Short-term auditory memory in children using cochlear implants and its relevance to receptive language.

The aim of this study was to assess auditory sequential, short-term-memory (SSTM) performance in young children using cochlear implants (CI group) and to examine the relationship of this performance to receptive language performance. Twenty-four children, 5 to 11 years old, using the Nucleus 22-electrode cochlear implant, were tested on a number of auditory and visual tasks of SSTM. The auditory memory tasks were designed to minimize the effect of auditory discrimination ability. Stimuli were chosen that children with cochlear implants could accurately identify with a reaction time similar to that of a control group of children with normal hearing (NH group). All children were also assessed on a receptive language test and on a nonverbal intelligence scale. As expected, children using cochlear implants demonstrated poorer auditory and visual SSTM skills than their hearing peers when the stimuli were verbal or were pictures that could be readily labeled. They did not differ from their peers with normal hearing on tasks where the stimuli were less likely to be verbally encoded. An important finding was that the CI group did not appear to have a sequential memory deficit specific to the auditory modality. The difference scores (auditory minus visual memory performance) for the CI group were not significantly different from those for the NH group. SSTM performance accounted for significant variance in the receptive language performance of the CI group. However, a forward stepwise regression analysis revealed that visual spatial memory (one of the subtests of the nonverbal IQ test) was the main predictor of variance in the language scores of the children using cochlear implants.

The results in patients implanted with the nucleus double array cochlear implant: pitch discrimination and auditory performance.

OBJECTIVE: In patients with total or surgically inaccessible cochlear obliteration, only a reduced number of active electrodes can be inserted with standard cochlear implants, resulting in below average auditory performance. Therefore, a special implant with two electrode arrays was developed on the basis of the Nucleus 22 cochlear implant, the socalled Double Array. One electrode array with 11 active electrodes is inserted into the basal turn of the cochlea, while the second array with 10 active electrodes is inserted into the second turn. The Double Array is now available on the basis of the more advanced Nucleus 24 with 11 active electrodes on each array and two reference electrodes, one at the case and the second one an additional ball electrode, which is placed under the temporalis muscle. For device description and surgical technique see Lenarz et al. (2001). This paper presents psychophysical data on pitch discrimination and auditory performance of patients implanted with a Double Array on the basis of the Nucleus 22. STUDY DESIGN: A prospective intra-individual study using a Latin square paradigm was performed in six adult patients with obliterated cochlea who received the Nucleus 22 Double Array. After appropriate fitting and loudness balancing, patients were tested either with the basal, the apical or both electrode arrays. Apart from auditory performance tests including numbers and monosyllable word tests, pitch discrimination was determined with a defined procedure. RESULTS: When activating each array alone, auditory performance was better with the basal array than with the apical array. Both arrays together showed marked improvement compared with the basal array, indicating an additional effect of the second array. Pitch discrimination was significantly better for the electrodes in the basal turn than in the second turn, indicating differences in electrical excitation of the auditory nerve fibers. Pitch discrimination was positively correlated with auditory performance data. CONCLUSION: The additional apical array leads to significant improvement in auditory performance in patients with obliterated cochleae by increasing the number of intracochlear electrodes. Despite reduced pitch discrimination, the apical array provides important information for speech recognition. For this reason the Double Array provides a profound advantage for patients with obliterated or surgically inaccessible cochleae.

Electrode impedance in adults and children using the Nucleus 24 cochlear implant system.

This study measured changes in electrode impedance over time in 19 adults and 29 children implanted with the Nucleus 24 cochlear implant system, using common ground and three monopolar modes of stimulation, over a series of time intervals. Impedances increased from the intraoperative to the initial fitting session, decreased during the initial fitting session and for the following week, and were then stable. Impedances were lowest for the common ground mode, while for the monopolar modes, impedances were related to the surface area of the return electrode. Impedances for children were higher than those for adults at the initial fitting session and for the following three weeks. The clinically measured impedance values increased in a basal-to-apical direction. When these data were corrected for differences in electrode surface area, impedances decreased in a basal-to-apical direction. Impedances were influenced by whether the electrodes were stimulated or unstimulated. Adults with higher electrode impedances tended to have lower hearing thresholds and comfortable listening levels, but this did not appear to clearly be the case for children.

