Place Coding in the Human Cochlea.

The cochlea's capacity to decode sound frequencies is enhanced by a unique structural arrangement along its longitudinal axis, a feature termed 'tonotopy' or place coding. Auditory hair cells at the cochlea's base are activated by high-frequency sounds, while those at the apex respond to lower frequencies. Presently, our understanding of tonotopy primarily hinges on electrophysiological, mechanical, and anatomical studies conducted in animals or human cadavers. However, direct in vivo measurements of tonotopy in humans have been elusive due to the invasive nature of these procedures. This absence of live human data has posed an obstacle in establishing an accurate tonotopic map for patients, potentially limiting advancements in cochlear implant and hearing enhancement technologies. In this study, we conducted acoustically-evoked intracochlear recordings in 50 human subjects using a longitudinal multi-electrode array. These electrophysiological measures, combined with postoperative imaging to accurately locate the electrode contacts allow us to create the first in vivo tonotopic map of the human cochlea. Furthermore, we examined the influences of sound intensity, electrode array presence, and the creation of an artificial third window on the tonotopic map. Our findings reveal a significant disparity between the tonotopic map at daily speech conversational levels and the conventional (i.e., Greenwood) map derived at close-to-threshold levels. Our findings have implications for advancing cochlear implant and hearing augmentation technologies, but also offer novel insights into future investigations into auditory disorders, speech processing, language development, age-related hearing loss, and could potentially inform more effective educational and communication strategies for those with hearing impairments. Significance Statement: The ability to discriminate sound frequencies, or pitch, is vital for communication and facilitated by a unique arrangement of cells along the cochlear spiral (tonotopic place). While earlier studies have provided insight into frequency selectivity based on animal and human cadaver studies, our understanding of the in vivo human cochlea remains limited. Our research offers, for the first time, in vivo electrophysiological evidence from humans, detailing the tonotopic organization of the human cochlea. We demonstrate that the functional arrangement in humans significantly deviates from the conventional Greenwood function, with the operating point of the in vivo tonotopic map showing a basal (or frequency downward) shift. This pivotal finding could have far-reaching implications for the study and treatment of auditory disorders.

Relationship between electrode position and temporal modulation sensitivity in cochlear implant users: Are close electrodes always better?

Temporal modulation sensitivity has been studied extensively for cochlear implant (CI) users due to its strong correlation to speech recognition outcomes. Previous studies reported that temporal modulation detection thresholds (MDTs) vary across the tonotopic axis and attributed this variation to patchy neural survival. However, correlates of neural health identified in animal models depend on electrode position in humans. Nonetheless, the relationship between MDT and electrode location has not been explored. We tested 13 ears for the effect of distance on modulation sensitivity, specifically targeting the question of whether electrodes closer to the modiolus are universally beneficial. Participants in this study were postlingually deafened and users of Cochlear Nucleus CIs. The distance of each electrode from the medial wall (MW) of the cochlea and mid-modiolar axis (MMA) was measured from scans obtained using computerized tomography (CT) imaging. The distance measures were correlated with slopes of spatial tuning curves measured on selected electrodes to investigate if electrode position accounts, at least in part, for the width of neural excitation. In accordance with previous findings, electrode position explained 24% of the variance in slopes of the spatial tuning curves. All functioning electrodes were also measured for MDTs. Five ears showed a positive correlation between MDTs and at least one distance measure across the array; 6 ears showed negative correlations and the remaining two ears showed no relationship. The ears showing positive MDT-distance correlations, thus benefiting from electrodes being close to the neural elements, were those who performed better on the two speech recognition measures, i.e., speech reception thresholds (SRTs) and recognition of the AzBio sentences. These results could suggest that ears able to take advantage of the proximal placement of electrodes are likely to have better speech recognition outcomes. Previous histological studies of humans demonstrated that speech recognition is correlated with spiral ganglion cell counts. Alternatively, ears with good speech recognition outcomes may have good overall neural health, which is a precondition for close electrodes to produce spatially confined neural excitation patterns that facilitate modulation sensitivity. These findings suggest that the methods to reduce channel interaction, e.g., perimodiolar electrode array or current focusing, may only be beneficial for a subgroup of CI users. Additionally, it suggests that estimating neural survival preoperatively is important for choosing the most appropriate electrode array type (perimodiolar vs. lateral wall) for optimal implant function.

