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Objective To determine if Meniere's disease is associated with fluctuations in afferent excitability in four human subjects previously implanted with vestibular stimulators. Study design Longitudinal repeated measures. Setting Tertiary referral center, human vestibular research laboratory. Patients Four human subjects with previously uncontrolled Meniere's disease unilaterally implanted in each semicircular canal with a vestibular stimulator. One subject had only two canals implanted. Intervention(s) Repeated measures of electrically-evoked slow phase eye velocity and vestibular electrically-evoked compound action potentials (vECAP) over 2 to 4 years. Main outcome measure(s) Slow phase eye velocity and N1-P1 vECAP amplitudes as a function of time. Results There were statistically significant fluctuations in electrically evoked slow phase eye velocity over time in at least one semicircular canal of each subject. vECAP N1-P1 amplitudes measured at similar time intervals and stimulus intensities seem to show somewhat correlated fluctuations. One of the subjects had a single Meniere's attack during this time period. The others did not. Conclusions In these four subjects originally diagnosed with Meniere's disease, there was fluctuating electrical excitability of the ampullar nerve of at least one canal in each subject. These fluctuations occurred without active symptoms of Meniere's disease.

Objective: Mandarin-speaking cochlear implant users have difficulty perceiving tonal changes in speech with current signal processing strategies. The purpose of this study was to evaluate w...

OBJECTIVE: To examine whether or not electric-acoustic music perception outcomes, observed in a recent Hybrid™ L24 clinical trial, were related to the availability of low-frequency acoustic cues not present in the electric domain. STUDY DESIGN: Prospective, repeated-measures, within-subject design. SETTING: Academic research hospital. SUBJECTS: Nine normally hearing individuals. INTERVENTION: Simulated electric-acoustic hearing in normally hearing individuals. MAIN OUTCOMES MEASURES: Acutely measured melody and timbre recognition scores from the University of Washington Clinical Assessment of Music Perception (CAMP) test. RESULTS: Melody recognition scores were consistently better for listening conditions that included low-frequency acoustic information. Mean scores for both acoustic (73.5%, S.D. = 15.5%) and electric-acoustic (67.9%, S.D. = 21.2%) conditions were significantly better (P < 0.001) than electric alone (39.2%, S.D. = 18.1%). This was not the case for timbre recognition for which scores were more variable across simulated listening modes with no significant differences found in mean scores across electric (36.1%, S.D. = 17.7%), acoustic (38.0%, S.D. = 20.4%), and electric-acoustic (40.7%, S.D. = 19.7%) conditions (P > 0.05). CONCLUSION: Recipients of hybrid cochlear implants demonstrate music perception abilities superior to those observed in traditional cochlear implant recipients. Results from the present study support the notion that electric-acoustic stimulation confers advantages related to the availability of low-frequency acoustic hearing, most particularly for melody recognition. However, timbre recognition remains more limited for both hybrid and traditional cochlear implant users. Opportunities remain for new coding strategies to improve timbre perception.

Background noise poses a significant challenge to people who have a cochlear implant for restoring their hearing ability. A cochlear implant can process sound into 12 to 24 channels and it provides limited temporal and spectral information to the auditory nerve through electrical current stimulation. In this paper, a specific noise reduction algorithm was developed to accommodate the need of adaptively applying a small number of gains to the stimulation signals in cochlear implants. A sound signal was first divided into 22 channels using the WOLA (Weighted Overlap Add) spectral analysis. The spectral templates of background noise were estimated by automatically tracking energy gaps between speech segments. The gap detection algorithm utilized a mechanism like the charging and discharging of a capacitor in an envelope detector, which offers the ability for the extracted energy signal to stay at noise floors. The noise templates were updated adaptively when a segment of signal was determined to be noise. Simulations of the proposed noise reduction algorithm were performed using offline processing and it has also been implemented on the Ezairo 7150 (ON Semiconductor Corporation) DSP platform with a WOLA co-processor. Initial evaluation results showed that the signal-to-noise (SNR) ratio can be improved by up to 10 dB after noise removal.

Spectral resolution limits speech perception with a cochlear implant (CI) in post-lingually deaf adults. However, the development of spectral resolution in pre-lingually deaf implanted children is not well understood. Acoustic spectral resolution was measured as a function of age (school-age versus adult) in CI and normal-hearing (NH) participants using spectral ripple discrimination (SRD). A 3-alternative forced-choice task was used to obtain SRD thresholds at five ripple depths. Effects of age and hearing method on SRD and spectral modulation transfer function (SMTF) slope (reflecting frequency resolution) and x-intercept (reflecting across-channel intensity resolution) were examined. Correlations between SRD, SMTF parameters, age, and speech perception in noise were studied. Better SRD in NH than CI participants was observed at all depths. SRD thresholds and SMTF slope correlated with speech perception in CI users. When adjusted for floor performance, x-intercept did not correlate with SMTF slope or speech perception. Age and x-intercept correlations were positive and significant in NH but not CI children suggesting that across-channel intensity resolution matures during school-age in NH children. No evidence for maturation of spectral resolution beyond early school-age in pre-lingually deaf implanted CI users was found in the present study.