Rate-of-processing ability in children using cochlear implants and its relevance to speech perception.

The aim was to assess the ability of young children using cochlear implants to process a change in place of stimulation under conditions of shortened stimulus duration and shortened interstimulus interval. The study investigated whether or not this ability accounted for a significant amount of the variance in the speech performance of the children additional to the variance accounted for by electrode discrimination ability (measured in a previous study). An adaptation of the play audiometry procedure was used to assess 'rate-of-processing' ability in 17 children aged between 4 and 10 years. Initially the child was required to respond with a game-like motor response when a repeating stimulation on a reference electrode 'changed' to a different electrode in relatively 'slow' conditions. The child was then required to respond to the 'change', when the duration of the stimuli and the time interval between the stimuli were decreased. All but one of the children using cochlear implants scored significantly above chance for all conditions of stimulus duration and interstimulus interval assessed. That is, they were able to discriminate place pitch changes when these changes occurred more rapidly in time. A stepwise regression was computed to determine the relative contributions of a number of variables, including rate-of-processing ability, in accounting for variance in the children's speech perception performance (measured in a previous study). Rate-of-processing ability did not account for any variance additional to that accounted for by electrode discrimination ability, which was found to be the most significant predictor of speech perception performance for this group of children in the previous study.

Electrode discrimination by early-deafened subjects using the cochlear limited multiple-electrode cochlear implant.

OBJECTIVE: The aims of this study were to determine whether electrode discrimination by early-deafened subjects using the Cochlear Limited prosthesis varied at different locations on the electrode array, was influenced by the effects of auditory deprivation and experience with electric stimulation, and was related to speech perception. DESIGN: Difference limens for electrode discrimination were measured in 16 early-deafened subjects at three positions on the array: electrodes 18 (apical), 14 (mid), and 8 (basal). Electrodes were stimulated using random variations in current level to minimize the influence of loudness cues. Assessed were correlations between the difference limens, subject variables related to auditory deprivation (age at onset of deafness, duration of deafness, and age at implantation) and auditory experience (duration of implant use and the total time period of auditory experience), and speech perception scores from two closed-set and two open-set tests. RESULTS: The average difference limens across the three positions were less than two electrodes for 75% of subjects, with average limens between 2 and 6.5 electrodes for the remaining 25% of subjects. Significant differences across the three positions were found for 69% of subjects. The average limens and those at the basal position positively correlated with variables related to auditory deprivation, with larger limens for subjects implanted at a later age and with a longer duration of deafness. The average limens and those at the apical position negatively correlated with closed-set speech perception scores, with lower scores for subjects with larger limens, but not with open-set scores. Speech scores also negatively correlated with variables related to auditory deprivation. CONCLUSIONS: These findings showed that early-deafened subjects were generally successful in electrode discrimination although performance varied across the array for over half the subjects. Discrimination performance was influenced by the effects of auditory deprivation, and both electrode discrimination and variables related to auditory deprivation influenced closed-set speech perception.

Pitch estimation by early-deafened subjects using a multiple-electrode cochlear implant.

Numerical estimates of pitch for stimulation of electrodes along the 22-electrode array of the Cochlear Limited cochlear implant were obtained from 18 subjects who became deaf very early in life. Examined were the relationships between subject differences in pitch estimation, subject variables related to auditory deprivation and experience, and speech-perception scores for closed-set monosyllabic words and open-set Bamford-Kowal-Bench (BKB) sentences. Reliability in the estimation procedure was examined by comparing subject performance in pitch estimation with that for loudness estimation for current levels between hearing threshold and comfortable listening level. For 56% of subjects, a tonotopic order of pitch percepts for electrodes on the array was found. A deviant but reliable order of pitch percepts was found for 22% of subjects, and essentially no pitch order was found for the remaining 22% of subjects. Subject differences in pitch estimation were significantly related to the duration of auditory deprivation prior to implantation, with the poorest performance for subjects who had a longer duration of deafness and a later age at implantation. Subjects with no tonotopic order of pitch percepts had the lowest scores for the BKB sentence test, but there were no differences across subjects for monosyllabic words. Performance in pitch estimation for electrodes did not appear to be related to performance in the estimation procedure, as all subjects were successful in loudness estimation for current level.

