SpeedCAP: An Efficient Method for Estimating Neural Activation Patterns Using Electrically Evoked Compound Action-Potentials in Cochlear Implant Users.

OBJECTIVES: Electrically evoked compound action-potentials (ECAPs) can be recorded using the electrodes in a cochlear implant (CI) and represent the synchronous responses of the electrically stimulated auditory nerve. ECAPs can be obtained using a forward-masking method that measures the neural response to a probe and masker electrode separately and in combination. The panoramic ECAP (PECAP) analyses measured ECAPs obtained using multiple combinations of masker and probe electrodes and uses a nonlinear optimization algorithm to estimate current spread from each electrode and neural health along the cochlea. However, the measurement of ECAPs from multiple combinations of electrodes is too time consuming for use in clinics. Here, we propose and evaluate SpeedCAP, a speedy method for obtaining the PECAP measurements that minimizes recording time by exploiting redundancies between multiple ECAP measures. DESIGN: In the first study, 11 users of Cochlear Ltd. CIs took part. ECAPs were recorded using the forward-masking artifact-cancelation technique at the most comfortable loudness level (MCL) for every combination of masker and probe electrodes for all active electrodes in the users' MAPs, as per the standard PECAP recording paradigm. The same current levels and recording parameters were then used to collect ECAPs in the same users with the SpeedCAP method. The ECAP amplitudes were then compared between the two conditions, as were the corresponding estimates of neural health and current spread calculated using the PECAP method previously described by Garcia et al. The second study measured SpeedCAP intraoperatively in 8 CI patients and with all maskers and probes presented at the same current level to assess feasibility. ECAPs for the subset of conditions where the masker and probe were presented on the same electrode were compared with those obtained using the slower approach leveraged by the standard clinical software. RESULTS: Data collection time was reduced from ≈45 to ≈8 minutes. There were no significant differences between normalized root mean squared error (RMSE) repeatability metrics for post-operative PECAP and SpeedCAP data, nor for the RMSEs calculated between PECAP and SpeedCAP data. The comparison achieved 80% power to detect effect sizes down to 8.2% RMSE. When between-participant differences were removed, both the neural-health (r = 0.73) and current-spread (r = 0.65) estimates were significantly correlated ( p < 0.0001, df = 218) between SpeedCAP and PECAP conditions across all electrodes, and showed RMSE errors of 12.7 ± 4.7% and 16.8 ± 8.8%, respectively (with the ± margins representing 95% confidence intervals). Valid ECAPs were obtained in all patients in the second study, demonstrating intraoperative feasibility of SpeedCAP. No significant differences in RMSEs were detectable between post- and intra-operative ECAP measurements, with the comparison achieving 80% power to detect effect sizes down to 13.3% RMSE. CONCLUSIONS: The improved efficiency of SpeedCAP provides time savings facilitating multi-electrode ECAP recordings in routine clinical practice. SpeedCAP data collection is sufficiently quick to record intraoperatively, and adds no more than 8.2% error to the ECAP amplitudes. Such measurements could thereafter be submitted to models such as PECAP to provide patient-specific patterns of neural activation to inform programming of clinical MAPs and identify causes of poor performance at the electrode-nerve interface of CI users. The speed and accuracy of these measurements also opens up a wide range of additional research questions to be addressed.

Effects of the relative timing of opposite-polarity pulses on loudness for cochlear implant listeners.

The symmetric biphasic pulses used in contemporary cochlear implants (CIs) consist of both cathodic and anodic currents, which may stimulate different sites on spiral ganglion neurons and, potentially, interact with each other. The effect on the order of anodic and cathodic stimulation on loudness at short inter-pulse intervals (IPIs; 0-800 µs) is investigated. Pairs of opposite-polarity pseudomonophasic (PS) pulses were used and the amplitude of each pulse was manipulated independently. In experiment 1 the two PS pulses differed in their current level in order to elicit the same loudness when presented separately. Six users of the Advanced Bionics CI (Valencia, CA) loudness-ranked trains of the pulse pairs using a midpoint-comparison procedure. Stimuli with anodic-leading polarity were louder than those with cathodic-leading polarity for IPIs shorter than 400 µs. This effect was small-about 0.3 dB-but consistent across listeners. When the same procedure was repeated with both PS pulses having the same current level (experiment 2), anodic-leading stimuli were still louder than cathodic-leading stimuli at very short intervals. However, when using symmetric biphasic pulses (experiment 3) the effect disappeared at short intervals and reversed at long intervals. Possible peripheral sources of such polarity interactions are discussed.

