Effects of level on nonspectral frequency difference limens for electrical and acoustic stimuli

The purpose of this experiment was to study the effects of stimulus level on discrimination of frequency as represented in the temporal waveforms of acoustic and electrical signals. The subjects were four nonhuman primates in which one ear had been deafened and implanted with an electrode array and the other ear was untreated. Frequency difference limens for 100 Hz electrical sinusoidal stimulation via a cochlear implant in the deafened ear were compared to those for 100 Hz sinusoidally amplitude-modulated white noise (SAM noise) acoustic stimuli to the normal-hearing contralateral ear. To correct for loudness cues, levels of the test stimuli were varied relative to the reference-stimulus level. The test-stimulus levels at which the percent responses were minimum were determined. These levels were used to measure the frequency difference limens. Frequency difference limens for the electrical stimuli decreased as a function of reference-stimulus level through most of the dynamic range, while those for the acoustic stimuli reached a minimum at 20 dB to 40 dB above threshold. For the electrical stimuli the slopes and relative positions of the frequency difference limen vs. level functions varied from subject to subject and with changes in electrode configuration within a subject. These differences were related to threshold level and dynamic range. At higher levels of stimulation, frequency difference limens for acoustic and electrical stimuli fell in the same range. The slopes and relative positions of the frequency difference limen vs. level functions for electrical stimuli did not parallel those of level difference limen vs. level functions collected simultaneously from the same ears. The data suggest that nonspectral frequency discrimination may depend on the number of nerve fibers stimulated. With prostheses in cochleas with less than a full complement of auditory nerve fibers, the data suggest that stimulation level is an important variable influencing discriminability.     

Experience with electrostimulation of the acoustic nerve before cochlea implantation

The electrical stimulation of the acoustic nerve plays an essential role in the selection of patients for cochlea implantation. The performance of a deaf ear under the conditions of electrical stimulation can be assessed by means of the pre-operative promontory test using a transtympanic needle electrode. Five components of this test were applied to 48 patients: the determination of perception threshold and upper comfortable level for pulse and burst stimulation, the pitch test, the temporal difference test and the gap detection test. The mean values emerging from these examinations may be useful as guidelines for the interpretation of individual results. A cross correlational analysis of the data was performed in order to eventually discover redundancies among the different test components. Indeed, the threshold values for pulses of a given duration are highly correlated to those for bursts of the corresponding frequency. One of these tests may therefore be eliminated for routine test purposes. Similarly, the assessment of time resolution capabilities with the temporal difference limen test yields results which show a strong correlation with those of the gap detection test.     

An investigation on the maturation of hearing abilities in children

A number of pure-tone tests were presented to 8 groups of children of different ages who had no ear, nose, and throat pathology and a normal I.Q., in order to investigate the degree of maturation of their hearing abilities. The Luescher test (identification of difference limen or intensity) showed a significant relationship between increasing age and precise identification of gradually decreasing levels of intensity. Performance on this test was shown to be very reliable in children, and may be used as an indication of the degree of physiological maturation of hearing abilities.     

The prognostic value preoperative promontory testing in Japanese cochlear implant patients]

The prognostic value of preoperative promontory testing was evaluated in Japanese cochlear implant patients. Promontory testing consisted of measurement of electrical thresholds (T), uncomfortable level (UCL), dynamic range (DR), gap detection (GAP), and temporal difference limen (TDL). Patients' performances were measured at 3 months (n = 46) and 1 year (n = 20) postoperatively, using a standard Japanese audiologic test battery without lip-reading. This study included only postlingual deaf patients who received the Nucleus multichannel cochlear implant. Wide DRs at low frequencies (50,100,200 Hz) and good GAP detection (< 20 ms) emerged as excellent preoperative predictors of the 3-month postoperative performances (P < 0.05). In contrast, any measurements could not serve as a good predictor of the 1-year performances. These results suggest that the preoperative promontory testing provides useful information only for early postoperative performances but that it could not predict the final language performances.     

Predictors of cochlear implant performance

Open set speech understanding with cochlear implants, without speechreading, is nowadays a common finding. However, there is a large variation in speech understanding between cochlear implant users. We tried to find pre-operative parameters which predicted the post-operative results. Thirty-seven adult post-lingually deafened Nucleus cochlear implant users with a mean age of 46 years (range 16 68) and a mean duration of deafness of 15 years (range 1.5-47) were studied. Pre-operatively, we performed pure-tone audiometry, round window and ear canal electrical stimulation, psychological tests and imaging. Additionally, we measured pre-operatively speech understanding in the auditory, the visual and the audiovisual conditions with several tests which were also administered after 6 and 12 months' implant experience. Correlation analysis between the pre-operative variables and the post-operative factors showed that duration of deafness and residual hearing are the most important predictors. The temporal difference limen in pre-operative round window electrical stimulation is a secondary predictor.     