Electrode discrimination and speech perception in young children using cochlear implants.

OBJECTIVE: The aim was to determine the efficacy of a child-appropriate procedure to assess electrode discrimination ability in young children using cochlear implants and to investigate the relationship of electrode discrimination ability and speech perception performance in children implanted at a young age. DESIGN: An adaptation of the play audiometry procedure was used to assess electrode discrimination in seventeen 4- to 10-yr-old children. The children were required to respond with a game-like motor response when a repeating stimulation on a reference electrode "changed" to a different electrode. They were also assessed on a speech feature discrimination test, a closed-set word recognition test and a nonverbal intelligence task. RESULTS: Sixty-five percent of subjects demonstrated ability to discriminate adjacent electrodes in mid and apical regions of the cochlea, whilst the remaining subjects needed electrode separations of between two and nine electrodes for successful discrimination. In a forward stepwise regression analysis electrode discrimination ability was found to be the strongest factor in accounting for variance in the speech perception scores. Subject variables such as duration of deafness, nonverbal intelligence and implant experience did not significantly account for further variance in the speech perception scores for this group of children. CONCLUSIONS: Electrode discrimination ability was the strongest factor in predicting performance on speech perception measures in a group of children using cochlear implants.

Gap detection by early-deafened cochlear-implant subjects.

Two studies investigating gap-detection thresholds were conducted with cochlear-implant subjects whose onset of profound hearing loss was very early in life. The Cochlear Limited multiple-electrode prosthesis was used. The first study investigated the effects of pulse rate (200, 500, and 1000 pulses/s) and stimulus duration (500 and 1000 ms) on gap thresholds in 15 subjects. Average gap thresholds were 1.8 to 32.1 ms. There was essentially no effect of pulse rate and for almost all subjects, no effect of stimulus duration. For two subjects, performance was poorer for the 1000-ms stimulus duration. The second study investigated the relationships between gap thresholds, subject variables, and speech-perception scores. Data from the first study were combined with those from previous studies [Busby et al., Audiology 31, 95-111 (1992); Tong et al., J. Acoust. Soc. Am. 84, 951-962 (1988)], providing data from 27 subjects. A significant negative correlation was found between age at onset of deafness and gap thresholds and most variability in gap thresholds was for the congenitally deaf subjects. Significant negative correlations were found between gap thresholds and word scores for open-set Bamford-Kowal-Bench (BKB) sentences in the auditory-visual condition and lipreading enhancement scores for the same test.

Studies of prosody perception by cochlear implant patients.

Prosodic information is conveyed to normally-hearing listeners by variations in acoustic fundamental frequency, amplitude envelope, and duration of speech segments. This study measured cochlear implant patients' sensitivity to these parameters in electrically coded speech. The psychophysical discrimination of electric parameters used to code prosodic information, were examined, together with prosody perception using speech processing strategies which modified the contributions of these parameters. Patients were implanted with the Cochlear Limited prosthesis and used the MPEAK speech processing strategy. In the psychophysical studies, difference limens were measured for steady-state and time-varying stimuli, of different pulse rates and pulse durations, over a series of different stimulus durations. These limens were obtained using an adaptive procedure which converged on the 50 per cent correct point. In the prosody perception studies, performance was measured for the MPEAK strategy and for strategies which modified the contributions of pulse rate and pulse duration. Data were collected for five tests of prosodic contrasts. Difference limens for steady-state pulse rates were larger at higher rates (17 per cent at 400 pulses/s) than at lower rates (6 per cent at 100 pulses/s). For some patients, limens for the time-varying pulse rates were larger than those for the steady-state pulse rates while for the other patients, the limens were similar. Difference limens for pulse duration were 0.3 dB, corresponding to 4 per cent of the dynamic range, for steady-state stimuli and doubled in size for the time-varying stimuli. Prosody perception performance was generally poorer for the modified strategies than for the MPEAK strategy, suggesting that the removal of information coded by pulse rate and pulse duration reduced the perception of prosodic contrasts.

Modulation detection interference in cochlear implant subjects.

