Acoustic component programming in children with cochlear implants using electrocochleography.

OBJECTIVE: Objective measurements improve reliability and effectiveness of hearing assessment and cochlear implant (CI) programming in young children. In CI recipients with acoustic hearing in the implanted ear, electrocochleography (ECochG) can be conducted using intracochlear electrodes. The cochlear microphonic (CM) portion of ECochG has been shown to correlate with pure-tone audiometric thresholds in adult and paediatric CI recipients. Our goal was to determine if ECochG thresholds can be used to appropriately fit the acoustic component to the implanted ear in children. DESIGN: Prospective. STUDY SAMPLE: Eight children (aged 3.5-15.5 years, 10 ears) implanted with Advanced Bionics HiFocus Mid-Scala electrode array were recruited. CI ear acoustic thresholds were measured behaviourally and via ECochG. Two acoustic component enabled CI programs were created using the two sets of thresholds. Age and language appropriate speech outcomes and subjective feedback were obtained. RESULTS: Speech scores were equivalent with the behavioural and ECochG thresholds programs. Subjectively, the ECochG thresholds program was preferred by 7/8 subjects. One subject preferred to use an electric only program. CONCLUSION: Our data suggest that ECochG thresholds can be used to supplement the behavioural clinical methods and aid the reliable fitting of the acoustic component in paediatric CI recipients.

Comparison of Pure-Tone Thresholds and Cochlear Microphonics Thresholds in Pediatric Cochlear Implant Patients.

OBJECTIVES: In adult cochlear implant patients, conventional audiometry is used to measure postoperative residual hearing which requires active listening and patient feedback. However, audiological measurements in pediatric cochlear implant patients are both challenging as well as time consuming. Intracochlear electrocochleography (ECOG) offers an objective and a time-efficient method to measure frequency-specific cochlear microphonic or difference thresholds (CM/DIF) thresholds that closely approximate auditory thresholds in adult cochlear implant patients. The correlation between CM/DIF and behavioral thresholds has not been established in pediatric cochlear implant patients. In the present study, CM/DIF thresholds were compared with audiometric thresholds in pediatric cochlear implant patients with postoperative residual hearing. DESIGN: Thirteen (11 unilateral and 2 bilateral) pediatric cochlear implant patients (mean age = 9.2 years ± 5.1) participated in this study. Audiometric thresholds were estimated using conventional, condition play, or visual reinforcement audiometry. A warble tone stimulus was used to measure audiometric thresholds at 125, 250, 500, 1000, and 2000 Hz. ECOG waveforms were elicited using 50-msec acoustic tone-bursts. The most apical intracochlear electrode was used as the recording electrode with an extra-cochlear ground electrode. The ECOG waveforms were analyzed to determine CM/DIF thresholds that were compared with pediatric cochlear implant patients' audiometric thresholds. RESULTS: The results show a significant correlation (r = 0.77, p < 0.01) between audiometric and CM/DIF thresholds over a frequency range of 125 to 2000 Hz in pediatric cochlear implant patients. Frequency-specific comparisons revealed a correlation of 0.82, 0.74, 0.69, 0.41, and 0.32 between the audiometric thresholds and CM/DIF thresholds measured at 125, 250, 500, 1000, and 2000 Hz, respectively. An average difference of 0.4 dB (±14 dB) was measured between the audiometric and CM/DIF thresholds. CONCLUSIONS: Intracochlear ECOG can be used to measure CM/DIF thresholds in pediatric cochlear implant patients with residual hearing in the implanted ear. The CM/DIF thresholds are similar to the audiometric thresholds at lower test frequencies and offer an objective method to monitor residual hearing in difficult-to-test pediatric cochlear implant patients.

Simulating intracochlear electrocochleography with a combined model of acoustic hearing and electric current spread in the cochlea.