Is Characteristic Frequency Limiting Real-Time Electrocochleography During Cochlear Implantation?

Objectives: Electrocochleography (ECochG) recordings during cochlear implantation have shown promise in estimating the impact on residual hearing. The purpose of the study was (1) to determine whether a 250-Hz stimulus is superior to 500-Hz in detecting residual hearing decrement and if so; (2) to evaluate whether crossing the 500-Hz tonotopic, characteristic frequency (CF) place partly explains the problems experienced using 500-Hz. Design: Multifrequency ECochG comprising an alternating, interleaved acoustic complex of 250- and 500-Hz stimuli was used to elicit cochlear microphonics (CMs) during insertion. The largest ECochG drops (≥30% reduction in CM) were identified. After insertion, ECochG responses were measured using the individual electrodes along the array for both 250- and 500-Hz stimuli. Univariate regression was used to predict whether 250- or 500-Hz CM drops explained low-frequency pure tone average (LFPTA; 125-, 250-, and 500-Hz) shift at 1-month post-activation. Postoperative CT scans were performed to evaluate cochlear size and angular insertion depth. Results: For perimodiolar insertions (N = 34), there was a stronger linear correlation between the largest ECochG drop using 250-Hz stimulus and LFPTA shift (r = 0.58), compared to 500-Hz (r = 0.31). The 250- and 500-Hz CM insertion tracings showed an amplitude peak at two different locations, with the 500-Hz peak occurring earlier in most cases than the 250-Hz peak, consistent with tonotopicity. When using the entire array for recordings after insertion, a maximum 500-Hz response was observed 2-6 electrodes basal to the most-apical electrode in 20 cases (58.9%). For insertions where the apical insertion angle is >350 degrees and the cochlear diameter is <9.5 mm, the maximum 500-Hz ECochG response may occur at the non-apical most electrode. For lateral wall insertions (N = 14), the maximum 250- and 500-Hz CM response occurred at the most-apical electrode in all but one case. Conclusion: Using 250-Hz stimulus for ECochG feedback during implantation is more predictive of hearing preservation than 500-Hz. This is due to the electrode passing the 500-Hz CF during insertion which may be misidentified as intracochlear trauma; this is particularly important in subjects with smaller cochlear diameters and deeper insertions. Multifrequency ECochG can be used to differentiate between trauma and advancement of the apical electrode beyond the CF.

Effects of Electrode Location on Estimates of Neural Health in Humans with Cochlear Implants.

There are a number of psychophysical and electrophysiological measures that are correlated with SGN density in animal models, and these same measures can be performed in humans with cochlear implants (CIs). Thus, these measures are potentially applicable in humans for estimating the condition of the neural population (so called "neural health" or "cochlear health") at individual sites along the electrode array and possibly adjusting the stimulation strategy in the CI sound processor accordingly. Some measures used to estimate neural health in animals have included the electrically evoked compound potential (ECAP), psychophysical detection thresholds, and multipulse integration (MPI). With regard to ECAP measures, it has been shown that the change in the ECAP response as a function of increasing the stimulus interphase gap ("IPG Effect") also reflects neural density in implanted animals. These animal studies have typically been conducted using preparations in which the electrode was in a fixed position with respect to the neural population, whereas in human cochlear implant users, the position of individual electrodes varies widely within an electrode array and also across subjects. The current study evaluated the effects of electrode location in the implanted cochlea (specifically medial-lateral location) on various electrophysiological and psychophysical measures in eleven human subjects. The results demonstrated that some measures of interest, specifically ECAP thresholds, psychophysical detection thresholds, and ECAP amplitude-growth function (AGF) linear slope, were significantly related to the distances between the electrode and mid-modiolar axis (MMA). These same measures were less strongly related or not significantly related to the electrode to medial wall (MW) distance. In contrast, neither the IPG Effect for the ECAP AGF slope or threshold, nor the MPI slopes were significantly related to MMA or MW distance from the electrodes. These results suggest that "within-channel" estimates of neural health such as the IPG Effect and MPI slope might be more suitable for estimating nerve condition in humans for clinical application since they appear to be relatively independent of electrode position.

