Monopolar Electrosurgery With Cochlear Implants.

OBJECTIVE: To evaluate safety of monopolar electrosurgery (MES) in patients with cochlear implants (CIs) by reporting outcomes of a series of patients who underwent MES after CI. STUDY DESIGN: Retrospective case series. SETTING: Tertiary referral center. PATIENTS: Patients with indwelling CI subsequently undergoing surgery with operative note specifically detailing MES use. MAIN OUTCOME MEASURES: Adverse outcomes in post-operative audiology/otolaryngology documentation; speech recognition scores. RESULTS: Thirty-five patients (10 with bilateral CI) experienced 63 unique MES exposure events, 85.7% below and 14.3% above the clavicle. No adverse events or decreased performance due to MES use were reported for any patient. Pre- and immediate postoperative speech recognition scores were not significantly different for patients using either consonant-nucleus-consonant (CNC; n = 23, 68%-66%, p = 0.80) or AzBio (n = 15, 82%-88%, p = 0.60). For individual CNC performance, 21 (91%) patients demonstrated stability, 1 improved >15%, and 1 declined >15%, although this patient had become a non-user due to magnet issues and, after resolution of these issues, exceeded baseline pre-operative score. For individual AzBio performance, 12 (80%) patients demonstrated stability, 3 improved >15%, and none declined >15%. CONCLUSIONS: No adverse events resulted from MES use in CI patients. Given the increased prevalence and expansion of indications for CIs, and widespread utility of MES, we suggest clarification and improved guidance from device manufacturers regarding safety and use of MES for patients with these devices. We hope that data regarding electrosurgery exposure events will better inform clinician decision-making with regards to relative benefits and risks for MES use for CI patients. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:933-937, 2023.

Cochlear Implantation: Systematic Approach to Preoperative Radiologic Evaluation.

Sensorineural hearing loss results from abnormalities that affect the hair cells of the membranous labyrinth, inner ear malformations, and conditions affecting the auditory pathway from the cochlear nerve to the processing centers of the brain. Cochlear implantation is increasingly being performed for hearing rehabilitation owing to expanding indications and a growing number of children and adults with sensorineural hearing loss. An adequate understanding of the temporal bone anatomy and diseases that affect the inner ear is paramount for alerting the operating surgeon about variants and imaging findings that can influence the surgical technique, affect the choice of cochlear implant and electrode type, and help avoid inadvertent complications. In this article, imaging protocols for sensorineural hearing loss and the normal inner ear anatomy are reviewed, with a brief description of cochlear implant devices and surgical techniques. In addition, congenital inner ear malformations and acquired causes of sensorineural hearing loss are discussed, with a focus on imaging findings that may affect surgical planning and outcomes. The anatomic factors and variations that are associated with surgical challenges and may predispose patients to periprocedural complications also are highlighted. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article.

Relationship between electrically evoked compound action potential thresholds and behavioral T-levels in implanted children with cochlear nerve deficiency.

It is challenging to program children with cochlear nerve deficiency (CND) due to limited auditory and speech abilities or concurrent neurological deficits. Electrically evoked compound action potential (ECAP) thresholds have been widely used by many audiologists to help cochlear implant programming for children who cannot cooperate with behavioral testing. However, the relationship between ECAP thresholds and behavioral levels of cochlear nerve in children with CND remains unclear. This study aimed to investigate how well ECAP thresholds are related to behavioral thresholds in the MAP for children with CND. This study included 29 children with CND who underwent cochlear implantation. For each participant, ECAP thresholds and behavioral T-levels were measured at three electrode locations across the electrode array post-activation. The relationship between ECAP thresholds and behavioral T-levels was analyzed using Pearson's correlation coefficient. The results showed that ECAP thresholds were significantly correlated with behavioral T-levels at the basal, middle, and apical electrodes. ECAP thresholds were equal to or higher than the behavioral T-levels for all tested electrodes, and fell within MAP's dynamic range for approximately 90% of the tested electrodes. Moreover, the contour of the ECAP thresholds was similar to the contour of T-levels across electrodes for most participants. ECAP thresholds can help audiologists select stimulation levels more efficiently for children with CND who cannot provide sufficient behavioral response.

Cochlear implant in tinnitus management.

