ABSTRACT
PURPOSE: In cochlear implantation (CI), the two factors that are determined by the surgeon with a potential significant impact on the position of the electrode within the cochlea and the potential outcome, are the surgical technique and electrode type. The objective of this prospective study was to evaluate the position of the slim, perimodiolar electrode (SPE), and to study the influence of the SPE position on CI outcome. METHODS: Twenty-three consecutively implanted, adult SPE candidates were included in this prospective cohort study conducted between December 2016 and April 2019. Mean age at surgery was 59.5 years. Mean preoperative residual hearing was 92.2 dB. Intra-operative fluoroscopy and high-resolution computed tomography scans were performed to evaluate electrode position after insertion using a cochleostomy (CS) approach. Follow-up was 12 months after implantation; residual hearing (6-8 weeks) and speech perception (6-8 weeks and 12 months) were evaluated in relation to the intracochlear SPE position. RESULTS: In most patients in whom the SPE was positioned in the scala tympani residual hearing was preserved [mean absolute increase in PTA of 4.4 dB and 77.2% relative hearing preservation (RHP%)]. Translocation into the scala vestibuli occurred in 36% of the insertions, resulting in a mean absolute increase in PTA of 17.9 dB, and a RHP% of 19.2%. Participants with a translocation had poorer speech perception scores at 12-month follow-up. CONCLUSION: Given the incidence of CS-associated translocations with the SPE and the negative effect on outcome, it is advised to insert the SPE using the (extended) round window approach.
Subject(s)
Cochlea/surgery , Cochlear Implantation/methods , Cochlear Implants , Hearing Loss/surgery , Adult , Aged , Aged, 80 and over , Cochlea/diagnostic imaging , Cochlear Implantation/adverse effects , Cochlear Implants/adverse effects , Cone-Beam Computed Tomography , Female , Fluoroscopy , Hearing Loss/diagnosis , Hearing Loss/diagnostic imaging , Hearing Tests , Humans , Intraoperative Care , Male , Middle Aged , Prospective Studies , Prosthesis Design , Prosthesis Failure/etiology , Round Window, Ear/surgery , Scala Tympani/surgeryABSTRACT
KEY POINTS: Long-chain acyl-CoA synthetase 6 (ACSL6) mRNA is present in human and rat skeletal muscle, and is modulated by nutritional status: exercise and fasting decrease ACSL6 mRNA, whereas acute lipid ingestion increase its expression. ACSL6 genic inhibition in rat primary myotubes decreased lipid accumulation, as well as activated the higher mitochondrial oxidative capacity programme and fatty acid oxidation through the AMPK/PGC1-α pathway. ACSL6 overexpression in human primary myotubes increased phospholipid species and decreased oxidative metabolism. ABSTRACT: Long-chain acyl-CoA synthetases (ACSL 1 to 6) are key enzymes regulating the partitioning of acyl-CoA species toward different metabolic fates such as lipid synthesis or ß-oxidation. Despite our understanding of ecotopic lipid accumulation in skeletal muscle being associated with metabolic diseases such as obesity and type II diabetes, the role of specific ACSL isoforms in lipid synthesis remains unclear. In the present study, we describe for the first time the presence of ACSL6 mRNA in human skeletal muscle and the role that ACSL6 plays in lipid synthesis in both rodent and human skeletal muscle. ACSL6 mRNA was observed to be up-regulated by acute high-fat meal ingestion in both rodents and humans. In rats, we also demonstrated that fasting and chronic aerobic training negatively modulated the ACSL6 mRNA and other genes of lipid synthesis. Similar results were obtained following ACSL6 knockdown in rat myotubes, which was associated with a decreased accumulation of TAGs and lipid droplets. Under the same knockdown condition, we further demonstrate an increase in fatty acid content, p-AMPK, mitochondrial content, mitochondrial respiratory rates and palmitate oxidation. These results were associated with increased PGC-1α, UCP2 and UCP3 mRNA and decreased reactive oxygen species production. In human myotubes, ACSL6 overexpression reduced palmitate oxidation and PGC-1α mRNA. In conclusion, ACSL6 drives acyl-CoA toward lipid synthesis and its downregulation improves mitochondrial biogenesis, respiratory capacity and lipid oxidation. These outcomes are associated with the activation of the AMPK/PGC1-α pathway.