Factors Affecting Outcomes in Cochlear Implant Recipients Implanted With a Perimodiolar Electrode Array Located in Scala Tympani.

OBJECTIVE: To identify primary biographic and audiologic factors contributing to cochlear implant (CI) performance variability in quiet and noise by controlling electrode array type and electrode position within the cochlea. BACKGROUND: Although CI outcomes have improved over time, considerable outcome variability still exists. Biographic, audiologic, and device-related factors have been shown to influence performance. Examining CI recipients with consistent array type and electrode position may allow focused investigation into outcome variability resulting from biographic and audiologic factors. METHODS: Thirty-nine adults (40 ears) implanted for at least 6 months with a perimodiolar electrode array known (via computed tomography [CT] imaging) to be in scala tympani participated. Test materials, administered CI only, included monosyllabic words, sentences in quiet and noise, and spectral ripple discrimination. RESULTS: In quiet, scores were high with mean word and sentence scores of 76 and 87%, respectively; however, sentence scores decreased by an average of 35 percentage points when noise was added. A principal components (PC) analysis of biographic and audiologic factors found three distinct factors, PC1 Age, PC2 Duration, and PC3 Pre-op Hearing. PC1 Age was the only factor that correlated, albeit modestly, with speech recognition in quiet and noise. Spectral ripple discrimination strongly correlated with speech measures. CONCLUSION: For these recipients with consistent electrode position, PC1 Age was related to speech recognition performance. Consistent electrode position may have contributed to high speech understanding in quiet. Inter-subject variability in noise may have been influenced by auditory/cognitive processing, known to decline with age, and mechanisms that underlie spectral resolution ability.

Examining the electro-neural interface of cochlear implant users using psychophysics, CT scans, and speech understanding.

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.

Factors affecting open-set word recognition in adults with cochlear implants.

OBJECTIVE: A great deal of variability exists in the speech-recognition abilities of postlingually deaf adult cochlear implant (CI) recipients. A number of previous studies have shown that duration of deafness is a primary factor affecting CI outcomes; however, there is little agreement regarding other factors that may affect performance. The objective of the present study was to determine the source of variability in CI outcomes by examining three main factors, biographic/audiologic information, electrode position within the cochlea, and cognitive abilities in a group of newly implanted CI recipients. DESIGN: Participants were 114 postlingually deaf adults with either the Cochlear or Advanced Bionics CI systems. Biographic/audiologic information, aided sentence-recognition scores, a high resolution temporal bone CT scan and cognitive measures were obtained before implantation. Monosyllabic word recognition scores were obtained during numerous test intervals from 2 weeks to 2 years after initial activation of the CI. Electrode position within the cochlea was determined by three-dimensional reconstruction of pre- and postimplant CT scans. Participants' word scores over 2 years were fit with a logistic curve to predict word score as a function of time and to highlight 4-word recognition metrics (CNC initial score, CNC final score, rise time to 90% of CNC final score, and CNC difference score). RESULTS: Participants were divided into six outcome groups based on the percentile ranking of their CNC final score, that is, participants in the bottom 10% were in group 1; those in the top 10% were in group 6. Across outcome groups, significant relationships from low to high performance were identified. Biographic/audiologic factors of age at implantation, duration of hearing loss, duration of hearing aid use, and duration of severe-to-profound hearing loss were significantly and inversely related to performance as were frequency modulated tone, sound-field threshold levels obtained with the CI. That is, the higher-performing outcome groups were younger in age at the time of implantation, had shorter duration of severe-to-profound hearing loss, and had lower CI sound-field threshold levels. Significant inverse relationships across outcome groups were also observed for electrode position, specifically the percentage of electrodes in scala vestibuli as opposed to scala tympani and depth of insertion of the electrode array. In addition, positioning of electrode arrays closer to the modiolar wall was positively correlated with outcome. Cognitive ability was significantly and positively related to outcome; however, age at implantation and cognition were highly correlated. After controlling for age, cognition was no longer a factor affecting outcomes. CONCLUSION: There are a number of factors that limit CI outcomes. They can act singularly or collectively to restrict an individual's performance and to varying degrees. The highest performing CI recipients are those with the least number of limiting factors. Knowledge of when and how these factors affect performance can favorably influence counseling, device fitting, and rehabilitation for individual patients and can contribute to improved device design and application.

