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In cochlear implants, loudness has been shown to grow more slowly with increasing pulse phase duration (PPD) than with pulse amplitude (PA), possibly due to “leaky” charge integration. This leakiness has been recently quantified in terms of “charge integration efficiency,” defined as the log difference between the PPD dynamic range and PA dynamic range (both expressed in charge units), relative to a common threshold anchor. Such leakiness may differ across electrodes and/or test ears, and may reflect underlying neural health. In this study, we examined the across-site variation of charge integration in recipients of Cochlear© devices. PPD and PA dynamic ranges were measured relative to two threshold anchors with either a 25- or 50-microsecond PPD. Strength-duration functions, previously shown to relate to survival of spiral ganglion cells and peripheral processes, were compared to charge integration efficiency on selected electrodes. Results showed no significant or systematic relationship between the across-site variation in charge integration efficiency and electrode position or threshold levels. Charge integration efficiency was poorer with the 50-μs threshold anchor, suggesting that greater leakiness was associated with larger PPD dynamic ranges. Poorer and more variable charge integration efficiency across electrodes was associated with longer duration of any hearing loss, consistent with the idea that poor integration is related to neural degeneration. More variable integration efficiency was also associated with poorer speech recognition performance across test ears. The slopes of the strength-duration functions at maximum acceptable loudness were significantly correlated with charge integration efficiency. However, the strength-duration slopes were not predictive of duration of any hearing loss or speech recognition performance in our participants. As such, charge integration efficiency may be a better candidate to measure leakiness in neural populations across the electrode array, as well as the general health of the auditory nerve in human cochlear implant recipients.

Understanding insincere language (sarcasm and teasing) is a fundamental part of communication and crucial for maintaining social relationships. This can be a challenging task for cochlear implant (CIs) users who receive degraded suprasegmental information important for perceiving a speaker’s attitude. We measured the perception of speaker sincerity (literal positive, literal negative, sarcasm, and teasing) in 16 adults with CIs using an established video inventory. Participants were presented with audio-only and audio-visual social interactions between two people with and without supporting verbal context. They were instructed to describe the content of the conversation and answer whether the speakers meant what they said. Results showed that subjects could not always identify speaker sincerity, even when the content of the conversation was perfectly understood. This deficit was greater for perceiving insincere relative to sincere utterances. Performance improved when additional visual cues or verbal context cues were provided. Subjects who were better at perceiving the content of the interactions in the audio-only condition benefited more from having additional visual cues for judging the speaker’s sincerity, suggesting that the two modalities compete for cognitive recourses. Perception of content also did not correlate with perception of speaker sincerity, suggesting that what was said vs. how it was said were perceived using unrelated segmental versus suprasegmental cues. Our results further showed that subjects who had access to lower-order resolved harmonic information provided by hearing aids in the contralateral ear identified speaker sincerity better than those who used implants alone. These results suggest that measuring speech recognition alone in CI users does not fully describe the outcome. Our findings stress the importance of measuring social communication functions in people with CIs.

The goal of the present study was to compare forward masking patterns by stimulation of low and high rates in cochlear implant users. Postlingually deafened Cochlear Nucleus® device users participated in the study. In experiment 1, two maskers of different rates (250 and 1000 pulses per second) were set at levels that produced equal masking for a probe presented at the same electrode as the maskers. This aligned the two masking functions at the on-site probe location. Then their forward masking patterns for the far probes were compared. Results showed that slope of the masked probe-threshold decay as a function of probe-masker separation was steeper for the high-rate than the low-rate masker. A linear model indicated that this difference in spread of neural excitation (SOE) was accounted for by two factors that were not correlated with each other. One factor that accounted for the difference in SOE was that the low-rate masker required a considerably higher current level to be equally effective in masking as the high-rate masker. The second factor was the effect of stimulation rate on loudness, i.e., integration of multiple pulses. This was consistent with our hypothesis that if an increase in stimulation rate does not result in an increased total neural response, then it is unlikely that the change in rate would change spatial distribution of the neural activity. Interestingly, the difference in masking effectiveness of the maskers predicted subjects’ speech recognition. Poorer performers were those who showed more comparable masking effects by maskers of different rates. The difference in the masking effectiveness may indirectly measure auditory neuron’s excitability, which predicts speech recognition. In experiment 2, SOE of the high-rate and low-rate maskers were compared at a level that is clinically relevant, i.e., equal loudness. At equal loudness, high-rate stimulation not only produced an overall greater amount of forward masking, but also a shallower decay of masking with probe-masker separation (wider SOE), relative to low-rate stimulation. The difference in SOE was the opposite to the findings from experiment 1. Whether the maskers were calibrated for equal masking or loudness, the absolute current level was always higher for the low-rate masker, which suggests that the SOE patterns cannot be explained by current spread alone. The fact that high-rate stimulation produced greater masking and wider SOE at equal loudness may explain why using high stimulation rates has not produced consistent benefits for speech recognition, and why lowering stimulation rate from the manufacturer’s default sometimes results in improved speech recognition for subjects.