Subject(s)
Coenzyme A Ligases/metabolism , Lipid Metabolism/physiology , Mitochondria, Muscle/metabolism , Muscle Fibers, Skeletal/metabolism , Animals , Cells, Cultured , Citrate (si)-Synthase/metabolism , Coenzyme A Ligases/genetics , Diet, High-Fat , Fatty Acids/metabolism , Female , Humans , Male , Obesity/metabolism , Oxidation-Reduction , Oxygen Consumption , RNA, Messenger/metabolism , Rats, WistarABSTRACT
Mitochondria play a critical role in several cellular processes and cellular homeostasis. Mitochondrion dysfunction has been correlated with numerous metabolic diseases such as obesity and type 2 diabetes. MicroRNAs are non-coding RNAs that have emerged as key regulators of cell metabolism. The microRNAs act as central regulators of metabolic gene networks by leading to the degradation of their target messenger RNA or repression of protein translation. In addition, vesicular and non-vesicular circulating miRNAs exhibit a potential role as mediators of the cross-talk between the skeletal muscle and other tissues/organs. In this review, we will focus on the emerging knowledge of miRNAs controlling mitochondrial function and insulin signaling in skeletal muscle cells. J. Cell. Physiol. 232: 958-966, 2017. © 2016 Wiley Periodicals, Inc.
Subject(s)
Insulin/metabolism , MicroRNAs/metabolism , Mitochondria/metabolism , Muscle, Skeletal/metabolism , Organelle Biogenesis , Signal Transduction , HumansABSTRACT
OBJECTIVES: The purpose of this study was to improve bimodal benefit in listeners using a cochlear implant (CI) and a hearing aid (HA) in contralateral ears, by matching the time constants and the number of compression channels of the automatic gain control (AGC) of the HA to the CI. Equivalent AGC was hypothesized to support a balanced loudness for dynamically changing signals like speech and improve bimodal benefit for speech understanding in quiet and with noise presented from the side(s) at 90 degree. DESIGN: Fifteen subjects participated in the study, all using the same Advanced Bionics Harmony CI processor and HA (Phonak Naida S IX UP). In a 3-visit crossover design with 4 weeks between sessions, performance was measured using a HA with a standard AGC (syllabic multichannel compression with 1 ms attack time and 50 ms release time) or an AGC that was adjusted to match that of the CI processor (dual AGC broadband compression, 3 and 240 msec attack time, 80 and 1500 msec release time). In all devices, the AGC was activated above the threshold of 63 dB SPL. The authors balanced loudness across the devices for soft and loud input sounds in 3 frequency bands (0 to 548, 548 to 1000, and >1000 Hz). Speech understanding was tested in free field in quiet and in noise for three spatial speaker configurations, with target speech always presented from the front. Single-talker noise was either presented from the CI side or the HA side, or uncorrelated stationary speech-weighted noise or single-talker noise was presented from both sides. Questionnaires were administered to assess differences in perception between the two bimodal fittings. RESULTS: Significant bimodal benefit over the CI alone was only found for the AGC-matched HA for the speech tests with single-talker noise. Compared with the standard HA, matched AGC characteristics significantly improved speech understanding in single-talker noise by 1.9 dB when noise was presented from the HA side. AGC matching increased bimodal benefit insignificantly by 0.6 dB when noise was presented from the CI implanted side, or by 0.8 (single-talker noise) and 1.1 dB (stationary noise) in the more complex configurations with two simultaneous maskers from both sides. In questionnaires, subjects rated the AGC-matched HA higher than the standard HA for understanding of one person in quiet and in noise, and for the quality of sounds. Listening to a slightly raised voice, subjects indicated increased listening comfort with matched AGCs. At the end of the study, 9 of 15 subjects preferred to take home the AGC-matched HA, 1 preferred the standard HA and 5 subjects had no preference. CONCLUSION: For bimodal listening, the AGC-matched HA outperformed the standard HA in speech understanding in noise tasks using a single competing talker and it was favored in questionnaires and in a subjective preference test. When noise was presented from the HA side, AGC matching resulted in a 1.9 dB SNR additional benefit, even though the HA was at the least favorable SNR side in this speaker configuration. Our results possibly suggest better binaural processing for matched AGCs.