Changes in auditory perceptions and cortex resulting from hearing recovery after extended congenital unilateral hearing loss.

Monaural hearing induces auditory system reorganization. Imbalanced input also degrades time-intensity cues for sound localization and signal segregation for listening in noise. While there have been studies of bilateral auditory deprivation and later hearing restoration (e.g., cochlear implants), less is known about unilateral auditory deprivation and subsequent hearing improvement. We investigated effects of long-term congenital unilateral hearing loss on localization, speech understanding, and cortical organization following hearing recovery. Hearing in the congenitally affected ear of a 41 year old female improved significantly after stapedotomy and reconstruction. Pre-operative hearing threshold levels showed unilateral, mixed, moderately-severe to profound hearing loss. The contralateral ear had hearing threshold levels within normal limits. Testing was completed prior to, and 3 and 9 months after surgery. Measurements were of sound localization with intensity-roved stimuli and speech recognition in various noise conditions. We also evoked magnetic resonance signals with monaural stimulation to the unaffected ear. Activation magnitudes were determined in core, belt, and parabelt auditory cortex regions via an interrupted single event design. Hearing improvement following 40 years of congenital unilateral hearing loss resulted in substantially improved sound localization and speech recognition in noise. Auditory cortex also reorganized. Contralateral auditory cortex responses were increased after hearing recovery and the extent of activated cortex was bilateral, including a greater portion of the posterior superior temporal plane. Thus, prolonged predominant monaural stimulation did not prevent auditory system changes consequent to restored binaural hearing. Results support future research of unilateral auditory deprivation effects and plasticity, with consideration for length of deprivation, age at hearing correction and degree and type of hearing loss.

Verification of computed tomographic estimates of cochlear implant array position: a micro-CT and histologic analysis.

OBJECTIVE: To determine the efficacy of clinical computed tomographic (CT) imaging to verify postoperative electrode array placement in cochlear implant (CI) patients. STUDY DESIGN: Nine fresh cadaver heads underwent clinical CT scanning, followed by bilateral CI insertion and postoperative clinical CT scanning. Temporal bones were removed, trimmed, and scanned using micro-CT. Specimens were then dehydrated, embedded in either methyl methacrylate or LR White resin, and sectioned with a diamond wafering saw. Histology sections were examined by 3 blinded observers to determine the position of individual electrodes relative to soft tissue structures within the cochlea. Electrodes were judged to be within the scala tympani, scala vestibuli, or in an intermediate position between scalae. RESULTS: The position of the array could be estimated accurately from clinical CT scans in all specimens using micro-CT and histology as a criterion standard. Verification using micro-CT yielded 97% agreement, and histologic analysis revealed 95% agreement with clinical CT results. CONCLUSION: A composite, 3-dimensional image derived from a patient's preoperative and postoperative CT images using a clinical scanner accurately estimates the position of the electrode array as determined by micro-CT imaging and histologic analyses. Information obtained using the CT method provides valuable insight into numerous variables of interest to patient performance such as surgical technique, array design, and processor programming and troubleshooting.

Consensus panel on a cochlear coordinate system applicable in histologic, physiologic, and radiologic studies of the human cochlea.

HYPOTHESIS: An objective cochlear framework, for evaluation of the cochlear anatomy and description of the position of an implanted cochlear implant electrode, would allow the direct comparison of measures performed within the various subdisciplines involved in cochlear implant research. BACKGROUND: Research on the human cochlear anatomy in relation to tonotopy and cochlear implantation is conducted by specialists from numerous disciplines such as histologists, surgeons, physicists, engineers, audiologists, and radiologists. To allow accurate comparisons between and combinations of previous and forthcoming scientific and clinical studies, cochlear structures and electrode positions must be specified in a consistent manner. METHODS: Researchers with backgrounds in the various fields of inner ear research as well as representatives of the different manufacturers of cochlear implants (Advanced Bionics Corp., Med-El, Cochlear Corp.) were involved in consensus meetings held in Dallas, March 2005, and Asilomar, August 2005. Existing coordinate systems were evaluated, and requisites for an objective cochlear framework were discussed. RESULTS: The consensus panel agreed upon a 3-dimensional, cylindrical coordinate system of the cochlea using the "Cochlear View" as a basis and choosing a z axis through the modiolus. The zero reference angle was chosen at the center of the round window, which has a close relationship to the basal end of the Organ of Corti. CONCLUSION: Consensus was reached on an objective cochlear framework, allowing the outcomes of studies from different fields of research to be compared directly.