PURPOSE OF REVIEW: To evaluate whether cochlear implantation can mitigate tinnitus perception and its discomfort among patients with severe-to-profound hearing loss, in order to provide an answer on a possible treatment for a health condition with high prevalence and impact on quality of life. RECENT FINDINGS: Tinnitus can develop after peripheral hearing loss and is associated with altered auditory processing. It does not only involve auditory structures but also aberrant neural activity and interaction with other regions of the Central Nervous System associated with emotion, attention, anguish, memory and motor activity. SUMMARY: Recent studies investigated the changes in tinnitus perception among patients who underwent cochlear implantation and demonstrated a postoperative decrease. Hence, patients with severe-to-profound sensorineural hearing loss and tinnitus are likely to benefit from cochlear implantation.

The impact of the COVID-19 pandemic on rehabilitation services provided for cochlear implant recipients in Saudi Arabia.

OBJECTIVE: This study examines the impact of the COVID-19 pandemic on cochlear implantation (CI) recipients in Saudi Arabia. The impact was measured using the results of an online survey that investigated challenges related to access to re/habilitation and programming services, increased dependence on virtual interaction, and emotional impact. METHODS: The cross-sectional online survey reached 353 pediatric and adult CI recipients between April 21st and May 3rd 2020, during the first weeks of implementing the lockdown strategy and the transitioning to virtual settings. RESULTS: It was revealed that overall access to aural re/habilitation was considerably affected during the pandemic, and that the impact of this disruption was significantly greater for pediatric recipients than for adults. On the other hand, overall access to programming services was not affected. Results also revealed that CI recipients' performance at school or work was negatively impacted by the transition to a virtual communication. In addition, participants noticed a decline in their auditory performance, language skills, and speech understanding. They also registered feelings of anxiety, social isolation, and fear related to sudden changes in their CI function. Finally, the study revealed a gap between CI clinical/non-clinical support provided during the pandemic and the expectations of CI recipients. CONCLUSION: Collectively, outcomes from this study highlight the importance of shifting towards a more patient -centered model that offers empowerment and self-advocacy. In addition, the outcomes also emphasize the importance of developing and adapting emergency protocols. This will ensure continuation of services provided to CI recipients during scenario disasters like a pandemic.Key messagesPediatric aural re/habilitation was subjected to a significantly greater interruption, compared to adult aural re/habilitation, duringthe COVID-19 shutdown.Cochlear Implant (CI) recipients expressed feelings of anxiety, social isolation, and fear. These feelings were related to sudden changes in their CI functioning, caused by interruption of support services during the pandemic.Patient -centered model can offer emergency protocols that ensure a smooth continuation of cochlear implant-related re/habilitation and services during disaster scenarios such as the COVID-19 pandemic.

Interaural time difference sensitivity under binaural cochlear implant stimulation persists at high pulse rates up to 900 pps.

Spatial hearing remains one of the major challenges for bilateral cochlear implant (biCI) users, and early deaf patients in particular are often completely insensitive to interaural time differences (ITDs) delivered through biCIs. One popular hypothesis is that this may be due to a lack of early binaural experience. However, we have recently shown that neonatally deafened rats fitted with biCIs in adulthood quickly learn to discriminate ITDs as well as their normal hearing litter mates, and perform an order of magnitude better than human biCI users. Our unique behaving biCI rat model allows us to investigate other possible limiting factors of prosthetic binaural hearing, such as the effect of stimulus pulse rate and envelope shape. Previous work has indicated that ITD sensitivity may decline substantially at the high pulse rates often used in clinical practice. We therefore measured behavioral ITD thresholds in neonatally deafened, adult implanted biCI rats to pulse trains of 50, 300, 900 and 1800 pulses per second (pps), with either rectangular or Hanning window envelopes. Our rats exhibited very high sensitivity to ITDs at pulse rates up to 900 pps for both envelope shapes, similar to those in common clinical use. However, ITD sensitivity declined to near zero at 1800 pps, for both Hanning and rectangular windowed pulse trains. Current clinical cochlear implant (CI) processors are often set to pulse rates ≥ 900 pps, but ITD sensitivity in human CI listeners has been reported to decline sharply above ~ 300 pps. Our results suggest that the relatively poor ITD sensitivity seen at > 300 pps in human CI users may not reflect the hard upper limit of biCI ITD performance in the mammalian auditory pathway. Perhaps with training or better CI strategies good binaural hearing may be achievable at pulse rates high enough to allow good sampling of speech envelopes while delivering usable ITDs.