Background In cochlear implants, pulse amplitude (PA) or pulse phase duration (PPD) can be used to increase loudness. Loudness grows more slowly with increasing PPD, resulting in a larger dynamic range (DR), possibly reflecting “leaky” charge integration associated with neural degeneration due to hearing loss. Here, we propose a method to estimate charge integration efficiency for CI users. New method The DR was measured with increasing PA or PPD, relative to a common threshold anchor with a short PPD (25μs/ph); DRs were converted to the common unit of charge (nC). Charge integration efficiency was calculated as the dB difference in DR with increasing PPD or PA. Loudness growth functions were also compared as PA or PPD was increased relative to the common threshold. Results Ten CI ears were tested; all participants were adult users of Cochlear© devices. DR was significantly larger when PPD was increased, requiring (on average) 70 % more charge than when PA was increased. A significant correlation (p = 0.007) was observed between duration of deafness and charge integration efficiency, largely driven by a participant with long auditory deprivation in both ears. Loudness growth was slower when PPD was increased, consistent with previous studies. Comparison to Existing Methods. The present method offers a quick behavioral test with which to measure charge integration efficiency, which may be a useful measure of neural health. Discussion Charge integration efficiency may be used to probe neural health independent of absolute detection thresholds, which mostly reflect the proximity of electrodes to neural populations.

Previous psychophysical studies have shown that a steep detection-threshold-versus-stimulation-rate function (multipulse integration; MPI) is associated with laterally positioned electrodes producing a broad neural excitation pattern. These findings are consistent with steep MPI depending on either a certain width of neural excitation allowing a large population of neurons operating at a low point on their dynamic range to respond to an increase in stimulation rate or a certain slope of excitation pattern that allows recruitment of neurons at the excitation periphery. Results of the current study provide additional support for these mechanisms by demonstrating significantly flattened MPI functions in narrow bipolar than monopolar stimulation. The study further examined the relationship between the steepness of the psychometric functions for detection (d’ versus log current level) and MPI. In contrast to findings in monopolar stimulation, current data measured in bipolar stimulation suggest that steepness of the psychometric functions explained a moderate amount of the across-site variance in MPI. Steepness of the psychometric functions, however, cannot explain why MPI flattened in bipolar stimulation, since slopes of the psychometric functions were comparable in the two stimulation modes. Lastly, our results show that across-site mean MPI measured in monopolar and bipolar stimulation correlated with speech recognition in opposite signs, with steeper monopolar MPI being associated with poorer performance but steeper bipolar MPI being associated with better performance. If steeper MPI requires broad stimulation of the cochlea, the correlation between monopolar MPI and speech recognition can be interpreted as the detrimental effect of poor spectral resolution on speech recognition. Assuming bipolar stimulation produces narrow excitation, and MPI measured in bipolar stimulation reflects primarily responses of the on-site neurons, the correlation between bipolar MPI and speech recognition can be understood in light of the importance of neural survival for speech recognition.

The study examined whether the benefit of deactivating stimulation sites estimated to have broad neural excitation was attributed to improved spectral resolution in cochlear implant users. The subjects' spatial neural excitation pattern was estimated by measuring low-rate detection thresholds across the array [see Zhou (2016). PLoS One 11, e0165476]. Spectral resolution, as assessed by spectral-ripple discrimination thresholds, significantly improved after deactivation of five high-threshold sites. The magnitude of improvement in spectral-ripple discrimination thresholds predicted the magnitude of improvement in speech reception thresholds after deactivation. Results suggested that a smaller number of relatively independent channels provide a better outcome than using all channels that might interact.

The decrease of psychophysical detection thresholds as a function of pulse rate for a fixed-duration electrical pulse train is referred to as multipulse integration (MPI). The MPI slopes correlate with anatomical and physiological indices of cochlear health in guinea pigs with cochlear implants. The aim of the current study was to assess whether the MPI slopes were related to the spatial spread of activation by electrical stimulation. The hypothesis was that MPI is dependent on the total number of excitable neurons at the stimulation site, with broader neural excitation producing a steeper threshold decrease as a function of stimulation rate. MPI functions were measured at all stimulation sites in 22-site electrode arrays in human subjects. Some sites with steep MPI functions and other sites with shallow functions were assessed for spatial spread of excitation at 900 pps using a forward-masking paradigm. The results showed a correlation between the slopes of the forward-masking functions and the steepness of MPI, with broader stimulation predicting greater integration. The results are consistent with the idea that integration of multiple pulses in a pulse train relies on the number of excitable neurons at the stimulation site.

OBJECTIVE: The objective of the current study was to examine the longitudinal effect of deactivating stimulation sites estimated to produce broad neural excitation on speech recognition. DESIGN: Spatial patterns of neural excitation were estimated based on a previously established psychophysical measure, i.e., detection threshold for low-rate pulse trains. Stimulation sites with relatively poor thresholds were deactivated in an experimental map. The acute effect was evaluated, in quiet and in noise, immediately after the experimental map was created (baseline), after the subjects practiced with the experimental map for two months (treatment), and after the subjects’ daily map was switched back again to the clinical map for another two months (withdrawal). STUDY SAMPLE: Eight Cochlear Nucleus device users participated in the study. RESULTS: For both listening in noise and in quiet, the greatest effect of deactivation was observed after the subjects were given time to adapt to the new frequency allocations. The effect was comparable for listening in fluctuating and steady-state noises. All subjects benefited from deactivation for listening in noise, but subjects with greater variability in thresholds were more likely to benefit from deactivation for listening in quiet. CONCLUSIONS: The benefit of electrode deactivation for speech recognition can increase with practice.