Optimal cochlear implant insertion vectors.

HYPOTHESIS: An optimal insertion trajectory during cochlear implantation may be determined from the anatomic relationship between the facial nerve and round window. BACKGROUND: Cochlear implantation functional outcomes improve with insertion of the implant into the scala tympani. This depends on creating a cochleostomy in the proper position and inserting the electrode along a trajectory coaxial with the centerline of the scala tympani. The anatomic landmarks for this insertion trajectory have not been described. METHODS: Clinical computed tomography and micro-computed tomographic analysis of 8 cadaveric temporal bones. RESULTS: Appropriate insertion vectors pass inferior or anteroinferior to the round window membrane. In many individuals, the facial nerve interrupts all or most of the insertion vectors coaxial to the centerline of the scala tympani. CONCLUSION: A cochleostomy placed inferior or anteroinferior to the round window membrane may facilitate atraumatic insertion of a cochlear implant along the centerline of the scala tympani. The lateral and anterior wall of the fallopian canal must be adequately thinned to achieve an optimal insertion trajectory. This is particularly true when inserting through cochleostomies placed away from the round window along the basal turn of the cochlea.

Role of electrode placement as a contributor to variability in cochlear implant outcomes.

HYPOTHESIS: Suboptimal cochlear implant (CI) electrode array placement may reduce presentation of coded information to the central nervous system and, consequently, limit speech recognition. BACKGROUND: Generally, mean speech reception scores for CI recipients are similar across different CI systems, yet large outcome variation is observed among recipients implanted with the same device. These observations suggest significant recipient-dependent factors influence speech reception performance. This study examines electrode array insertion depth and scalar placement as recipient-dependent factors affecting outcome. METHODS: Scalar location and depth of insertion of intracochlear electrodes were measured in 14 patients implanted with Advanced Bionics electrode arrays and whose word recognition scores varied broadly. Electrode position was measured using computed tomographic images of the cochlea and correlated with stable monosyllabic word recognition scores. RESULTS: Electrode placement, primarily in terms of depth of insertion and scala tympani versus scala vestibuli location, varies widely across subjects. Lower outcome scores are associated with greater insertion depth and greater number of contacts being located in scala vestibuli. Three patterns of scalar placement are observed suggesting variability in insertion dynamics arising from surgical technique. CONCLUSION: A significant portion of variability in word recognition scores across a broad range of performance levels of CI subjects is explained by variability in scalar location and insertion depth of the electrode array. We suggest that this variability in electrode placement can be reduced and average speech reception improved by better selection of cochleostomy sites, revised insertion approaches, and control of insertion depth during surgical placement of the array.

Use of computed tomography scans for cochlear implants.

While 3-dimensional (3D) imaging by computed tomography has long been desirable for research and treatment of cochlear-implant patients, technical challenges have limited its wide application. Recent developments in scanner hardware and image processing techniques now allow image quality improvements that make clinical applications feasible. Validation experiments were performed to characterize a new methodology and its imaging performance.

In vivo estimates of the position of advanced bionics electrode arrays in the human cochlea.

OBJECTIVES: A new technique for determining the position of each electrode in the cochlea is described and applied to spiral computed tomography data from 15 patients implanted with Advanced Bionics HiFocus I, Ij, or Helix arrays. METHODS: ANALYZE imaging software was used to register 3-dimensional image volumes from patients' preoperative and postoperative scans and from a single body donor whose unimplanted ears were scanned clinically, with micro computed tomography and with orthogonal-plane fluorescence optical sectioning (OPFOS) microscopy. By use of this registration, we compared the atlas of OPFOS images of soft tissue within the body donor's cochlea with the bone and fluid/ tissue boundary available in patient scan data to choose the midmodiolar axis position and judge the electrode position in the scala tympani or scala vestibuli, including the distance to the medial and lateral scalar walls. The angular rotation 0 degrees start point is a line joining the midmodiolar axis and the middle of the cochlear canal entry from the vestibule. RESULTS: The group mean array insertion depth was 477 degrees (range, 286 degrees to 655 degrees). The word scores were negatively correlated (r = -0.59; p = .028) with the number of electrodes in the scala vestibuli. CONCLUSIONS: Although the individual variability in all measures was large, repeated patterns of suboptimal electrode placement were observed across subjects, underscoring the applicability of this technique.

