactile devices for people with hearing impairment.

The electric stimulation provided by current cochlear implants (CI) is not power efficient. One underlying problem is the poor efficiency by which information from electric pulses is transformed into auditory nerve responses. A novel stimulation paradigm using ramped pulse shapes has recently been proposed to remedy this inefficiency. The primary motivation is a better biophysical fit to spiral ganglion neurons with ramped pulses compared to the rectangular pulses used in most contemporary CIs. Here, we tested the hypotheses that ramped pulses provide more efficient stimulation compared to rectangular pulses and that a rising ramp is more efficient than a declining ramp. Rectangular, rising ramped and declining ramped pulse shapes were compared in terms of charge efficiency and discriminability, and threshold variability in seven CI listeners. The tasks included single-channel threshold detection, loudness-balancing, discrimination of pulse shapes, and threshold measurement across the electrode array. Results showed that reduced charge, but increased peak current amplitudes, was required at threshold and most comfortable levels with ramped pulses relative to rectangular pulses. Furthermore, only one subject could reliably discriminate between equally-loud ramped and rectangular pulses, suggesting variations in neural activation patterns between pulse shapes in that participant. No significant difference was found between rising and declining ramped pulses across all tests. In summary, the present findings show some benefits of charge efficiency with ramped pulses relative to rectangular pulses, that the direction of a ramped slope is of less importance, and that most participants could not perceive a difference between pulse shapes.

The effect of the relative timing between pairs of same-polarity monophasic pulses has been studied extensively in single-neuron animal studies and has revealed fundamental properties of the neurons. For human cochlear implant listeners, the requirement to use charge-balanced stimulation and the typical use of symmetric, biphasic pulses limits such measures, because currents of opposite polarities interact at the level of the neural membrane. Here, we propose a paradigm to study same-polarity summation of currents while keeping the stimulation charge-balanced within a short time window. We used pairs of mirrored pseudo-monophasic pulses (a long-low phase followed by a short-high phase for the first pulse and a short-high phase followed by a long-low phase for the second pulse). We assumed that most of the excitation would stem from the two adjacent short-high phases, which had the same polarity. The inter-pulse interval between the short-high phases was varied from 0 to 345 μs. The inter-pulse interval had a significant effect on the perceived loudness, and this effect was consistent with both passive (membrane-related) and active (ion-channel-related) neuronal mechanisms contributing to facilitation. Furthermore, the effect of interval interacted with the polarity of the pulse pairs. At threshold, there was an effect of polarity, but, surprisingly, no effect of interval nor an interaction between the two factors. We discuss possible peripheral origins of these results.

It has been suggested that a specialized high-temporal-acuity brainstem pathway can be activated by stimulating more apically in the cochlea than is achieved by cochlear implants (CIs) when programmed with contemporary clinical settings. We performed multiple experiments to test the effect on pitch perception of phantom stimulation and asymmetric current pulses, both supposedly stimulating beyond the most apical electrode of a CI. The two stimulus types were generated using a bipolar electrode pair, composed of the most apical electrode of the array and a neighboring, more basal electrode. Experiment 1 used a pitch-ranking procedure where neural excitation was shifted apically or basally using so-called phantom stimulation. No benefit of apical phantom stimulation was found on the highest rate up to which pitch ranks increased (upper limit), nor on the slopes of the pitch-ranking function above 300 pulses per second (pps). Experiment 2 used the same procedure to study the effects of apical pseudomonophasic pulses, where the locus of excitation was manipulated by changing stimulus polarity. A benefit of apical stimulation was obtained for the slopes above 300 pps. Experiment 3 used an adaptive rate discrimination procedure and found a small but significant benefit of both types of apical stimulation. Overall, the results show some benefit for apical stimulation on temporal pitch processing at high pulse rates but reveal that the effect is smaller and more variable across listeners than suggested by previous research. The results also provide some indication that the benefit of apical stimulation may decline over time since implantation.