The aim of this study was to determine whether detection thresholds for amplitude modulated signals on a single electrode were influenced by a masking modulation on a second electrode in cochlear implant users. Data were collected from four post-linguistically deafened subjects using the Cochlear Limited prosthesis. Investigated were the effects of the spatial separation between test and masker electrodes, 0 to 5 electrodes (0 to 3.75 mm), and the amount of masking modulation: 24%, 48%, 72%, and 96% above detection thresholds. Initially, modulation detection thresholds for stimulation on a single electrode without masking modulation were obtained for a set of six electrodes in the middle of the array. Modulation detection thresholds on a fixed test electrode were then obtained with unmodulated and modulated masking on a second electrode, which was one of the six electrodes in the initial study. In both studies, thresholds were measured for modulated pulse duration at the modulation frequencies of 10-200 Hz. In the first study, the shape of the detection thresholds as a function of modulation frequency, the temporal modulation transfer function, generally resembled a low-pass filter for two subjects. For the other two subjects, the functions were relatively flat across modulation frequencies. In the second study, unmodulated masking resulted in a small elevation in detection thresholds across electrodes. Modulation detection interference (MDI), the difference between thresholds for the modulated maskers and the unmodulated masker, was greater for larger amounts of masking modulation than for smaller amounts of masking modulation. For three of the four subjects, MDI was higher for smaller spatial separations between the two electrodes than for larger spatial separations suggesting that a portion of MDI may be due to overlap of neural excitation distributions produced by stimulation on two electrodes in close proximity on the array.

Pitch and loudness estimation for single and multiple pulse per period electric pulse rates by cochlear implant patients.

Numerical estimates of loudness and pitch for electric pulse rates were obtained from 14 patients using the 22 electrode cochlear implant manufactured by Cochlear Limited. Six patients were postlinguistically deafened adults, and eight patients were adults and children who became deaf very early in life. Comparisons were made between two types of pulse rate patterns. The SPP pulse pattern presented a single pulse every period, the inverse of the pulse rate. The MPP pulse pattern presented multiple pulses in the first half of the period, using a rate of 1000 pulses/s, with no stimulation in the second half of the period. The pulse rates used for the SPP and MPP pulse patterns were 71.4-500 pulses/s, which corresponded to periods of 14-2 ms. For the SPP pulse pattern, the total number of pulses over the duration of the stimulus increased with increases in pulse rate, while for the MPP pulse pattern, the total number of pulses remained constant. Pitch and loudness estimates were obtained from the postlinguistically deafened patients for the SPP and MPP pulse patterns, and from the early-deafened patients for the MPP pulse pattern. Loudness estimates for the SPP pulse pattern increased with increases in pulse rate for all postlinguistically deafened patients. Loudness estimates for the MPP pulse pattern decreased with increases in pulse rate for three of the six postlinguistically deafened patients and for six of the eight early-deafened patients. For the other patients (three postlinguistically deafened and two early-deafened), loudness estimates marginally increased with increases in pulse rate. Pitch estimates for the SPP and MPP pulse patterns increased with increases in pulse rate for the six postlinguistically deafened patients. For the early-deafened patients, pitch estimates for the MPP pulse patterns increased with increases in pulse rate for only five of the eight patients. For the other three early-deafened patients, pitch estimates were similar to the loudness estimates and decreased with increases in pulse rate.

Cochlear implant place psychophysics 1. Pitch estimation with deeply inserted electrodes.

Numerical estimation of pitch was performed by 8 adult subjects implanted with cochlear prostheses manufactured by Cochlear Limited. The electrode arrays had been inserted into the scale tympani to between one and one and a half turns of the cochlea. Using bipolar stimulation, the pitch estimates for each subjects showed an overall reduction with insertion depth of the stimulated electrode. However, for several subjects, after decreasing regularly for the more basal electrodes, pitch estimates showed an abrupt decrease, followed in some cases by a region of low pitch. Two of the subjects, implanted with a modified electrode array, the '20 + 2' which allowed monopolar in addition to bipolar stimulation, exhibited an abrupt decrease in pitch estimate with bipolar but not with monopolar stimulation. In these two subjects, for stimulating electrodes inserted more deeply than about three quarters of a turn, bipolar stimuli produced lower pitch sensations, and presumably more apical neural excitation patterns, than monopolar stimuli.

