Effects of the Clarion Electrode Positioning System on auditory thresholds and comfortable loudness levels in pediatric patients with cochlear implants.

OBJECTIVE: To evaluate the effects of using the Electrode Positioning System on psychophysical auditory thresholds, most comfortable loudness levels, and electric auditory brainstem response (EABR) thresholds in children with the Clarion version 1.2 cochlear implant. DESIGN: Retrospective analysis. SETTING: Academic tertiary care center. PATIENTS AND METHODS: Clinical records of a series of 25 children who received the Clarion version 1.2 cochlear implant at the University of Minnesota, Minneapolis, between January 1997 and August 1999 were examined. Measures evaluated were psychophysical thresholds (T-levels) and most comfortable loudness levels (M-levels) obtained at the 3-month posthookup audiologic evaluation and EABR thresholds obtained during implant surgery. Relevant threshold measures were available for 24 patients, 11 of whom had received the Clarion spiral electrode and electrode positioner (EP group) and 13 of whom had received the spiral electrode without positioner (non-EP group). The 3 measures (T-levels, M-levels, and EABR thresholds) were compared across groups. In addition, EABR thresholds were compared with T-levels and M-levels within groups. RESULTS: Mean T-levels and M-levels were significantly lower for the EP group than for the non-EP group, and interpatient variability for these measures was considerably smaller in the EP group. Electric auditory brainstem response thresholds were not significantly different for EP vs non-EP patients; however, EABR data were available for only a few non-EP patients. CONCLUSIONS: Use of the electrode positioner results in lower T-levels and M-levels in children with the Clarion version 1.2 cochlear implant, consistent with results of previous studies in adults, and reduces across-patient variability for these measures. It is unclear from the present data whether use of the electrode positioner systematically reduces intraoperative EABR thresholds.

Intensity discrimination and detection of amplitude modulation in electric hearing.

Wojtczak and Viemeister [J. Acoust. Soc. Am. 106, 1917-1924 (1999)] demonstrated a close relationship between intensity difference limens (DLs) and 4-Hz amplitude modulation (AM) detection thresholds in normal-hearing acoustic listeners. The present study demonstrates a similar relationship between intensity DLs and AM detection thresholds in cochlear-implant listeners, for gated stimuli. This suggests that acoustic and cochlear-implant listeners make use of a similar decision variable to perform intensity discrimination and modulation detection tasks. It can be shown that the absence of compression in electric hearing does not preclude this possibility.

Derived band auditory brain-stem response estimates of traveling wave velocity in humans. I: Normal-hearing subjects.

Estimates of cochlear traveling wave velocity (TWV) were computed from derived band auditory brain-stem response (ABR) latencies in 24 normal-hearing subjects. Wave V latencies were determined for each of six derived frequency bands (unmasked-8 kHz, 8-4 kHz, 4-2 kHz, 2-1 kHz, 1 kHz-500 Hz, and 500-250 Hz). Representative frequencies were assigned to the derived bands by estimating their energy midpoints, and cochlear positions corresponding to these frequencies were determined using Greenwood's [J. Acoust. Soc. Am. 33, 1344-1356 (1961)] place-frequency function for humans. Two procedures were used to estimate TWV. In one procedure, an exponential function of the form l = A + BeCd was fitted to each subject's latency-by-distance data using a least-squares algorithm, and a TWV function was generated by taking the inverse derivative of the latency function with respect to time. In the second procedure, average TWVs between adjacent derived bands were computed directly from subjects' ipsilateral wave V latencies. Values obtained with the two procedures were similar for middle and apical cochlear loci; however, TWV functions produced lower estimates of TWV at the most basal of five cochlear sites. TWVs based on ipsilateral wave V latencies ranged from 5.6 to 78.0 m/s (geometric mean 11.2 m/s) in the cochlear base (7.53 mm from the stapes) and from 1.2 to 3.4 m/s (geometric mean 1.96 m/s) in the cochlear apex (24.1 mm from the stapes). Intersubject variability was large at the most basal point of TWV estimation but was progressively smaller at more apical sites. Mean TWV estimates were lower than those reported by several previous investigators. The range of values obtained in various studies may stem from differences in the procedures used to estimate TWV.

Derived-band auditory brain-stem response estimates of traveling wave velocity in humans: II. Subjects with noise-induced hearing loss and Meniére's disease.

Estimates of cochlear traveling wave velocity (TWV) were computed from derived-band auditory brain-stem response (ABR) latencies in subjects with noise-induced hearing loss (NIHL) or Meniére's disease (MD). ABR wave V latencies were determined for each of six derived frequency bands (unmasked-8 kHz, 8-4 kHz, 4-2 kHz, 2-1 kHz, 1 kHz-500 Hz, and 500-250 Hz). Representative frequencies were assigned to the derived bands by estimating their energy midpoints, and cochlear positions corresponding to these frequencies were determined using Greenwood's (1961) place-frequency function for humans. An exponential function of the form I = A + BeCd was fitted to each subject's latency-by-distance data using a least-squares algorithm, and a TWV function was generated by taking the reciprocal of the derivative of the latency function with respect to distance [v = 1/(BCeCd)]. Expected values for subjects' TWV functions were compared to normative data from Donaldson and Ruth (1993) at five cochlear loci. NIHL subjects' TWV estimates fell within normal limits at all cochlear loci, and no relation between severity of high-frequency hearing loss and TWV could be discerned. MD subjects with good low-frequency hearing sensitivity generally yielded normal TWV estimates, whereas MD subjects with low-frequency hearing loss yielded either normal or elevated TWVs. MD subjects' data generally support the hypothesis that endolymphatic hydrops results in increased TWV or, alternatively, a basalward shift in the peak of the traveling wave, in cochleas with presumed normal basilar membrane elasticity.