Development and validation of a spectro-temporal processing test for cochlear-implant listeners.

Psychophysical tests of spectro-temporal resolution may aid the evaluation of methods for improving hearing by cochlear implant (CI) listeners. Here the STRIPES (Spectro-Temporal Ripple for Investigating Processor EffectivenesS) test is described and validated. Like speech, the test requires both spectral and temporal processing to perform well. Listeners discriminate between complexes of sine sweeps which increase or decrease in frequency; difficulty is controlled by changing the stimulus spectro-temporal density. Care was taken to minimize extraneous cues, forcing listeners to perform the task only on the direction of the sweeps. Vocoder simulations with normal hearing listeners showed that the STRIPES test was sensitive to the number of channels and temporal information fidelity. An evaluation with CI listeners compared a standard processing strategy with one having very wide filters, thereby spectrally blurring the stimulus. Psychometric functions were monotonic for both strategies and five of six participants performed better with the standard strategy. An adaptive procedure revealed significant differences, all in favour of the standard strategy, at the individual listener level for six of eight CI listeners. Subsequent measures validated a faster version of the test, and showed that STRIPES could be performed by recently implanted listeners having no experience of psychophysical testing.

Combined neural and behavioural measures of temporal pitch perception in cochlear implant users.

Four experiments measured the perceptual and neural correlates of the temporal pattern of electrical stimulation applied to one cochlear-implant (CI) electrode, for several subjects. Neural effects were estimated from the electrically evoked compound action potential (ECAP) to each pulse. Experiment 1 attenuated every second pulse of a 200-pps pulse train. Increasing attenuation caused pitch to drop and the ECAP to become amplitude modulated, thereby providing an estimate of the relationship between neural modulation and pitch. Experiment 2 showed that the pitch of a 200-pps pulse train can be reduced by delaying every second pulse, so that the inter-pulse-intervals alternate between longer and shorter intervals. This caused the ECAP to become amplitude modulated, but not by enough to account for the change in pitch. Experiment 3 replicated the finding that rate discrimination deteriorates with increases in baseline rate. This was accompanied by an increase in ECAP modulation, but by an amount that produced only a small effect on pitch in experiment 1. Experiment 4 showed that preceding a pulse train with a carefully selected "pre-pulse" could reduce ECAP modulation, but did not improve rate discrimination. Implications for theories of pitch and for limitations of pitch perception in CI users are discussed.

Evaluation of a cochlear-implant processing strategy incorporating phantom stimulation and asymmetric pulses.

OBJECTIVE: To evaluate a speech-processing strategy in which the lowest frequency channel is conveyed using an asymmetric pulse shape and "phantom stimulation", where current is injected into one intra-cochlear electrode and where the return current is shared between an intra-cochlear and an extra-cochlear electrode. This strategy is expected to provide more selective excitation of the cochlear apex, compared to a standard strategy where the lowest-frequency channel is conveyed by symmetric pulses in monopolar mode. In both strategies all other channels were conveyed by monopolar stimulation. DESIGN: Within-subjects comparison between the two strategies. Four experiments: (1) discrimination between the strategies, controlling for loudness differences, (2) consonant identification, (3) recognition of lowpass-filtered sentences in quiet, (4) sentence recognition in the presence of a competing speaker. STUDY SAMPLE: Eight users of the Advanced Bionics CII/Hi-Res 90k cochlear implant. RESULTS: Listeners could easily discriminate between the two strategies but no consistent differences in performance were observed. CONCLUSIONS: The proposed method does not improve speech perception, at least in the short term.

Relationships between auditory nerve activity and temporal pitch perception in cochlear implant users.

