Lateralization of interaural time differences with mixed rates of stimulation in bilateral cochlear implant listeners.

While listeners with bilateral cochlear implants (BiCIs) are able to access information in both ears, they still struggle to perform well on spatial hearing tasks when compared to normal hearing listeners. This performance gap could be attributed to the high stimulation rates used for speech representation in clinical processors. Prior work has shown that spatial cues, such as interaural time differences (ITDs), are best conveyed at low rates. Further, BiCI listeners are sensitive to ITDs with a mixture of high and low rates. However, it remains unclear whether mixed-rate stimuli are perceived as unitary percepts and spatially mapped to intracranial locations. Here, electrical pulse trains were presented on five, interaurally pitch-matched electrode pairs using research processors, at either uniformly high rates, low rates, or mixed rates. Eight post-lingually deafened adults were tested on perceived intracranial lateralization of ITDs ranging from 50 to 1600 µs. Extent of lateralization depended on the location of low-rate stimulation along the electrode array: greatest in the low- and mixed-rate configurations, and smallest in the high-rate configuration. All but one listener perceived a unitary auditory object. These findings suggest that a mixed-rate processing strategy can result in good lateralization and convey a unitary auditory object with ITDs.

Lateralization of binaural envelope cues measured with a mobile cochlear-implant research processora).

Bilateral cochlear implant (BICI) listeners do not have full access to the binaural cues that normal hearing (NH) listeners use for spatial hearing tasks such as localization. When using their unsynchronized everyday processors, BICI listeners demonstrate sensitivity to interaural level differences (ILDs) in the envelopes of sounds, but interaural time differences (ITDs) are less reliably available. It is unclear how BICI listeners use combinations of ILDs and envelope ITDs, and how much each cue contributes to perceived sound location. The CCi-MOBILE is a bilaterally synchronized research processor with the untested potential to provide spatial cues to BICI listeners. In the present study, the CCi-MOBILE was used to measure the ability of BICI listeners to perceive lateralized sound sources when single pairs of electrodes were presented amplitude-modulated stimuli with combinations of ILDs and envelope ITDs. Young NH listeners were also tested using amplitude-modulated high-frequency tones. A cue weighting analysis with six BICI and ten NH listeners revealed that ILDs contributed more than envelope ITDs to lateralization for both groups. Moreover, envelope ITDs contributed to lateralization for NH listeners but had negligible contribution for BICI listeners. These results suggest that the CCi-MOBILE is suitable for binaural testing and developing bilateral processing strategies.

Web-based psychoacoustics of binaural hearing: Two validation experiments.

Web-based testing is an appealing option for expanding psychoacoustics research outside laboratory environments due to its simple logistics. For example, research participants partake in listening tasks using their own computer and audio hardware and can participate in a comfortable environment of their choice at their own pace. However, it is unknown how deviations from conventional in-lab testing affect data quality, particularly in binaural hearing tasks that traditionally require highly precise audio presentation. Here, we used an online platform to replicate two published in-lab experiments: lateralization to interaural time and level differences (ITD and ILD, experiment I) and dichotic and contralateral unmasking of speech (experiment II) in normal-hearing (NH) young adults. Lateralization data collected online were strikingly similar to in-lab results. Likewise, the amount of unmasking measured online and in-lab differed by less than 1 dB, although online participants demonstrated higher speech reception thresholds overall than those tested in-lab by up to ∼7 dB. Results from online participants who completed a hearing screening versus those who self-reported NH did not differ significantly. We conclude that web-based psychoacoustics testing is a viable option for assessing binaural hearing abilities among young NH adults and discuss important considerations for online study design.

Mixed stimulation rates to improve sensitivity of interaural timing differences in bilateral cochlear implant listeners.

Normal hearing listeners extract small interaural time differences (ITDs) and interaural level differences (ILDs) to locate sounds and segregate targets from noise. Bilateral cochlear implant listeners show poor sensitivity to ITDs when using clinical processors. This is because common clinical stimulation approaches use high rates [∼1000 pulses per-second (pps)] for each electrode in order to provide good speech representation, but sensitivity to ITDs is best at low rates of stimulation (∼100-300 pps). Mixing rates of stimulation across the array is a potential solution. Here, ITD sensitivity for a number of mixed-rate configurations that were designed to preserve speech envelope cues using high-rate stimulation and spatial hearing using low rate stimulation was examined. Results showed that ITD sensitivity in mixed-rate configurations when only one low rate electrode was included generally yielded ITD thresholds comparable to a configuration with low rates only. Low rate stimulation at basal or middle regions on the electrode array yielded the best sensitivity to ITDs. This work provides critical evidence that supports the use of mixed-rate strategies for improving ITD sensitivity in bilateral cochlear implant users.