Intracochlear electrocochleography (ECochG) is a potential tool for the assessment of residual hearing in cochlear implant users during implantation and acoustical tuning postoperatively. It is, however, unclear how these ECochG recordings from different locations in the cochlea depend on the stimulus parameters, cochlear morphology, implant design, or hair cell degeneration. In this paper, a model is presented that simulates intracochlear ECochG recordings by combining two existing models, namely a peripheral one that simulates hair cell activation and a three-dimensional (3D) volume-conduction model of the current spread in the cochlea. The outcomes were compared to actual ECochG recordings from subjects with a cochlear implant (CI). The 3D volume conduction simulations showed that the intracochlear ECochG is a local measure of activation. Simulations showed that increasing stimulus frequency resulted in a basal shift of the peak cochlear microphonic (CM) amplitude. Increasing the stimulus level resulted in wider tuning curves as recorded along the array. Simulations with hair cell degeneration resulted in ECochG responses that resembled the recordings from the two subjects in terms of CM onset responses, higher harmonics, and the width of the tuning curve. It was concluded that the model reproduced the patterns seen in intracochlear hair cell responses recorded from CI-subjects.

Pure-Tone Masking Patterns for Monopolar and Phantom Electrical Stimulation in Cochlear Implants.

OBJECTIVES: Monopolar stimulation of the most apical electrode produces the lowest pitch sensation in cochlear implants clinically. A phantom electrode that uses out-of-phase electrical stimulation between the most apical and the neighboring basal electrode can produce a lower pitch sensation than that associated with the most apical electrode. However, because of the absence of contacts beyond the apical tip of the array, the ability to assess the spread of electrical excitation associated with phantom stimulation is limited in the typical cochlear implant subject with no residual hearing. In the present study, the spread of electrical excitation associated with monopolar and phantom stimulation of the most apical electrode was assessed using electrical masking of acoustic thresholds in cochlear implant subjects with residual, low-frequency, acoustic hearing. DESIGN: Eight subjects with an Advanced Bionics cochlear implant and residual hearing in the implanted ear participated in this study (nine ears in total). Unmasked and masked thresholds for acoustic pure tones were measured at 125, 250, 500, 750, 1000, and 2000 Hz in the presence of monopolar and phantom electrode stimulation presented at the apical-most end of the array. The current compensation for phantom electrode stimulation was fixed at 50%. The two electrical maskers were loudness balanced. Differences between the unmasked and masked acoustic thresholds can be attributed to (1) the electrical stimulus-induced interference in the transduction/conduction of the acoustic signal through cochlear periphery and the auditory nerve and/or (2) masking at the level of the central auditory system. RESULTS: The results show a significant elevation in pure-tone thresholds in the presence of the monopolar and phantom electrical maskers. The unmasked thresholds were subtracted from the masked thresholds to derive masking patterns as a function of the acoustic probe frequency. The masking patterns show that phantom stimulation was able to produce more masking than that associated with the monopolar stimulation of the most apical electrode. CONCLUSION: These results suggest that for some cochlear implant subjects, phantom electrode stimulation can shift the neural stimulation pattern more apically in the cochlea, which is consistent with reports that phantom electrode stimulation produces lower pitch sensations than those associated with monopolar stimulation of the most apical electrode alone.

Electrocochleography in Cochlear Implant Recipients With Residual Hearing: Comparison With Audiometric Thresholds.