Ten cochlear implant (CI) users with single-sided deafness were asked to vary the parameters of an acoustic sound played to their contralateral ear to characterize the perception evoked by a pure tone played through the direct audio input of their CI. Two frequencies, centered on an apical and a medial electrode, were tested. In six subjects, the electrode positions were estimated on CT scans. The study was divided in 3 experiments in which the parameters of the acoustic sound varied. The listeners had to vary the frequency of a pure tone (Exp.1), the center frequency and the bandwidth of a filter applied to a harmonic complex sound (Exp.2), and the frequency of the components and the inharmonicity factor of a complex sound (Exp.3). Two testing sessions were performed at 3 and 12 months after activation. The mean results of Exp. 1 showed that the frequency of the matched tone was significantly lower for the apical than for the medial stimulus. In Exp.2, the mean center frequencies of the filters were also significantly lower for the apical than for the medial stimulus. As this parameter modifies the energy ratio between the high and low-frequency components, this result suggests that the medial stimulus was perceived with a brighter timbre than the apical stimulus. In Exp.3, the mean frequencies of the components were not significantly different between the sounds resulting from the stimulation of the two electrodes, but were significantly lower at the12-month session compared to the 3-month visit. These results suggest that a change in place of excitation may be perceived as a change in timbre rather than a change in pitch, and that an effect of adaptation can be observed., Competing Interests: DG and MA are employees of Oticon Medical. This does not alter our adherence to PLOS ONE policies on sharing data and materials

Speech recognition in noisy environments remains a challenge for cochlear implant (CI) recipients. Unwanted charge interactions between current pulses, both within and between electrode channels, are likely to impair performance. Here we investigate the effect of reducing the number of current pulses on speech perception. This was achieved by implementing a psychoacoustic temporal-masking model where current pulses in each channel were passed through a temporal integrator to identify and remove pulses that were less likely to be perceived by the recipient. The decision criterion of the temporal integrator was varied to control the percentage of pulses removed in each condition. In experiment 1, speech in quiet was processed with a standard Continuous Interleaved Sampling (CIS) strategy and with 25, 50 and 75% of pulses removed. In experiment 2, performance was measured for speech in noise with the CIS reference and with 50 and 75% of pulses removed. Speech intelligibility in quiet revealed no significant difference between reference and test conditions. For speech in noise, results showed a significant improvement of 2.4 dB when removing 50% of pulses and performance was not significantly different between the reference and when 75% of pulses were removed. Further, by reducing the overall amount of current pulses by 25, 50, and 75% but accounting for the increase in charge necessary to compensate for the decrease in loudness, estimated average power savings of 21.15, 40.95, and 63.45%, respectively, could be possible for this set of listeners. In conclusion, removing temporally masked pulses may improve speech perception in noise and result in substantial power savings., Competing Interests: Declaration of competing interest None., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

In all commercial cochlear implant (CI) devices, the electric stimulation is performed with a rectangular pulse that generally has two phases of opposite polarity. To date, developing new stimulation strategies has relied on the efficacy of this shape. Here, we investigate the potential of a novel stimulation paradigm that uses biophysically-inspired electrical ramped pulses. Using electrically-evoked auditory brainstem response (eABR) recordings in mice, we found that less charge, but higher current level amplitude, is needed to evoke responses with ramped shapes that are similar in amplitude to responses obtained with rectangular shapes. The most charge-efficient pulse shape had a rising ramp over both phases, supporting findings from previous in vitro studies. This was also true for longer phase durations. Our study presents the first physiological data on CI-stimulation with ramped pulse shapes. By reducing charge consumption ramped pulses have the potential to produce more battery-efficient CIs and may open new perspectives for designing other efficient neural implants in the future.