Cochlear implant place psychophysics. 2. Comparison of forward masking and pitch estimation data.

Results for forward masking and numerical estimation of pitch were compared in a group of 6 adult subjects implanted with cochlear prostheses manufactured by Cochlear Limited. Data were collected for bipolar + 1 stimulation in all subjects, and for stimulation in one other mode, either common ground or monopolar, for all subjects but one. The pitch data show various irregularities and in each case can be seen to be broadly consistent with the corresponding forward masking data. It is shown that a 'centre of gravity' of the forward masking distribution varies with masker electrode in a manner that is qualitatively very similar to the variation of pitch estimate. It is suggested that, while pitch estimation results are consistent with those from forward masking, the latter contain more detailed information that may be useful in understanding intersubject variations in speech comprehension.

Electrode discrimination by early-deafened cochlear implant patients.

Electrode discrimination was measured in six cochlear-implant patients who became profoundly deaf prior to the full development of auditory and speech skills. The cochlear implant manufactured by Cochlear Limited was used. Comparisons were made between two electric stimulation paradigms and two data collection procedures. The paradigms consisted of electrode trajectories and electrodes with random variation in electric current levels. The data collection methods consisted of an adaptive procedure to obtain difference limens and a method of constant stimuli that gives psychometric functions of discrimination performance. Data were collected for reference electrodes at the apical, mid, and basal positions on the array. The psychometric functions showed that discrimination performance improved with increases in the spatial separation between reference and comparison electrodes. The difference limens were similar to the corresponding spatial separation estimated from the psychometric function in most cases. The discrimination performance of most patients was consistent across the two stimulation paradigms. Difference limens were 1-4 electrodes from the reference electrode for most patients. There were differences in performance across patients and the three positions on the array.

A clinical report on speech production of cochlear implant users.

OBJECTIVE: The aim was to assess articulation and speech intelligibility over time in a group of cochlear implant users implanted at 8 yr or over. The hypothesis was that the postoperative speech production performance would be greater than the preoperative performance. DESIGN: A test of intelligibility using sentences and an articulation test measuring non-imitative elicited speech were administered to 11 and 10 subjects, respectively, who were implanted with the 22-electrode cochlear implant. Nine subjects received both tests. Age at implantation ranged from 8 yr to 20 yr and implant use ranged from 1 yr to 4 yr 5 mo. RESULTS: For both the intelligibility and articulation tests roughly half of the subjects showed significant improvements over time and group mean postoperative performance significantly exceeded preoperative performance. Improvements occurred for front, middle, and back consonants; for stops, fricatives, and glides and for voiceless and voiced consonants. CONCLUSIONS: Despite being deprived of acoustic speech information for many childhood years, roughly half of the patients assessed showed significant gains in speech intelligibility and articulation postimplantation. The lack of a control group of non-implanted patients means that we cannot separate out the influence of the implant on speech production from other influences such as training and tactile-kinaesthetic feedback.

Formant frequency values of vowels produced by preadolescent boys and girls.

The fundamental frequency (F0) and the first three formant frequency (F1, F2, and F3) values of vowels produced by 40 preadolescents were measured. There were five boys and five girls in each of four age groups: 5, 7, 9, and 11 years old. The 11 nondiphthong vowels of Australian English which can be produced in a stressed syllable were used. The F0 values decreased with increases in age, but there was no difference between boys and girls. In general, the F1, F2, and F3 values decreased with increases in age, and the values for girls were higher than those for boys.

Pitch perception for different modes of stimulation using the cochlear multiple-electrode prosthesis.