Familiar and unfamiliar speaker recognition assessment and system emulation for cochlear implant users.

In the area of speech processing, human speaker identification under naturalistic environments is a challenging task, especially for hearing-impaired individuals with cochlear implants (CIs) or hearing aids (HAs). Motivated by the fact that electrodograms reflect direct CI stimulation of input audio, this study proposes a speaker identification (ID) investigation using two-dimensional electrodograms constructed from the responses of a CI auditory system to emulate CI speaker ID capabilities. Features are extracted from electrodograms through an identity vector (i-vector) framework to train and generate identity models for each speaker using a Gaussian mixture model-universal background model followed by probabilistic linear discriminant analysis. To validate the proposed system, perceptual speaker ID for 20 normal hearing (NH) and seven CI listeners was evaluated with a total of 41 different speakers and compared with the scores from the proposed system. A one-way analysis of variance showed that the proposed system can reliably predict the speaker ID capability of CI (F[1,10] = 0.18, p = 0.68) and NH (F[1,20] = 0, p = 0.98) listeners in naturalistic environments. The impact of speaker familiarity is also addressed, and the results show a reduced performance for speaker recognition by CI subjects using their CI processor, highlighting limitations of current speech processing strategies used in CIs/HAs.

A subjective evaluation of different music preprocessing approaches in cochlear implant listeners.

Cochlear implants (CIs) can partially restore speech perception to relatively high levels in listeners with moderate to profound hearing loss. However, for most CI listeners, the perception and enjoyment of music remains notably poor. Since a number of technical and physiological restrictions of current implant designs cannot be easily overcome, a number of preprocessing methods for music signals have been proposed recently. They aim to emphasize the leading voice and rhythmic elements and to reduce their spectral complexity. In this study, CI listeners evaluated five remixing approaches in comparison to unprocessed signals. To identify potential explaining factors of CI preference ratings, different signal quality criteria of the processed signals were additionally assessed by normal-hearing listeners. Additional factors were investigated based on instrumental signal-level features. For three preprocessing methods, a significant improvement over the unprocessed reference was found. Especially, two deep neural network-based remix strategies proved to enhance music perception in CI listeners. These strategies provide remixes of the respective harmonic and percussive signal components of the four source stems "vocals," "bass," "drums," and "other accompaniment." Moreover, the results demonstrate that CI listeners prefer an attenuation of sustained components of drum source signals.

Revision cochlear implant surgery for clinical reasons.

Objective: To report the authors' experience in a series of patients treated with cochlear implant (CI) revision surgery due to medical problems. Methods: Revision CI surgeries performed in a tertiary referral centre for medical reasons not related to skin conditions were reviewed; patients were included if device removal was required. Results: 17 cochlear implant patients were reviewed. The main reasons requiring revision surgery with device removal were: retraction pocket/iatrogenic cholesteatoma (6/17), chronic otitis (3/17), extrusion in previous canal wall down procedures (2/17) or in previous subtotal petrosectomy (2/17), misplacement/partial array insertion (2/17) and residual petrous bone cholesteatoma (2/17). In all cases surgery was performed through a subtotal petrosectomy. Cochlear fibrosis/ossification of the basal turn was found in 5 cases and uncovered mastoid portion of the facial nerve in 3 patients. The only complication was an abdominal seroma. A positive difference was observed between the number of active electrodes and comfort levels before and after revision surgery. Conclusions: In CI revision surgeries performed for medical reasons, subtotal petrosectomy offers invaluable advantages and should be considered as first choice during surgical planning.

Ten-year follow-up of auditory brainstem implants: From intra-operative electrical auditory brainstem responses to perceptual results.