The auditory system can theoretically encode frequencies by either the rate or place of stimulation within the cochlea. Previous work with cochlear implants has demonstrated that both changes in timing and place can be described as pitch changes but are perceptually orthogonal. Using multidimensional scaling, the present experiment extends the previous findings that timing and place changes are perceptually orthogonal into the cochlear apex using long 31-mm electrode arrays. However, temporal cues seem to be more reliable across subjects at the apex while place cues seem to be more reliable at the middle of the cochlea.

The symmetric biphasic pulses used in contemporary cochlear implants (CIs) consist of both cathodic and anodic currents, which may stimulate different sites on spiral ganglion neurons and, potentially, interact with each other. The effect on the order of anodic and cathodic stimulation on loudness at short inter-pulse intervals (IPIs; 0-800  μ s) is investigated. Pairs of opposite-polarity pseudomonophasic (PS) pulses were used and the amplitude of each pulse was manipulated independently. In experiment 1 the two PS pulses differed in their current level in order to elicit the same loudness when presented separately. Six users of the Advanced Bionics CI (Valencia, CA) loudness-ranked trains of the pulse pairs using a midpoint-comparison procedure. Stimuli with anodic-leading polarity were louder than those with cathodic-leading polarity for IPIs shorter than 400  μ s. This effect was small-about 0.3 dB-but consistent across listeners. When the same procedure was repeated with both PS pulses having the same current level (experiment 2), anodic-leading stimuli were still louder than cathodic-leading stimuli at very short intervals. However, when using symmetric biphasic pulses (experiment 3) the effect disappeared at short intervals and reversed at long intervals. Possible peripheral sources of such polarity interactions are discussed.

Sequential stream segregation by cochlear implant (CI) listeners was investigated using a temporal delay detection task composed of a sequence of regularly presented bursts of pulses on a single electrode (B) interleaved with an irregular sequence (A) presented on a different electrode. In half of the trials, a delay was added to the last burst of the regular B sequence, and the listeners were asked to detect this delay. As a jitter was added to the period between consecutive A bursts, time judgments between the A and B sequences provided an unreliable cue to perform the task. Thus, the segregation of the A and B sequences should improve performance. In Experiment 1, the electrode separation and the sequence duration were varied to clarify whether place cues help CI listeners to voluntarily segregate sounds and whether a two-stream percept needs time to build up. Results suggested that place cues can facilitate the segregation of sequential sounds if enough time is provided to build up a two-stream percept. In Experiment 2, the duration of the sequence was fixed, and only the electrode separation was varied to estimate the fission boundary. Most listeners were able to segregate the sounds for separations of three or more electrodes, and some listeners could segregate sounds coming from adjacent electrodes.

The role of temporal cues in sequential stream segregation was investigated in cochlear implant (CI) listeners using a delay detection task composed of a sequence of bursts of pulses (B) on a single electrode interleaved with a second sequence (A) presented on the same electrode with a different pulse rate. In half of the trials, a delay was added to the last burst of the otherwise regular B sequence and the listeners were asked to detect this delay. As a jitter was added to the period between consecutive A bursts, time judgments between the A and B sequences provided an unreliable cue to perform the task. Thus, the segregation of the A and B sequences should improve performance. The pulse rate difference and the duration of the sequences were varied between trials. The performance in the detection task improved by increasing both the pulse rate differences and the sequence duration. This suggests that CI listeners can use pulse rate differences to segregate sequential sounds and that a segregated percept builds up over time. In addition, the contribution of place versus temporal cues for voluntary stream segregation was assessed by combining the results from this study with those from our previous study, where the same paradigm was used to determine the role of place cues on stream segregation. Pitch height differences between the A and the B sounds accounted for the results from both studies, suggesting that stream segregation is related to the salience of the perceptual difference between the sounds.