Place-pitch sensitivity and its relation to consonant recognition by cochlear implant listeners using the MPEAK and SPEAK speech processing strategies.

Two related studies investigated the relationship between place-pitch sensitivity and consonant recognition in cochlear implant listeners using the Nucleus MPEAK and SPEAK speech processing strategies. Average place-pitch sensitivity across the electrode array was evaluated as a function of electrode separation, using a psychophysical electrode pitch-ranking task. Consonant recognition was assessed by analyzing error matrices obtained with a standard consonant confusion procedure to obtain relative transmitted information (RTI) measures for three features: stimulus (RTI stim), envelope (RTI env[plc]), and place-of-articulation (RTI plc[env]). The first experiment evaluated consonant recognition performance with MPEAK and SPEAK in the same subjects. Subjects were experienced users of the MPEAK strategy who used the SPEAK strategy on a daily basis for one month and were tested with both processors. It was hypothesized that subjects with good place-pitch sensitivity would demonstrate better consonant place-cue perception with SPEAK than with MPEAK, by virtue of their ability to make use of SPEAK's enhanced representation of spectral speech cues. Surprisingly, all but one subject demonstrated poor consonant place-cue performance with both MPEAK and SPEAK even though most subjects demonstrated good or excellent place-pitch sensitivity. Consistent with this, no systematic relationship between place-pitch sensitivity and consonant place-cue performance was observed. Subjects' poor place-cue perception with SPEAK was subsequently attributed to the relatively short period of experience that they were given with the SPEAK strategy. The second study reexamined the relationship between place-pitch sensitivity and consonant recognition in a group of experienced SPEAK users. For these subjects, a positive relationship was observed between place-pitch sensitivity and consonant place-cue performance, supporting the hypothesis that good place-pitch sensitivity facilitates subjects' use of spectral cues to consonant identity. A strong, linear relationship was also observed between measures of envelope- and place-cue extraction, with place-cue performance increasing as a constant proportion (approximately 0.8) of envelope-cue performance. To the extent that the envelope-cue measure reflects subjects' abilities to resolve amplitude fluctuations in the speech envelope, this finding suggests that both envelope- and place-cue perception depend strongly on subjects' envelope-processing abilities. Related to this, the data suggest that good place-cue perception depends both on envelope-processing abilities and place-pitch sensitivity, and that either factor may limit place-cue perception in a given cochlear implant listener. Data from both experiments indicate that subjects with small electric dynamic ranges (< 8 dB for 125-Hz, 205-microsecond/ph pulse trains) are more likely to demonstrate poor electrode pitch-ranking skills and poor consonant recognition performance than subjects with larger electric dynamic ranges.

Effects of stimulus repetition rate on ABR threshold, amplitude and latency in neonatal and adult Mongolian gerbils.

The ABR wave forms of 16-day-old and adult Mongolian gerbils were evoked by click stimuli presented at rates ranging from 1 to 80/sec. Wave I and wave IV thresholds were determined for each of 5 click rates. Amplitudes and latencies of waves I and IV were measured at each of 7 click rates and 3 intensity levels (15, 40 and 65 dB above threshold). Thresholds for waves I and IV in the adult gerbil and wave I in the 16 day gerbil were unaffected by changes in stimulus repetition rate. Neonatal wave IV thresholds were unaffected by click rate for rates below 25/sec but increased approximately 7 dB/decade increase in click rate when rate exceeded 25/sec. Increasing click rate produced greater reductions in ABR amplitude among neonates than adults for both waves I and IV. Decreases in amplitude due to increasing rate were independent of intensity level in both neonatal and adult subjects. Increasing rate produced similar increases in wave I latency among 16 day and adult subjects, but produced much greater increases in wave IV latency among neonates. Stimulus intensity level and click rate acted independently on wave I and wave IV latency in adult subjects and wave I latency in neonates. However, an interaction between rate and intensity was observed with respect to neonatal wave IV latency.

Psychophysical recovery from single-pulse forward masking in electric hearing.