The present study evaluated the slopes of threshold-versus-pulse-rate functions (multipulse integration, MPI) in humans with cochlear implants in relation to recovery from 300-ms forward maskers. MPI has been correlated with spiral ganglion cell density in animals. The present study showed that steeper MPI functions were correlated with faster recovery from forward masking. The findings suggested that the variations in the MPI slopes are explained not only by the quantity of neurons contributing to the integration process but also by the neurons' temporal response characteristics and possibly central inhibition.

Previous cochlear implant (CI) research has shown that at a pulse train with a long pulse phase duration (PPD) requires less current but greater charge to obtain the same loudness as a pulse train with a short PPD. This might result in different excitation patterns between long and short PPDs. At equal loudness, long PPDs might produce greater masking due to greater charge. However, because they require less current, long PPDs may produce a smaller spatial spread of excitation (SOE) compared to short PPDs by evoking a greater neural firing probability within the relatively small current field. To investigate the effects of PPD on excitation patterns, overall masking and SOE were compared for equally loud stimuli with short or long PPD in 10 adult CI ears. Forward masking patterns were measured at relatively soft, medium, and loud presentation levels. Threshold shifts were calculated in terms of percent dynamic range (DR) of the probe. The area under the curve (AUC) of the masking functions was significantly larger for the long PPD than for the short PPD masker. The difference in AUC was proportional to the difference in charge between the short and long PPD maskers. To estimate SOE, the masking patterns were first normalized to the peak masking, and then AUC was calculated. SOE was significantly larger for the short PPD than for the long PPD masker. Thus, at equal loudness, long PPDs produced greater overall masking (possibly due to greater charge) but less SOE (possibly due to less current spread) than did short PPDs. The effect of the interaction between masking and SOE by long PPD stimulation remains to be tested.

This study examined the contribution of temporal and spectral modulation sensitivity to discrimination of stimuli modulated in both the time and frequency domains. The spectrotemporally modulated stimuli contained spectral ripples that shifted systematically across frequency over time at a repetition rate of 5 Hz. As the ripple density increased in the stimulus, modulation depth of the 5 Hz amplitude modulation (AM) reduced. Spectrotemporal modulation discrimination was compared with subjects’ ability to discriminate static spectral ripples and the ability to detect slow AM. The general pattern from both the cochlear implant (CI) and normal hearing groups showed that spectrotemporal modulation thresholds were correlated more strongly with AM detection than with static ripple discrimination. CI subjects’ spectrotemporal modulation thresholds were also highly correlated with speech recognition in noise, when partialing out static ripple discrimination, but the correlation was not significant when partialing out AM detection. The results indicated that temporal information was more heavily weighted in spectrotemporal modulation discrimination, and for CI subjects, it was AM sensitivity that drove the correlation between spectrotemporal modulation thresholds and speech recognition. The results suggest that for the rates tested here, temporal information processing may limit performance more than spectral information processing in both CI users and normal hearing listeners.

Prior research has shown that in electrical hearing, cochlear implant (CI) users’ speech recognition performance is related in part to their ability to detect temporal modulation (i.e., modulation sensitivity). Previous studies have also shown better speech recognition when selectively stimulating sites with good modulation sensitivity rather than all stimulation sites. Site selection based on channel interaction measures, such as those using imaging or psychophysical estimates of spread of neural excitation, has also been shown to improve speech recognition. This led to the question of whether temporal modulation sensitivity and spatial selectivity of neural excitation are two related variables. In the present study, CI users’ modulation sensitivity was compared for sites with relatively broad or narrow neural excitation patterns. This was achieved by measuring temporal modulation detection thresholds (MDTs) at stimulation sites that were significantly different in their sharpness of the psychophysical spatial tuning curves (PTCs) and measuring MDTs at the same sites in monopolar (MP) and bipolar (BP) stimulation modes. Nine postlingually deafened subjects implanted with Cochlear Nucleus® device took part in the study. Results showed a significant correlation between the sharpness of PTCs and MDTs, indicating that modulation detection benefits from a more spatially restricted neural activation pattern. There was a significant interaction between stimulation site and mode. That is, using BP stimulation only improved MDTs at stimulation sites with broad PTCs but had no effect or sometimes a detrimental effect on MDTs at stimulation sites with sharp PTCs. This interaction could suggest that a criterion number of nerve fibers is needed to achieve optimal temporal resolution, and, to achieve optimized speech recognition outcomes, individualized selection of site-specific current focusing strategies may be necessary. These results also suggest that the removal of stimulation sites measured with poor MDTs might improve both temporal and spectral resolution.