Promontory stimulation following labyrinthectomy: implications for cochlear implantation

Transtympanic electric promontory stimulation is a psychoacoustic test used to assess residual acoustic neurons in profound sensorineural hearing loss. The test was performed in six patients who had previously undergone transmastoid (N = 5) or transcanal-oval window (N = 1) labyrinthectomy as a means of determining the feasibility of future cochlear implantation. Four patients had unilateral Meniere's disease, one had labyrinthitis, and one had delayed onset vertigo. All patients perceived a definite auditory sensation in the labyrinthectomized ear during stimulation. The results of threshold, dynamic range, and difference limen testing were similar to those obtained during preoperative stimulation of cochlear implant candidates (N = 12) who subsequently became successful users. There was no evidence of response degradations as the time following labyrinthectomy increased. The results of this study suggest the possibility of successful cochlear implantation following labyrinthectomy. Supporting histologic data are reviewed.     

On the auditory and cognitive functions that may explain an individual's elevation of the speech reception threshold in noise

It is generally recognized that poor results of speech-in-noise tests by hearing-impaired persons cannot be fully explained by the elevated pure-tone hearing threshold. Plomp has shown, among others, that an additional factor has to be taken into account, often referred to in general terms as distortion. In an attempt to specify auditory and cognitive functions which may underlie this distortion, various studies on this topic originating from Plomp's research group are reviewed, as well as other relevant studies which provide quantitative data on the correlations between various types of auditory or cognitive tests (the predictor tests) and speech-in-noise tests. The predictor variables considered include, besides the pure-tone audiogram, measures of spectral and temporal resolution, intensity difference limen, age, and some cognitive aspects. The results indicate that, by and large, these variables fall short in fully explaining the variance observed in the speech-in-noise tests. This strongly suggests that the predictor variables considered so far do not cover all sources of variance relevant for speech reception in noise.     

Single-channel versus multichannel electrical stimulation. Voicing-frequency and formant-transition difference limens

The 'frequency' processing ability of 11 cochlear-implant patients wearing the Symbion device was evaluated with the stimuli presented in a multichannel mode and in a single-channel mode. A fixed-formant synthetic vowel /a/ was used to measure voicing-frequency difference limen. A voiced, synthetic single formant was used to measure the formant-transition difference limen. On the voicing-frequency test, patients obtained a median difference limen of 8 Hz when stimuli were presented in the multichannel mode and 14.7 Hz in the single-channel mode. On the formant-transition test, patients obtained a median difference limen of 589 Hz in the multichannel mode and 611 Hz in the single-channel mode. Three patients were unable to obtain a difference limen within the range of available stimuli. The performance with multichannel stimulation was significantly better (lower difference limen) than performance in the single channel stimulation. Temporal information in more channels and place information may contribute to the superior performance with multichannel stimulation.     

Audiological Evaluation of Affected Members from a Dutch DFNA8/12 (<Emphasis Type="Italic">TECTA</Emphasis>) Family

In DFNA8/12, an autosomal dominantly inherited type of nonsyndromic hearing impairment, the TECTA gene mutation causes a defect in the structure of the tectorial membrane in the inner ear. Because DFNA8/12 affects the tectorial membrane, patients with DFNA8/12 may show specific audiometric characteristics. In this study, five selected members of a Dutch DFNA8/12 family with a TECTA sensorineural hearing impairment were evaluated with pure-tone audiometry, loudness scaling, speech perception in quiet and noise, difference limen for frequency, acoustic reflexes, otoacoustic emissions, and gap detection. Four out of five subjects showed an elevation of pure-tone thresholds, acoustic reflex thresholds, and loudness discomfort levels. Loudness growth curves are parallel to those found in normal-hearing individuals. Suprathreshold measures such as difference limen for frequency modulated pure tones, gap detection, and particularly speech perception in noise are within the normal range. Distortion otoacoustic emissions are present at the higher stimulus level. These results are similar to those previously obtained from a Dutch DFNA13 family with midfrequency sensorineural hearing impairment. It seems that a defect in the tectorial membrane results primarily in an attenuation of sound, whereas suprathreshold measures, such as otoacoustic emissions and speech perception in noise, are preserved rather well. The main effect of the defects is a shift in the operation point of the outer hair cells with near intact functioning at high levels. As most test results reflect those found in middle-ear conductive loss in both families, the sensorineural hearing impairment may be characterized as a cochlear conductive hearing impairment.     