Subject(s)
Cochlear Implantation , Deafness/rehabilitation , Hearing Aids , Speech Perception , Aged , Cochlear Implants , Combined Modality Therapy , Female , Humans , Male , Middle AgedABSTRACT
Melatonin has a number of beneficial metabolic actions and reduced levels of melatonin may contribute to type 2 diabetes. The present study investigated the metabolic pathways involved in the effects of melatonin on mitochondrial function and insulin resistance in rat skeletal muscle. The effect of melatonin was tested both in vitro in isolated rats skeletal muscle cells and in vivo using pinealectomized rats (PNX). Insulin resistance was induced in vitro by treating primary rat skeletal muscle cells with palmitic acid for 24 hr. Insulin-stimulated glucose uptake was reduced by palmitic acid followed by decreased phosphorylation of AKT which was prevented my melatonin. Palmitic acid reduced mitochondrial respiration, genes involved in mitochondrial biogenesis and the levels of tricarboxylic acid cycle intermediates whereas melatonin counteracted all these parameters in insulin-resistant cells. Melatonin treatment increases CAMKII and p-CREB but had no effect on p-AMPK. Silencing of CREB protein by siRNA reduced mitochondrial respiration mimicking the effect of palmitic acid and prevented melatonin-induced increase in p-AKT in palmitic acid-treated cells. PNX rats exhibited mild glucose intolerance, decreased energy expenditure and decreased p-AKT, mitochondrial respiration, and p-CREB and PGC-1 alpha levels in skeletal muscle which were restored by melatonin treatment in PNX rats. In summary, we showed that melatonin could prevent mitochondrial dysfunction and insulin resistance via activation of CREB-PGC-1 alpha pathway. Thus, the present work shows that melatonin play an important role in skeletal muscle mitochondrial function which could explain some of the beneficial effects of melatonin in insulin resistance states.
Subject(s)
Insulin Resistance/physiology , Melatonin/pharmacology , Muscle, Skeletal/drug effects , Muscle, Skeletal/metabolism , Animals , Cells, Cultured , Citric Acid Cycle/drug effects , Glucose Tolerance Test , Male , Oxygen Consumption/drug effects , Rats , Rats, Wistar , Signal Transduction/drug effectsABSTRACT
OBJECTIVE: To test speech understanding in noise using array microphones integrated in an eyeglass device and to test if microphones placed anteriorly at the temple provide better directivity than above the pinna. DESIGN: Sentences were presented from the front and uncorrelated noise from 45, 135, 225 and 315°. STUDY SAMPLE: Fifteen hearing impaired participants with a significant speech discrimination loss were included, as well as 5 normal hearing listeners. RESULTS: The device (Varibel) improved speech understanding in noise compared to most conventional directional devices with a directional benefit of 5.3 dB in the asymmetric fit mode, which was not significantly different from the bilateral fully directional mode (6.3 dB). Anterior microphones outperformed microphones at a conventional position above the pinna by 2.6 dB. CONCLUSIONS: By integrating microphones in an eyeglass frame, a long array can be used resulting in a higher directionality index and improved speech understanding in noise. An asymmetric fit did not significantly reduce performance and can be considered to increase acceptance and environmental awareness. Directional microphones at the temple seemed to profit more from the head shadow than above the pinna, better suppressing noise from behind the listener.
Subject(s)
Comprehension , Correction of Hearing Impairment , Eyeglasses , Hearing Aids , Hearing Loss/rehabilitation , Noise/adverse effects , Perceptual Masking , Persons With Hearing Impairments/rehabilitation , Speech Perception , Acoustic Stimulation , Aged , Aged, 80 and over , Audiometry, Pure-Tone , Auditory Threshold , Correction of Hearing Impairment/psychology , Equipment Design , Female , Hearing Loss/psychology , Humans , Male , Middle Aged , Persons With Hearing Impairments/psychology , Sound Localization , Speech Acoustics , Speech Intelligibility , Speech Reception Threshold Test , TransducersABSTRACT
PURPOSE: Speech understanding in noise and horizontal sound localization is poor in most cochlear implant (CI) users with a hearing aid (bimodal stimulation). This study investigated the effect of static and less-extreme adaptive frequency compression in hearing aids on spatial hearing. By means of frequency compression, we aimed to restore high-frequency audibility, and thus improve sound localization and spatial speech recognition. METHOD: Sound-detection thresholds, sound localization, and spatial speech recognition were measured in eight bimodal CI users, with and without frequency compression. We tested two compression algorithms: a static algorithm, which compressed frequencies beyond the compression knee point (160 or 480 Hz), and an adaptive algorithm, which aimed to compress only consonants leaving vowels unaffected (adaptive knee-point frequencies from 736 to 2946 Hz). RESULTS: Compression yielded a strong audibility benefit (high-frequency thresholds improved by 40 and 24 dB for static and adaptive compression, respectively), no meaningful improvement in localization performance (errors remained > 30 deg), and spatial speech recognition across all participants. Localization biases without compression (toward the hearing-aid and implant side for low- and high-frequency sounds, respectively) disappeared or reversed with compression. The audibility benefits provided to each bimodal user partially explained any individual improvements in localization performance; shifts in bias; and, for six out of eight participants, benefits in spatial speech recognition. CONCLUSIONS: We speculate that limiting factors such as a persistent hearing asymmetry and mismatch in spectral overlap prevent compression in bimodal users from improving sound localization. Therefore, the benefit in spatial release from masking by compression is likely due to a shift of attention to the ear with the better signal-to-noise ratio facilitated by compression, rather than an improved spatial selectivity. Supplemental Material https://doi.org/10.23641/asha.16869485.
