Electric-acoustic interaction measurements in cochlear-implant users with ipsilateral residual hearing using electrocochleography.

Cochlear implantation is increasingly being used as a hearing-loss treatment for patients with residual hearing in the low acoustic frequencies. These patients obtain combined electric-acoustic stimulation (EAS). Substantial residual hearing and relatively long electrode arrays can lead to interactions between the electric and acoustic stimulation. This work investigated EAS interaction through psychophysical and electrophysiological measures. Moreover, cone-beam computed-tomography data was used to characterize the interaction along spatial cochlear locations. Psychophysical EAS interaction was estimated based on the threshold of audibility of an acoustic probe stimulus in the presence of a simultaneously presented electric masker stimulus. Intracochlear electrocochleography was used to estimate electrophysiological EAS interaction via the telemetry capability of the cochlear implant. EAS interaction was observed using psychophysical and electrophysiological measurements. While psychoacoustic EAS interaction was most pronounced close to the electrical stimulation site, electrophysiological EAS interaction was observed over a wider range of spatial cochlear locations. Psychophysical EAS interaction was significantly larger than electrophysiological EAS interaction for acoustic probes close to the electrode position.

Contralateral suppression of human hearing sensitivity in single-sided deaf cochlear implant users.

Cochlear implants (CIs) are being implanted in people with unilateral hearing loss because they can improve speech intelligibility and sound source localization. Though designed to restore the afferent auditory stimulation, the CI possibly restores some efferent effects. The present study aimed at investigating this possibility. Five single-sided deaf CI users with less than 30 dB hearing loss up to 4 kHz in their acoustic ear participated in the study. Absolute thresholds for their acoustic ears were measured for pure tones of 500 and 4000 Hz with durations of 10 and 200 ms in the presence and in the absence of contralateral broadband electrical stimulation (CBES) delivered with the CI. The electrical stimulus consisted of pulse trains (symmetric biphasic pulses with phase duration 36 µs) on all 16 electrodes sequentially stimulated at a rate of 843 Hz. Its intensity was set to sound as loud as broadband noise at 50 or 60 dB SPL in the acoustic ear. Thresholds were measured using a three-interval, three-alternative, forced-choice procedure with a two-down, one-up adaptive rule to estimate the level for 71% correct in the psychometric function. Thresholds measured without the CBES were lower for the longer than for the shorter tones, and the difference was larger at 500 than at 4000 Hz. CBES equivalent to 50 or 60 dB SPL caused significant threshold elevation only for short (10 ms) and low frequency (500 Hz) acoustic tones of 1.2 and 2.2 dB. These increases appear smaller than previously reported for normal hearing listeners in related experiments. These results support the notion that for single-sided deaf CI users, the CI modulates hearing in the acoustic ear. The possible mechanisms that may be contributing this effect are discussed.

Electric-acoustic forward masking in cochlear implant users with ipsilateral residual hearing.

In order to investigate the temporal mechanisms of the auditory system, psychophysical forward masking experiments were conducted in cochlear implant users who had preserved acoustic hearing in the ipsilateral ear. This unique electric-acoustic stimulation (EAS) population allowed the measurement of threshold recovery functions for acoustic or electric probes in the presence of electric or acoustic maskers, respectively. In the electric masking experiment, the forward masked threshold elevation of acoustic probes was measured as a function of the time interval after the offset of the electric masker, i.e. the masker-to-probe interval (MPI). In the acoustic masking experiment, the forward masked threshold elevation of electric probe stimuli was investigated under the influence of a preceding acoustic masker. Since electric pulse trains directly stimulate the auditory nerve, this novel experimental setup allowed the acoustic adaptation properties (attributed to the physiology of the hair cells) to be differentiated from the subsequent processing by more central mechanisms along the auditory pathway. For instance, forward electric masking patterns should result more from the auditory-nerve response to electrical stimulation, while forward acoustic masking patterns should primarily be the result of the recovery from adaptation at the hair-cell neuron interface. Electric masking showed prolonged threshold elevation of acoustic probes, which depended significantly on the masker-to-probe interval. Additionally, threshold elevation was significantly dependent on the similarity between acoustic stimulus frequency and electric place frequency, the electric-acoustic frequency difference (EAFD). Acoustic masking showed a reduced, but statistically significant effect of electric threshold elevation, which did not significantly depend on MPI. Lastly, acoustic masking showed longer decay times than electric masking and a reduced dependency on EAFD. In conclusion, the forward masking patterns observed for combined electric-acoustic stimulation provide further insights into the temporal mechanisms of the auditory system. For instance, the asymmetry in the amount of threshold elevation, the dependency on EAFD and the time constants for the recovery functions of acoustic and electric masking all indicate that there must be several processes with different latencies (e.g. neural adaptation, depression of spontaneous activity, efferent systems) that are involved in forward masking recovery functions.

Simultaneous masking between electric and acoustic stimulation in cochlear implant users with residual low-frequency hearing.

Ipsilateral electric-acoustic stimulation (EAS) is becoming increasingly important in cochlear implant (CI) treatment. Improvements in electrode designs and surgical techniques have contributed to improved hearing preservation during implantation. Consequently, CI implantation criteria have been expanded toward people with significant residual low-frequency hearing, who may benefit from the combined use of both the electric and acoustic stimulation in the same ear. However, only few studies have investigated the mutual interaction between electric and acoustic stimulation modalities. This work characterizes the interaction between both stimulation modalities using psychophysical masking experiments and cone beam computer tomography (CBCT). Two psychophysical experiments for electric and acoustic masking were performed to measure the hearing threshold elevation of a probe stimulus in the presence of a masker stimulus. For electric masking, the probe stimulus was an acoustic tone while the masker stimulus was an electric pulse train. For acoustic masking, the probe stimulus was an electric pulse train and the masker stimulus was an acoustic tone. Five EAS users, implanted with a CI and ipsilateral residual low-frequency hearing, participated in the study. Masking was determined at different electrodes and different acoustic frequencies. CBCT scans were used to determine the individual place-pitch frequencies of the intracochlear electrode contacts by using the Stakhovskaya place-to-frequency transformation. This allows the characterization of masking as a function of the difference between electric and acoustic stimulation sites, which we term the electric-acoustic frequency difference (EAFD). The results demonstrate a significant elevation of detection thresholds for both experiments. In electric masking, acoustic-tone thresholds increased exponentially with decreasing EAFD. In contrast, for the acoustic masking experiment, threshold elevations were present regardless of the tested EAFDs. Based on the present findings, we conclude that there is an asymmetry between the electric and the acoustic masker modalities. These observations have implications for the design and fitting of EAS sound-coding strategies.