OBJECTIVES: To determine whether electrocochleography (ECoG) thresholds, especially cochlear microphonic and auditory nerve neurophonic thresholds, measured using an intracochlear electrode, can be used to predict pure-tone audiometric thresholds following cochlear implantation in ears with residual hearing. DESIGN: Pure-tone audiometric thresholds and ECoG waveforms were measured at test frequencies from 125 to 4000 Hz in 21 Advanced Bionics cochlear implant recipients with residual hearing in the implanted ear. The "difference" and "summation" responses were computed from the ECoG waveforms measured from two alternating phases of stimulation. The interpretation is that difference responses are largely from the cochlear microphonic while summating responses are largely from the auditory nerve neurophonic. The pure-tone audiometric thresholds were also measured with same equipment used for ECoG measurements. RESULTS: Difference responses were observed in all 21 implanted ears, whereas summation response waveforms were observed in only 18 ears. The ECoG thresholds strongly correlated (r = 0.87, n = 150 for difference response; r = 0.82, n = 72 for summation response) with audiometric thresholds. The mean difference between the difference response and audiometric thresholds was -3.2 (±9.0) dB, while the mean difference between summation response and audiometric thresholds was -14 (±11) dB. In four out of 37 measurements, difference responses were measured to frequencies where no behavioral thresholds were present. CONCLUSIONS: ECoG thresholds may provide a useful metric for the assessment of residual hearing in cochlear implant subjects for whom it is not possible to perform behavioral audiometric testing.

Sound frequency-invariant neural coding of a frequency-dependent cue to sound source location.

The century-old duplex theory of sound localization posits that low- and high-frequency sounds are localized with two different acoustical cues, interaural time and level differences (ITDs and ILDs), respectively. While behavioral studies in humans and behavioral and neurophysiological studies in a variety of animal models have largely supported the duplex theory, behavioral sensitivity to ILD is curiously invariant across the audible spectrum. Here we demonstrate that auditory midbrain neurons in the chinchilla (Chinchilla lanigera) also encode ILDs in a frequency-invariant manner, efficiently representing the full range of acoustical ILDs experienced as a joint function of sound source frequency, azimuth, and distance. We further show, using Fisher information, that nominal "low-frequency" and "high-frequency" ILD-sensitive neural populations can discriminate ILD with similar acuity, yielding neural ILD discrimination thresholds for near-midline sources comparable to behavioral discrimination thresholds estimated for chinchillas. These findings thus suggest a revision to the duplex theory and reinforce ecological and efficiency principles that hold that neural systems have evolved to encode the spectrum of biologically relevant sensory signals to which they are naturally exposed.

Biophysics of directional hearing in the American alligator (Alligator mississippiensis).

Physiological and anatomical studies have suggested that alligators have unique adaptations for spatial hearing. Sound localization cues are primarily generated by the filtering of sound waves by the head. Different vertebrate lineages have evolved external and/or internal anatomical adaptations to enhance these cues, such as pinnae and interaural canals. It has been hypothesized that in alligators, directionality may be enhanced via the acoustic coupling of middle ear cavities, resulting in a pressure difference receiver (PDR) mechanism. The experiments reported here support a role for a PDR mechanism in alligator sound localization by demonstrating that (1) acoustic space cues generated by the external morphology of the animal are not sufficient to generate location cues that match physiological sensitivity, (2) continuous pathways between the middle ears are present to provide an anatomical basis for coupling, (3) the auditory brainstem response shows some directionality, and (4) eardrum movement is directionally sensitive. Together, these data support the role of a PDR mechanism in crocodilians and further suggest this mechanism is a shared archosaur trait, most likely found also in the extinct dinosaurs.

The sound source distance dependence of the acoustical cues to location and their encoding by neurons in the inferior colliculus: implications for the Duplex theory.

For over a century, the Duplex theory has posited that low- and ­high-frequency sounds are localized using two different acoustical cues, interaural time (ITDs) and level (ILDs) differences, respectively. Psychophysical data have generally supported the theory for pure tones. Anatomically, ITDs and ILDs are separately encoded in two parallel brainstem pathways. Acoustically ILDs are a function of location and frequency such that lower and higher frequencies exhibit smaller and larger ILDs, respectively. It is well established that neurons throughout the auditory neuraxis encode high-frequency ILDs. Acoustically, low-frequency ILDs are negligible (∼1­2 dB); however, humans are still sensitive to them and physiological studies often report low-frequency ILD-sensitive neurons. These ­latter findings are at odds with the Duplex theory. We suggest that these discrepancies arise from an inadequate characterization of the acoustical environment. We hypothesize that low-frequency ILDs become large and useful when sources are located near the head. We tested this hypothesis by making measurements of the ILDs in chinchillas as a function of source distance and the sensitivity to ILDs in 103 neurons in the inferior colliculus (IC). The ILD sensitivity of IC neurons was found to be frequency independent even though far-field acoustical ILDs were frequency dependent. However, as source distance was decreased, the magnitudes of low-frequency ILDs increased. Using information theoretic methods, we ­demonstrate that a population of IC neurons can encode the full range of acoustic ILDs across frequency that would be experienced as a joint function of source location and distance.