Subject(s)
Cochlear Implantation , Cochlear Implants , Hearing Aids , Sound Localization , Speech Perception , Hearing , Humans , Speech Perception/physiologyABSTRACT
This study describes sound localization and speech-recognition-in-noise abilities of a cochlear-implant user with electro-acoustic stimulation (EAS) in one ear, and a hearing aid in the contralateral ear. This listener had low-frequency, up to 250 Hz, residual hearing within the normal range in both ears. The objective was to determine how hearing devices affect spatial hearing for an individual with substantial unaided low-frequency residual hearing. Sound-localization performance was assessed for three sounds with different bandpass characteristics: low center frequency (100-400 Hz), mid center frequency (500-1,500 Hz) and high frequency broad-band (500-20,000 Hz) noise. Speech recognition was assessed with the Dutch Matrix sentence test presented in noise. Tests were performed while the listener used several on-off combinations of the devices. The listener localized low-center frequency sounds well in all hearing conditions, but mid-center frequency and high frequency broadband sounds were localized well almost exclusively in the completely unaided condition (mid-center frequency sounds were also localized well with the EAS device alone). Speech recognition was best in the fully aided condition with speech presented in the front and noise presented at either side. Furthermore, there was no significant improvement in speech recognition with all devices on, compared to when the listener used her cochlear implant only. Hearing aids and cochlear implant impair high frequency spatial hearing due to improper weighing of interaural time and level difference cues. The results reinforce the notion that hearing symmetry is important for sound localization. The symmetry is perturbed by the hearing devices for higher frequencies. Speech recognition depends mainly on hearing through the cochlear implant and is not significantly improved with the added information from hearing aids. A contralateral hearing aid provides benefit when the noise is spatially separated from the speech. However, this benefit is explained by the head shadow in that ear, rather than by an ability to spatially segregate noise from speech, as sound localization was perturbed with all devices in use.
ABSTRACT
Osteogenesis imperfecta (OI) is a heterogeneous disease of the connective tissue caused by a defective gene that is responsible for the production of collagen type I, leading to defective bone matrix and connective tissue. Hearing loss affects 35-60% of the patients and will progress to deafness in 2-11% of OI patients for whom cochlear implantation may become the only remaining treatment option. Three patients with OI were retrieved from the Nijmegen Cochlear Implant Centre's database. Most of the specific observations in ear surgery on patients with OI, such as brittle scutum, sclerotic thickening of the cochlea, hyperplastic mucosa in the middle ear and persistent bleeding, were encountered in these 3 patients. In case 3, with severe deformities on the CT scan, misplacement of the electrode array into the horizontal semicircular canal occurred. In all 3 cases, programming was hindered by nonauditory stimulation. Even after reimplantation, nonauditory sensations lead to case 3 becoming a nonuser. Averaged electrode voltages in case 3 were deviant in accordance with an abnormally conductive otic capsule. Spatial spread of neural excitation responses in cases 1 and 2 suggested intracochlear channel interaction for several electrodes, often in combination with facial nerve stimulation (FNS). In case 1, the estimated pitch of the electrodes that caused FNS varied consistently. Despite the electrophysiological changes, after 1-year follow-up, open set phoneme scores of 81% and 78% were reached in cases 1 and 2, respectively. When aware and prepared for the specific changes of the temporal bone in OI, cochlear implantation can be a safe and feasible procedure. Preoperative imaging is recommended to be fully informed on the morphology of the petrosal bone. In case of severe deformities on the CT scan, during counseling the possibility of misplacement should be mentioned. Rehabilitation is often hindered by FNS requiring frequent refitting.
