Evaluating multipulse integration as a neural-health correlate in human cochlear-implant users: Relationship to forward-masking recovery.

The present study evaluated the slopes of threshold-versus-pulse-rate functions (multipulse integration, MPI) in humans with cochlear implants in relation to recovery from 300-ms forward maskers. MPI has been correlated with spiral ganglion cell density in animals. The present study showed that steeper MPI functions were correlated with faster recovery from forward masking. The findings suggested that the variations in the MPI slopes are explained not only by the quantity of neurons contributing to the integration process but also by the neurons' temporal response characteristics and possibly central inhibition.

Relationship between multipulse integration and speech recognition with cochlear implants.

Comparisons of performance with cochlear implants and postmortem conditions in the cochlea in humans have shown mixed results. The limitations in those studies favor the use of within-subject designs and non-invasive measures to estimate cochlear conditions. One non-invasive correlate of cochlear health is multipulse integration, established in an animal model. The present study used this measure to relate neural health in human cochlear implant users to their speech recognition performance. The multipulse-integration slopes were derived based on psychophysical detection thresholds measured for two pulse rates (80 and 640 pulses per second). A within-subject design was used in eight subjects with bilateral implants where the direction and magnitude of ear differences in the multipulse-integration slopes were compared with those of the speech-recognition results. The speech measures included speech reception threshold for sentences and phoneme recognition in noise. The magnitude of ear difference in the integration slopes was significantly correlated with the magnitude of ear difference in speech reception thresholds, consonant recognition in noise, and transmission of place of articulation of consonants. These results suggest that multipulse integration predicts speech recognition in noise and perception of features that use dynamic spectral cues.

Across-site patterns of modulation detection: relation to speech recognition.

The aim of this study was to identify across-site patterns of modulation detection thresholds (MDTs) in subjects with cochlear implants and to determine if removal of sites with the poorest MDTs from speech processor programs would result in improved speech recognition. Five hundred millisecond trains of symmetric-biphasic pulses were modulated sinusoidally at 10 Hz and presented at a rate of 900 pps using monopolar stimulation. Subjects were asked to discriminate a modulated pulse train from an unmodulated pulse train for all electrodes in quiet and in the presence of an interleaved unmodulated masker presented on the adjacent site. Across-site patterns of masked MDTs were then used to construct two 10-channel MAPs such that one MAP consisted of sites with the best masked MDTs and the other MAP consisted of sites with the worst masked MDTs. Subjects' speech recognition skills were compared when they used these two different MAPs. Results showed that MDTs were variable across sites and were elevated in the presence of a masker by various amounts across sites. Better speech recognition was observed when the processor MAP consisted of sites with best masked MDTs, suggesting that temporal modulation sensitivity has important contributions to speech recognition with a cochlear implant.

Characteristics of detection thresholds and maximum comfortable loudness levels as a function of pulse rate in human cochlear implant users.

The ability of an implanted ear to integrate multiple pulses, as measured by the slopes of detection threshold level (T level) versus pulse rate functions, may reflect cochlear health in the cochlea, as suggested by previous animal studies (Kang et al., 2010; Pfingst et al., 2011). In the current study, we examined the slopes of T level versus pulse rate functions in human subjects with cochlear implants. Typically, T levels decrease as a function of pulse rate, consistent with a multipulse integration mechanism. The magnitudes of the slopes of the T level versus pulse rate functions obtained from the human subjects were comparable to those reported in the animal studies. The slopes varied across stimulation sites, but did not change systematically along the tonotopic axis. This suggests that the slopes are dependent on local conditions near the individual stimulation sites. The characteristics of these functions were also similar to those found in animals in that the slopes for higher pulse rates were steeper than those for the lower pulse rates, consistent with a combined effect of multipulse integration and cumulative partial depolarization mechanisms at rates above 1000 pps. The maximum comfortable loudness level (C level) versus pulse rate functions were also examined to determine the effect of level on the slopes. Slopes of C-level functions were shallower than those for the T-level functions and were not correlated with those of the T-level functions, so the mechanisms underlying these two functions are probably not identical. The slopes of the T- or C-level functions were not dependent on stimulus-current level. Based on these results, we suggest that slopes of T level versus pulse rate functions might be a useful measure for estimating nerve survival in the cochlea in regions close to the stimulation sites.

Effects of electrode configuration on cochlear implant modulation detection thresholds.

Cochlear implant function, as assessed by psychophysical measures, varies from one stimulation site to another within a patient's cochlea. This suggests that patient performance might be improved by selection of the best-functioning sites for the processor map. In evaluating stimulation sites for such a strategy, electrode configuration is an important variable. Variation across stimulation sites in loudness-related measures (detection thresholds and maximum comfortable loudness levels), is much larger for stimulation with bipolar electrode configurations than with monopolar configurations. The current study found that, in contrast to the loudness-related measures, magnitudes of across-site means and the across-site variances of modulation detection thresholds were not dependent on electrode configuration, suggesting that the mechanisms underlying variation in these various psychophysical measures are not all the same. The data presented here suggest that bipolar and monopolar electrode configurations are equally effective in identifying good and poor stimulation sites for modulation detection but that the across-site patterns of modulation detection thresholds are not the same for the two configurations. Therefore, it is recommended to test all stimulation sites using the patient's clinically assigned electrode configuration when performing psychophysical evaluation of a patient's modulation detection acuity to select sites for the processor map.