Evidence for a neural source of the precedence effect in sound localization.

Normal-hearing human listeners and a variety of studied animal species localize sound sources accurately in reverberant environments by responding to the directional cues carried by the first-arriving sound rather than spurious cues carried by later-arriving reflections, which are not perceived discretely. This phenomenon is known as the precedence effect (PE) in sound localization. Despite decades of study, the biological basis of the PE remains unclear. Though the PE was once widely attributed to central processes such as synaptic inhibition in the auditory midbrain, a more recent hypothesis holds that the PE may arise essentially as a by-product of normal cochlear function. Here we evaluated the PE in a unique human patient population with demonstrated sensitivity to binaural information but without functional cochleae. Users of bilateral cochlear implants (CIs) were tested in a psychophysical task that assessed the number and location(s) of auditory images perceived for simulated source-echo (lead-lag) stimuli. A parallel experiment was conducted in a group of normal-hearing (NH) listeners. Key findings were as follows: 1) Subjects in both groups exhibited lead-lag fusion. 2) Fusion was marginally weaker in CI users than in NH listeners but could be augmented by systematically attenuating the amplitude of the lag stimulus to coarsely simulate adaptation observed in acoustically stimulated auditory nerve fibers. 3) Dominance of the lead in localization varied substantially among both NH and CI subjects but was evident in both groups. Taken together, data suggest that aspects of the PE can be elicited in CI users, who lack functional cochleae, thus suggesting that neural mechanisms are sufficient to produce the PE.

Internalized elevation perception of simple stimuli in cochlear-implant and normal-hearing listeners.

In normal-hearing (NH) listeners, elevation perception is produced by the spectral cues imposed by the pinna, head, and torso. Elevation perception in cochlear-implant (CI) listeners appears to be non-existent; this may be a result of poorly encoded spectral cues. In this study, an analog of elevation perception was investigated by having 15 CI and 8 NH listeners report the intracranial location of spectrally simple signals (single-electrode or bandlimited acoustic stimuli, respectively) in both horizontal and vertical dimensions. Thirteen CI listeners and all of the NH listeners showed an association between place of stimulation (i.e., stimulus frequency) and perceived elevation, generally responding with higher elevations for more basal stimulation. This association persisted in the presence of a randomized temporal pitch, suggesting that listeners were not associating pitch with elevation. These data provide evidence that CI listeners might perceive changes in elevation if they were presented stimuli with sufficiently salient elevation cues.

A Mixed-Rate Strategy on a Bilaterally-Synchronized Cochlear Implant Processor Offering the Opportunity to Provide Both Speech Understanding and Interaural Time Difference Cues.

Background/Objective: Bilaterally implanted cochlear implant (CI) users do not consistently have access to interaural time differences (ITDs). ITDs are crucial for restoring the ability to localize sounds and understand speech in noisy environments. Lack of access to ITDs is partly due to lack of communication between clinical processors across the ears and partly because processors must use relatively high rates of stimulation to encode envelope information. Speech understanding is best at higher stimulation rates, but sensitivity to ITDs in the timing of pulses is best at low stimulation rates. Methods: We implemented a practical "mixed rate" strategy that encodes ITD information using a low stimulation rate on some channels and speech information using high rates on the remaining channels. The strategy was tested using a bilaterally synchronized research processor, the CCi-MOBILE. Nine bilaterally implanted CI users were tested on speech understanding and were asked to judge the location of a sound based on ITDs encoded using this strategy. Results: Performance was similar in both tasks between the control strategy and the new strategy. Conclusions: We discuss the benefits and drawbacks of the sound coding strategy and provide guidelines for utilizing synchronized processors for developing strategies.

Interaural speech asymmetry predicts bilateral speech intelligibility but not listening effort in adults with bilateral cochlear implants.