Subject(s)
Cochlear Implantation , Hearing Loss, Sensorineural/rehabilitation , Osteogenesis Imperfecta/diagnostic imaging , Osteogenesis Imperfecta/surgery , Telemetry/instrumentation , Adult , Child , Diagnosis, Differential , Electric Stimulation/instrumentation , Electrophysiology/instrumentation , Facial Nerve/physiology , Female , Hearing Loss, Sensorineural/diagnosis , Hearing Loss, Sensorineural/epidemiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neural Conduction/physiology , Osteogenesis Imperfecta/epidemiology , Otosclerosis/diagnostic imaging , Otosclerosis/pathology , Petrous Bone/diagnostic imaging , Petrous Bone/pathology , Preoperative Care , Speech Perception/physiology , Tomography, X-Ray ComputedABSTRACT
Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been reported to improve insulin sensitivity and glucose homeostasis in animal models of insulin resistance, but the involved mechanisms still remain unresolved. In this study, we evaluated the effects of fish oil (FO), a source of n-3 PUFAs, on obesity, insulin resistance and muscle mitochondrial function in mice fed a high-fat diet (HFD). C57Bl/6 male mice, 8 weeks old, were divided into four groups: control diet (C), high-fat diet (H), C+FO (CFO) and H+FO (HFO). FO was administered by oral gavage (2 g/kg b.w.), three times a week, starting 4 weeks before diet administration until the end of the experimental protocol. HFD-induced obesity and insulin resistance associated with impaired skeletal muscle mitochondrial function, as indicated by decreased oxygen consumption, tricarboxylic acid cycle intermediate (TCAi) contents (citrate, α-ketoglutarate, malate and oxaloacetate), oxidative phosphorylation protein content and mitochondrial biogenesis. These effects were associated with elevated reactive oxygen species production, decreased PGC1-a transcription and reduced Akt phosphorylation. The changes induced by the HFD were partially attenuated by FO, which decreased obesity and insulin resistance and increased mitochondrial function. In the H group, FO supplementation also improved oxygen consumption; increased TCAi content, and Akt and AMPK phosphorylation; and up-regulated mRNA expression of Gpat1, Pepck, catalase and mitochondrial proteins (Pgc1α, Pparα, Cpt1 and Ucp3). These results suggest that dietary FO attenuates the deleterious effects of the HFD (obesity and insulin resistance) by improving skeletal muscle mitochondrial function.
Subject(s)
Fish Oils/pharmacology , Insulin Resistance , Mitochondria, Muscle/physiology , Obesity/diet therapy , Adiposity/drug effects , Animals , Anti-Obesity Agents/pharmacology , Catalase/metabolism , Diet, High-Fat/adverse effects , Dietary Supplements , Fatty Acids/analysis , Fatty Acids/metabolism , Fatty Acids, Omega-3/pharmacology , Hydrogen Peroxide/metabolism , Male , Mice, Inbred C57BL , Mitochondria, Muscle/drug effects , Muscle, Skeletal/drug effects , Muscle, Skeletal/physiology , Obesity/etiology , Proteins/genetics , Proteins/metabolismABSTRACT
During the last decade, cochlear implantation has evolved into a well-established treatment of deafness, predominantly because of many improvements in speech processing and the controlled excitation of the auditory nerve. Cochlear implants now also feature telemetry, which is highly useful to monitor the proper functioning of the implanted electronics and electrode contacts. Telemetry can also support the clinical management in young children and difficult cases where neural unresponsiveness is suspected. This article will review recent advances in the telemetry of the electrically evoked compound action potential that have made these measurements simple and routine procedures in most cases. The distribution of the electrical stimulus itself sampled by "electrical field imaging" reveals general patterns of current flow in the normal cochlea and gross abnormalities in individual patients; models have been developed to derive more subtle insights from an individual electrical field imaging. Finally, some thoughts are given to the extended application of telemetry, for example, in monitoring the neural responses or in combination with other treatments of the deaf ear.
Subject(s)
Cochlear Implants/trends , Deafness/physiopathology , Deafness/surgery , Evoked Potentials, Auditory , Telemetry/instrumentation , Electromagnetic Fields , Electronics, Medical/instrumentation , HumansABSTRACT
OBJECTIVES: This study aimed to improve access to high-frequency interaural level differences (ILD), by applying extreme frequency compression (FC) in the hearing aid (HA) of 13 bimodal listeners, using a cochlear implant (CI) and conventional HA in opposite ears. DESIGN: An experimental signal-adaptive frequency-lowering algorithm was tested, compressing frequencies above 160â Hz into the individual audible range of residual hearing, but only for consonants (adaptive FC), thus protecting vowel formants, with the aim to preserve speech perception. In a cross-over design with at least 5 weeks of acclimatization between sessions, bimodal performance with and without adaptive FC was compared for horizontal sound localization, speech understanding in quiet and in noise, and vowel, consonant and voice-pitch perception. RESULTS: On average, adaptive FC did not significantly affect any of the test results. Yet, two subjects who were fitted with a relatively weak frequency compression ratio, showed improved horizontal sound localization. After the study, four subjects preferred adaptive FC, four preferred standard frequency mapping, and four had no preference. Noteworthy, the subjects preferring adaptive FC were those with best performance on all tasks, both with and without adaptive FC. CONCLUSION: On a group level, extreme adaptive FC did not change sound localization and speech understanding in bimodal listeners. Possible reasons are too strong compression ratios, insufficient residual hearing or that the adaptive switching, although preserving vowel perception, may have been ineffective to produce consistent ILD cues. Individual results suggested that two subjects were able to integrate the frequency-compressed HA input with that of the CI, and benefitted from enhanced binaural cues for horizontal sound localization.
