Effect of Stimulation Rate on Cochlear Implant Recipients' Thresholds and Maximum Acceptable Loudness Levels

Clinically, speech processor programs are created using electrical thresholds and maximum acceptable loudness levels (MALs) at several different stimulation rates to determine what rate will provide cochlear implant recipients with the best speech recognition when using fast-rate speech coding strategies. This study was designed to determine the difference in thresholds and MALs (expressed in the clinical unit, Current Level [CL]) for pairs of six rates spanning those available with the Nucleus 24 device (i.e., 250 to 2400 pps/ch) using monopolar, 25 μsec/phase stimulation. Test-retest measures of threshold and MAL for each rate were obtained from seven adult Nucleus 24 recipients on each of 11 electrodes. The difference in threshold and in MAL between pairs of rates was dependent on the absolute CL. Below approximately 190 CL, thresholds and MALs decreased with increasing rate; above 210 CL, there was little change in threshold or MAL with increasing rate. Based on these findings, an approach to estimating threshold and MAL from one rate to another is suggested, pending further research. Abbreviations: ACE = advanced combination encoder, CIS = continuous interleaved sampling, CT = computed tomography, CL = current level, FDA = U.S. Food and Drug Administration, MALs = maximum acceptable loudness levels, NRT = neural response telemetry, pps/ch = pulses per second per channel, SPEAK = spectral peak speech coding strategy, WinDPS = Windows programming and diagnostic system