Preoperative evaluation of ossicular chain abnormality in patients with conductive deafness without perforation of the tympanic membrane

OBJECTIVE: To evaluate the usefulness of pure-tone audiometry, tympanometry, and liquid and acoustic reflex (AR) tests in the differential diagnosis of ossicular fixation and discontinuity. DESIGN: A prospective clinical trial. SETTING: Tertiary referral center. PATIENTS: Thirty-nine patients (46 ears) undergoing operations at University of Tsukuba Hospital, Tsukuba, Japan, from 1990 through 2003 for conductive deafness without perforation of the tympanic membrane. Clinical examinations for the preoperative diagnosis included pure-tone audiometry, tympanometry, and liquid and AR tests. We compared the preoperative diagnosis with the surgical findings. RESULTS: Although neither pure-tone audiometry nor tympanometry contributed to the differential diagnosis of ossicular chain abnormality, liquid and AR test results showed a significant difference between fixation and discontinuity of the ossicular chain. With the liquid test, bone conduction at lower frequencies was improved by filling the external auditory canal with water at lower frequencies in cases of ossicular fixation. In contrast to the findings observed in ossicular fixation, no improvement of the threshold of bone conduction was recognized at any frequency in the ears with ossicular discontinuity. In ipsilaterally stimulated AR, the reversed pattern was the most marked at 2000 and 500 Hz in ossicular fixation and discontinuity, respectively. CONCLUSION: Liquid and AR tests are reliable examinations for the differential diagnosis of ossicular fixation and discontinuity.     

Multichannel electrical stimulation of the auditory nerve in man. I. Basic psychophysics

Basic psychophysical measurements were obtained from three patients implanted with multichannel cochlear implants. This paper presents measurements from stimulation of a single channel at a time (either monopolar or bipolar). The shape of the threshold vs. frequency curve can be partially related to the membrane biophysics of the remaining spiral ganglion and/or dendrites. Nerve survival in the region of the electrode may produce some increase in the dynamic range on that electrode. Loudness was related to the stimulus amplitude by a power law with exponents between 1.6 and 3.4, depending on frequency. Intensity discrimination was better than for normal auditory stimulation, but not enough to offset the small dynamic range for electrical stimulation. Measures of temporal integration were comparable to normals, indicating a central mechanism that is still intact in implant patients. No frequency analysis of the electrical signal was observed. Each electrode produced a unique pitch sensation, but they were not simply related to the tonotopic position of the stimulated electrode. Pitch increased over more than 4 octaves (for one patient) as the frequency was increased from 100 to 300 Hz, but above 300 Hz no pitch change was observed. Possibly the major limitation of single channel cochlear implants is the 1–2 ms integration time (probably due to the capacitative properties of the nerve membrane which acts as a low-pass filter at 100 Hz) Another limitation of electrical stimulation is that there is no spectral analysis of the electrical waveform so that temporal waveform alone determines the effective stimulus.     

Current steering and results from novel speech coding strategies

OBJECTIVE: Advanced Bionics' cochlear implants have independent current sources that can share stimulation current between 2 contacts (Current Steering). By stimulating 2 adjacent electrodes with different weights, different pitches can be evoked, allowing to increase the number of processing channels. STUDY DESIGN: A counterbalanced crossover design was used to compare 3 different current steering implementations to the clinical HiRes strategy. SETTING: The study was a prospective, within-subject, repeated-measure experiment. PATIENTS: The study group consisted of 8 postlingually deaf subjects with a minimum of 12-month experience in HiRes. INTERVENTION: The following programs were evaluated: 1) a Fast Fourier Transformation (FFT)-based current steering implementation with 120 stimulation sites; 2) the same current steering implementation but with 16,000 stimulation sites; and 3) a current steering implementation based on a sinusoidal decomposition of the original signal with 16,000 stimulation sites. MAIN OUTCOME MEASURES: Speech perception tests in quiet and in Comité Consultatif International Télégraphique et Téléphonique (CCITT) noise, as well as with competing talker; an adaptive test of the frequency difference limen; a Quality Assessment Questionnaire. RESULTS: Current results do not show any improvement in speech perception for a certain current steering strategy compared with HiRes. However, when selecting the optimal current steering strategy, subjects could achieve a significant benefit compared with the clinical HiRes. In addition, the frequency difference limen could be reduced significantly at 1,280 Hz. CONCLUSION: Current steering seems to have the potential to improve both understanding in adverse listening situations and frequency resolution. However, the optimal implementation needs further investigation.     