Subject(s)
Cochlear Implants , Correction of Hearing Impairment/methods , Hearing Aids , Hearing Loss/rehabilitation , Sound Localization/physiology , Speech Perception/physiology , Aged , Aged, 80 and over , Cochlear Implantation/methods , Combined Modality Therapy , Cues , Female , Hearing Loss/physiopathology , Humans , Male , Middle Aged , Noise , Pitch Perception , Treatment OutcomeABSTRACT
Conclusion In users of a cochlear implant (CI) and a hearing aid (HA) in contralateral ears, frequency-dependent loudness balancing between devices did, on average, not lead to improved speech understanding as compared to broadband balancing. However, nine out of 15 bimodal subjects showed significantly better speech understanding with either one of the fittings. Objectives Sub-optimal fittings and mismatches in loudness are possible explanations for the large individual differences seen in listeners using bimodal stimulation. Methods HA gain was adjusted for soft and loud input sounds in three frequency bands (0-548, 548-1000, and >1000 Hz) to match loudness with the CI. This procedure was compared to a simple broadband balancing procedure that reflected current clinical practice. In a three-visit cross-over design with 4 weeks between sessions, speech understanding was tested in quiet and in noise and questionnaires were administered to assess benefit in real world. Results Both procedures resulted in comparable HA gains. For speech in noise, a marginal bimodal benefit of 0.3 ± 4 dB was found, with large differences between subjects and spatial configurations. Speech understanding in quiet and in noise did not differ between the two loudness balancing procedures.
Subject(s)
Cochlear Implants , Loudness Perception , Speech Perception , Aged , Female , Humans , Male , Middle Aged , NoiseABSTRACT
Interaural differences in sound arrival time (ITD) and in level (ILD) enable us to localize sounds in the horizontal plane, and can support source segregation and speech understanding in noisy environments. It is uncertain whether these cues are also available to hearing-impaired listeners who are bimodally fitted, i.e. with a cochlear implant (CI) and a contralateral hearing aid (HA). Here, we assessed sound localization behavior of fourteen bimodal listeners, all using the same Phonak HA and an Advanced Bionics CI processor, matched with respect to loudness growth. We aimed to determine the availability and contribution of binaural (ILDs, temporal fine structure and envelope ITDs) and monaural (loudness, spectral) cues to horizontal sound localization in bimodal listeners, by systematically varying the frequency band, level and envelope of the stimuli. The sound bandwidth had a strong effect on the localization bias of bimodal listeners, although localization performance was typically poor for all conditions. Responses could be systematically changed by adjusting the frequency range of the stimulus, or by simply switching the HA and CI on and off. Localization responses were largely biased to one side, typically the CI side for broadband and high-pass filtered sounds, and occasionally to the HA side for low-pass filtered sounds. HA-aided thresholds better than 45 dB HL in the frequency range of the stimulus appeared to be a prerequisite, but not a guarantee, for the ability to indicate sound source direction. We argue that bimodal sound localization is likely based on ILD cues, even at frequencies below 1500 Hz for which the natural ILDs are small. These cues are typically perturbed in bimodal listeners, leading to a biased localization percept of sounds. The high accuracy of some listeners could result from a combination of sufficient spectral overlap and loudness balance in bimodal hearing.