Using Stapes Velocity to Estimate the Efficacy of Mechanical Stimulation of the Round Window With an Active Middle Ear Implant.

OBJECTIVE: To test a method to measure the efficacy of active middle ear implants when coupled to the round window. METHODS: Data previously published in Koka et al. ( Hear Res 2010;263:128-137) were used in this study. Simultaneous measurements of cochlear microphonics (CM) and stapes velocity in response to both acoustic stimulation (forward direction) and round window (RW) stimulation (reverse direction) with an active middle ear implant (AMEI) were made in seven ears in five chinchillas. For each stimulus frequency, the amplitude of the CM was measured separately as a function of intensity (dB SPL or dB mV). Equivalent vibrational input to the cochlea was determined by equating the acoustic and AMEI-generated CM amplitudes for a given intensity. In the condition of equivalent CM amplitude between acoustic and RW stimulation-generated output, we assume that the same vibrational input to the cochlea was present regardless of the route of stimulation. RESULTS: The measured stapes velocities for equivalent CM output from the two types of input were not significantly different for low and medium frequencies (0.25-4 kHz); however, the velocities for AMEI-RW drive were significantly lower for higher frequencies (4-14 kHz). Thus, for RM stimulation with an AMEI, stapes velocities can underestimate the mechanical input to the cochlea by ~20 dB for frequencies greater than ~4 kHz. CONCLUSIONS: This study confirms that stapes velocity (with the assumption of equivalent stapes velocity for forward and reverse stimulation) cannot be used as a proxy for effective input to the cochlea when it is stimulated in the reverse direction. Future research on application of intraoperative electrophysiological measurements during surgery (CM, compound action potential, or auditory brainstem response) for estimating efficacy and optimizing device coupling and performance is warranted.

Multi-Frequency Electrocochleography and Electrode Scan to Identify Electrode Insertion Trauma during Cochlear Implantation.

Intraoperative electrocochleography (ECOG) is performed using a single low-frequency acoustic stimulus (e.g., 500 Hz) to monitor cochlear microphonics (CM) during cochlear implant (CI) electrode insertion. A decrease in CM amplitude is commonly associated with cochlear trauma and is used to guide electrode placement. However, advancement of the recording electrode beyond the sites of CM generation can also lead to a decrease in CM amplitude and is sometimes interpreted as cochlear trauma, resulting in unnecessary electrode manipulation and increased risk of cochlear trauma during CI electrode placement. In the present study, multi-frequency ECOG was used to monitor CM during CI electrode placement. The intraoperative CM tracings were compared with electrode scan measurements, where CM was measured for each of the intracochlear electrodes. Comparison between the peak CM amplitude measured during electrode placement and electrode scan measurements was used to differentiate between different mechanisms for decrease in CM amplitude during CI electrode insertion. Analysis of the data shows that both multi-frequency electrocochleography and electrode scan could potentially be used to differentiate between different mechanisms for decreasing CM amplitude and providing appropriate feedback to the surgeon during CI electrode placement.

Neural encoding of sound source location in the presence of a concurrent, spatially separated source.