This study systematically investigated the effects of frequency, level, and spectral envelope on pitch matching in twelve bimodal cochlear implant (CI) users. The participants were asked to vary the frequency and level of a pure or complex tone (adjustable sounds) presented in the non-implanted ear to match the pitch and loudness of different reference stimuli presented to the implanted ear. Three reference sounds were used: single electrode pulse trains, pure tones, and piano notes. The data showed a significant effect of the frequency and complexity of the reference sounds. No significant effect of the level of the reference sounds was found. The magnitude of effect of frequency was compressed in the implanted ear: on average a difference of seven semitones in the non-implanted ear induced the same pitch change as a difference of 19 to 24 semitones for a stimulus presented to the implanted ear. The spectral envelope of the adjustable sound presented to the non-implanted ear also had a significant effect. The matched frequencies were higher by an average of six semitones for the pure tone compared to a complex tone. Overall, the CI listeners might have matched the stimuli based on timbre characteristics such as brightness.

It has been argued that a main limitation of the cochlear implant is the spread of current induced by each electrode, which activates an inappropriately large range of sensory neurons. To reduce this spread, an alternative stimulation mode, the all-polar mode, was tested with five participants. It was designed to activate all the electrodes simultaneously with appropriate current levels and polarities to recruit narrower regions of auditory nerves at specific intracochlear electrode positions (denoted all-polar electrodes). In this study, the all-polar mode was compared with the current commercial stimulation mode: the monopolar mode. The participants were asked to judge the sound dissimilarity between pairs of two-electrode pulse-train stimuli that differed in the electrode positions and were presented in either monopolar or all-polar mode with pulses on the two electrodes presented either sequentially or simultaneously. The dissimilarity ratings were analyzed using a multidimensional scaling technique and three-dimensional stimulus perceptual spaces were produced. For all the conditions (mode and simultaneity), the first perceptual dimension was highly correlated with the position of the most apical activated electrode of the electrical stimulation and the second dimension with the position of the most basal electrode. In both sequential and simultaneous conditions, the monopolar and all-polar stimuli were significantly separated by a third dimension, which may indicate that all-polar stimuli have a perceptual quality that differs from monopolar stimuli. Overall, the results suggest that both modes might successfully represent spectral information in a sound processing strategy., (© The Author(s) 2016.)

Musical enjoyment for cochlear implant (CI) recipients is often reported to be unsatisfactory. Our goal was to determine whether the musical experience of postlingually deafened adult CI recipients could be enriched by presenting the bass and treble clef parts of short polyphonic piano pieces separately to each ear (dichotic). Dichotic presentation should artificially enhance the lateralization cues of each part and help the listeners to better segregate them and thus provide greater clarity. We also hypothesized that perception of the intended emotion of the pieces and their overall enjoyment would be enhanced in the dichotic mode compared with the monophonic (both parts in the same ear) and the diotic mode (both parts in both ears). Twenty-eight piano pieces specifically composed to induce sad or happy emotions were selected. The tempo of the pieces, which ranged from lento to presto covaried with the intended emotion (from sad to happy). Thirty participants (11 normal-hearing listeners, 11 bimodal CI and hearing-aid users, and 8 bilaterally implanted CI users) participated in this study. Participants were asked to rate the perceived clarity, the intended emotion, and their preference of each piece in different listening modes. Results indicated that dichotic presentation produced small significant improvements in subjective ratings based on perceived clarity and preference. We also found that preference and clarity ratings were significantly higher for pieces with fast tempi compared with slow tempi. However, no significant differences between diotic and dichotic presentation were found for the participants' preference ratings, or their judgments of intended emotion., (© The Author(s) 2015.)

Unlabelled: Although the perception of music is generally poor in cochlear implant users, there are a few excellent performers., Objective: The aim of this study was the assessment of different aspects of music perception in one exceptional cochlear implant user., Design: The assessments included pitch direction discrimination, melody and timbre recognition, relative and absolute pitch judgment, and consonance rating of musical notes presented through the sound processor(s)., Study Sample: An adult cochlear implant user with musical background who lost her hearing postlingually, and five normally-hearing listeners with musical training participated in the study., Results: The CI user discriminated pitch direction for sounds differing by one semitone and recognized melody with nearly 100% accuracy. Her results in timbre recognition were better than average published data for cochlear implant users. Her consonance rating, and relative and absolute pitch perception were comparable to normally-hearing listeners with musical training., Conclusion: The results in this study showed that excellent performance is possible on musical perception tasks including pitch perception using present day cochlear implant technologies. Factors that may explain this user's exceptional performance are short duration of deafness, pre- and post-deafness musical training, and perfect pitch abilities before the onset of deafness.