Subject(s)
Cochlear Implants , Deafness/therapy , Hearing , Sound Localization , Acoustic Stimulation , Aged , Aged, 80 and over , Auditory Perception , Calibration , Cochlear Implantation , Cues , Female , Hearing Tests , Humans , Male , Middle Aged , Sound , Speech PerceptionABSTRACT
OBJECTIVE: To study the effect of two multipolar electrode configurations on speech perception, pitch perception, and the intracochlear electrical field. STUDY DESIGN: Crossover design; within subject. SETTING: Tertiary referral center. PATIENTS: Eight experienced adult cochlear implant users. INTERVENTION: Each subject used each of three experimental processors for 3 weeks. The following processors were compared that differed only in electrode configuration: 1) monopolar; 2) hybrid quadrupolar, in which half of the current returned to the extracochlear reference electrode and half to two electrodes immediately to the left and right of the active electrode; and 3) flat tripolar +2, which directed all the current to four reference electrodes (two on each side), separated from the active electrode by two inactive electrodes. All the processors used the standard Advanced Bionics HiRes speech-processing strategy, 12 channels, 1,220 pulses per second per channel, and with a pulse width of 33 (micros/phase). RESULTS: The monopolar processors had the largest stimulation efficiency and the smallest dynamic range in linear current units. The reverse was true of flat tripolar +2 processor, whereas the hybrid quadrupolar processor fell in between. Insufficient loudness growth prevented the use of the flat tripolar +2 processor in three subjects. Word recognition did not differ between the clinically used 16-channel monopolar processor and the experimental monopolar processor, regardless of the differences in the number of channels, pulse rate, and duration of experience. Word recognition with the flat tripolar +2 processor was significantly poorer than with the monopolar and hybrid quadrupolar processors; monopolar and quadrupolar processors did not differ. There was no significant interaction between processor type and competing noise type (stationary or fluctuating), but performance at the higher level of fluctuating noise was best with the hybrid quadrupolar processor in almost all the subjects. Pitch scaling showed ceiling performance in five subjects and differed between processors in the two other subjects with imperfect tonotopy. Intracochlear current spread was considerable with the monopolar configuration; it was reduced with the hybrid quadrupolar configuration and virtually absent beyond the active electrodes with the tripolar configuration. CONCLUSION: More confined configurations reduced the longitudinal width of the electrical field, which was expected to enhance channel separation, but no improvement in word recognition was found. More research is needed to test confined configurations that have enhanced efficiency and to evaluate the fundamental effects of configuration on channel discriminability.
Subject(s)
Cochlea/physiology , Cochlear Implants , Electric Stimulation/instrumentation , Pitch Perception/physiology , Speech Perception/physiology , Acoustic Stimulation , Adult , Aged , Cochlear Implantation , Cross-Over Studies , Deafness/rehabilitation , Electrodes , Female , Humans , Male , Middle AgedABSTRACT
Averaged electrode voltages (AEVs) are of secondary importance for integrity testing of cochlear implant devices featuring back-telemetry. However, AEVs are device-independent and may show intermittent failures and deviant stimulation patterns unnoticed by telemetry. We collected AEVs from 18 users of the Clarion 1.2 system and 6 users of the HiFocus system in order to establish norms for evaluating AEVs in difficult cases. The stimuli were presented with the standard clinical software. Monopolar stimulation at about 16 microA showed large AEVs (mean, 173 microV) suitable for integrity testing. No electrode failures were found. The AEV amplitudes from neighboring electrodes differed by less than 30% (2 SD). The AEVs from subjects with the Clarion HiFocus electrode and/or the Clarion electrode positioner were within the normal range. The AEV amplitudes from bipolar stimulation were much more variable. Inversion of phases between electrodes was found in patients with an altered state of the cochlea (otosclerosis and osteogenesis imperfecta) and in a patient with a curled electrode tip. There was no correlation across subjects between AEVs and electrode impedances. Therefore, impedances are dominated by the electrode-tissue interface, in contrast to AEVs, which are determined by the volume conduction in the body.
Subject(s)
Cochlear Implants , Adult , Cochlear Implants/standards , Deafness/etiology , Electric Impedance , Electrodes , Equipment Failure , Humans , Osteogenesis Imperfecta/complications , Otosclerosis/complications , Surface Properties , Telemetry , Time FactorsABSTRACT
The Auditory Steady-State Response (ASSR) was recorded in 20 awake adults with normal hearing on ten EEG channels simultaneously to find derivations with the best signal-to-noise ratios (SNRs). Stimuli were 20% frequency modulated tones of 0.5 and 2 kHz at 20 dB SL, 100% amplitude modulated at 90 or 94 Hz, and presented one at a time to one ear. ASSR recordings using a set of at least three channels improved SNRs significantly by an average of between 6% (500 Hz right ear) to 118% (2 kHz right ear) above the SNRs from the conventional channels. Assuming that the recording time was proportional to 1/(SNR)2, this translates into a recording time of 89% (500 Hz right ear) to 21% (2 kHz right ear) of that for conventional single-channel recording. The three channels comprised the electrode positions inion, right mastoid, and left mastoid. All three electrode positions were referenced to Cz. Adding a fourth channel (Pz-Cz) increases the number of participants with significant responses from the 500 Hz right ear stimulus from 13 to 17. Electrode position F4 and other commonly used positions such as the forehead and right earlobe made significantly less contribution to test efficiency.