Use of time differences in normal hearing--cortical processing of promontorial stimuli

To test the hypothesis that ability to discriminate small duration differences is positively correlated with activity in the right temporal lobe, we used positron emission tomography in six normally hearing subjects, stimulated via the promontory in a procedure that mimics the auditory nerve stimulation with a cochlear implant. Stimulus consisted of electrical bursts, and tasks included gap detection and temporal difference limen (TDL). TDL is a measure of discriminatory processing of sound duration in cochlear implant candidates, demonstrated to predict outcome. Good speech perception after cochlear implantation is associated with activity in right temporal areas. Although perceived variably by the subjects, the stimulus itself activated bilateral secondary somatosensory cortex, suggesting differential stimulation of multiple sensory modalities. Only TDL raised blood flow in both posterior middle temporal gyri (MTG) and the right prefrontal cortex. As the right posterior MTG is known to be active during duration discrimination of different modalities and in the perception of words containing manipulated phonemes, we conclude that recruitment of this part of the right hemisphere is important to the comprehension of speech containing mostly temporal cues. The study shows that stimulus-induced activation reflects the goal of the task rather than the nature of the stimulus.     

The vienna cochlear implant in patients with obliteration of the cochlea

Twelve deaf patients with obliterated or ossified cochleas received the extracochlear version of the Vienna Cochlear Implant. Four patients, 1 of them a child, developed open speech comprehension. Obliteration of the cochlea could not always be predicted by conventional tomography of the temporal bone. Short duration of deafness, wide dynamic range, and good ability of time resolution (small temporal difference limen [TDL]) are predictors for good postoperative results. Obliteration or ossification of the cochlea per se is no contraindication to cochlear implantation.     

Auditory frequency and intensity discrimination in pigmented rats

Auditory function was investigated in seven pigmented hooded rats (strain Long-Evans) with the aid of an operant conditioning procedure. Frequency difference limen was measured at frequencies from 0.5 to 64 kHz at 50 dB sensation level (SL). Weber ratios (frequency difference limen/frequency) in this range varied between 3.7 and 7.3%. The decline in the intensity of the stimulus from 50 to 10 dB SL was accompanied by a slight increase in the frequency difference limen. The frequency difference limen values were similar for frequency shifts upwards or downwards. Intensity discrimination was measured at 50 dB SL at frequencies of 2, 8 and 32 kHz. Intensity difference limen was frequency independent and amounted to 2.9 ± 0.5 dB in conditions of upward intensity shift. The values of intensity difference limen measured in conditions of downward intensity shift were significantly larger and amounted to 6.5 ± 1.6 dB. The characteristics of hearing function found in these experiments correspond with those described by other authors in albino rats and indicate that albinism in the rat has no significant influence on auditory frequency and intensity discrimination.     

Audiological characteristics of some affected members of a Dutch DFNA13/COL11A2 family

Members of a Dutch DFNA13/COL11A2 family were evaluated with pure tone audiometry, stapedial reflexes, otoacoustic emissions, loudness scaling, difference limen for frequency, gap detection, and speech perception in quiet and noise. The tone audiometry showed a predominant loss for the low and middle frequencies, with only a few otoacoustic emissions at thresholds better than 25 dB hearing level. The stapedial reflexes appeared elevated, and loudness growth curves were shifted parallel to those for normal-hearing subjects, indicating a shift of the dynamic range toward higher presentation levels. The data for the difference limen for frequency, gap detection, and speech perception in noise fell within the (near-)normal range. Despite elevated thresholds, all suprathreshold functions showed fairly normal properties, suggesting an attenuation of signal energy in the cochlea with limited degradation of the cochlea's signal analyzing capabilities. The effect of DFNA13/COL11A2 may thus be characterized as a cochlear conductive loss.     

Simulation of sensorineural hearing impairment

A hearing loss simulation system (HELOS) was designed and constructed to simulate various aspects of sensorineural hearing impairment. The theoretical bases for HELOS were several threshold and suprathreshold auditory phenomena typically exhibited by people with sensorineural hearing losses. In addition to providing differential attenuation of acoustic signals across the frequency range, HELOS simulated loudness recruitment, loudness discomfort thresholds, reduced dynamic range, and reduced frequency selectivity. Three basic audiometric configurations were chosen to investigate the effects of the aforementioned components of a sensorineural hearing impairment on the auditory perception of speech. They were: (1) a sloping high-frequency hearing loss; (2) a flat, severe hearing loss; (3) a severe/profound hearing loss. The battery of tests administered to a group of normal-hearing adults consisted of pure-tone audiometry and PB-word recognition tests, as well as vowel and consonant identification tests. For comparable audiometric configurations, the results from the speech-perception tests were in good agreement with the published results of similar tests administered to persons with sensorineural hearing losses.     