The auditory brainstem implant (ABI) can provide hearing sensation to individuals where the auditory nerve is damaged. However, patient outcomes with the ABI are typically much poorer than those for cochlear implant recipients. A major limitation to ABI outcomes is the number of implanted electrodes that can produce auditory responses to electric stimulation. One of the greatest challenges in ABI surgery is the intraoperative positioning of the electrode paddle, which must fit snugly within the cochlear nucleus complex. While there presently is no optimal procedure for intraoperative electrode positioning, intraoperative assessments may provide useful information regarding viable electrodes that may be included in patients' clinical speech processors. Currently, there is limited knowledge regarding the relationship between intraoperative data and post-operative outcomes. Furthermore, the relationship between initial ABI stimulation with and long-term perceptual outcomes is unknown. In this retrospective study, we reviewed intraoperative electrophysiological data from 24 ABI patients (16 adults and 8 children) obtained with two stimulation approaches that differed in terms of neural recruitment. The interoperative electrophysiological recordings were used to estimate the number of viable electrodes and were compared to the number of activated electrodes at initial clinical fitting. Regardless of the stimulation approach, the intraoperative estimate of viable electrodes greatly overestimated the number of active electrodes in the clinical map. The number of active electrodes was associated with long-term perceptual outcomes. Among patients with 10-year follow-up, at least 11/21 active electrodes were needed to support good word detection and closed-set recognition and 14/21 electrodes to support good open-set word and sentence recognition. Perceptual outcomes were better for children than for adults, despite a lower number of active electrodes.

A cortical biomarker of audibility and processing efficacy in children with single-sided deafness using a cochlear implant.

The goals of the current study were to evaluate audibility and cortical speech processing, and to provide insight into binaural processing in children with single-sided deafness (CHwSSD) using a cochlear implant (CI). The P1 potential to acoustically-presented speech stimuli (/m/, /g/, /t/) was recorded during monaural [Normal hearing (NH), CI], and bilateral (BIL, NH + CI) listening conditions within a clinical setting in 22 CHwSSD (mean age at CI/testing 4.7, 5.7 years). Robust P1 potentials were elicited in all children in the NH and BIL conditions. In the CI condition: (1) P1 prevalence was reduced yet was elicited in all but one child to at least one stimulus; (2) P1 latency was prolonged and amplitude was reduced, consequently leading to absence of binaural processing manifestations; (3) Correlation between P1 latency and age at CI/testing was weak and not significant; (4) P1 prevalence for /m/ was reduced and associated with CI manufacturer and duration of CI use. Results indicate that recording CAEPs to speech stimuli in clinical settings is feasible and valuable for the management of CHwSSD. While CAEPs provided evidence for effective audibility, a substantial mismatch in timing and synchrony of early-stage cortical processing between the CI and NH ear remains a barrier for the development of binaural interaction components.

Electrically evoked mismatch negativity responses to loudness and pitch cues in cochlear implant users.

Objective measurements could improve cochlear implant (CI) fitting, especially for CI users who have difficulty assessing their hearing impressions. In this study, we investigated the electrically evoked mismatch negativity (eMMN) brain potential as a mainly preattentive response to pitch and loudness changes. In an electrophysiological exploratory study with 21 CI users, pitch and loudness cues were presented in controlled oddball paradigms that directly electrically stimulated the CI via software. Out of them 17 valid data sets were analyzed. A pitch cue was produced by changing the stimulating CI electrodes (pairs of adjacent electrodes). A loudness cue originated from changing the stimulation amplitude on one CI electrode. MMN responses were measured unsing clinical electroencephalography recording according to a standard recording protocol. At the group level, significant eMMN responses were elicited for loudness cues and for pitch cues at basal electrode pairs but not at apical electrode pairs. The effect of deviance direction was not significant and no stimulus artifacts were observed. Recording an electrically evoked MMN in response to loudness changes in CI users is generally feasible, and is, therefore, promising to support CI fitting procedures in the future. Detection of pitch cues would require a greater electrode distance between selected electrodes for standard and deviant stimuli, especially in apical regions. A routine clinical setup can be used to measure eMMN.

A longitudinal study of cortical auditory maturation and implications of the short inter-implant delay in children with bilateral sequential cochlear implants.

OBJECTIVE: This longitudinal study aimed to investigate the maturational development of P1 latency and the effects of a short inter-implant delay in children who received bilateral sequential cochlear implants. MATERIALS AND METHODS: Fourteen children (first CI mean age: 1.4 ± 0.4 years and Second CI mean age: 3.3 ± 0.5 years) who had received sequential bilateral cochlear implants during the sensitive period for auditory maturation participated in our study. The speech-evoked cortical P1 response was recorded after the activation of the second CI at four intervals (implant activation, 3 months, 6 months, 12 months) under three listening conditions (first CI, second CI, binaural). RESULTS: Our results showed that the P1 latencies of the second CI reached normative values within 3 months, but did not reach the P1 latency of the first CI until 12 months. We found a strong negative correlation between the inter-implant delay and the P1 latencies of the second CI when the second CI was activated. CONCLUSION: Changes in cortical auditory responses over time resulted in normal auditory maturation in children with sequential bilateral cochlear implants during the sensitive period. The results also provide evidence that the timing of auditory experience in the first ear during the sensitive period may influence the speed of compensation in children receiving sequential cochlear implants.