Hypothesis A functional vestibular prosthesis can be implanted in human such that electrical stimulation of each semicircular canal produces canal-specific eye movements while preserving vestibular and auditory function. Background A number of vestibular disorders could be treated with prosthetic stimulation of the vestibular end organs. We have previously demonstrated in rhesus monkeys that a vestibular neurostimulator, based on the Nucleus Freedom cochlear implant, can produce canal-specific electrically evoked eye movements while preserving auditory and vestibular function. An investigational device exemption has been obtained from the FDA to study the feasibility of treating uncontrolled Meniere's disease with the device. Methods The UW/Nucleus vestibular implant was implanted in the perilymphatic space adjacent to the three semicircular canal ampullae of a human subject with uncontrolled Meniere's disease. Preoperative and postoperative vestibular and auditory function was assessed. Electrically evoked eye movements were measured at 2 time points postoperatively. Results Implantation of all semicircular canals was technically feasible. Horizontal canal and auditory function were largely, but not totally, lost. Electrode stimulation in 2 of 3 canals resulted in canal-appropriate eye movements. Over time, stimulation thresholds increased. Conclusion Prosthetic implantation of the semicircular canals in humans is technically feasible. Electrical stimulation resulted in canal-specific eye movements, although thresholds increased over time. Preservation of native auditory and vestibular function, previously observed in animals, was not demonstrated in a single subject with advanced Meniere's disease.

Previous work showed that the Fidelity120 processing strategy provides better spectral sensitivity, while the HiResolution processing strategy can deliver more detailed temporal information for Advanced Bionics cochlear implant users. The goal of this study was to develop a new sound processing strategy by maximizing the spectral benefit of Fidelity120 and the temporal benefit of HiResolution to improve both aspects of hearing. Using acoustic simulations of Fidelity120 and HiResolution strategies, a dual-processing strategy was created by combining Fidelity120 in the low frequency channels and HiResolution in the high frequency channels. Compared to Fidelity120, the dual processing provided an improvement in performance for Schroeder-phase discrimination at 200 Hz and temporal modulation detection at 200 Hz with the cost of a slightly decreased performance for spectral-ripple discrimination relative to Fidelity120. Spectral-ripple discrimination was better with the dual processing than with HiResolution. However, no benefit for speech perception in noise was found for the dual-processing strategy over Fidelity 120 or HiResolution in our preliminary tests. Some other more optimal combination of Fidelity120 and HiResolution may be required to maximize the spectral and temporal benefits to yield improved speech perception.

It is possible to implant a stimulating electrode array in the semicircular canals without damaging rotational sensitivity or hearing. The electrodes will evoke robust and precisely controlled eye movements.A number of groups are attempting to develop a neural prosthesis to ameliorate abnormal vestibular function. Animal studies demonstrate that electrodes near the canal ampullae can produce electrically evoked eye movements. The target condition of these studies is typically bilateral vestibular hypofunction. Such a device could potentially be more widely useful clinically and would have a simpler roadmap to regulatory approval if it produced minimal or no damage to the native vestibular and auditory systems.An electrode array was designed for insertion into the bony semicircular canal adjacent to the membranous canal. It was designed to be sufficiently narrow so as to not compress the membranous canal. The arrays were manufactured by Cochlear, Ltd., and linked to a Nucleus Freedom receiver/stimulator. Seven behaviorally trained rhesus macaques had arrays placed in 2 semicircular canals using a transmastoid approach and "soft surgical" procedures borrowed from Hybrid cochlear implant surgery. Postoperative vestibulo-ocular reflex was measured in a rotary chair. Click-evoked auditory brainstem responses were also measured in the 7 animals using the contralateral ear as a control.All animals had minimal postoperative vestibular signs and were eating within hours of surgery. Of 6 animals tested, all had normal postoperative sinusoidal gain. Of 7 animals, 6 had symmetric postoperative velocity step responses toward and away from the implanted ear. The 1 animal with significantly asymmetric velocity step responses also had a significant sensorineural hearing loss. One control animal that underwent canal plugging had substantial loss of the velocity step response toward the canal-plugged ear. In 5 animals, intraoperative electrically evoked vestibular compound action potential recordings facilitated electrode placement. Postoperatively, electrically evoked eye movements were obtained from electrodes associated with an electrically evoked vestibular compound action potential wave form. Hearing was largely preserved in 6 animals and lost in 1 animal.It is possible to implant the vestibular system with prosthetic stimulating electrodes without loss of rotational sensitivity or hearing. Because electrically evoked eye movements can be reliably obtained with the assistance of intraoperative electrophysiology, it is appropriate to consider treatment of a variety of vestibular disorders using prosthetic electrical stimulation. Based on these findings, and others, a feasibility study for the treatment of human subjects with disabling Ménière's disease has begun.

The goals of the present study were to measure acoustic temporal modulation transfer functions (TMTFs) in cochlear implant listeners and examine the relationship between modulation detection and speech recognition abilities. The effects of automatic gain control, presentation level and number of channels on modulation detection thresholds (MDTs) were examined using the listeners’ clinical sound processor. The general form of the TMTF was low-pass, consistent with previous studies. The operation of automatic gain control had no effect on MDTs when the stimuli were presented at 65 dBA. MDTs were not dependent on the presentation levels (ranging from 50 to 75 dBA) nor on the number of channels. Significant correlations were found between MDTs and speech recognition scores. The rates of decay of the TMTFs were predictive of speech recognition abilities. Spectral-ripple discrimination was evaluated to examine the relationship between temporal and spectral envelope sensitivities. No correlations were found betw...