In the presence of multiple, spatially separated sound sources, the binaural cues used for sound localization in the horizontal plane become distorted from the cues from each sound in isolation, yet localization in everyday multisource acoustic environments remains robust. We examined changes in the azimuth tuning functions of inferior colliculus (IC) neurons in unanesthetized rabbits to a target broadband noise when a concurrent broadband noise interferer was presented at different locations in virtual acoustic space. The presence of an interferer generally degraded sensitivity to target azimuth and distorted the shape of the tuning function, yet most neurons remained significantly sensitive to target azimuth and maintained tuning function shapes somewhat similar to those for the target alone. Using binaural cue manipulations in virtual acoustic space, we found that single-source tuning functions of neurons with high best frequencies (BFs) were primarily determined by interaural level differences (ILDs) or monaural level, with a small influence of interaural time differences (ITDs) in some neurons. However, with a centrally located interferer, the tuning functions of most high-BF neurons were strongly influenced by ITDs as well as ILDs. Model-based analysis showed that the shapes of these tuning functions were in part produced by decorrelation of the left and right cochlea-induced envelopes that occurs with source separation. The strong influence of ITD on the tuning functions of high-BF neurons poses a challenge to the "duplex theory" of sound localization and suggests that ITD may be important for localizing high-frequency sounds in multisource environments.

Analysis of electrode impedance and its subcomponents for lateral wall, mid-scala, and perimodiolar electrodes in cochlear implants.

OBJECTIVE: Electrode impedances play an important role in cochlear implant patient management. During clinical visits, electrode impedances are calculated from a single point voltage waveform. In the present study, multipoint electrode impedance analysis was performed to study electrode impedance and its subcomponents in patients with three different types of cochlear implant electrode arrays. DESIGN: Voltage waveforms were measured at six different time points during the cathodic phase of a biphasic pulse in forty-seven cochlear implant patients with perimodiolar, mid-scala, or lateral wall electrode arrays. Multipoint electrode impedances were used to determine access resistance and polarization impedance. RESULTS: Access resistance of approximately 5 kΩ was calculated across the three different electrode arrays. Mid-scala electrodes showed a smaller increase in impedances as a function of pulse duration compared to the other electrodes. Patients with lower impedances showed higher capacitance and lower resistance, suggesting that differences in electrochemical reaction at the electrodes' surface can influence impedances in cochlear implants. CONCLUSIONS: Analysis of cochlear implant electrode impedances and their subcomponents provides valuable information about resistance to the flow of current between stimulating and return electrodes, and build an understanding of the contribution of electrochemical processes used to deliver electrical stimulation to the auditory nerve.

Predicting Cochlear Implant Electrode Placement Using Monopolar, Three-Point and Four-Point Impedance Measurements.

OBJECTIVE: This study aimed to investigate the relationship between cochlear implant (CI) electrode distances to the cochlea's inner wall (the modiolus) and electrical impedance measurements made at the CI's electrode contacts. We introduced a protocol for "three-point impedances" in which we recorded bipolar impedances in response to monopolar stimulation at a neighboring electrode. We aimed to assess the usability of three-point impedances and two existing CI impedance measurement methods (monopolar and four-point impedances) for predicting electrode positioning during CI insertion. METHODS: Impedances were recorded during stepwise CI electrode array insertions in cadaveric human temporal bones. The positioning of the electrodes with respect to the modiolus was assessed at each step using cone beam computed tomography. Linear mixed regression analysis was performed to assess the relationship between the impedances and electrode-modiolar distances. The experimental results were compared to clinical impedance data and to an existing lumped-element model of an implanted CI. RESULTS: Three-point and four-point impedances strongly correlated with electrode-modiolar distance. In contrast, monopolar impedances were only minimally affected by changes in electrode positioning with respect to the modiolus. An overall model specificity of 62% was achieved when incorporating all impedance parameters. This specificity could be increased beyond 73% when prior expectations of electrode positioning were incorporated in the model. CONCLUSION: Three-point and four-point impedances are promising measures to predict electrode-modiolar distance in real-time during CI insertion. SIGNIFICANCE: This work shows how electrical impedance measurements can be used to predict the CI's electrode positioning in a biologically realistic model.