The hearing loss criterion for cochlear implant candidacy in mainland China is extremely stringent (bilateral severe to profound hearing loss), resulting in few patients with substantial residual hearing in the nonimplanted ear. The main objective of the current study was to examine the benefit of bimodal hearing in typical Mandarin-speaking implant users who have poorer residual hearing in the nonimplanted ear relative to those used in the English-speaking studies. Seventeen Mandarin-speaking bimodal users with pure-tone averages of ∼80 dB HL participated in the study. Sentence recognition in quiet and in noise as well as tone and word recognition in quiet were measured in monaural and bilateral conditions. There was no significant bimodal effect for word and sentence recognition in quiet. Small bimodal effects were observed for sentence recognition in noise (6%) and tone recognition (4%). The magnitude of both effects was correlated with unaided thresholds at frequencies near voice fundamental frequencies (F0s). A weak correlation between the bimodal effect for word recognition and unaided thresholds at frequencies higher than F0s was identified. These results were consistent with previous findings that showed more robust bimodal benefits for speech recognition tasks that require higher spectral resolution than speech recognition in quiet. The significant but small F0-related bimodal benefit was also consistent with the limited acoustic hearing in the nonimplanted ear of the current subject sample, who are representative of the bimodal users in mainland China. These results advocate for a more relaxed implant candidacy criterion to be used in mainland China.

Temporal integration (TI; threshold versus stimulus duration) functions and multipulse integration (MPI; threshold versus pulse rate) functions were measured behaviorally in guinea pigs and humans with cochlear implants. Thresholds decreased with stimulus duration at a fixed pulse rate and with pulse rate at a fixed stimulus duration. The rates of threshold decrease (slopes) of the TI and MPI functions were not statistically different between the guinea pig and human subject groups. A characteristic of the integration functions that the two groups shared was that the slopes of the TI functions were similar in magnitude to slopes of the MPI function only at low pulse rates (< approximately 300 pulses per second). This is consistent with the notion that the TI functions and the MPI functions at the low rates are mediated by a mechanism of long-term integration described in the statistical “multiple looks” model. Histological analysis of the guinea pig cochleae suggested that the slopes of both the MPI and the TI functions were dependent on sensory and neural health near the stimulated regions. The strongest predictor for spiral ganglion cell densities measured near the stimulation sites was the slope of the MPI functions below 1,000 pps. Several mechanisms may be considered to account for the association of shallow integration functions with poor sensory and neural status. These mechanisms are related to abnormal across-fiber synchronization, increased refractoriness and adaptation with impaired neural function, and steep growth of neural excitation with current level associated with neural pathology. The slope of the integration functions can potentially be used as a non-invasive measure for identifying stimulation sites with poor neural health and selecting those sites for removal or rehabilitation, but these applications remain to be tested.

Amazing progress has been made in providing useful hearing to hearing-impaired individuals using cochlear implants, but challenges remain. One such challenge is understanding the effects of partial degeneration of the auditory nerve, the target of cochlear implant stimulation. Here we review studies from our human and animal laboratories aimed at characterizing the health of the implanted cochlea and the auditory nerve. We use the data on cochlear and neural health to guide rehabilitation strategies. The data also motivate the development of tissue-engineering procedures to preserve or build a healthy cochlea and improve performance obtained by cochlear implant recipients or eventually replace the need for a cochlear implant. This article is part of a Special Issue entitledLasker Award.

Comparisons of performance with cochlear implants and postmortem conditions in the cochlea in humans have shown mixed results. The limitations in those studies favor the use of within-subject designs and non-invasive measures to estimate cochlear conditions. One non-invasive correlate of cochlear health is multipulse integration, established in an animal model. The present study used this measure to relate neural health in human cochlear implant users to their speech recognition performance. The multipulse-integration slopes were derived based on psychophysical detection thresholds measured for two pulse rates (80 and 640 pulses per second). A within-subject design was used in eight subjects with bilateral implants where the direction and magnitude of ear differences in the multipulse-integration slopes were compared with those of the speech-recognition results. The speech measures included speech reception threshold for sentences and phoneme recognition in noise. The magnitude of ear difference in the integration slopes was significantly correlated with the magnitude of ear difference in speech reception thresholds, consonant recognition in noise, and transmission of place of articulation of consonants. These results suggest that multipulse integration predicts speech recognition in noise and perception of features that use dynamic spectral cues.

In electrical hearing, multipulse integration (MPI) describes the rate at which detection threshold decreases with increasing stimulation rate in a fixed-duration pulse train. In human subjects, MPI has been shown to be dependent on the psychophysically estimated spread of neural excitation at a high stimulation rate, with broader spread predicting greater integration. The first aim of the present study was to replicate this finding using alternative methods for measuring MPI and spread of neural excitation. The second aim was to test the hypothesis that MPI is related to the slope of the psychometric function for detection. Specifically, a steep d' versus stimulus level function would predict shallow MPI since the amount of current reduction necessary to compensate for an increase in stimulation rate to maintain threshold would be small. The MPI function was measured by obtaining adaptive detection thresholds at 160 and 640 pulses per second. Spread of neural excitation was measured by forward-masked psychophysical tuning curves. All psychophysical testing was performed in a monopolar stimulation mode (MP 1 + 2). Results showed that MPI was correlated with the slopes of the tuning curves, with broader tuning predicting steeper MPI, confirming the earlier finding. However, there was no relationship between MPI and the slopes of the psychometric functions. These results suggest that a broad stimulation of the cochlea facilitates MPI. MPI however is not related to the estimated neural excitation growth with current level near the behavioral threshold, at least in monopolar stimulation.