Experienced users of the Clarion cochlear implant were tested acutely with the HiResolution (HiRes) and HiRes Fidelity120 (F120) processing strategies. Three psychophysically-based tests were used including spectral-ripple discrimination, Schroeder-phase discrimination and temporal modulation detection. Three clinical outcome measures were used including consonant-nucleus-consonant (CNC) word recognition in quiet, word recognition in noise and the clinical assessment of music perception (CAMP). Listener's spectral-ripple discrimination ability improved with F120, but Schroeder-phase discrimination was worse with F120 than with HiRes. Listeners who had better than average acuity showed the biggest effects. There were no significant effects of the processing strategy on any of the clinical abilities nor on temporal modulation detection. Additionally, the listeners' day-to-day clinical strategy did not appear to influence the result suggesting that experience with the strategies did not play a significant role. The results underscore the value of acoustic psychophysical measures through the sound processor as a tool in clinical research, because these measures are more sensitive to changes in the processing strategies than traditional clinical measures, e.g. speech understanding. The measures allow for the evaluation of sensitivity to specific acoustic attributes revealing the extent to which different processing strategies affect these basic abilities and could thus improve the efficiency of the development of processing strategies.

Implanted vestibular neurostimulators are effective in driving slow phase eye movements in monkeys and humans. Furthermore, increases in slow phase velocity and electrically evoked compound action potential (vECAP) amplitudes occur with increasing current amplitude of electrical stimulation. In intact monkeys, protracted intermittent stimulation continues to produce robust behavioral responses and preserved vECAPs. In lesioned monkeys, shorter duration studies show preserved but with somewhat lower or higher velocity behavioral responses. It has been proposed that such changes are due to central adaptive changes in the electrically elicited vestibulo-ocular reflex (VOR). It is equally possible that these differences are due to changes in the vestibular periphery in response to activation of the vestibular efferent system. In order to investigate the site of adaptive change in response to electrical stimulation, we performed transtympanic gentamicin perfusions to induce rapid changes in vestibular input in monkeys with long-standing stably functioning vestibular neurostimulators, disambiguating the effects of implantation from the effects of ototoxic lesion. Gentamicin injection was effective in producing a large reduction in natural VOR only when it was performed in the non-implanted ear, suggesting that the implanted ear contributed little to the natural rotational response before injection. Injection of the implanted ear produced a reduction in the vECAP responses in that ear, suggesting that the intact hair cells in the non-functional ipsilateral ear were successfully lesioned by gentamicin, reducing the efficacy of stimulation in that ear. Despite this, injection of both ears produced central plastic changes that resulted in a dramatically increased slow phase velocity nystagmus elicited by electrical stimulation. These results suggest that loss of vestibular afferent activity, and a concurrent loss of electrically elicited vestibular input, produces an increase in the efficacy of a vestibular neurostimulator by eliciting centrally adapted behavioral responses without concurrent adaptive increase of galvanic afferent activation in the periphery.

Objective: Taking advantage of the flexibility in the number of stimulating electrodes and the stimulation rate in a modern cochlear implant, the present study evaluated relative contributions of spectral and temporal cues to cochlear implant speech perception. Design: Four experiments were conducted by using a Research Interface Box in five MED-EL COMBI 40 cochlear implant users. Experiment 1 varied the number of electrodes from four to twelve or the maximal number of available active electrodes while keeping a constant stimulation rate at 1000 Hz per electrode. Experiment 2 varied the stimulation rate from 1000 to 4000 Hz per electrode on four pairs of fixed electrodes. Experiment 3 covaried the number of stimulating electrodes and the stimulation rate to study the trade-off between spectral and temporal cues. Experiment 4 studied the effects of envelope extraction on speech perception and listening preference, including half-wave rectification, full-wave rectification, and the Hilbert transform. Vowels, consonants, and HINT sentences in quiet, as well as with a competing female voice served as test materials. Results: Experiment 1 found significant improvement in all speech tests with a higher number of stimulating electrodes. Experiment 2 found a significant advantage of the high stimulation rate only on consonant recognition and sentence recognition in noise. Experiment 3 found an almost linear tradeoff between the number of stimulation electrodes and the stimulation rate for consonant and sentence recognition in quiet, but not for vowel and sentence recognition in noise. Experiment 4 found significantly better performance with the Hilbert transform and the full-wave rectification than the half-wave rectification. In addition, envelope extraction with the Hilbert transform produced the highest rating on subjective judgment of sound quality. Conclusions: Consistent with previous studies, the present result from the five MED-EL subjects showed that (1) the temporal envelope cues from a limited number of channels are sufficient to support high levels of phoneme and sentence recognition in quiet but not for speech recognition in a competing voice, (2) consonant recognition relies more on temporal cues while vowel recognition relies more on spectral cues, (3) spectral and temporal cues can be traded to some degree to produce similar performance in cochlear implant speech recognition, and (4) the Hilbert envelope improves both speech intelligibility and quality in cochlear implants.