Relationship Between Intraoperative Electrocochleography and Hearing Preservation.

OBJECTIVES: To compare intraoperative intracochlear electrocochleography (ECochG) with hearing preservation outcomes in cochlear implant (CI) subjects. DESIGN: Intraoperative electrocochleography was performed in adult CI subjects who were recipients of Advanced Bionics' Bionics LLC precurved HiFocus MidScala or straight HiFocus SlimJ electrode arrays. ECochG responses were recorded from the most apical electrode contact during insertion. No changes to the insertions were made due to ECochG monitoring. No information about insertion resistance was collected. ECochG drops were estimated as the change in amplitude from peak (defined as maximum amplitude response) to drop (largest drop) point after the peak during insertion was measured following the peak response. Audiometric thresholds from each subject were obtained before and approximately 1 month after CI surgery. The change in pure tone average for frequencies between 125 Hz and 500 Hz was measured after surgery. No postoperative CT scans were collected as part of this study. RESULTS: A total of 68 subjects from five surgical centers participated in the study. The study sample included 30 MidScala and 38 SlimJ electrodes implanted by approximately 20 surgeons who contributed to the study. Although a wide range of results were observed, there was a moderate positive correlation (Pearson Correlation coefficient, r = 0.56, p < 0.01) between the size of the ECochG drop and the magnitude of pure tone average change. This trend was present for both the MidScala and SlimJ arrays. The SlimJ and MidScala arrays produced significantly different hearing loss after surgery. CONCLUSION: Large ECochG amplitude drops observed during electrode insertion indicated poorer hearing preservation. Although the outcomes were variable, this information may be helpful to guide surgical decision-making when contemplating full electrode insertion and the likelihood of hearing preservation.

Postnatal development of cochlear microphonic and compound action potentials in a precocious species, Chinchilla lanigera.

The development of sound-evoked responses in Chinchilla lanigera was studied from postnatal ages P0-1 (first 24 h) to adult. Cochlear microphonic (CMs) and compound action potentials (CAPs), representing ensemble sound-evoked activities of hair cells and auditory nerve fibers, respectively, were present as early as age P0-1. The data indicate that CM thresholds and sensitivities were generally adult-like (i.e., fall into adult ranges) at birth, but suprathreshold CM amplitudes remained below adult ranges through P28. CAP thresholds reached adult-like values between P7-P14, but the suprathreshold CAP amplitude continued to increase until ∼P28. The results confirm the auditory precociousness of the chinchilla.

Effect of exceeding compliance voltage on speech perception in cochlear implants.

OBJECTIVES: In cochlear implants, the maximum current I (Amperes) that can be delivered on a cochlear implant electrode is determined by V = I * R, where V = compliance voltage (Volts) and R = electrode impedance (Ohms). Generally, electrode impedances are measured during each clinical visit and are used to set electrical stimulation parameters in cochlear implants. However, electrode impedances can rise during the course of cochlear implant use and lead to electrical stimulation voltage requirements exceeding the maximum compliance voltage of the medical device. Electric stimulation requirements that exceed the compliance voltage lead to clipping of the biphasic electrical pulse (current going into the cochlea) and are known to adversely affect cochlear implant outcomes. DESIGN: Thirteen (11 unilateral and 2 bilateral) Advanced Bionics cochlear implant patients with a HiRes 90k™ cochlear implant participated in this study. Speech perception scores were measured using the patient's baseline clinical program with the most comfortable loudness levels (M-levels) and the following four test programs: (1) stimulation clipped at 15% below clinical M-levels (15%C) (2) stimulation clipped at 30% below clinical M-levels (30%C) (3) M-levels decreased by 15% (15%M) and (4) M-levels decreased by 30% (30%C). Speech perception scores were measured using AzBio sentences presented at 60 dB SPL in quiet and in the presence of multi-talker babble (+10 dB SNR). RESULTS: Relative to the clinical baseline program, speech perception scores with the four test programs decreased in both quiet and noisy listening conditions. In quiet, speech perception scores measured with the 30%M and 30%C programs were significantly (p < 0.001) poorer than the baseline program. No significant differences in speech perception scores were measured between the baseline and the 15%C or 15%M programs. In the noisy listening condition, speech perception scores were significantly poorer than the baseline program for the 15%C (p = 0.008), 30%C (p < 0.001), and 30%M (p < 0.001) programs. No significant differences in speech perception scores were obtained between the baseline and the 15%M program in the noisy listening condition. Speech perception scores measured with the 30%C program were significantly (p < 0.001) poorer than those with the 30%M program, suggesting that clipping was more detrimental than reducing electrical stimulation levels. CONCLUSION: Small amounts (15%) of clipping can significantly decrease speech perception in the presence of background noise. Large amounts (30%) of both clipping and M-level reduction may lead to significantly poorer speech perception in quiet and in background noise. The decrease in speech perception scores can most likely be attributed to reduced volume and poorer spectro-temporal representation. Therefore, it is important to establish comfortably loud electrical stimulation levels without exceeding the compliance voltage to maximize cochlear implant outcomes.