Objectives Modulation detection thresholds (MDTs) vary across stimulation sites in a cochlear implant (CI) electrode array in a manner that is subject and ear specific. Previous studies have demonstrated that speech recognition with a CI can be improved by site-selection strategies, where selected stimulation sites with poor modulation sensitivity are removed from a subject's processor MAP. Limitations of site-selection strategies are that they can compromise spectral resolution and distort frequency-place mapping because the frequencies assigned to the removed sites are usually reallocated to other sites, and site bandwidths are broadened. The objective of the present study was to test an alternative approach for rehabilitation that aimed at improving the across-site mean MDTs by adjusting stimulation parameters at the poorly performing sites. On the basis of previous findings that modulation detection contributes to speech recognition and improves significantly with stimulus level, the authors hypothesized that modulation sensitivity at the poor sites could be improved by artificially increasing stimulation levels at those sites in the speech processor, which then would lead to improved speech recognition. Design Nine postlingually deafened ears implanted with Nucleus CIs were evaluated for MDTs, absolute-detection threshold levels (T levels), and the maximum loudness levels (C levels) on each of the available stimulation sites. For each ear, the minimum stimulation level settings in the speech-processor MAP were raised by 5%, and alternatively by 10%, of the dynamic range (DR) from true thresholds on five stimulation sites with the poorest MDTs. For comparison, a 5% level raise was applied globally to all stimulation sites. The C levels were fixed during these level manipulations. MDTs at the five poorest stimulation sites were compared at 20% DR before and after the level adjustments. Speech-reception thresholds (SRTs), that is, signal to noise ratios required for 50% correct speech recognition, were evaluated for these MAPs using CUNY sentences. The site-specific level-adjusted MAPs were compared with the global-level-adjusted MAP and the MAP without level adjustment. The effects on speech recognition of adjusting the minimal stimulation level settings on the five poorest stimulation sites were also compared with effects of removing these sites from the speech-processor MAP. Results The 5% level increase on the five electrodes with the worst MDTs resulted in an improvement in the group mean SRT of 2.36 dB SNR relative to the MAP without level adjustment. The magnitude of level increase that resulted in the greatest SRT improvement for individuals varied across ears. MDTs measured at 20% DR significantly improved on the poor sites after the level adjustment that resulted in the best SRT for that ear was applied. Increasing the minimal stimulation levels on all stimulation sites or removing sites selected for rehabilitation, the parsimonious approaches, did not improve SRTs. Conclusions The site-specific adjustments of the T level settings improved modulation sensitivity at low levels and significantly improved subjects' SRTs. Thus, this site-rehabilitation strategy was an effective alternative to site-selection strategies for improving speech recognition in CI users.

The ability to perceive important features of electrical stimulation varies across stimulation sites within a multichannel implant. The aim of this study was to optimize speech processor MAPs for bilateral implant users by identifying and removing sites with poor psychophysical performance. The psychophysical assessment involved amplitude-modulation detection with and without a masker, and a channel interaction measure quantified as the elevation in modulation detection thresholds in the presence of the masker. Three experimental MAPs were created on an individual-subject basis using data from one of the three psychophysical measures. These experimental MAPs improved the mean psychophysical acuity across the electrode array and provided additional advantages such as increasing spatial separations between electrodes and/or preserving frequency resolution. All 8 subjects showed improved speech recognition in noise with one or more experimental MAPs over their everyday-use clinical MAP. For most subjects, phoneme and sentence recognition in noise were significantly improved by a dichotic experimental MAP that provided better mean psychophysical acuity, a balanced distribution of selected stimulation sites, and preserved frequency resolution. The site-selection strategies serve as useful tools for evaluating the importance of psychophysical acuities needed for good speech recognition in implant users.

The ability of an implanted ear to integrate multiple pulses, as measured by the slopes of detection threshold level (T level) versus pulse rate functions, may reflect cochlear health in the cochlea, as suggested by previous animal studies (Kang et al., 2010; Pfingst et al., 2011). In the current study, we examined the slopes of T level versus pulse rate functions in human subjects with cochlear implants. Typically, T levels decrease as a function of pulse rate, consistent with a multipulse integration mechanism. The magnitudes of the slopes of the T level versus pulse rate functions obtained from the human subjects were comparable to those reported in the animal studies. The slopes varied across stimulation sites, but did not change systematically along the tonotopic axis. This suggests that the slopes are dependent on local conditions near the individual stimulation sites. The characteristics of these functions were also similar to those found in animals in that the slopes for higher pulse rates were steeper than those for the lower pulse rates, consistent with a combined effect of multipulse integration and cumulative partial depolarization mechanisms at rates above 1000 pps. The maximum comfortable loudness level (C level) versus pulse rate functions were also examined to determine the effect of level on the slopes. Slopes of C-level functions were shallower than those for the T-level functions and were not correlated with those of the T-level functions, so the mechanisms underlying these two functions are probably not identical. The slopes of the T- or C-level functions were not dependent on stimulus-current level. Based on these results, we suggest that slopes of T level versus pulse rate functions might be a useful measure for estimating nerve survival in the cochlea in regions close to the stimulation sites.