Amplitude modulation (AM) and frequency modulation (FM) are commonly used in communication, but their relative contributions to speech recognition have not been fully explored. To bridge this gap, we derived slowly varying AM and FM from speech sounds and conducted listening tests using stimuli with different modulations in normal-hearing and cochlear-implant subjects. We found that although AM from a limited number of spectral bands may be sufficient for speech recognition in quiet, FM significantly enhances speech recognition in noise, as well as speaker and tone recognition. Additional speech reception threshold measures revealed that FM is particularly critical for speech recognition with a competing voice and is independent of spectral resolution and similarity. These results suggest that AM and FM provide independent yet complementary contributions to support robust speech recognition under realistic listening situations. Encoding FM may improve auditory scene analysis, cochlear-implant, and audiocoding performance.

Different from traditional Fourier analysis, a signal can be decomposed into amplitude and frequency modulation components. The speech processing strategy in most modern cochlear implants only extracts and encodes amplitude modulation in a limited number of frequency bands. While amplitude modulation encoding has allowed cochlear implant users to achieve good speech recognition in quiet, their performance in noise is severely compromised. Here, we propose a novel speech processing strategy that encodes both amplitude and frequency modulations in order to improve cochlear implant performance in noise. By removing the center frequency from the subband signals and additionally limiting the frequency modulation's range and rate, the present strategy transforms the fast-varying temporal fine structure into a slowly varying frequency modulation signal. As a first step, we evaluated the potential contribution of additional frequency modulation to speech recognition in noise via acoustic simulations of the cochlear implant. We found that while amplitude modulation from a limited number of spectral bands is sufficient to support speech recognition in quiet, frequency modulation is needed to support speech recognition in noise. In particular, improvement by as much as 71 percentage points was observed for sentence recognition in the presence of a competing voice. The present result strongly suggests that frequency modulation be extracted and encoded to improve cochlear implant performance in realistic listening situations. We have proposed several implementation methods to stimulate further investigation. Index Terms-Amplitude modulation, cochlear implant, fine structure, frequency modulation, signal processing, speech recognition, temporal envelope.

It is important to know what cues the sensory system extracts from natural stimuli and how the brain uses them to form perception. To explore this issue, Smith, Delgutte, and Oxenham [Nature (London) 416, 87–90 (2002)] mixed one sound’s temporal envelope with another sound’s fine temporal structure to produce auditory chimaeras and found that “the perceptual importance of the envelope increases with the number of frequency bands, while that of the fine structure diminishes.” This study addressed two technical issues related to natural cochlear filtering and artificial filter ringing in the chimaerizing algorithm. In addition, this study found that the dichotomy in auditory perception revealed by auditory chimaeras is an epiphenomenon of the classic dichotomy between low- and high-frequency processing. Finally, this study found that the temporal envelope determines sound location as long as the interaural level difference cue is present. The present result reinforces the original hypothesis that the temporal envelope is critical for speech perception whereas temporal fine structure is critical for pitch perception, but does not support the assertion regarding the temporal envelope and fine structure as the acoustic basis for the “what” and “where” mechanisms.

Good performance in cochlear implant users depends in large part on the ability of a speech processor to effectively decompose speech signals into multiple channels of narrow-band electrical pulses for stimulation of the auditory nerve. Speech processors that extract only envelopes of the narrow-band signals (e.g., the continuous interleaved sampling (CIS) processor) may not provide sufficient information to encode the tonal cues in languages such as Chinese. To improve the performance in cochlear implant users who speak tonal language, we proposed and developed a novel speech-processing strategy, which extracted both the envelopes of the narrow-band signals and the fundamental frequency (F/sub 0/) of the speech signal, and used them to modulate both the amplitude and the frequency of the electrical pulses delivered to stimulation electrodes. We developed an algorithm to extract the fundamental frequency and identified the general patterns of pitch variations of four typical tones in Chinese speech. The effectiveness of the extraction algorithm was verified with an artificial neural network that recognized the tonal patterns from the extracted F/sub 0/ information. We then compared the novel strategy with the envelope-extraction CIS strategy in human subjects with normal hearing. The novel strategy produced significant improvement in perception of Chinese tones, phrases, and sentences. This novel processor with dynamic modulation of both frequency and amplitude is encouraging for the design of a cochlear implant device for sensorineurally deaf patients who speak tonal languages.

Spectral resolution limits speech perception with a cochlear implant (CI) in post-lingually deaf adults. However, the development of spectral resolution in pre-lingually deaf implanted children is not well understood. Acoustic spectral resolution was measured as a function of age (school-age versus adult) in CI and normal-hearing (NH) participants using spectral ripple discrimination (SRD). A 3-alternative forced-choice task was used to obtain SRD thresholds at five ripple depths. Effects of age and hearing method on SRD and spectral modulation transfer function (SMTF) slope (reflecting frequency resolution) and x-intercept (reflecting across-channel intensity resolution) were examined. Correlations between SRD, SMTF parameters, age, and speech perception in noise were studied. Better SRD in NH than CI participants was observed at all depths. SRD thresholds and SMTF slope correlated with speech perception in CI users. When adjusted for floor performance, x-intercept did not correlate with SMTF slope or speech perception. Age and x-intercept correlations were positive and significant in NH but not CI children suggesting that across-channel intensity resolution matures during school-age in NH children. No evidence for maturation of spectral resolution beyond early school-age in pre-lingually deaf implanted CI users was found in the present study.