Introduction: Bilateral cochlear implants (BiCIs) can facilitate improved speech intelligibility in noise and sound localization abilities compared to a unilateral implant in individuals with bilateral severe to profound hearing loss. Still, many individuals with BiCIs do not benefit from binaural hearing to the same extent that normal hearing (NH) listeners do. For example, binaural redundancy, a speech intelligibility benefit derived from having access to duplicate copies of a signal, is highly variable among BiCI users. Additionally, patients with hearing loss commonly report elevated listening effort compared to NH listeners. There is some evidence to suggest that BiCIs may reduce listening effort compared to a unilateral CI, but the limited existing literature has not shown this consistently. Critically, no studies to date have investigated this question using pupillometry to quantify listening effort, where large pupil sizes indicate high effort and small pupil sizes indicate low effort. Thus, the present study aimed to build on existing literature by investigating the potential benefits of BiCIs for both speech intelligibility and listening effort. Methods: Twelve BiCI adults were tested in three listening conditions: Better Ear, Poorer Ear, and Bilateral. Stimuli were IEEE sentences presented from a loudspeaker at 0° azimuth in quiet. Participants were asked to repeat back the sentences, and responses were scored by an experimenter while changes in pupil dilation were measured. Results: On average, participants demonstrated similar speech intelligibility in the Better Ear and Bilateral conditions, and significantly worse speech intelligibility in the Poorer Ear condition. Despite similar speech intelligibility in the Better Ear and Bilateral conditions, pupil dilation was significantly larger in the Bilateral condition. Discussion: These results suggest that the BiCI users tested in this study did not demonstrate binaural redundancy in quiet. The large interaural speech asymmetries demonstrated by participants may have precluded them from obtaining binaural redundancy, as shown by the inverse relationship between the two variables. Further, participants did not obtain a release from effort when listening with two ears versus their better ear only. Instead, results indicate that bilateral listening elicited increased effort compared to better ear listening, which may be due to poor integration of asymmetric inputs.

Systematic Comparison of Trial Exclusion Criteria for Pupillometry Data Analysis in Individuals With Single-Sided Deafness and Normal Hearing.

The measurement of pupil dilation has become a common way to assess listening effort. Pupillometry data are subject to artifacts, requiring highly contaminated data to be discarded from analysis. It is unknown how trial exclusion criteria impact experimental results. The present study examined the effect of a common exclusion criterion, percentage of blinks, on speech intelligibility and pupil dilation measures in 9 participants with single-sided deafness (SSD) and 20 participants with normal hearing. Participants listened to and repeated sentences in quiet or with speech maskers. Pupillometry trials were processed using three levels of blink exclusion criteria: 15%, 30%, and 45%. These percentages reflect a threshold for missing data points in a trial, where trials that exceed the threshold are excluded from analysis. Results indicated that pupil dilation was significantly greater and intelligibility was significantly lower in the masker compared with the quiet condition for both groups. Across-group comparisons revealed that speech intelligibility in the SSD group decreased significantly more than the normal hearing group from quiet to masker conditions, but the change in pupil dilation was similar for both groups. There was no effect of blink criteria on speech intelligibility or pupil dilation results for either group. However, the total percentage of blinks in the masker condition was significantly greater than in the quiet condition for the SSD group, which is consistent with previous studies that have found a relationship between blinking and task difficulty. This association should be carefully considered in future experiments using pupillometry to gauge listening effort.

Evaluating the Impact of Age, Acoustic Exposure, and Electrical Stimulation on Binaural Sensitivity in Adult Bilateral Cochlear Implant Patients.

Deafness in both ears is highly disruptive to communication in everyday listening situations. Many individuals with profound deafness receive bilateral cochlear implants (CIs) to gain access to spatial cues used in localization and speech understanding in noise. However, the benefit of bilateral CIs, in particular sensitivity to interaural time and level differences (ITD and ILDs), varies among patients. We measured binaural sensitivity in 46 adult bilateral CI patients to explore the relationship between binaural sensitivity and three classes of patient-related factors: age, acoustic exposure, and electric hearing experience. Results show that ILD sensitivity increased with shorter years of acoustic exposure, younger age at testing, or an interaction between these factors, moderated by the duration of bilateral hearing impairment. ITD sensitivity was impacted by a moderating effect between years of bilateral hearing impairment and CI experience. When age at onset of deafness was treated as two categories (<18 vs. >18 years of age), there was no clear effect for ILD sensitivity, but some differences were observed for ITD sensitivity. Our findings imply that maximal binaural sensitivity is obtained by listeners with a shorter bilateral hearing impairment, a longer duration of CI experience, and potentially a younger age at testing. 198/200.