Although the cochlear implant is already the world's most successful neural prosthesis, opportunities for further improvement abound. Promising areas of current research include work on improving the biological infrastructure in the implanted cochlea to optimize reception of cochlear implant stimulation and on designing the pattern of electrical stimulation to take maximal advantage of conditions in the implanted cochlea. In this review we summarize what is currently known about conditions in the cochlea of deaf, implanted humans and then review recent work from our animal laboratory investigating the effects of preserving or reinnervating tissues on psychophysical and electrophysiological measures of implant function. Additionally we review work from our human laboratory on optimizing the pattern of electrical stimulation to better utilize strengths in the cochlear infrastructure. Histological studies of human temporal bones from implant users and from people who would have been candidates for implants show a range of pathologic conditions including spiral ganglion cell counts ranging from approximately 2% to 92% of normal and partial hair cell survival in some cases. To duplicate these conditions in a guinea pig model, we use a variety of deafening and implantation procedures as well as post1-deafening therapies designed to protect neurons and/or regenerate neurites. Across populations of human patients, relationships between nerve survival and functional measures such as speech have been difficult to demonstrate, possibly due to the numerous subject variables that can affect implant function and the elapsed time between functional measures and postmortem histology. However, psychophysical studies across stimulation sites within individual human subjects suggest that biological conditions near the implanted electrodes contribute significantly to implant function, and this is supported by studies in animal models comparing histological findings to psychophysical and electrophysiological data. Results of these studies support the efforts to improve the biological infrastructure in the implanted ear and guide strategies which optimize stimulation patterns to match patient-specific conditions in the cochlea.

The effects of frequency-place shift on consonant recognition and confusion matrices were examined. Frequency-place shift was manipulated using a noise-excited vocoder with 4 to 16 channels. In the vocoder processing, the location of the most apical carrier band varied from the matched condition (i.e., 28 mm from the base of the cochlear) to a basal shift (i.e., 22 mm from the base) in a step size of 1 mm. Ten normal-hearing subjects participated in the 20-alternative forced-choice test, where the consonants were presented in a /Ca/ context. Shift of 3 mm or more caused the consonant recognition scores to decrease significantly. The effects of spectral resolution disappeared when the amount of shift reachedor=3 mm. Information transmitted for voicing and place of articulation varied with spectral shift and spectral resolution, while information transmitted for manner was affected only by spectral shift but not spectral resolution. Spectral shift has shown specific effects on the confusion patterns of the consonants. The direction of errors reversed as spectral shift increased and the patterns of reversal were consistent across channel conditions. Overall, transmission of the consonant features can be accounted for by the acoustic features of the speech signal.

Objectives: Lexical tone recognition tends to be poor in cochlear implant users. The HiResolution (HiRes) sound-processing strategy is designed to better preserve temporal fine structure, or the detailed envelope information, of an acoustic signal. The newer HiRes 120 strategy builds on HiRes by increasing the amount of potential spectral information delivered to the implant user. The purpose of this study was to examine lexical tone recognition in native Mandarin Chinese-speaking children with cochlear implants using the HiRes and HiRes 120 sound-processing strategies. Tone recognition performance was tested with HiRes at baseline and then after up to 6 mo of HiRes 120 experience in the same subjects. Design: Twenty prelingually deafened, native Mandarin-speaking children, with ages ranging from 3.5 to 16.5 yr, participated. All children completed a computerized tone contrast test on three occasions: (1) using HiRes immediately before conversion to HiRes 120 (baseline), (2) 1 mo after conversion, and (3) 3 mo after conversion. Twelve of the 20 children also were tested 6 mo after conversion. In addition, the parents of 18 children completed a questionnaire at the 3-mo follow-up visit regarding the preference of sound-processing strategies and the children’s experience related to various aspects of auditory perception and speech production using HiRes 120. Results: As a group, no statistically significant differences were seen between the tone recognition scores using HiRes and HiRes 120. Individual scores showed great variability. Tone recognition performance ranged from chance (50% correct) to nearly perfect. Using the conventional HiRes strategy, 6 of the 20 children achieved high-level tone recognition performance (i.e., 90% correct), whereas 7 performed at a level not significantly different from chance (50–60% correct). At the final test, either 3 or 6 mo after conversion, all children achieved tone recognition performance with HiRes 120 that was equal to or better than that with HiRes, although some children’s tone recognition performance was worse initially at the 1 or 3 mo follow-up intervals than at baseline. Eight of the 20 children showed statistically significant improvement in tone recognition performance with HiRes 120 on at least one of the follow-up tests. Age at implantation was correlated with tone recognition performance at all four test intervals. Parents of most of the children indicated that the children preferred HiRes 120 more than HiRes. Conclusions: As a group, HiRes 120 did not provide significantly improved lexical tone recognition compared to HiRes, at least throughout the length of the study (up to 6 mo). There were large individual differences in lexical tone recognition among the prelingually deafened, native Mandarin-speaking children with cochlear implants using either HiRes or HiRes 120. Six of the 20 children performed at or near ceiling in the baseline HiRes condition. Of the remainder, approximately half showed significantly better tone recognition when subsequently tested with HiRes 120, although the extent to which this improvement may be attributable to factors other than the change in processing strategy (e.g., general development) is unknown. The children who benefited most from HiRes 120 tended to be those who were implanted at younger ages.

