Vestibular implantation and longitudinal electrical stimulation of the semicircular canal afferents in human subjects.

Animal experiments and limited data in humans suggest that electrical stimulation of the vestibular end organs could be used to treat loss of vestibular function. In this paper we demonstrate that canal-specific two-dimensionally (2D) measured eye velocities are elicited from intermittent brief 2 s biphasic pulse electrical stimulation in four human subjects implanted with a vestibular prosthesis. The 2D measured direction of the slow phase eye movements changed with the canal stimulated. Increasing pulse current over a 0-400 µA range typically produced a monotonic increase in slow phase eye velocity. The responses decremented or in some cases fluctuated over time in most implanted canals but could be partially restored by changing the return path of the stimulation current. Implantation of the device in Meniere's patients produced hearing and vestibular loss in the implanted ear. Electrical stimulation was well tolerated, producing no sensation of pain, nausea, or auditory percept with stimulation that elicited robust eye movements. There were changes in slow phase eye velocity with current and over time, and changes in electrically evoked compound action potentials produced by stimulation and recorded with the implanted device. Perceived rotation in subjects was consistent with the slow phase eye movements in direction and scaled with stimulation current in magnitude. These results suggest that electrical stimulation of the vestibular end organ in human subjects provided controlled vestibular inputs over time, but in Meniere's patients this apparently came at the cost of hearing and vestibular function in the implanted ear.

Prosthetic implantation of the human vestibular system.

HYPOTHESIS: A functional vestibular prosthesis can be implanted in human such that electrical stimulation of each semicircular canal produces canal-specific eye movements while preserving vestibular and auditory function. BACKGROUND: A number of vestibular disorders could be treated with prosthetic stimulation of the vestibular end organs. We have previously demonstrated in rhesus monkeys that a vestibular neurostimulator, based on the Nucleus Freedom cochlear implant, can produce canal-specific electrically evoked eye movements while preserving auditory and vestibular function. An investigational device exemption has been obtained from the FDA to study the feasibility of treating uncontrolled Ménière's disease with the device. METHODS: The UW/Nucleus vestibular implant was implanted in the perilymphatic space adjacent to the three semicircular canal ampullae of a human subject with uncontrolled Ménière's disease. Preoperative and postoperative vestibular and auditory function was assessed. Electrically evoked eye movements were measured at 2 time points postoperatively. RESULTS: Implantation of all semicircular canals was technically feasible. Horizontal canal and auditory function were largely, but not totally, lost. Electrode stimulation in 2 of 3 canals resulted in canal-appropriate eye movements. Over time, stimulation thresholds increased. CONCLUSION: Prosthetic implantation of the semicircular canals in humans is technically feasible. Electrical stimulation resulted in canal-specific eye movements, although thresholds increased over time. Preservation of native auditory and vestibular function, previously observed in animals, was not demonstrated in a single subject with advanced Ménière's disease.

Detection of acoustic temporal fine structure by cochlear implant listeners: behavioral results and computational modeling.

A test of within-channel detection of acoustic temporal fine structure (aTFS) cues is presented. Eight cochlear implant listeners (CI) were asked to discriminate between two Schroeder-phase (SP) complexes using a two-alternative, forced-choice task. Because differences between the acoustic stimuli are primarily constrained to their aTFS, successful discrimination reflects a combination of the subjects' perception of and the strategy's ability to deliver aTFS cues. Subjects were mapped with single-channel Continuous Interleaved Sampling (CIS) and Simultaneous Analog Stimulation (SAS) strategies. To compare within- and across- channel delivery of aTFS cues, a 16-channel clinical HiRes strategy was also fitted. Throughout testing, SAS consistently outperformed the CIS strategy (p ≤ 0.002). For SP stimuli with F0 = 50 Hz, the highest discrimination scores were achieved with the HiRes encoding, followed by scores with the SAS and the CIS strategies, respectively. At 200 Hz, single-channel SAS performed better than HiRes (p = 0.022), demonstrating that under a more challenging testing condition, discrimination performance with a single-channel analog encoding can exceed that of a 16-channel pulsatile strategy. To better understand the intermediate steps of discrimination, a biophysical model was used to examine the neural discharges evoked by the SP stimuli. Discrimination estimates calculated from simulated neural responses successfully tracked the behavioral performance trends of single-channel CI listeners.

The ability of cochlear implant users to use temporal envelope cues recovered from speech frequency modulation.

Previous studies have demonstrated that normal-hearing listeners can understand speech using the recovered "temporal envelopes," i.e., amplitude modulation (AM) cues from frequency modulation (FM). This study evaluated this mechanism in cochlear implant (CI) users for consonant identification. Stimuli containing only FM cues were created using 1, 2, 4, and 8-band FM-vocoders to determine if consonant identification performance would improve as the recovered AM cues become more available. A consistent improvement was observed as the band number decreased from 8 to 1, supporting the hypothesis that (1) the CI sound processor generates recovered AM cues from broadband FM, and (2) CI users can use the recovered AM cues to recognize speech. The correlation between the intact and the recovered AM components at the output of the sound processor was also generally higher when the band number was low, supporting the consonant identification results. Moreover, CI subjects who were better at using recovered AM cues from broadband FM cues showed better identification performance with intact (unprocessed) speech stimuli. This suggests that speech perception performance variability in CI users may be partly caused by differences in their ability to use AM cues recovered from FM speech cues.