Effect of increased IIDR in the nucleus freedom cochlear implant system.

The objective of this study was to evaluate the effect of the increased instantaneous input dynamic range (IIDR) in the Nucleus Freedom cochlear implant (CI) system on recipients' ability to perceive soft speech and speech in noise. Ten adult Freedom CI recipients participated. Two maps differing in IIDR were placed on each subject's processor at initial activation. The IIDR was set to 30 dB for one map and 40 dB for the other. Subjects used both maps for at least one month prior to speech perception testing. Results revealed significantly higher scores for words (50 dB SPL), for sentences in background babble (65 dB SPL), and significantly lower sound field threshold levels with the 40 compared to the 30 dB IIDR map. Ceiling effects may have contributed to non-significant findings for sentences in quiet (50 dB SPL). The Freedom's increased IIDR allows better perception of soft speech and speech in noise.

Effect of frequency boundary assignment on speech recognition with the Nucleus 24 ACE speech coding strategy.

The choice of frequency boundaries for the analysis channels of cochlear implants has been shown to impact the speech perception performance of adult recipients (Skinner et al, 1995; Fourakis et al, 2004). While technological limitations heretofore have limited the clinical feasibility of investigating novel frequency assignments, the SPEAR3 research processor affords the opportunity to investigate an unlimited number of possibilities. Here, four different assignments are evaluated using a variety of speech stimuli. All participants accommodated to assignment changes, and no one assignment was significantly preferred. The results suggest that better performance can be achieved using a strategy whereby (1) there are at least 7-8 electrodes allocated below 1000 Hz, (2) the majority of remaining electrodes are allocated between 1100-3000 Hz, and (3) the region above 3 kHz is represented by relatively few electrodes (i.e., 1-3). The results suggest that such frequency assignment flexibility should be made clinically available.

Speech recognition with the advanced combination encoder and transient emphasis spectral maxima strategies in nucleus 24 recipients.

One of the difficulties faced by cochlear implant (CI) recipients is perception of low-intensity speech cues. A. E. Vandali (2001) has developed the transient emphasis spectral maxima (TESM) strategy to amplify short-duration, low-level sounds. The aim of the present study was to determine whether speech scores would be significantly higher with TESM than with the advanced combination encoder (ACE) strategy fitted using procedures that optimize perception of soft speech and other sounds. Eight adult recipients of the Nucleus 24 CI system participated in this study. No significant differences in scores were seen between ACE and TESM for consonant-vowel nucleus-consonant (CNC) words presented at 55 and 65 dB SPL, for sentences in noise presented at 65 dB SPL at 2 different signal-to-noise ratios, or for closed-set vowels and consonants presented at 60 dB SPL. However, perception of stop consonants within CNC words presented at the lower level (55 dB SPL) was significantly higher with TESM than ACE. In addition, percentage of information transmitted for words at 55 dB SPL was significantly higher with TESM than with ACE for manner and voicing features for consonants in the initial word position. Analysis of closed-set consonants presented at 60 dB SPL revealed percentage of information transmitted for manner was significantly higher with TESM than with ACE. These improvements with TESM were small compared with those reported by Vandali for recipients of the Nucleus 22 CI system. It appears that mapping techniques used to program speech processors and improved processing capabilities of the Nucleus 24 system contributed to soft sounds being understood almost as well with ACE as with TESM. However, half of the participants preferred TESM to ACE for use in everyday life, and all but 1 used TESM in specific listening situations. Clinically, TESM may be useful to ensure the audibility of low-intensity, short-duration acoustic cues that are important for understanding speech, for recipients who are difficult to map, or if insufficient time precludes the use of mapping techniques to increase audibility of soft sound.