The aim of the study was (1) to develop methods for evaluating tone production of children with cochlear implants (CIs) who speak Mandarin Chinese and (2) to evaluate the efficacy of using these methods to assess tone production. The subjects included two groups of native-Mandarin-Chinese-speaking children: 14 prelingually deafened children who had received CIs and 61 normal-hearing (NH) children as controls. The acoustic analysis focused on quantification of the degree of differentiation among lexical tones based on tonal ellipses and the overall similarity of tone contours produced by the children with CIs to normative contours derived from the 61 NH children. An artificial neural network was used to recognize tones produced by the children with CIs after trained with tone tokens produced by the NH children. Finally, perceptual judgments on the tone production of both groups were obtained from eight native-Mandarin-speaking NH adults to evaluate the efficacy of the methods. The results showed that all measures using the acoustic, neural-network, and perceptual analyses were highly correlated with each other and could be used to effectively evaluate tone production of children with CIs.

The purpose of the present study was to investigate tone production performance of native Mandarin Chinese speaking children with cochlear implants and to evaluate the effects of age at implantation and duration of implant use on tone production in those children.Fourteen prelingually deaf children who had received cochlear implantation and 14 age-matched normal-hearing children participated in the study. Both groups were of native Mandarin Chinese speaking children. One hundred and sixty tone tokens were recorded from each of the children. The total of 4480 tokens (160x28) were then used in the tone perception tests in which seven normal-hearing native Mandarin Chinese speaking adults participated.The tone production of the cochlear implant children showed tremendous individual variability. The group mean performance was 48.4% correct, statistically significantly lower than the group mean performance of 78.0% correct in the normal-hearing controls. The tone confusion matrix analysis revealed that the production of Mandarin tone 2 (the rising tone) was most severely impaired in the cochlear implant children, followed by tone 3 (the low and dipping tone) and tone 4 (the falling tone). The most frequently perceived tone irrespective of the target tone was tone 1 (the high level tone). The tone production performance was negatively correlated with the age at implantation and positively correlated with the duration of implant use.There is a remarkable deficit in tone production in a majority of native tone language speaking, prelingually deaf children who have received cochlear implants. While an increased duration of implant use might facilitate tone production, the age at implantation appears to have a negative effect on tone production in cochlear implant children. Therefore, early implantation might be beneficial to tone production in prelingually deaf children whose native language is a tone language.

The objectives of the study were to (1) investigate the potential of using monopolar psychophysical detection thresholds for estimating spatial selectivity of neural excitation with cochlear implants and to (2) examine the effect of site removal on speech recognition based on the threshold measure. Detection thresholds were measured in Cochlear Nucleus® device users using monopolar stimulation for pulse trains that were of (a) low rate and long duration, (b) high rate and short duration, and (c) high rate and long duration. Spatial selectivity of neural excitation was estimated by a forward-masking paradigm, where the probe threshold elevation in the presence of a forward masker was measured as a function of masker-probe separation. The strength of the correlation between the monopolar thresholds and the slopes of the masking patterns systematically reduced as neural response of the threshold stimulus involved interpulse interactions (refractoriness and sub-threshold adaptation), and spike-rate adaptation. Detection threshold for the low-rate stimulus most strongly correlated with the spread of forward masking patterns and the correlation reduced for long and high rate pulse trains. The low-rate thresholds were then measured for all electrodes across the array for each subject. Subsequently, speech recognition was tested with experimental maps that deactivated five stimulation sites with the highest thresholds and five randomly chosen ones. Performance with deactivating the high-threshold sites was better than performance with the subjects’ clinical map used every day with all electrodes active, in both quiet and background noise. Performance with random deactivation was on average poorer than that with the clinical map but the difference was not significant. These results suggested that the monopolar low-rate thresholds are related to the spatial neural excitation patterns in cochlear implant users and can be used to select sites for more optimal speech recognition performance.

Hypothesis The purpose of the present study was to investigate the consonant recognition of Mandarin-speaking children with cochlear implants (CIs) and hearing aids (HAs) and to determine if they reach a level of consonant recognition similar to that of normal-hearing (NH) children. Background Little information is available in the literature regarding the consonant perception abilities of prelingually deafened young children with either CIs or HAs. No studies have compared Mandarin-Chinese consonant contrast recognition in CI and HA children. Methods Forty-one prelingually deafened children with CIs, 26 prelingually deafened children with HAs, and 30 NH children participated in this study. The 3 groups were matched for chronologic age (3-5 yr). The hearing-impaired groups were matched for age at fitting of the devices, duration of device use, and aided hearing threshold. All subjects completed a computerized Mandarin consonant phonetic contrast perception test. Results CI and HA children scored, on average, approximately 8 percentage points below the mean NH group performance on the consonant contrast recognition. Approximately 40% of the CI and HA children had not reached a performance level of the NH group. No significant differences in the consonant recognition scores were found between the CI and HA groups. Age of implantation was correlated with consonant contrast recognition in the CI group. Conclusion When age at fitting of the devices, duration of device use, and aided thresholds are matched at the group level, consonant recognition is similar between the CI and HA children after 2 years of device use. Early implantation tends to yield better consonant contrast recognition in the young children with CIs. However, a large amount of variance in performance was not accounted for by the demographic variables studied.