Cochlear implant (CI) users can derive a musical pitch from the temporal pattern of pulses delivered to one electrode. However, pitch perception deteriorates with increasing pulse rate, and most listeners cannot detect increases in pulse rate beyond about 300 pps. In addition, previous studies using irregular pulse trains suggest that pitch can be substantially influenced by neural refractory effects. We presented electric pulse trains to one CI electrode and measured rate discrimination, pitch perception, and auditory nerve (AN) activity in the same subjects and with the same stimuli. The measures of AN activity, obtained using the electrically evoked compound action potential (ECAP), replicated the well-known finding that the neural response to isochronous pulse trains at rates above about 200-300 pps is modulated, with the ECAP being larger to odd-numbered than to even-numbered pulses. This finding has been attributed to refractoriness. Behavioural results replicated the deterioration in rate discrimination at rates above 200-300 pps and the finding that pulse trains whose inter-pulse intervals (IPIs) alternate between a shorter and a longer value (e.g. 4 and 6 ms) have a pitch lower than that corresponding to the mean IPI. To link ECAP modulation to pitch, we physically modulated a 200-pps pulse train by attenuating every other pulse and measured both ECAPs and pitch as a function of modulation depth. Our results show that important aspects of temporal pitch perception cannot be explained in terms of the AN response, at least as measured by ECAPs, and suggest that pitch is influenced by refractory effects occurring central to the AN.

Further examination of complex pitch perception in the absence of a place-rate match.

Oxenham et al. [Proc. Nat. Acad. Sci. 101, 1421-1425 (2004)] reported that listeners cannot derive a "missing fundamental" from three transposed tones having high carrier frequencies and harmonically related low-frequency modulators. This finding was attributed to complex pitch perception requiring correct tonotopic representation but could have been due to the very high modulator rate difference limens (DLs) observed for individual transposed tones. Experiments 1 and 2 showed that much lower DLs could be obtained for bandpass-filtered pulse trains than for transposed tones with repetition rates of 100 or 300 pps; however, DLs were still larger than for low-frequency pure tones. Experiment 3 presented three pulse trains filtered between 1375 and 1875, 3900 and 5400, and 7800 and 10 800 Hz simultaneously with a pink-noise background. Listeners could not compare the "missing fundamental" of a stimulus in which the pulse rates were, respectively, 150, 225, and 300 pps, to one where all pulse trains had a rate of 75 pps, even though they could compare a 150 + 225 + 300 Hz complex tone to a 75-Hz pure tone. Hence although filtered pulse trains can produce fairly good pitch perception of simple stimuli having low repetition rates and high-frequency spectral content, no evidence that such stimuli enable complex pitch perception in the absence of a place-rate match was found.

Polarity effects on place pitch and loudness for three cochlear-implant designs and at different cochlear sites.

Users of Advanced Bionics, MedEl, and Cochlear Corp. implants balanced the loudness of trains of asymmetric pulses of opposite polarities presented in monopolar mode. For the Advanced Bionics and MedEl users the pulses were triphasic and consisted of a 32-µs central phase flanked by two 32-µs phases of opposite polarity and half the amplitude. The central phase was either anodic (TP-A) or cathodic (TP-C). For the Cochlear Corp. users, pulses consisted of two 32-µs phases of the same polarity separated by an 8-µs gap, flanked by two 32-µs phases of the opposite polarity, each of which was separated from the central portion by a 58-µs gap. The central portion of these quadraphasic pulses was either anodic (QP-A) or cathodic (QP-C), and all phases had the same amplitude. The current needed to achieve matched loudness was lower for the anodic than for the cathodic stimuli. This polarity effect was similar across all electrode locations studied, including the most apical electrode of the MedEl device which stimulates the very apex of the cochlea. In addition, when quadraphasic pulses were presented in bipolar mode, listeners reported hearing a lower pitch when the central portion was anodic at the more apical, than at the more basal, electrode. The results replicate previous reports that, unlike the results of most animal studies, human cochlear implant listeners are more sensitive to anodic than to cathodic currents, and extend those findings to a wider range of cochlear sites, implant types, and pulse shapes.

Using Interleaved Stimulation and EEG to Measure Temporal Smoothing and Growth of the Sustained Neural Response to Cochlear-Implant Stimulation.