Numerical estimations of pitch were obtained from nine postlinguistically deafened adults using the 22-electrode cochlear implant manufactured by Cochlear Pty. Limited. A series of electrodes on the array were stimulated using three modes of stimulation: Bipolar (BP), common ground (CG), and monopolar (MONO). In BP stimulation, an electric current was passed between two electrodes separated by one electrode for eight patients and two electrodes for one patient. In CG stimulation, a single electrode was activated and the other electrodes on the array were connected together to serve as the return path for the current. In MONO stimulation, an electric current was passed between a single electrode and the most basal electrode on the array. Pitch estimations were generally consistent with the tonotopic organization of the cochlea. There was a marked reversal in pitch for electrodes in the middle of the array using CG stimulation for three patients. A reduced range of pitch using MONO stimulation was recorded for patients where the most basal electrode was internal to the cochlea. There were also individual differences in pitch estimations between the three modes of stimulation for most patients. The current levels required to elicit threshold (T) and comfortable listening (C) levels were, in general, higher for BP stimulation than for CG stimulation and were lowest for MONO stimulation. For CG stimulation, there was a tendency for T and C levels to be higher for electrodes in the middle of the array than at the basal or apical ends. For MONO stimulation, T and C levels uniformly increased in an apical to basal direction for the majority of patients. There was no consistent pattern in T and C levels for BP stimulation. The size of the range of usable hearing using CG stimulation tended to be similar to that using BP stimulation and was usually higher than that using MONO stimulation.

The effects of auditory feedback from the nucleus cochlear implant on the vowel formant frequencies produced by children and adults.

Cochlear implants provide an auditory signal with which profoundly deaf users may monitor their own speech production. The vowel production of two adults and three children who used the Nucleus multiple-electrode cochlear implant was examined to assess the effect of altered auditory feedback. Productions of words were recorded under conditions where the talkers received auditory feedback (speech processor turned on) and where no auditory feedback was provided (speech processor turned off). Data were collected over 3 days at weekly intervals. First and second formant frequencies were measured and the data were analysed to assess significant differences between auditory feedback conditions, vowel context, and data collection points. Overall, the results varied across talkers, across the data collection days, and depended on the consonant environment of the vowel. However, two effects of auditory feedback were noted. First, there was a generalized shift in first formant frequencies between the processor on and processor off conditions across three of the five subjects, but the shift differed in direction for each subject. Second, for three of the five talkers, the two front vowels /epsilon/ and /i/ were more neutralised in the absence of auditory feedback. However, this effect was less pronounced than that noted by previous studies.

The perception of temporal modulations by cochlear implant patients.

The perception of temporal modulations of pulsatile electric stimuli was measured in seven cochlear implant patients using the Cochlear Pty. Limited prosthesis. Four patients were postlingually deafened adults and three patients were young adults who were deafened very early in life. The first study measured detection thresholds for modulated pulse duration for a series of modulation frequencies and pulse rates. The shape of the detection thresholds as a function of modulation frequency, the temporal modulation transfer function, often resembled a low-pass filter with a 50-100-Hz cut-off frequency. Thresholds did not markedly vary across the different pulse rates for most patients. Thresholds were less than 10%-20% of the range of usable hearing for most patients. The second study compared detection thresholds for modulated pulse durations around different reference pulse durations: 50, 100, and 300 microseconds. Detection thresholds were generally proportional to the different reference pulse durations. The third study measured difference limens for the discrimination of modulation depth. The difference limens were similar to the detection thresholds for the same reference pulse duration and pulse rate. The three patients deafened very early in life showed more within-group variation in performance, and their overall levels of performance were poorer than those of the postlingually deafened adults.

Electrode position, repetition rate, and speech perception by early- and late-deafened cochlear implant patients.

Psychophysical and speech perception studies were conducted on eight patients using the 22-electrode cochlear implant manufactured by Cochlear Pty. Ltd. Four early-deafened patients became deafened at 1-3 years of age and were implanted at 5-14 years of age. Four late-deafened (postlingual adult) patients became deafened at 38-47 years of age and were implanted at 42-68 years of age. Psychophysical studies measured the discrimination of trajectories with time-varying electrode positions and repetition rates. Speech perception studies measured performance using two speech coding strategies: a multi-electrode strategy which coded the first and second formant frequencies, the amplitudes of the two formants, and the fundamental frequency; and a single-electrode strategy which coded the amplitudes of the first and second formants, and the fundamental frequency. In general, the four late-deafened patients and one early-deafened patient were more successful than the other three early-deafened patients in the discrimination of electrode position trajectories and in speech perception using the multi-electrode strategy. Three of the four late-deafened patients were more successful than the early-deafened patients in the discrimination of repetition rate trajectories. Speech perception performance in the single-electrode strategy was closely related to performance in repetition rate discrimination. The improvement in speech perception performance from the single-electrode to multi-electrode strategy was consistent with successful performance in electrode discrimination.