Psychoacoustic performance and music and speech perception in prelingually deafened children with cochlear implants.

The number of pediatric cochlear implant (CI) recipients has increased substantially over the past 10 years, and it has become more important to understand the underlying mechanisms of the variable outcomes in this population. In this study, psychoacoustic measures of spectral-ripple and Schroeder-phase discrimination, the Clinical Assessment of Music Perception, and consonant-nucleus-consonant (CNC) word recognition in quiet and spondee reception threshold (SRT) in noise tests have been presented to 11 prelingually deafened CI users, aged 8-16 years with at least 5 years of CI experience. The children's performance was compared to the previously reported results of postlingually deafened adult CI users. The average spectral-ripple threshold (n = 10) was 2.08 ripples/octave. The average Schroeder-phase discrimination was 67.3% for 50 Hz and 56.5% for 200 Hz (n = 9). The Clinical Assessment of Music Perception test showed that the average complex pitch direction discrimination was 2.98 semitones. The mean melody score was at a chance level, and the mean timbre score was 34.1% correct. The mean CNC word recognition score was 68.6%, and the mean SRT in steady noise was -8.5 dB SNR. The children's spectral-ripple resolution, CNC word recognition, and SRT in noise performances were, within statistical bounds, the same as in a population of postlingually deafened adult CI users. However, Schroeder-phase discrimination and music perception were generally poorer than in the adults. It is possible then that this poorer performance seen in the children might be partly accounted for by the delayed maturation in their temporal processing ability, and because of this, the children's performance may have been driven more by their spectral sensitivity.

Evidence of across-channel processing for spectral-ripple discrimination in cochlear implant listeners.

Spectral-ripple discrimination has been used widely for psychoacoustical studies in normal-hearing, hearing-impaired, and cochlear implant listeners. The present study investigated the perceptual mechanism for spectral-ripple discrimination in cochlear implant listeners. The main goal of this study was to determine whether cochlear implant listeners use a local intensity cue or global spectral shape for spectral-ripple discrimination. The effect of electrode separation on spectral-ripple discrimination was also evaluated. Results showed that it is highly unlikely that cochlear implant listeners depend on a local intensity cue for spectral-ripple discrimination. A phenomenological model of spectral-ripple discrimination, as an "ideal observer," showed that a perceptual mechanism based on discrimination of a single intensity difference cannot account for performance of cochlear implant listeners. Spectral modulation depth and electrode separation were found to significantly affect spectral-ripple discrimination. The evidence supports the hypothesis that spectral-ripple discrimination involves integrating information from multiple channels.

Acoustic temporal modulation detection and speech perception in cochlear implant listeners.

The goals of the present study were to measure acoustic temporal modulation transfer functions (TMTFs) in cochlear implant listeners and examine the relationship between modulation detection and speech recognition abilities. The effects of automatic gain control, presentation level and number of channels on modulation detection thresholds (MDTs) were examined using the listeners' clinical sound processor. The general form of the TMTF was low-pass, consistent with previous studies. The operation of automatic gain control had no effect on MDTs when the stimuli were presented at 65 dBA. MDTs were not dependent on the presentation levels (ranging from 50 to 75 dBA) nor on the number of channels. Significant correlations were found between MDTs and speech recognition scores. The rates of decay of the TMTFs were predictive of speech recognition abilities. Spectral-ripple discrimination was evaluated to examine the relationship between temporal and spectral envelope sensitivities. No correlations were found between the two measures, and 56% of the variance in speech recognition was predicted jointly by the two tasks. The present study suggests that temporal modulation detection measured with the sound processor can serve as a useful measure of the ability of clinical sound processing strategies to deliver clinically pertinent temporal information.

Sensitivity of psychophysical measures to signal processor modifications in cochlear implant users.

Experienced users of the Clarion cochlear implant were tested acutely with the HiResolution (HiRes) and HiRes Fidelity120 (F120) processing strategies. Three psychophysically-based tests were used including spectral-ripple discrimination, Schroeder-phase discrimination and temporal modulation detection. Three clinical outcome measures were used including consonant-nucleus-consonant (CNC) word recognition in quiet, word recognition in noise and the clinical assessment of music perception (CAMP). Listener's spectral-ripple discrimination ability improved with F120, but Schroeder-phase discrimination was worse with F120 than with HiRes. Listeners who had better than average acuity showed the biggest effects. There were no significant effects of the processing strategy on any of the clinical abilities nor on temporal modulation detection. Additionally, the listeners' day-to-day clinical strategy did not appear to influence the result suggesting that experience with the strategies did not play a significant role. The results underscore the value of acoustic psychophysical measures through the sound processor as a tool in clinical research, because these measures are more sensitive to changes in the processing strategies than traditional clinical measures, e.g. speech understanding. The measures allow for the evaluation of sensitivity to specific acoustic attributes revealing the extent to which different processing strategies affect these basic abilities and could thus improve the efficiency of the development of processing strategies.