The relation between cochlear implant programming levels and speech perception performance in post-lingually deafened adults: a data-driven approach.

PURPOSE: Programming a cochlear implant (fitting) is an essential part of a user's post-implantation journey, defining how sound will be translated into electrical stimulation and aiming to provide optimal speech perception outcomes. Currently, there are no established, evidence-based guidelines for fitting cochlear implant users, leading to a high degree of variability in fitting practices, users' parameters, and probably outcomes. In this study a data-driven approach is used to retrospectively investigate the relation between cochlear implant fitting parameters and speech perception outcomes in post-lingually deafened adults. METHODS: 298 data points corresponding to fitting parameters and speech audiometry test results for the same number of adult, post-lingually deafened, experienced CI users were analyzed. Correlation analysis was performed, after which parameters from the top-scoring and bottom-scoring tertiles were compared via the Mann-Whitney-Wilcoxon u test. RESULTS: Weak correlations between dynamic range and speech audiometry outcomes were identified, having p values lower than (albeit close to) 0.05. A significant (p < 0.05) difference in electrical dynamic range (the difference between the minimum and maximum amount of current which may be delivered by each electrode) was found, with top-scoring subjects having on average a wider dynamic range. CONCLUSION: The association between dynamic range and speech perception outcomes shown in this retrospective study highlights the need for deeper investigation into evidence-driven fitting. It might be a first step in the direction of evidence-based fitting, minimizing variability in outcomes for cochlear implant users and helping mitigate the issue of unexplained low performance.

Virtual reality simulation of epiretinal stimulation highlights the relevance of the visual angle in prosthetic vision.

OBJECTIVE: Retinal prostheses hold the potential for artificial vision in blind patients suffering from outer retinal dystrophies. The optimal number, density and coverage of the electrodes that a retinal prosthesis should have to provide adequate artificial vision in daily activities is still an open question and an important design parameter needed to develop better implants. APPROACH: To address this question, we investigated the interaction between the visual angle, the pixel number and the pixel density without being limited by a small electrode count. We implemented prosthetic vision in a virtual reality environment in order to simulate the real-life experience of using a retinal prosthesis. We designed four different tasks simulating: object recognition, word reading, perception of a descending step and crossing a street. MAIN RESULTS: The results of our study showed that in all the tasks the visual angle played the most significant role in improving the performance of the participant. SIGNIFICANCE: The design of new retinal prostheses should take into account the relevance of the restored visual angle to provide a helpful and valuable visual aid to profoundly or totally blind patients.