The dichotomy between acoustic temporal envelope (ENV) and fine structure (TFS) cues has stimulated numerous studies over the past decade to understand the relative role of acoustic ENV and TFS in human speech perception. Such acoustic temporal speech cues produce distinct neural discharge patterns at the level of the auditory nerve, yet little is known about the central neural mechanisms underlying the dichotomy in speech perception between neural ENV and TFS cues. We explored the question of how the peripheral auditory system encodes neural ENV and TFS cues in steady or fluctuating background noise, and how the central auditory system combines these forms of neural information for speech identification. We sought to address this question by (1) measuring sentence identification in background noise for human subjects as a function of the degree of available acoustic TFS information and (2) examining the optimal combination of neural ENV and TFS cues to explain human speech perception performance using computational models of the peripheral auditory system and central neural observers. Speech-identification performance by human subjects decreased as the acoustic TFS information was degraded in the speech signals. The model predictions best matched human performance when a greater emphasis was placed on neural ENV coding rather than neural TFS. However, neural TFS cues were necessary to account for the full effect of background-noise modulations on human speech-identification performance.

Loss of vestibular function may be treatable with an implantable vestibular prosthesis that stimulates semicircular canal afferents with biphasic pulse trains. Several studies have demonstrated short-term activation of the vestibulo-ocular reflex (VOR) with electrical stimulation. Fewer long-term studies have been restricted to small numbers of animals and stimulation designed to produce adaptive changes in the electrically elicited response. This study is the first large consecutive series of implanted rhesus macaque to be studied longitudinally using brief stimuli designed to limit adaptive changes in response, so that the efficacy of electrical activation can be studied over time, across surgeries, canals and animals. The implantation of a vestibular prosthesis in animals with intact vestibular end organs produces variable responses to electrical stimulation across canals and animals, which change in threshold for electrical activation of eye movements and in elicited slow phase velocities over time. These thresholds are consistently lower, and the slow phase velocities higher, than those obtained in human subjects. The changes do not appear to be correlated with changes in electrode impedance. The variability in response suggests that empirically derived transfer functions may be required to optimize the response of individual canals to a vestibular prosthesis, and that this function may need to be remapped over time. This article is part of a Special Issue entitled .

In order to analyze the characteristics of EEG signals collected prior, during and post electrical acupuncture with nonlinear methods and to discuss the nonlinear properties of EEG under these conditions, eleven subjects were involved in the study. The subjects were kept quiet with eyes closed during acupuncture. EEG nonlinear indices correlation dimension were calculated for all the subjects. Results showed that correlation dimension D2 decreased gradually during the processes of acupuncture, and it reached the minimum point after the power was on for 20 minutes. The values of D2 in needle-withdrawal also decreased in comparison to the quiet status of pre-acupuncture. With EEG nonlinear analysis, the changes in brain function could be captured at different status of acupuncture. The results are in accord with the principle of Traditional Chinese Medicine. Stimulation of Neiguan and Shenmen could regulate of both the peripheral and the central nervous systems, providing a potential way of solving emotional issues, such as insomnia and muddled thinking. It was found that EEG nonlinear analysis could characterize the changes of brain functions pre-during- and after acupuncture states and might have some value in exploring the mechanism of acupuncture.

The lack of fine structure information in conventional cochlear implant (CI) encoding strategies presumably contributes to the generally poor music perception with CIs. To improve CI users' music perception, a harmonic-single-sideband-encoder (HSSE) strategy was developed , which explicitly tracks the harmonics of a single musical source and transforms them into modulators conveying both amplitude and temporal fine structure cues to electrodes. To investigate its effectiveness, vocoder simulations of HSSE and the conventional continuous-interleaved-sampling (CIS) strategy were implemented. Using these vocoders, five normal-hearing subjects' melody and timbre recognition performance were evaluated: a significant benefit of HSSE to both melody (p0.002) and timbre (p0.026) recognition was found. Additionally, HSSE was acutely tested in eight CI subjects. On timbre recognition, a significant advantage of HSSE over the subjects' clinical strategy was demonstrated: the largest improvement was 35% and the mean 17% (p0.013). On melody recognition, two subjects showed 20% improvement with HSSE; however, the mean improvement of 7% across subjects was not significant (p0.090). To quantify the temporal cues delivered to the auditory nerve, the neural spike patterns evoked by HSSE and CIS for one melody stimulus were simulated using an auditory nerve model. Quantitative analysis demonstrated that HSSE can convey temporal pitch cues better than CIS. The results suggest that HSSE is a promising strategy to enhance music perception with CIs.

A multichannel vestibular prosthesis that delivers electrical stimulation to the perilymph of individual semicircular canals is a potential new treatment modality for patients with vestibular deficiencies. Most research in this field has evaluated the efficacy of this approach by its ability to reproduce eye movements in response to head rotations. Our group has developed such a device and implanted it in four human subjects with intractable unilateral Meniere’s disease. This allows us to evaluate individual semicircular canal contribution to the control of balance and posture in human subjects. In this report, we demonstrate that electrical stimulation trains delivered to the perilymph of individual semicircular canals elicit postural responses specific to the particular canal stimulated, with some current spread to adjacent end organs. Modulation of stimulation current modulates the amplitude of the postural response. However, eye movements elicited by the same electrical stimuli were not consistent with postural responses in magnitude or direction in all subjects. Taken together, these findings support the feasibility of a vestibular prosthesis for the control of balance and illustrate new challenges for the development of this technology.