Two EEG experiments measured the sustained neural response to amplitude-modulated (AM) high-rate pulse trains presented to a single cochlear-implant (CI) electrode. Stimuli consisted of two interleaved pulse trains with AM rates F1 and F2 close to 80 and 120 Hz respectively, and where F2 = 1.5F1. Following Carlyon et al. (J Assoc Res Otolaryngol, 2021), we assume that such stimuli can produce a neural distortion response (NDR) at F0 = F2-F1 Hz if temporal dependencies ("smoothing") in the auditory system are followed by one or more neural nonlinearities. In experiment 1, the rate of each pulse train was 480 pps and the gap between pulses in the F1 and F2 pulse trains ranged from 0 to 984 µs. The NDR had a roughly constant amplitude for gaps between 0 and about 200-400 µs, and decreased for longer gaps. We argue that this result is consistent with a temporal dependency, such as facilitation, operating at the level of the auditory nerve and/or with co-incidence detection by cochlear-nucleus neurons. Experiment 2 first measured the NDR for stimuli at each listener's most comfortable level ("MCL") and for F0 = 37, 40, and 43 Hz. This revealed a group delay of about 42 ms, consistent with a thalamic/cortical source. We then showed that the NDR grew steeply with stimulus amplitude and, for most listeners, decreased by more than 12 dB between MCL and 75% of the listener's dynamic range. We argue that the NDR is a potentially useful objective estimate of MCL.

Modulation Depth Discrimination by Cochlear Implant Users.

Cochlear implants (CIs) convey the amplitude envelope of speech by modulating high-rate pulse trains. However, not all of the envelope may be necessary to perceive amplitude modulations (AMs); the effective envelope depth may be limited by forward and backward masking from the envelope peaks. Three experiments used modulated pulse trains to measure which portions of the envelope can be effectively processed by CI users as a function of AM frequency. Experiment 1 used a three-interval forced-choice task to test the ability of CI users to discriminate less-modulated pulse trains from a fully modulated standard, without controlling for loudness. The stimuli in experiment 2 were identical, but a two-interval task was used in which participants were required to choose the less-modulated interval, ignoring loudness. Catch trials, in which judgements based on level or modulation depth would give opposing answers, were included. Experiment 3 employed novel stimuli whose modulation envelope could be modified below a variable point in the dynamic range, without changing the loudness of the stimulus. Overall, results showed that substantial portions of the envelope are not accurately encoded by CI users. In experiment 1, where loudness cues were available, participants on average were insensitive to changes in the bottom 30% of their dynamic range. In experiment 2, where loudness was controlled, participants appeared insensitive to changes in the bottom 50% of the dynamic range. In experiment 3, participants were insensitive to changes in the bottom 80% of the dynamic range. We discuss potential reasons for this insensitivity and implications for CI speech-processing strategies.

Evaluating and Comparing Behavioural and Electrophysiological Estimates of Neural Health in Cochlear Implant Users.

Variations in neural health along the cochlea can degrade the spectral and temporal representation of sounds conveyed by cochlear implants (CIs). We evaluated and compared one electrophysiological measure and two behavioural measures that have been proposed as estimates of neural health patterns, in order to explore the extent to which the different measures provide converging and consistent neural health estimates. All measures were obtained from the same 11 users of the Cochlear Corporation CI. The two behavioural measures were multipulse integration (MPI) and the polarity effect (PE), both measured on each of seven electrodes per subject. MPI was measured as the difference between thresholds at 80 pps and 1000 pps, and PE as the difference in thresholds between cathodic- and anodic-centred quadraphasic (QP) 80-pps pulse trains. It has been proposed that good neural health corresponds to a large MPI and to a large negative PE (lower thresholds for cathodic than anodic pulses). The electrophysiological measure was the effect of interphase gap (IPG) on the offset of the ECAP amplitude growth function (AGF), which has been correlated with spiral ganglion neuron density in guinea pigs. This 'IPG offset' was obtained on the same subset of electrodes used for the behavioural measures. Despite high test-retest reliability, there were no significant correlations between the neural health estimates for either within-subject comparisons across the electrode array, or between-subject comparisons of the means. A phenomenological model of a population of spiral ganglion neurons was then used to investigate physiological mechanisms that might underlie the different neural health estimates. The combined experimental and modelling results provide evidence that PE, MPI and IPG offset may reflect different characteristics of the electrode-neural interface.