Simultaneous Intra- and Extracochlear Electrocochleography During Cochlear Implantation to Enhance Response Interpretation.

The use of electrocochleography (ECochG) for providing real-time feedback of cochlear function during cochlear implantation is receiving increased attention for preventing cochlear trauma and preserving residual hearing. Although various studies investigated the relationship between intra-operative ECochG measurements and surgical outcomes in recent years, the limited interpretability of ECochG response changes leads to conflicting study results and prevents the adoption of this method for clinical use. Specifically, the movement of the recording electrode with respect to the different signal generators in intracochlear recordings makes the interpretation of signal changes with respect to cochlear trauma difficult. Here, we demonstrate that comparison of ECochG signals recorded simultaneously from intracochlear locations and from a fixed extracochlear location can potentially allow a differentiation between traumatic and atraumatic signal changes in intracochlear recordings. We measured ECochG responses to 500 Hz tone bursts with alternating starting phases during cochlear implant insertions in six human cochlear implant recipients. Our results show that an amplitude decrease with associated near 180° phase shift and harmonic distortions in the intracochlear difference curve during the first half of insertion was not accompanied by a decrease in the extracochlear difference curve's amplitude (n = 1), while late amplitude decreases in intracochlear difference curves (near full insertion, n = 2) did correspond to extracochlear amplitude decreases. These findings suggest a role for phase shifts, harmonic distortions, and recording location in interpreting intracochlear ECochG responses.

Intracochlear Electrocochleography and Speech Perception Scores in Cochlear Implant Recipients.

OBJECTIVES/HYPOTHESIS: Previous studies have demonstrated that electrocochleography (ECochG) measurements made at the round window prior to cochlear implant (CI) electrode insertion can account for 47% of the variability in 6-month speech perception scores. Recent advances have made it possible to use the apical CI electrode to record intracochlear responses to acoustic stimuli. Study objectives were to determine 1) the relationship between intracochlear ECochG response amplitudes and 6-month speech perception scores and 2) to determine the relationship between behavioral auditory thresholds and ECochG threshold estimates. The hypothesis was that intracochlear ECochG response amplitudes made immediately after electrode insertion would be larger than historical controls (at the extracochlear site) and explain more variability in speech perception scores. STUDY DESIGN: Prospective case series. METHODS: Twenty-two adult CI recipients with varying degrees of low-frequency hearing had intracochlear ECochG measurements made immediately after CI electrode insertion using 110 dB SPL tone bursts. Tone bursts were centered at five octave-spaced frequencies between 125 and 2,000 Hz. RESULTS: There was no association between intracochlear ECochG response amplitudes and speech perception scores. But, the data suggest a mild to moderate relationship between preoperative behavioral audiometric testing and intraoperative ECochG threshold estimates. CONCLUSION: Performing intracochlear ECochG is highly feasible and results in larger response amplitudes, but performing ECochG before, rather than after, CI insertion may provide a more accurate assessment of a patient's speech perception potential. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E2681-E2688, 2021.