Effect of frequency boundary assignment on vowel recognition with the Nucleus 24 ACE speech coding strategy.

Two speech processor programs (MAPs) differing only in electrode frequency boundary assignments were created for each of eight Nucleus 24 Cochlear Implant recipients. The default MAPs used typical frequency boundaries, and the experimental MAPs reassigned one additional electrode to vowel formant regions. Four objective speech tests and a questionnaire were used to evaluate speech recognition with the two MAPs. Results for the closed-set vowel test and the formant discrimination test showed small but significant improvement in scores with the experimental MAP. Differences for the Consonant-Vowel Nucleus-Consonant word test and closed-set consonant test were nonsignificant. Feature analysis revealed no significant differences in information transmission. Seven of the eight subjects preferred the experimental MAP, reporting louder, crisper, and clearer sound. The results suggest that Nucleus 24 recipients should be given an opportunity to compare a MAP that assigns more electrodes in vowel formant regions with the default MAP to determine which provides the most benefit in everyday life.

An investigation of input level range for the nucleus 24 cochlear implant system: speech perception performance, program preference, and loudness comfort ratings.

OBJECTIVE: Cochlear implant recipients often have limited access to lower level speech sounds. In this study we evaluated the effects of varying the input range characteristics of the Nucleus 24 cochlear implant system on recognition of vowels, consonants, and sentences in noise and on listening in everyday life. DESIGN: Twelve subjects participated in the study that was divided into two parts. In Part 1 subjects used speech processor (Nucleus 24 SPrint trade mark ) programs adjusted for three input sensitivity settings: a standard or default microphone sensitivity setting (MS 8), a setting that increased the input sensitivity by 10.5 dB (MS 15), and the same setting that increased input sensitivity but also incorporated the automatic sensitivity control (ASC; i.e., MS 15A) that is designed to reduce the loudness of noise. The default instantaneous input dynamic range (IIDR) of 30 dB was used in these programs (i.e., base level of 4; BL 4). Subjects were tested using each sensitivity program with vowels and consonants presented at very low to casual conversational levels of 40 dB SPL and 55 dB SPL, respectively. They were also tested with sentences presented at a raised level of 65 dB SPL in multi-talker babble at individually determined signal to noise ratios. In addition, subjects were given experience outside of the laboratory for several weeks. They were asked to complete a questionnaire where they compared the programs in different listening situations as well as the loudness of environmental sounds, and state the setting they preferred overall. In Part 2 of the study, subjects used two programs. The first program was their preferred sensitivity program from Part 1 that had an IIDR of 30 dB (BL 4). Seven subjects used MS 8 and four used MS 15, and one used the noise reduction program MS 15A. The second program used the same microphone sensitivity but had the IIDR extended by an additional 8 to 10 dB (BL 1/0). These two programs were evaluated similarly in the speech laboratory and with take-home experience as in Part 1. RESULTS PART 1: Increasing the microphone input sensitivity by 10.5 dB (from MS 8 to MS 15) significantly improved the perception of vowels and consonants at 40 and 55 dB SPL. The group mean improvement in vowel scores was 25 percentage points at 40 dB SPL and 4 percentage points at 55 dB SPL. The group mean improvement for consonants was 23 percentage points at 40 dB SPL and 11 percentage points at 55 dB SPL. Increased input sensitivity did not significantly reduce the perception of sentences presented at 65 dB SPL in babble despite the fact that speech peaks were then within the compressed range above the SPrint processor's automatic gain control (AGC) knee-point. Although there was a demonstrable advantage for perception of low-level speech with the higher input sensitivity (MS 15 and 15A), seven of the 12 subjects preferred MS 8, four preferred MS 15 or 15A, and one had no preference overall. Approximately half the subjects preferred MS 8 across the 18 listening situations, whereas an average of two subjects preferred MS 15 or 15A. The increased microphone sensitivity of MS 15 substantially increased the loudness of environmental sounds. However, use of the ASC noise reduction setting with MS 15 reduced the loudness of environmental sounds to equal or below that for MS 8. RESULTS PART 2: The increased instantaneous input range gave some improvement (8 to 9 percentage points for the 40 dB SPL presentation level) in the perception of consonants. There was no statistically significant increase in vowel scores. Mean scores for sentences presented at 65 dB SPL in babble were significantly lower (5 percentage points) for the increased IIDR setting. Subjects had no preference for the increased IIDR over the default. The IIDR setting had no effect on the loudness of environmental sounds. CONCLUSIONS: Given the fact that individuals differ in threshold (T) and comfort (C) levels for electrical stimulation, and preferred microphone sensitivity, volume control, and noise-reduction settings, it is essential for the clinicid recipient to determine what combination is best for the individual over several sessions. The results of this study clearly show the advantage of using higher microphone sensitivity settings than the default MS 8 to provide better speech recognition for low-level stimuli. However, it was also necessary to adjust other parameters such as map C levels, automatic sensitivity control and base level, to optimize loudness comfort in the diversity of listening situations an individual encounters in everyday life.