Using Interleaved Stimulation to Measure the Size and Selectivity of the Sustained Phase-Locked Neural Response to Cochlear Implant Stimulation.

We measured the sustained neural response to electrical stimulation by a cochlear implant (CI). To do so, we interleaved two stimuli with frequencies F1 and F2 Hz and recorded a neural distortion response (NDR) at F2-F1 Hz. We show that, because any one time point contains only the F1 or F2 stimulus, the instantaneous nonlinearities typical of electrical artefact should not produce distortion at this frequency. However, if the stimulus is smoothed, such as by charge integration at the nerve membrane, subsequent (neural) nonlinearities can produce a component at F2-F1 Hz. We stimulated a single CI electrode with interleaved sinusoids or interleaved amplitude-modulated pulse trains such that F2 = 1.5F1, and found no evidence for an NDR when F2-F1 was between 90 and 120 Hz. However, interleaved amplitude-modulated pulse trains with F2-F1~40 Hz revealed a substantial NDR with a group delay of about 45 ms, consistent with a thalamic and/or cortical response. The NDR could be measured even from recording electrodes adjacent to the implant and at the highest pulse rates (> 4000 pps) used clinically. We then measured the selectivity of this sustained response by presenting F1 and F2 to different electrodes and at different between-electrode distances. This revealed a broad tuning that, we argue, reflects the overlap between the excitation elicited by the two electrodes. Our results also provide a glimpse of the neural nonlinearity in the auditory system, unaffected by the biomechanical cochlear nonlinearities that accompany acoustic stimulation. Several potential clinical applications of our findings are discussed.

The Panoramic ECAP Method: Estimating Patient-Specific Patterns of Current Spread and Neural Health in Cochlear Implant Users.

The knowledge of patient-specific neural excitation patterns from cochlear implants (CIs) can provide important information for optimizing efficacy and improving speech perception outcomes. The Panoramic ECAP ('PECAP') method (Cosentino et al. 2015) uses forward-masked electrically evoked compound action-potentials (ECAPs) to estimate neural activation patterns of CI stimulation. The algorithm requires ECAPs be measured for all combinations of probe and masker electrodes, exploiting the fact that ECAP amplitudes reflect the overlapping excitatory areas of both probes and maskers. Here we present an improved version of the PECAP algorithm that imposes biologically realistic constraints on the solution, that, unlike the previous version, produces detailed estimates of neural activation patterns by modelling current spread and neural health along the intracochlear electrode array and is capable of identifying multiple regions of poor neural health. The algorithm was evaluated for reliability and accuracy in three ways: (1) computer-simulated current-spread and neural-health scenarios, (2) comparisons to psychophysical correlates of neural health and electrode-modiolus distances in human CI users, and (3) detection of simulated neural 'dead' regions (using forward masking) in human CI users. The PECAP algorithm reliably estimated the computer-simulated scenarios. A moderate but significant negative correlation between focused thresholds and the algorithm's neural-health estimates was found, consistent with previous literature. It also correctly identified simulated 'dead' regions in all seven CI users evaluated. The revised PECAP algorithm provides an estimate of neural excitation patterns in CIs that could be used to inform and optimize CI stimulation strategies for individual patients in clinical settings.

Effect of stimulus level and place of stimulation on temporal pitch perception by cochlear implant users.

Three experiments studied the effect of pulse rate on temporal pitch perception by cochlear implant users. Experiment 1 measured rate discrimination for pulse trains presented in bipolar mode to either an apical, middle, or basal electrode and for standard rates of 100 and 200 pps. In each block of trials the signals could have a level of -0.35, 0, or +0.35 dB re the standard, and performance for each signal level was recorded separately. Signal level affected performance for just over half of the combinations of subject, electrode, and standard rate studied. Performance was usually, but not always, better at the higher signal level. Experiment 2 showed that, for a given subject and condition, the direction of the effect was similar in monopolar and bipolar mode. Experiment 3 employed a pitch comparison procedure without feedback, and showed that the signal levels in experiment 1 that produced the best performance for a given subject and condition also led to the signal having a higher pitch. It is concluded that small level differences can have a robust and substantial effect on pitch judgments and argue that these effects are not entirely due to response biases or to co-variation of place-of-excitation with level.