Varying overall sound intensity to the two ears impacts interaural level difference discrimination thresholds by single neurons in the lateral superior olive.

The lateral superior olive (LSO) is one of the earliest sites in the auditory pathway involved in processing acoustical cues to sound location. LSO neurons encode the interaural level difference (ILD) cue to azimuthal location. Here we investigated the effect of variations in the overall stimulus levels of sounds at the two ears on the sensitivity of LSO neurons to small differences in ILDs of pure tones. The neuronal firing rate versus ILD functions were found to depend greatly on the overall stimulus level, typically shifting along the ILD axis toward the excitatory ear and attaining greater maximal firing rates as stimulus level increased. Seventy-five percent of neurons showed significant shifts with changes in overall sound level. The range of ILDs corresponding to best neural acuity for ILDs shifted accordingly. In a simulation using the empirical data, when the overall stimulus level was randomly changed from one trial to the next, the neural discrimination thresholds for ILD, or ILD acuities, were worsened by 50-60% across the population of neurons relative to fixed stimulus levels whether ILD acuity was measured at the azimuthal midline or the ILD pedestal producing the best acuity. The impairment in ILD discrimination was attributed to the increased neural response variance imparted by varying the stimulus level. These results contrast to those observed in psychophysical studies where ILD discrimination thresholds under similar experimental conditions are invariant to overall changes in stimulus level. A simple computational model that incorporated the antagonistic inputs of bilateral LSO nuclei as well as the dorsal nuclei of the lateral lemniscus to the inferior colliculus produced a more robust encoding of ILD even in the setting of roving stimulus level. Testable predictions of this model and comparison to other computational models addressing stimulus invariance were considered.

Round window membrane implantation with an active middle ear implant: a study of the effects on the performance of round window exposure and transducer tip diameter in human cadaveric temporal bones.

OBJECTIVES: To assess the importance of 2 variables, transducer tip diameter and resection of the round window (RW) niche, affecting the optimization of the mechanical stimulation of the RW membrane with an active middle ear implant (AMEI). MATERIALS AND METHODS: Ten temporal bones were prepared with combined atticotomy and facial recess approach to expose the RW. An AMEI stimulated the RW with 2 ball tip diameters (0.5 and 1.0 mm) before and after the resection of the bony rim of the RW niche. The RW drive performance, assessed by stapes velocities using laser Doppler velocimetry, was analyzed in 3 frequency ranges: low (0.25-1 kHz), medium (1-3 kHz) and high (3-8 kHz). RESULTS: Driving the RW produced mean peak stapes velocities (H(EV)) of 0.305 and 0.255 mm/s/V at 3.03 kHz, respectively, for the 1- and 0.5-mm tips, with the RW niche intact. Niche drilling increased the H(EV) to 0.73 and 0.832 mm/s/V for the 1- and 0.5-mm tips, respectively. The tip diameter produced no difference in output at low and medium frequencies; however, the 0.5-mm tip was 5 and 6 dB better than the 1-mm tip at high frequencies before and after niche drilling, respectively. Drilling the niche significantly improved the output by 4 dB at high frequencies for the 1-mm tip, and by 6 and 10 dB in the medium- and high-frequency ranges for the 0.5-mm tip. CONCLUSION: The AMEI was able to successfully drive the RW membrane in cadaveric temporal bones using a classical facial recess approach. Stimulation of the RW membrane with an AMEI without drilling the niche is sufficient for successful hearing outputs. However, the resection of the bony rim of the RW niche significantly improved the RW stimulation at medium and higher frequencies. Drilling the niche enhances the exposure of the RW membrane and facilitates positioning the implant tip.