Detection of pulse trains in the electrically stimulated cochlea: effects of cochlear health.

Perception of electrical stimuli varies widely across users of cochlear implants and across stimulation sites in individual users. It is commonly assumed that the ability of subjects to detect and discriminate electrical signals is dependent, in part, on conditions in the implanted cochlea, but evidence supporting that hypothesis is sparse. The objective of this study was to define specific relationships between the survival of tissues near the implanted electrodes and the functional responses to electrical stimulation of those electrodes. Psychophysical and neurophysiological procedures were used to assess stimulus detection as a function of pulse rate under the various degrees of cochlear pathology. Cochlear morphology, assessed post-mortem, ranged from near-normal numbers of hair cells, peripheral processes and spiral ganglion cells, to complete absence of hair cells and peripheral processes and small numbers of surviving spiral ganglion cells. The psychophysical and neurophysiological studies indicated that slopes and levels of the threshold versus pulse rate functions reflected multipulse integration throughout the 200 ms pulse train with an additional contribution of interactions between adjacent pulses at high pulse rates. The amount of multipulse integration was correlated with the health of the implanted cochlea with implications for perception of more complex prosthetic stimuli.

Over-expression of BDNF by adenovirus with concurrent electrical stimulation improves cochlear implant thresholds and survival of auditory neurons.

The survival of the auditory nerve in cases of sensorineural hearing loss is believed to be a major factor in effective cochlear implant function. The current study assesses two measures of cochlear implant thresholds following a post-deafening treatment intended to halt auditory nerve degeneration. We used an adenoviral construct containing a gene insert for brain-derived neurotrophic factor (BDNF), a construct that has previously been shown to promote neuronal survival in a number of biological systems. We implanted ototoxically deafened guinea pigs with a multichannel cochlear implant and delivered a single inoculation of an adenovirus suspension coding for BDNF (Ad.BDNF) into the scala tympani at the time of implantation. Thresholds to electrical stimulation were assessed both psychophysically and electrophysiologically over a period of 80 days. Spiral ganglion cell survival was analyzed at the 80 days time point. Compared to the control group, the Ad.BDNF treated group had lower psychophysical and electrophysiological thresholds as well as higher survival of spiral ganglion cells. Electrophysiological, but not psychophysical, thresholds correlated well with the density of spiral ganglion cells. These results indicate that the changes in the anatomy of the auditory nerve induced by the combination of Ad.BDNF inoculation and the electrical stimulation used for testing improved functional measures of CI performance.

Across-site patterns of modulation detection in listeners with cochlear implants.

In modern cochlear implants, much of the information required for recognition of important sounds is conveyed by temporal modulation of the charge per phase in interleaved trains of electrical pulses. In this study, modulation detection thresholds (MDTs) were used to assess listeners' abilities to detect sinusoidal modulation of charge per phase at each available stimulation site in their 22-electrode implants. Fourteen subjects were tested. MDTs were found to be highly variable across stimulation sites in most listeners. The across-site patterns of MDTs differed considerably from subject to subject. The subject-specific patterns of across-site variability of MDTs suggest that peripheral site-specific characteristics, such as electrode placement and the number and condition of surviving neurons, play a primary role in determining modulation sensitivity. Across-site patterns of detection thresholds (T levels), maximum comfortable loudness levels (C levels) and dynamic ranges (DRs) were not consistently correlated with across-site patterns of MDTs within subjects, indicating that the mechanisms underlying across-site variation in these measures differed from those underlying across-site variation in MDTs. MDTs sampled from multiple sites in a listener's electrode array might be useful for diagnosing across-subject differences in speech recognition with cochlear implants and for guiding strategies to improve the individual's perception.

Features of stimulation affecting tonal-speech perception: implications for cochlear prostheses.

Tone languages differ from English in that the pitch pattern of a single-syllable word conveys lexical meaning. In the present study, dependence of tonal-speech perception on features of the stimulation was examined using an acoustic simulation of a CIS-type speech-processing strategy for cochlear prostheses. Contributions of spectral features of the speech signals were assessed by varying the number of filter bands, while contributions of temporal envelope features were assessed by varying the low-pass cutoff frequency used for extracting the amplitude envelopes. Ten normal-hearing native Mandarin Chinese speakers were tested. When the low-pass cutoff frequency was fixed at 512 Hz, consonant, vowel, and sentence recognition improved as a function of the number of channels and reached plateau at 4 to 6 channels. Subjective judgments of sound quality continued to improve as the number of channels increased to 12, the highest number tested. Tone recognition, i.e., recognition of the four Mandarin tone patterns, depended on both the number of channels and the low-pass cutoff frequency. The trade-off between the temporal and spectral cues for tone recognition indicates that temporal cues can compensate for diminished spectral cues for tone recognition and vice versa. An additional tone recognition experiment using syllables of equal duration showed a marked decrease in performance, indicating that duration cues contribute to tone recognition. A third experiment showed that recognition of processed FM patterns that mimic Mandarin tone patterns was poor when temporal envelope and duration cues were removed.