The upper limit of temporal pitch for cochlear-implant listeners: stimulus duration, conditioner pulses, and the number of electrodes stimulated.

Three experiments studied discrimination of changes in the rate of electrical pulse trains by cochlear-implant (CI) users and investigated the effect of manipulations that would be expected to substantially affect the pattern of auditory nerve (AN) activity. Experiment 1 used single-electrode stimulation and tested discrimination at baseline rates between 100 and 500 pps. Performance was generally similar for stimulus durations of 200 and 800 ms, and, for the longer duration, for stimuli that were gated on abruptly or with 300-ms ramps. Experiment 2 used a similar procedure and found that no substantial benefit was obtained by the addition of background 5000-pps "conditioning" pulses. Experiment 3 used a pitch-ranking procedure and found that the range of rates over which pitch increased with increasing rate was not greater for multiple-electrode than for single-electrode stimulation. The results indicate that the limitation on pulse-rate discrimination by CI users, at high baseline rates, is not specific to a particular temporal pattern of the AN response.

Simulations of cochlear-implant speech perception in modulated and unmodulated noise.

Experiment 1 replicated the finding that normal-hearing listeners identify speech better in modulated than in unmodulated noise. This modulated-unmodulated difference ("MUD") has been previously shown to be reduced or absent for cochlear-implant listeners and for normal-hearing listeners presented with noise-vocoded speech. Experiments 2-3 presented normal-hearing listeners with noise-vocoded speech in unmodulated or 16-Hz-square-wave modulated noise, and investigated whether the introduction of simple binaural differences between target and masker could restore the masking release. Stimuli were presented over headphones. When the target and masker were presented to one ear, adding a copy of the masker to the other ear ("diotic configuration") aided performance but did so to a similar degree for modulated and unmodulated maskers, thereby failing to improve the modulation masking release. Presenting an uncorrelated noise to the opposite ear ("dichotic configuration") had no effect, either for modulated or unmodulated maskers, consistent with the improved performance in the diotic configuration being due to interaural decorrelation processing. For noise-vocoded speech, the provision of simple spatial differences did not allow listeners to take greater advantage of the dips present in a modulated masker.

The Effect of Phantom Stimulation and Pseudomonophasic Pulse Shapes on Pitch Perception by Cochlear Implant Listeners.

It has been suggested that a specialized high-temporal-acuity brainstem pathway can be activated by stimulating more apically in the cochlea than is achieved by cochlear implants (CIs) when programmed with contemporary clinical settings. We performed multiple experiments to test the effect on pitch perception of phantom stimulation and asymmetric current pulses, both supposedly stimulating beyond the most apical electrode of a CI. The two stimulus types were generated using a bipolar electrode pair, composed of the most apical electrode of the array and a neighboring, more basal electrode. Experiment 1 used a pitch-ranking procedure where neural excitation was shifted apically or basally using so-called phantom stimulation. No benefit of apical phantom stimulation was found on the highest rate up to which pitch ranks increased (upper limit), nor on the slopes of the pitch-ranking function above 300 pulses per second (pps). Experiment 2 used the same procedure to study the effects of apical pseudomonophasic pulses, where the locus of excitation was manipulated by changing stimulus polarity. A benefit of apical stimulation was obtained for the slopes above 300 pps. Experiment 3 used an adaptive rate discrimination procedure and found a small but significant benefit of both types of apical stimulation. Overall, the results show some benefit for apical stimulation on temporal pitch processing at high pulse rates but reveal that the effect is smaller and more variable across listeners than suggested by previous research. The results also provide some indication that the benefit of apical stimulation may decline over time since implantation.

Limits of temporal pitch in cochlear implants.