Subject(s)
Artifacts , Audiometry, Evoked Response/methods , Electroencephalography , Evoked Potentials, Auditory/physiology , Noise , Acoustic Stimulation , Adult , Electrodes , Female , Humans , Male , Middle AgedABSTRACT
Tripolar and other electrode configurations that use simultaneous stimulation inside the cochlea have been tested to reduce channel interactions compared to the monopolar stimulation conventionally used in cochlear implant systems. However, these "focused" configurations require increased current levels to achieve sufficient loudness. In this study, we investigate whether highly accurate recordings of the intracochlear electrical field set up by monopolar and tripolar configurations correlate to their effect on loudness. We related the intra-scalar potential distribution to behavioral loudness, by introducing a free parameter (α) which parameterizes the degree to which the potential field peak set up inside the scala tympani is still present at the location of the targeted neural tissue. Loudness balancing was performed on four levels between behavioral threshold and the most comfortable loudness level in a group of 10 experienced Advanced Bionics cochlear implant users. The effect of the amount of focusing on loudness was well explained by α per subject location along the basilar membrane. We found that α was unaffected by presentation level. Moreover, the ratios between the monopolar and tripolar currents, balanced for equal loudness, were approximately the same for all presentation levels. This suggests a linear loudness growth with increasing current level and that the equal peak hypothesis may predict the loudness of threshold as well as at supra-threshold levels. These results suggest that advanced electrical field imaging, complemented with limited psychophysical testing, more specifically at only one presentation level, enables estimation of the loudness growth of complex electrode configurations.
Subject(s)
Cochlea/physiopathology , Cochlear Implantation/instrumentation , Cochlear Implants , Correction of Hearing Impairment , Loudness Perception , Persons With Hearing Impairments/rehabilitation , Signal Processing, Computer-Assisted , Acoustic Stimulation , Aged , Auditory Threshold , Correction of Hearing Impairment/psychology , Electric Stimulation , Humans , Middle Aged , Persons With Hearing Impairments/psychology , PsychoacousticsABSTRACT
OBJECTIVES: To compare the effects of Monopole (Mono), Tripole (Tri), and "Virtual channel" (Vchan) electrode configurations on spectral resolution and speech perception in a crossover design. DESIGN: Nine experienced adults who received an Advanced Bionics CII/90K cochlear implant participated in a crossover design using three experimental strategies for 2 wk each. Three strategies were compared: (1) Mono; (2) Tri with current partly returning to adjacent electrodes and partly (25 or 75%) to the extracochlear reference; and (3) a monopolar "Vchan" strategy creating seven intermediate channels between two contacts. Each strategy was a variant of the standard "HiRes" processing strategy using 14 channels and 1105 pulses/sec/ channel, and a pulse duration of 32 microsec/phase. Spectral resolution was measured using broadband noise with a sinusoidally rippled spectral envelope with peaks evenly spaced on a logarithmic frequency scale. Speech perception was measured for monosyllables in quiet and in steady-state and fluctuating noises. Subjective comments on music experience and preferences in everyday use were assessed through questionnaires. RESULTS: Thresholds and most comfortable levels with Mono and Vchan were both significantly lower than levels with Tri. Spectral resolution was significantly higher with Tri than with Mono; spectral resolution with Vchan did not differ significantly from the other configurations. Moderate but significant correlations between word recognition and spectral resolution were found in speech in quiet and fluctuating noise. For speech in quiet, word recognition was best with Mono and worst with Vchan; Tri did not significantly differ from the other configurations. Pooled across the noise conditions, word recognition was best with Tri and worst with Vchan (Mono did not significantly differ from the other configurations). These differences were small and insufficient to result in a clear increase in performance across subjects if the result from the best configuration per subject was compared with the result from Mono. Across all subjects, music appreciation and satisfaction in everyday use did not clearly differ between configurations. CONCLUSIONS: (1) Although spectral resolution was improved with the tripolar configuration, differences in speech performance were too small in this limited group of subjects to justify clinical introduction. (2) Overall spectral resolution remained extremely poor compared with normal hearing; it remains to be seen whether further manipulations of the electrical field will be more effective.