Background: Studies using vocoders as acoustic simulators of cochlear implants have generally focused on simulation of speech understanding, gender recognition, or music appreciation. The aim of the present experiment was to study the auditory sensation perceived by cochlear implant (CI) recipients with steady electrical stimulation on the most-apical electrode., Methodology/principal Findings: Five unilateral CI users with contralateral residual hearing were asked to vary the parameters of an acoustic signal played to the non-implanted ear, in order to match its sensation to that of the electric stimulus. They also provided a rating of similarity between each acoustic sound they selected and the electric stimulus. On average across subjects, the sound rated as most similar was a complex signal with a concentration of energy around 523 Hz. This sound was inharmonic in 3 out of 5 subjects with a moderate, progressive increase in the spacing between the frequency components., Conclusions/significance: For these subjects, the sound sensation created by steady electric stimulation on the most-apical electrode was neither a white noise nor a pure tone, but a complex signal with a progressive increase in the spacing between the frequency components in 3 out of 5 subjects. Knowing whether the inharmonic nature of the sound was related to the fact that the non-implanted ear was impaired has to be explored in single-sided deafened patients with a contralateral CI. These results may be used in the future to better understand peripheral and central auditory processing in relation to cochlear implants.

Purpose: The purpose of this study was to investigate musical timbre perception in cochlear-implant (CI) listeners using a multidimensional scaling technique to derive a timbre space. Methods Sixteen stimuli that synthesized western musical instruments were used (McAdams, Winsberg, Donnadieu, De Soete, & Krimphoff, 1995). Eight CI listeners and 15 normal-hearing (NH) listeners participated. Each listener made judgments of dissimilarity between stimulus pairs. Acoustical analyses that characterized the temporal and spectral characteristics of each stimulus were performed to examine the psychophysical nature of each perceptual dimension., Results: For NH listeners, the timbre space was best represented in three dimensions, one correlated with the temporal envelope (log-attack time) of the stimuli, one correlated with the spectral envelope (spectral centroid), and one correlated with the spectral fine structure (spectral irregularity) of the stimuli. The timbre space from CI listeners, however, was best represented by two dimensions, one correlated with temporal envelope features and the other weakly correlated with spectral envelope features of the stimuli., Conclusions: Temporal envelope was a dominant cue for timbre perception in CI listeners. Compared to NH listeners, CI listeners showed reduced reliance on both spectral envelope and spectral fine structure cues for timbre perception.

Although in normal hearing listeners, a sound is conveyed to the brain through two ears, it is perceived as one single sound source. This process known as binaural fusion is very important for sounds localization and the perception of speech in noise. The aim of this experiment was to investigate if bilateral cochlear implant (CI) users can fuse sounds in a similar way. Binaural fusion was tested through a modified version of the scale illusion proposed by Diana Deutsch in 1975. In that experiment, six listeners bilaterally implanted had to detect one deviant note within a stream composed of a repeating melody, while simultaneously being presented with a distractor stream of randomized notes. The experiments included two conditions. In a binaural condition, every second note from the melody and the randomized stream was presented to the other ear. In a monaural condition, both streams were presented to the same ear. Of the six CI users, two could perform the task binaurally, and one only monaurally. The other three could not do the task at all. This result suggests that binaural fusion can be achieved only by a minority of CI listeners. A good alignment between the two sound processors might be critical to achieve good binaural processes. [ABSTRACT FROM AUTHOR]