Hypothesis: Performance in tone perception and production are correlated in prelingually deafened pediatric cochlear implant (CI) users across individuals. Demographic variables, such as age at implantation, contribute to the performance variability. Background: Poor representation of pitch information in CI devices hinders pitch perception and affects perception of lexical tones in cochlear implant users who speak tonal languages. Methods: One hundred ten Mandarin-speaking, prelingually deafened CI subjects and 125 typically developing, normalhearing subjects were recruited from Beijing, China. Lexical tone perception was measured using a computerized tone contrast test. Tone production was judged by native Mandarin-speaking adult listeners as well as analyzed acoustically and with an artificial neural network. A general linear model analysis was performed to determine factors that accounted for performance variability. Results: CI subjects scored E67% correct on the lexical tone perception task. The degree of differentiation of tones produced by the CI group was significantly lower than the control group as revealed by acoustic analysis. Tone production performance assessed by the neural network was highly correlated with that evaluated by human listeners. There was a moderate correlation between the overall tone perception and production performance across CI subjects. Duration of implant use and age at implantation jointly explained E29% of the variance in the tone perception performance. Age at implantation was the only significant predictor for tone production performance in the CI subjects. Conclusion: Tone production performance in pediatric CI users is dependent on accurate perception. Early implantation predicts a better outcome in lexical tone perception and production.

The purpose of the present study was to test the hypothesis that cochlear implant (CI) users ' music perception is correlated with their lexical tone perception, and the two types of perception share similar mechanisms in electric hearing. Design: A lexical tone perception test and a pitch interval discrimination test were administered to a group of CI users and a group of normal-hearing (NH) listeners. Sample study: Nineteen adult CI users and 10 NH listeners who are native-Mandarin-Chinese speakers participated in the study. Result: Tone-perception performance of the CI group was, on average, 58.3% correct ( � 19.78% correct), and performance of the NH group was near perfect. The CI group had a mean threshold of 5.66 semitones ( � 5.57 semitones) in pitch discrimination as compared to the threshold of 0.44 semitone from the NH group. There was a strong correlation between the CI users ' tone-perception performance and their pitch discrimination threshold ( r � � 0.75, p � 0.001). Conclution: Musical and lexical pitch perceptions are strongly correlated with each other and they might share similar mechanisms in electric hearing.

In prelingually deaf children with cochlear implants, tone perception and production performance are highly correlated. This result is consistent with the hypothesis that tone perception is the prerequisite for good tone production.Previous research has shown remarkable deficits in tone perception and production in native tone language-speaking, prelingually deafened children with cochlear implants. The purpose of the present study was to investigate the relationship between tone perception and production in those children.Twenty-five prelingually deaf children with cochlear implants participated in the study. All subjects were Advanced Bionics CII/90K users with various lengths of implant use. To evaluate tone perception performance, subjects completed a computerized tone contrast test. For tone production performance, an artificial neural network was used to evaluate the accuracy of tones recorded from each of the 25 subjects.Large individual differences in tone perception and production performance were observed in these subjects. Tone perception accuracy ranged from 50.0 to 96.9% correct (chance performance = 50% correct; mean = 71.0% correct). Tone production performance ranged from 19.4 to 97.2% correct (mean = 52.0% correct). A strong correlation was found between tone perception and production performance in this group of subjects (r = 0.805).

The coarse pitch information in cochlear implants might hinder the development of singing in prelingually-deafened pediatric users. In the present study, seven prelingually-deafened children with cochlear implants (5.4 to 12.3 years old) sang one song that was the most familiar to him or her. The control group consisted of 14 normal-hearing children (4.1 to 8.0 years old). The fundamental frequencies (F0) of each note in the recorded songs were extracted. The following five metrics were computed based on the reference music scores: (1) F0 contour direction of the adjacent notes, (2) F0 compression ratio of the entire song, (3) mean deviation of the normalized F0 across the notes, (4) mean deviation of the pitch intervals, and (5) standard deviation of the note duration differences. Children with cochlear implants showed significantly poorer performance in the pitch-based assessments than the normal-hearing children. No significant differences were seen between the two groups in the rhythm-based measure. Prelingually-deafened children with cochlear implants have significant deficits in singing due to their inability to manipulate pitch in the correct directions and to produce accurate pitch height. Future studies with a large sample size are warranted in order to account for the large variability in singing performance.

It has been shown that frequency-place mismatch has detrimental effects on English speech recognition. The present study investigated the effects of mismatched spectral distribution of envelopes on Mandarin Chinese tone recognition using a noise-excited vocoder. In Experiment 1, speech samples were processed to simulate a cochlear implant with various insertion depths. The carrier bands were shifted basally relative to the analysis bands by 1 to 7 mm in the cochlea. Nine normal-hearing Mandarin Chinese listeners participated in this experiment. Basal shift of the carriers only slightly affected tone recognition. The resistance of tone recognition to spectral shift can be attributed to the overall amplitude contour cues that are independent from spectral manipulations. Experiment 2 examined the effects of frequency compression, where widened analysis bands by 2, 6, and 10 mm were compressively allocated to narrower carrier bands. Five of the 9 subjects participated in Experiment 2. It appears that the expanded frequency information especially on the low frequency end can compensate for the distortion from frequency compression. Thus, spectral shift might not pose a severe problem for tone recognition, and allocation of wider frequency range to include more low frequency information might be beneficial for tone recognition.