Psychophysical single-pulse forward-masking (SPFM) recovery functions were measured for three electrodes in each of eight subjects with the nucleus mini-22 cochlear implant. Masker and probe stimuli were single 200-micros/phase biphasic current pulses. Recovery functions were measured at several masker levels spanning the electric dynamic range of electrodes chosen from the apical, middle, and basal regions of each subject's electrode array. Recovery functions were described by an exponential process in which threshold shift (in microA) decreased exponentially with increasing time delay between the masker and probe pulses. Two recovery processes were observed: An initial, rapid-recovery process with an average time constant of 5.5 ms was complete by about 10 ms. A second, slow-recovery process involved less masking than the rapid-recovery process but encompassed much longer time delays, sometimes as long as several hundred milliseconds. Growth-of-masking slopes for the rapid process depended upon time delay, as expected in an exponential recovery process. Unity slopes were observed at a time delay of 0 ms, whereas progressively shallower slopes were observed at time delays of 2 ms and 5 ms. Many recovery functions demonstrated nonmonotonicities or "facilitation" at very short masker-probe delays (1-2 ms). Such nonmonotonicities were usually most pronounced at low masker levels. Time constants for the rapid-recovery process did not vary systematically with masker level or with electrode location along the implanted array. Most subjects demonstrated rapid-recovery time constants less than 7 ms; however, the subject with the longest duration of deafness prior to implantation exhibited clearly prolonged time constants (9-24 ms). Time constants obtained on basal electrodes were inversely related to word recognition scores.

Psychometric functions and temporal integration in electric hearing.

Temporal-integration functions and psychometric functions for detection were obtained in eight users of the Nucleus 22-electrode cochlear implant. Stimuli were 100-Hz, 200-microseconds/phase trains of biphasic pulses with durations ranging from 0.44 to 630.4 ms (1 to 64 pulses). Temporal-integration functions were measured for 21 electrodes. Slopes of these functions were considerably shallower than the 2.5 dB/doubling slopes typically observed in acoustic hearing. They varied widely across subjects and for different electrodes in a given subject, ranging from 0.06 to 1.94 dB/doubling of stimulus pulses, with a mean [standard deviation (s.d.)] value of 0.42 (0.38). Psychometric functions were measured for 11 of the same 21 electrodes. Slopes of psychometric functions also varied across subjects and electrodes, and were 2-20 times steeper than those reported by other investigators for normal-hearing and cochlear-impaired acoustic listeners. Slopes of individual psychometric functions for 1-, 2-, 4-, and 8-pulse stimuli ranged from 0.20 to 1.84 log d'/dB with a mean (s.d.) value of 0.77 (0.45). Psychometric-function slopes did not vary systematically with stimulus duration in most cases. A clear inverse relation between slopes of psychometric functions and slopes of temporal-integration functions was observed. This relation was reasonably well described by a hyperbolic function predicted by the multiple-looks model of temporal integration [Viemeister and Wakefield, J. Acoust. Soc. Am. 90, 858-865 (1991)]. Psychometric-function slopes tended to increase with absolute threshold and were inversely correlated with dynamic range, suggesting that observed differences in psychometric-function slopes across subjects and electrodes may reflect underlying differences in neural survival.

Intensity discrimination as a function of stimulus level with electric stimulation.

Difference limens (DLs) for changes in electric current were measured from multiple electrodes in each of eight cochlear-implanted subjects. Stimuli were 200-microseconds/phase biphasic pulse trains delivered at 125 Hz in 300-ms bursts. DLs were measured with an adaptive three-alternative forced-choice procedure. Fixed-level psychometric functions were also obtained in four subjects to validate the adaptive DLs. Relative intensity DLs, specified as Weber fractions in decibels [10 log (delta I/I)] for standards above absolute threshold, decreased as a power function of stimulus intensity relative to absolute threshold [delta I/I = beta (I/I0) alpha] in the same manner as Weber fractions for normal acoustic stimulation reported in previous studies. Exponents (alpha) of the power function for electric stimulation ranged from -0.4 to -3.2, on average, an order of magnitude larger than exponents for acoustic stimulation, which range from -0.07 to -0.11. Normalization of stimulus intensity to the dynamic range of hearing resulted in Weber functions with similar negative slopes for electric and acoustic stimulation, corresponding to an 8-dB average improvement in Weber fractions across the dynamic range. Sensitivity to intensity change ¿10 log beta¿ varied from -0.42 to -13.5 dB compared to +0.60 to -3.34 dB for acoustic stimulation, but on average was better with electric stimulation than with acoustic stimulation. Psychometric functions for intensity discrimination yielded Weber fractions consistent with adaptive procedures and d' was a linear function of delta I. Variability among repeated Weber-fraction estimates was constant across dynamic range. Relatively constant Weber fractions across all or part of the dynamic range, observed in some subjects, were traced to the intensity resolution limits of individual implanted receiver/stimulators. DLs could not be accurately described by constant amplitude changes, expressed as a percentage of dynamic range ¿delta A(% DR)¿. Weber fractions from prelingually deafened subjects were no better or worse than those from postlingually deafened subjects. The cumulative number of discriminable intensity steps across the dynamic range of electric hearing ranged from as few as 6.6 to as many as 45.2. Physiologic factors that may determine important features of electric intensity discrimination are discussed in the context of a simple, qualitative, rate-based model. These factors include the lack of compressive cochlear preprocessing, the relative steepness of neural rate-intensity functions, and individual differences in patterns of neural survival.