Pediatric cochlear implant explantation and reimplantation over a 32-year period.

OBJECTIVES: Cochlear implantation is indicated for pediatric patients with bilateral severe to profound sensorineural hearing loss. The literature reports large variability in cochlear implant (CI) device survival and rates of explantation and reimplantation. This retrospective chart review summarizes CI survival and rates of explantation and reimplantation in pediatric CI recipients at a Canadian tertiary pediatric hospital over 32 years. METHODS: A retrospective chart review of all pediatric patients who received a Cochlear Corporation® CI between April 1988 and June 2020 was undertaken. Rates of explantation/reimplantation were collected and categorized based on device type and reason for failure (medical, device, and inconclusive failure). Device survival analysis based on implant model was also completed utilizing Kaplan-Meier curves. RESULTS: 512 CIs were implanted over the 32-year period by four surgeons (77.1%, 18.16%, 4.49%, and 0.20%, respectively). Patient age ranged from seven months to 20.4 years. The overall explantation and reimplantation rate was 3.32% (17/512 implants), with seven as a result of device failure (1.37%), nine events of medical failure (1.76%), and one inconclusive failure (0.20%). Cumulative CI survival rates at 5, 10, 15, and 20 years were 98.15%, 96.33%, 95.53%, and 94.39%. CONCLUSION: The overall institutional CI failure, explantation, and reimplantation rates are lower than the average reported rates in the literature.

Recognition of Sentences With Complex Syntax in Speech Babble by Adolescents With Normal Hearing or Cochlear Implants.

PURPOSE: General language abilities of children with cochlear implants have been thoroughly investigated, especially at young ages, but far less is known about how well they process language in real-world settings, especially in higher grades. This study addressed this gap in knowledge by examining recognition of sentences with complex syntactic structures in backgrounds of speech babble by adolescents with cochlear implants, and peers with normal hearing. DESIGN: Two experiments were conducted. First, new materials were developed using young adults with normal hearing as the normative sample, creating a corpus of sentences with controlled, but complex syntactic structures presented in three kinds of babble that varied in voice gender and number of talkers. Second, recognition by adolescents with normal hearing or cochlear implants was examined for these new materials and for sentence materials used with these adolescents at younger ages. Analyses addressed three objectives: (1) to assess the stability of speech recognition across a multiyear age range, (2) to evaluate speech recognition of sentences with complex syntax in babble, and (3) to explore how bottom-up and top-down mechanisms account for performance under these conditions. RESULTS: Results showed: (1) Recognition was stable across the ages of 10-14 years for both groups. (2) Adolescents with normal hearing performed similarly to young adults with normal hearing, showing effects of syntactic complexity and background babble; adolescents with cochlear implants showed poorer recognition overall, and diminished effects of both factors. (3) Top-down language and working memory primarily explained recognition for adolescents with normal hearing, but the bottom-up process of perceptual organization primarily explained recognition for adolescents with cochlear implants. CONCLUSIONS: Comprehension of language in real-world settings relies on different mechanisms for adolescents with cochlear implants than for adolescents with normal hearing. A novel finding was that perceptual organization is a critical factor. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21965228.

Anatomically and mechanically accurate scala tympani model for electrode insertion studies.

The risk of insertion trauma in cochlear implantation is determined by the interplay between individual cochlear anatomy and electrode insertion mechanics. Whereas patient anatomy cannot be changed, new surgical techniques, devices for cochlear monitoring, drugs, and electrode array designs are continuously being developed and tested, to optimize the insertion mechanics and prevent trauma. Preclinical testing of these developments is a crucial step in feasibility testing and optimization for clinical application. Human cadaveric specimens allow for the best simulation of an intraoperative setting. However, their availability is limited and it is not possible to conduct repeated, controlled experiments on the same sample. A variety of artificial cochlear models have been developed for electrode insertion studies, but none of them were both anatomically and mechanically representative for surgical insertion into an individual cochlea. In this study, we developed anatomically representative models of the scala tympani for surgical insertion through the round window, based on microCT images of individual human cochleae. The models were produced in transparent material using commonly-available 3D printing technology at a desired scale. The anatomical and mechanical accuracy of the produced models was validated by comparison with human cadaveric cochleae. Mechanical evaluation was performed by recording insertion forces, counting the number of inserted electrodes and grading tactile feedback during manual insertion of a straight electrode by experienced cochlear implant surgeons. Our results demonstrated that the developed models were highly representative for the anatomy of the original cochleae and for the insertion mechanics in human cadaveric cochleae. The individual anatomy of the produced models had a significant impact on the insertion mechanics. The described models have a promising potential to accelerate preclinical development and testing of atraumatic insertion techniques, reducing the need for human cadaveric material. In addition, realistic models of the cochlea can be used for surgical training and preoperative planning of patient-tailored cochlear implantation surgery.