Animal experiments and limited data in humans suggest that electrical stimulation of the vestibular end organs could be used to treat loss of vestibular function. In this paper we demonstrate that canal-specific two-dimensionally (2D) measured eye velocities are elicited from intermittent brief 2 s biphasic pulse electrical stimulation in four human subjects implanted with a vestibular prosthesis. The 2D measured direction of the slow phase eye movements changed with the canal stimulated. Increasing pulse current over a 0–400 μA range typically produced a monotonic increase in slow phase eye velocity. The responses decremented or in some cases fluctuated over time in most implanted canals but could be partially restored by changing the return path of the stimulation current. Implantation of the device in Meniere's patients produced hearing and vestibular loss in the implanted ear. Electrical stimulation was well tolerated, producing no sensation of pain, nausea, or auditory percept with stimulation that elicited robust eye movements. There were changes in slow phase eye velocity with current and over time, and changes in electrically evoked compound action potentials produced by stimulation and recorded with the implanted device. Perceived rotation in subjects was consistent with the slow phase eye movements in direction and scaled with stimulation current in magnitude. These results suggest that electrical stimulation of the vestibular end organ in human subjects provided controlled vestibular inputs over time, but in Meniere's patients this apparently came at the cost of hearing and vestibular function in the implanted ear.

Harmonic and temporal fine structure (TFS) information are important cues for speech perception in noise and music perception. However, due to the inherently coarse spectral and temporal resolution in electric hearing, the question of how to deliver harmonic and TFS information to cochlear implant (CI) users remains unresolved. A harmonic-single-sideband-encoder [(HSSE); Nie et al. (2008). Proceedings of IEEE International Conference on Acoustics, Speech, and Signal Processing; Lie et al., (2010). Proceedings of IEEE International Conference on Acoustics, Speech, and Signal Processing] strategy has been proposed that explicitly tracks the harmonics in speech and transforms them into modulators conveying both amplitude modulation and fundamental frequency information. For unvoiced speech, HSSE transforms the TFS into a slowly varying yet still noise-like signal. To investigate its potential, four- and eight-channel vocoder simulations of HSSE and the continuous-interleaved-sampling (CIS) strategy were implemented, respectively. Using these vocoders, five normal-hearing subjects’ speech recognition performance was evaluated under different masking conditions; another five normal-hearing subjects’ Mandarin tone identification performance was also evaluated. Additionally, the neural discharge patterns evoked by HSSE- and CIS-encoded Mandarin tone stimuli were simulated using an auditory nerve model. All subjects scored significantly higher with HSSE than with CIS vocoders. The modeling analysis demonstrated that HSSE can convey temporal pitch cues better than CIS. Overall, the results suggest that HSSE is a promising strategy to enhance speech perception with CIs.

Electrical stimulation of the vestibular end organ with a vestibular prosthesis may provide an effective treatment for vestibular loss if the stimulation remains effective over a significant period of time after implantation of the device. To assess efficacy of electrical stimulation in an animal model, we implanted 3 rhesus monkeys with a vestibular prosthesis based on a cochlear implant. We then recorded vestibular electrically evoked compound action potentials (vECAPs) longitudinally in each of the implanted canals to see how the amplitude of the response changed over time. The results suggest that vECAPs, and therefore electrical activation of vestibular afferent fibers, can remain largely stable over time following implantation.

We measured auditory brainstem responses (ABRs) in eight Rhesus monkeys after implantation of electrodes in the semicircular canals of one ear, using a multi-channel vestibular prosthesis based on cochlear implant technology. In five animals, click-evoked ABR thresholds in the implanted ear were within 10 dB of thresholds in the non-implanted control ear. Threshold differences in the remaining three animals varied from 18 to 69 dB, indicating mild to severe hearing losses. Click- and tone-evoked ABRs measured in a subset of animals before and after implantation revealed a comparable pattern of threshold changes. Thresholds obtained five months or more after implantation – a period in which the prosthesis regularly delivered electrical stimulation to achieve functional activation of the vestibular system – improved in three animals with no or mild initial hearing loss and increased in a fourth with a moderate hearing loss. These results suggest that, although there is a risk of hearing loss with unilateral vestibular implantation to treat balance disorders, the surgery can be performed in a manner that preserves hearing over an extended period of functional stimulation.

Previous studies have found a significant correlation between spectral-ripple discrimination and speech and music perception in cochlear implant (CI) users. This relationship could be of use to clinicians and scientists who are interested in using spectral-ripple stimuli in the assessment and habilitation of CI users. However, previous psychoacoustic tasks used to assess spectral discrimination are not suitable for all populations, and it would be beneficial to develop methods that could be used to test all age ranges, including pediatric implant users. Additionally, it is important to understand how ripple stimuli are processed in the central auditory system and how their neural representation contributes to behavioral performance. For this reason, we developed a single-interval, yes/no paradigm that could potentially be used both behaviorally and electrophysiologically to estimate spectral-ripple threshold. In experiment 1, behavioral thresholds obtained using the single-interval method were compared to thresholds obtained using a previously established three-alternative forced-choice method. A significant correlation was found (r = 0.84, p = 0.0002) in 14 adult CI users. The spectral-ripple threshold obtained using the new method also correlated with speech perception in quiet and noise. In experiment 2, the effect of the number of vocoder-processing channels on the behavioral and physiological threshold in normal-hearing listeners was determined. Behavioral thresholds, using the new single-interval method, as well as cortical P1-N1-P2 responses changed as a function of the number of channels. Better behavioral and physiological performance (i.e., better discrimination ability at higher ripple densities) was observed as more channels added. In experiment 3, the relationship between behavioral and physiological data was examined. Amplitudes of the P1-N1-P2 “change” responses were significantly correlated with d′ values from the single-interval behavioral procedure. Results suggest that the single-interval procedure with spectral-ripple phase inversion in ongoing stimuli is a valid approach for measuring behavioral or physiological spectral resolution.