A common finding in the cochlear implant literature is that the upper limit of rate discrimination on a single channel is about 300 pps. The present study investigated rate discrimination using a procedure in which, in each block of two-interval trials, the standard could have one of the five baseline rates (100, 200, 300, 400, and 500 pps) and the signal rate was a given percentage higher than the standard. Eight Med-El C40+ subjects took part. The pattern of results was different than those reported previously: six Med-El subjects performed better at medium rates (200-300 pps) compared to both lower (100 pps) and higher (400-500 pps) rates. A similar pattern of results was obtained both with the method of constant stimuli and for 5000-pps pulse trains amplitude modulated at rates between 100 and 500 Hz. Compared to an unmatched group of eight Nucleus CI24 listeners tested using a similar paradigm and stimuli, Med-El subjects performed significantly better at 300 pps and higher but slightly worse at 100 pps. These results are discussed in relation to evidence on the limits of temporal pitch at low and high rates in normal-hearing listeners.

A Site-Selection Strategy Based on Polarity Sensitivity for Cochlear Implants: Effects on Spectro-Temporal Resolution and Speech Perception.

Thresholds of asymmetric pulses presented to cochlear implant (CI) listeners depend on polarity in a way that differs across subjects and electrodes. It has been suggested that lower thresholds for cathodic-dominant compared to anodic-dominant pulses reflect good local neural health. We evaluated the hypothesis that this polarity effect (PE) can be used in a site-selection strategy to improve speech perception and spectro-temporal resolution. Detection thresholds were measured in eight users of Advanced Bionics CIs for 80-pps, triphasic, monopolar pulse trains where the central high-amplitude phase was either anodic or cathodic. Two experimental MAPs were then generated for each subject by deactivating the five electrodes with either the highest or the lowest PE magnitudes (cathodic minus anodic threshold). Performance with the two experimental MAPs was evaluated using two spectro-temporal tests (Spectro-Temporal Ripple for Investigating Processor EffectivenesS (STRIPES; Archer-Boyd et al. in J Acoust Soc Am 144:2983-2997, 2018) and Spectral-Temporally Modulated Ripple Test (SMRT; Aronoff and Landsberger in J Acoust Soc Am 134:EL217-EL222, 2013)) and with speech recognition in quiet and in noise. Performance was also measured with an experimental MAP that used all electrodes, similar to the subjects' clinical MAP. The PE varied strongly across subjects and electrodes, with substantial magnitudes relative to the electrical dynamic range. There were no significant differences in performance between the three MAPs at group level, but there were significant effects at subject level-not all of which were in the hypothesized direction-consistent with previous reports of a large variability in CI users' performance and in the potential benefit of site-selection strategies. The STRIPES but not the SMRT test successfully predicted which strategy produced the best speech-in-noise performance on a subject-by-subject basis. The average PE across electrodes correlated significantly with subject age, duration of deafness, and speech perception scores, consistent with a relationship between PE and neural health. These findings motivate further investigations into site-specific measures of neural health and their application to CI processing strategies.

Effect of Chronic Stimulation and Stimulus Level on Temporal Processing by Cochlear Implant Listeners.

A series of experiments investigated potential changes in temporal processing during the months following activation of a cochlear implant (CI) and as a function of stimulus level. Experiment 1 tested patients on the day of implant activation and 2 and 6 months later. All stimuli were presented using direct stimulation of a single apical electrode. The dependent variables were rate discrimination ratios (RDRs) for pulse trains with rates centred on 120 pulses per second (pps), obtained using an adaptive procedure, and a measure of the upper limit of temporal pitch, obtained using a pitch-ranking procedure. All stimuli were presented at their most comfortable level (MCL). RDRs decreased from 1.23 to 1.16 and the upper limit increased from 357 to 485 pps from 0 to 2 months post-activation, with no overall change from 2 to 6 months. Because MCLs and hence the testing level increased across sessions, two further experiments investigated whether the performance changes observed across sessions could be due to level differences. Experiment 2 re-tested a subset of subjects at 9 months post-activation, using current levels similar to those used at 0 months. Although the stimuli sounded softer, some subjects showed lower RDRs and/or higher upper limits at this re-test. Experiment 3 measured RDRs and the upper limit for a separate group of subjects at levels equal to 60 %, 80 % and 100 % of the dynamic range. RDRs decreased with increasing level. The upper limit increased with increasing level for most subjects, with two notable exceptions. Implications of the results for temporal plasticity are discussed, along with possible influences of the effects of level and of across-session learning.