The effect of SLC26A4 gene mutations on long-term rehabilitative outcomes in cochlear implant patients.

BACKGROUND: SLC26A4 gene mutations related to hearing loss patients can obtain good hearing and speech rehabilitation effects after cochlear implantation (CI). OBJECTIVE: To explore the long-term rehabilitative outcomes of CI in patients with different SLC26A4 mutation groups. MATERIAL AND METHODS: Clinical data of 71 patients with SLC26A4 gene mutations who received CI in the Second Hospital of Lanzhou University from 2012 to 2015 were retrospectively reviewed. According to the genetic test results, use One-way ANOVA analysis to compare the differences in auditory results, categories of auditory performance (CAP) and speech intelligibility rating (SIR) index questionnaire scores and speech recognition rates among different groups in 4-5 years after CI. RESULT: Compared with other genotypes of SLC26A4, the patients with homozygous mutation of c.919-2A > G in SLC26A4 had better hearing aid threshold at 500 Hz and better recognition rates of Yangyang words than other monoallelic mutation groups after CI (p < .05). CONCLUSIONS AND SIGNIFICANCE: The most common hot spot mutation of SLC26A4 gene is c.919-2A > G. The patients with homozygous mutation of c.919-2A > G in SLC26A4 gene had partly better hearing and speech rehabilitation than other monoallelic mutation groups after CI.

Cochlear implantation in a patient with congenital microtia, cochlear hypoplasia, venous anomalies of the temporal bone and laryngomalacia: Challenges and surgical considerations.

RATIONALE AND PATIENT CONCERNS: Congenital hearing loss is often caused by an inner ear malformation, in such cases, the presence of other anomalies, such as microtia, and venous anomalies of the temporal bone and laryngomalacia makes it challenging to perform cochlear implantation surgery. DIAGNOSES: This study reports the case of a 28-month-old girl with congenital profound hearing loss, laryngomalacia, and malformed inner ear, who received cochlear implantation surgery. The bony structure, vessels and nerves were first assessed through magnetic resonance imaging and computed tomography before exploring the genetic basis of the condition using trio-based whole exome sequencing. Perioperative evaluation and management of the airway was then performed by experienced anesthesiologist, with the surgical challenges as well as problems encountered fully evaluated. INTERVENTIONS: Cochlear implantation was eventually performed using a trans-mastoid approach under uneventful general anesthesia. OUTCOMES: Due to the small size of the cochlea, a short electrode FLEX24 was inserted through the cochleostomy. LESSONS: Considering the high risk of facial nerve injury and limited access to the cochlea when patients present significant bony and venous anomalies, cochlear implantation in such patients require careful preoperative evaluation and thoughtful planning. In these cases, airway assessment, magnetic resonance venography, magnetic resonance arteriography, and magnetic resonance imaging and computed tomography can be useful to minimize the risks. Intraoperative facial nerve monitoring is also recommended to assist in the safe location of facial nerve.

An online implementation of a measure of spectro-temporal processing by cochlear-implant listeners.

The spectro-temporal ripple for investigating processor effectiveness (STRIPES) test is a psychophysical measure of spectro-temporal resolution in cochlear-implant (CI) listeners. It has been validated using direct-line input and loudspeaker presentation with listeners of the Advanced Bionics CI. This article investigates the suitability of an online application using wireless streaming (webSTRIPES) as a remote test. It reports a strong across-listener correlation between STRIPES thresholds obtained using laboratory testing with loudspeaker presentation vs remote testing with streaming presentation, with no significant difference in STRIPES thresholds between the two measures. WebSTRIPES also produced comparable and robust thresholds with users of the Cochlear CI.