We recorded intraoperative and postoperative electrically evoked compound action potentials (ECAPs) in rhesus monkeys implanted with a vestibular neurostimulator. The objectives were to correlate the generation of slow-phase nystagmus or eye twitches induced by electrical stimulation of the implanted semicircular canal with the presence or absence of the vestibular ECAP responses and to assess the effectiveness of ECAP monitoring during surgery to guide surgical insertion of electrode arrays into the canals.Four rhesus monkeys (a total of 7 canals) were implanted with a vestibular neurostimulator modified from the Nucleus Freedom cochlear implant. ECAP recordings were obtained during surgery or at various intervals after surgery using the Neural Response Telemetry feature of the clinical Custom Sound EP software. Eye movements during electrical stimulation of individual canals were recorded with a scleral search coil system in the same animals.Measurable vestibular ECAPs were observed intraoperatively or postoperatively in 3 implanted animals. Robust and sustained ECAPs were obtained in 3 monkeys at the test intervals of 0, 7, or greater than 100 days after implantation surgery. In all 3 animals, stimulation with electrical pulse trains produced measurable eye movements in a direction consistent with the vestibulo-ocular reflex from the implanted semicircular canal. In contrast, electrically evoked eye movements could not be measured in 3 of the 7 implanted canals, none of which produced distinct vestibular ECAPs. In 2 animals, ECAP waveforms were systematically monitored during surgery, and the procedure proved crucial to the success of vestibular implantation.Vestibular ECAPs exhibit similar morphology and growth characteristics to cochlear ECAPs from human cochlear implant patients. The ECAP measure is well correlated with the functional activation of eye movements by electrical stimulation after implantation surgery. The intraoperative ECAP recording technique is an efficient tool to guide the placement of electrode array into the semicircular canals.

An implanted vestibular neurostimulator has been developed based on commercial cochlear implant technology. It has been implanted chronically in Rhesus monkeys and the physiology of electrical stimulation of the vestibular periphery has been studied. We are currently proposing a human feasibility study of implantation of the device for the treatment of incapacitating Meniere's disease. Because no animal model of Meniere's disease exists, signal processing for such a device must be based on prior observations of human subjects who have suffered Meniere's attacks while their eye-movements could be quantified. Based on such data, and on the leading theories for the pathophysiology of a Meniere's attack, our animal data suggests that fixed amplitude, constant frequency biphasic pulse trains should be adequate to suppress the symptoms of an attack when they occur. The intensity of the stimuli and efficacy of vertigo suppression should be readily modulated either by amplitude or frequency adjustments.

Cortical auditory evoked potentials (CAEPs) are frequently used to detect the maturational status of the central auditory system in both healthy persons and cochlear implant listeners. However, with cochlear implant patients, the CAEP is partly or completely submerged in stimulus artifacts induced by current stimulation, making it difficult to faithfully detect auditory evoked potentials with cochlear implants. The aim of this study was to determine if a systematic relationship exists between the artifacts and cochlear implant fitting parameters using speech-like or tone stimuli. Chicken carcus was used as an experimental model to record stimulus artifacts at various implant settings, e.g. monopolar/bipolar stimulation, pulse width, and most comfortable level. The influence of the implant parameter variation on stimulus artifacts was systematically studied. The results of this study could potentially provide useful information for developing methods of eliminating stimulus artifacts in EEG recordings with cochlear implant patients.

Assessment of cochlear implant outcomes centers around speech discrimination. Despite dramatic improvements in speech perception, music perception remains a challenge for most cochlear implant users. No standardized test exists to quantify music perception in a clinically practical manner. This study presents the University of Washington Clinical Assessment of Music Perception (CAMP) test as a reliable and valid music perception test for English-speaking, adult cochlear implant users.Forty-two cochlear implant subjects were recruited from the University of Washington Medical Center cochlear implant program and referred by two implant manufacturers. Ten normal-hearing volunteers were drawn from the University of Washington Medical Center and associated campuses. A computer-driven, self-administered test was developed to examine three specific aspects of music perception: pitch direction discrimination, melody recognition, and timbre recognition. The pitch subtest used an adaptive procedure to determine just-noticeable differences for complex tone pitch direction discrimination within the range of 1 to 12 semitones. The melody and timbre subtests assessed recognition of 12 commonly known melodies played with complex tones in an isochronous manner and eight musical instruments playing an identical five-note sequence, respectively. Testing was repeated for cochlear implant subjects to evaluate test-retest reliability. Normal-hearing volunteers were also tested to demonstrate differences in performance in the two populations.For cochlear implant subjects, pitch direction discrimination just-noticeable differences ranged from 1 to 8.0 semitones (Mean = 3.0, SD = 2.3). Melody and timbre recognition ranged from 0 to 94.4% correct (mean = 25.1, SD = 22.2) and 20.8 to 87.5% (mean = 45.3, SD = 16.2), respectively. Each subtest significantly correlated at least moderately with both Consonant-Nucleus-Consonant (CNC) word recognition scores and spondee recognition thresholds in steady state noise and two-talker babble. Intraclass coefficients demonstrating test-retest correlations for pitch, melody, and timbre were 0.85, 0.92, and 0.69, respectively. Normal-hearing volunteers had a mean pitch direction discrimination threshold of 1.0 semitone, the smallest interval tested, and mean melody and timbre recognition scores of 87.5 and 94.2%, respectively.The CAMP test discriminates a wide range of music perceptual ability in cochlear implant users. Moderate correlations were seen between music test results and both Consonant-Nucleus-Consonant word recognition scores and spondee recognition thresholds in background noise. Test-retest reliability was moderate to strong. The CAMP test provides a reliable and valid metric for a clinically practical, standardized evaluation of music perception in adult cochlear implant users.