Effects of stimulation rate with the Nucleus 24 ACE speech coding strategy.

OBJECTIVE: The primary objective of the study was to determine whether individual cochlear implant recipients recognize speech better with an electrical stimulation rate of 720 or 1800 pulses per second per channel (pps/ch) using the Nucleus 24 Advanced Combination Encoder (ACE) speech coding strategy. The secondary objective was to determine, for each active electrode, the relation between psychophysical measures and MAP minimum and maximum stimulation levels for each rate, as well as the stability of MAP minimum and maximum levels during the study. DESIGN: Eight postlinguistically deaf adults implanted with the Nucleus 24 device participated in this study comparing the effect of a moderate (720 pps/ch) and a fast (1800 pps/ch) rate of electrical stimulation on speech recognition of words in quiet and sentences in noise presented at 50, 60, and 70 dB SPL in the laboratory and on listening to sound in everyday life over a 14-wk time period. At the beginning of the study, psychophysical measures (i.e., counted threshold and maximum acceptable loudness [MAL] levels) were obtained for each active electrode with each of the two rates to initially set MAP minimum and maximum stimulation levels. These levels were then adjusted to make speech and environmental sound clear and comfortable in everyday life. Threshold and MAL levels were obtained again half way through the study to monitor possible hearing changes. A four-phase test design for evaluation of speech recognition was followed; an equal number of subjects started with each of the two rates and alternated rates for each phase. In the last 2 wk of each phase, word and sentence scores were obtained, and subjects responded to a questionnaire. For the group, factorial analyses of variance were conducted for subject, stimulation rate, and time period (first two phases versus second two phases) for words, phonemes within words, and sentences at each level. Additional analyses were obtained for individual subjects. RESULTS: Group mean scores across time periods were significantly higher for 1800 pps/ch than 720 pps/ch for phonemes and sentences in noise at 50 dB SPL. There was no significant difference in scores for phonemes and sentences at 60 and 70 dB SPL or for words at any of the three levels. Group mean scores across stimulation rate were significantly higher during the second half than the first half of the study for words, phonemes, and sentences at 50 dB SPL. This result is consistent with subjects learning to recognize speech cues near threshold. A subject by rate interaction was seen for sentences at 70 dB SPL and for all three speech measures at 50 dB SPL. These interactions reflect the fact that two subjects performed significantly better with 720 pps/ch, whereas two other subjects performed significantly better with 1800 pps/ch. Responses to the questionnaire indicated that two subjects preferred 720 pps/ch, three preferred 1800 pps/ch, and three had no preference. The minimum and/or maximum levels in most subjects' final MAPs differed from the psychophysical measures for both rates. Changes in Current Level at threshold and MAL were minimal from the first to the second half of the study for each rate. CONCLUSIONS: More than half the subjects preferred one of the two rates for use in everyday life, and four subjects performed significantly better with one of the two rates on at least one test measure. These findings underscore the clinical importance of creating MAPs for each implant recipient that include at least a moderate and a fast rate within ACE during the first months of device use. Given the significant learning effects for soft speech that occurred over several weeks use of each rate in this study, it is suggested that each rate be used alone for a week or two before comparing them and deciding which provides more benefit. In addition, adjustments in an individual's MAP minimum and maximum levels are needed at each rate so soft and normal conversational speech as well as loud sound are clear and comfortable in everyday life.