Objectives: First, to establish the feasibility of the observer-based psychophysical procedure (OPP) in measuring sound detection in infant and toddler cochlear implant (CI) recipients. Second, to measure the psychometric function for detection (PFD) from individual subjects. Third, to determine whether reaction time (RT) provides information about the auditory sensitivity of young CI users. Design: Twelve CI recipients, 11 to 32 mo old, participated in our study. Initially, tones were presented in sound field, and children learned to respond when they heard tones but not at other times. Once an 80% correct criterion was met in sound field, a novel stimulation paradigm was used to present stimuli to a single electrode while the child listened to acoustic input on most other electrodes using their usual map. The PFD and RT were measured using this single-electrode stimulation paradigm. Results: Eleven subjects met criterion, 6 within the minimum possible number of trials. For eight subjects, the asymptotic level of detecting single-electrode stimuli averaged 86% correct, similar to levels achieved by normal-hearing infants and toddlers detecting pure tones. The PFD slope of infant and toddler CI recipients was less than or equal to the slope for adult CI users reported in previous studies. RT decreased significantly with stimulus level in four children. Conclusions: These preliminary results suggest that psychophysical detection data can be obtained from infant and toddler CI recipients using OPP. The PFD of young CI users may be shallower than that of adult CI users. Relatively good asymptotic detection performance implies that young CI users are more attentive to sound than has been suggested in previous studies. RT tended to be a less reliable measure of detection, but methodological changes could improve its utility.

We explore the use of the modulation frequency domain for single channel speaker separation. We discuss features of the modulation spectrogram of speech signals that suggest that multiple speakers are highly separable in this space. In a preliminary experiment, we separate a target speaker from an interfering speaker by manually masking out modulation spectral features of the interferer. We extend this experiment into a new automatic speaker separation algorithm, and show that it achieves an acceptable level of separation. The new algorithm only needs a rough estimate of the target speaker's pitch range.

In October, 2010, we began human studies of a vestibular prosthesis. Our goal is to develop a device for the management of several vestibular disorders that defy existing treatment modalities. We have long-term data on four human subjects and ten non-human primates and are awaiting regulatory approval of our second-generation device, modified based on that data. We have been guided by a wealth of information based on lessons learned from cochlear implants. These lessons include first and foremost the otherwise hubristic idea that an effective vestibular prosthesis is technically feasible. Indeed the extraordinary compensation mechanisms of the central vestibular system convince us that such a prosthesis could be even more effective than for hearing. Second, the ability to leverage CI engineering expertise and industry relationships has been critical to our success so far. Third, the regulatory comfort with the success and favorable risk profile of cochlear implants has greatly speeded up human translation. Fourth, surgical familiarity with these devices has greatly enabled our research and facilitates future multicenter studies. Lastly, experience with “soft-surgery”, hearing preservation, and single-sided deafness cochlear implantation holds forth alluring possibilities for the range of vestibular disorders that may eventually succumb to this closely related technology.

Recent studies have revealed temporal waveform envelope cues as a function of time having significant influence on tone recognition in continuous interleaved sampling (CIS) of cochlear implants. In this study, temporal cues of speech signal have been modulated so that to different tones have nearly the same temporal waveform envelope. The processing signal is named modulated signal. The modulated signals and original signals are processed through software emulations of cochlear-implant signal processors. The recognition score of the modulated signals and originals are compared. The result indicates that temporal cues have great influence on tone recognition, but spectral cues are the principal factor determining the identification of tones.

Cochlear implants allow most patients with profound deafness to successfully communicate under optimal listening conditions. However, the amplitude modulation (AM) information provided by most implants is not sufficient for speech recognition in realistic settings where noise is typically present. This study added slowly varying frequency modulation (FM) to the existing algorithm of an implant simulation and used competing sentences to evaluate FM contributions to speech recognition in noise. Potential FM advantage was evaluated as a function of the number of spectral bands, FM depth, FM rate, and FM band distribution. Barring floor and ceiling effects, significant improvement was observed for all bands from 1 to 32 with the additional FM cue both in quiet and noise. Performance also improved with greater FM depth and rate, which might reflect resolved sidebands under the FM condition. Having FM present in low-frequency bands was more beneficial than in high-frequency bands, and only half of the bands required the presence of FM, regardless of position, to achieve performance similar to when all bands had the FM cue. These results provide insight into the relative contributions of AM and FM to speech communication and the potential advantage of incorporating FM for cochlear implant signal processing.