Factors predicting postoperative sentence scores in postlinguistically deaf adult cochlear implant patients.

A sample of 64 postlinguistically profoundly to totally deaf adult cochlear implant patients were tested without lipreading by means of the Central Institute for the Deaf (CID) sentence test 3 months postoperatively. Preoperative promontory stimulation results (thresholds, gap detection, and frequency discrimination), age, duration of profound deafness, cause of deafness, lipreading ability, postoperative intracochlear thresholds and dynamic ranges for electrical stimulation, depth of insertion of the electrode array into the scala tympani, and number of electrodes in use were considered as possible factors that might be related to the postoperative sentence scores. A multiple regression analysis with stepwise inclusion of independent variables indicated that good gap detection and frequency discrimination during preoperative promontory testing, larger numbers of electrodes in use, and greater dynamic ranges for intracochlear electrical stimulation were associated with better CID scores. The CID scores tended to decrease with longer periods of profound deafness.     

Effects of Stimulus Level on Speech Perception with Cochlear Prostheses

This study is one of a series that examines stimulus features important for cochlear implant function. Here, we examine effects of stimulus level. In subjects with cochlear implants, a number of psychophysical tests of temporal discrimination (pulse rate discrimination, gap detection, etc.) show marked improvement as a function of stimulus level through most or all of the dynamic range, while electrode-place discrimination can improve or degrade as a function of level. In this study, effects of these combined potential influences were studied by examining the effects of stimulus level on syllable identification. We tested two hypotheses: that syllable identification varies as a function of stimulus level and that level and electrode configuration interact in affecting syllable identification. We examined vowel and consonant identification as a function of stimulus level for bipolar and monopolar electrode configurations. We used experimental processor maps where upper and lower stimulation limits of each electrode pair were equated to eliminate confounding effects of dynamic range, which varies across subjects and electrodes. For each channel, stimulation amplitude was set to a fixed percentage of its dynamic range. Eight adult subjects with Nucleus CI24M implants were tested using the SPEAK processing strategy. With each electrode configuration, stimulus levels were tested from 0% to 90% of the dynamic range in nine steps. The effects on consonant and vowel identification were similar. Phoneme identification was usually better for monopolar than for bipolar stimulation. In the lower half of the dynamic range, syllable identification usually increased as a function of stimulus level. In the upper half of the dynamic range, syllable identification continued to increase as a function of level to 90% of the dynamic range for some subjects, while for others there was no appreciable change or a decrease as a function of level. Decreases in performance at high levels were more common with monopolar than bipolar stimulation. These results suggest that if speech processors are programmed to optimize level for each individual, speech perception performance could be improved.     

Psychophysical measures from electrical stimulation of the human cochlear nucleus

Auditory performance on basic psychophysical tasks was measured in ten deaf patients with electrodes positioned near their cochlear nucleus. The device is called the auditory brainstem implant (ABI). Electrodes were placed during surgery to remove an acoustic neuroma, which results in the removal of the VIII nerve and, thus deafness. In patients who received auditory sensation from electrical stimulation we measured auditory performance on standard psychophysical tasks: thresholds, loudness growth, intensity discrimination, temporal integration, temporal modulation detection, gap detection, and forward masking. Plots of threshold as a function of frequency or biphasic pulse duration were markedly different from those of patients with cochlear implants. The difference in threshold functions is probably partly due to the biophysical difference in the neural elements stimulated. Another possibility is that part of the difference is due to the highly abnormal spatial pattern of activation in the cochlear nucleus from electrical stimulation, which prevents normal spatial integration of activity. The usable range of electrical amplitudes above threshold is comparable with that of cochlear implants, typically 10-15 dB. Little temporal integration occurs over a range of stimulus durations from 2-1000 ms. When compared at equivalent loudness levels, gap detection thresholds are similar to, or a bit longer than, gap thresholds in normal-hearing listeners and cochlear implant patients. Forward masking recovery functions are similar to those of normal listeners and cochlear implant patients. Patients' ability to detect amplitude modulation as a function of modulation frequency is similar to that of cochlear implant patients and normal listeners. Thus, direct electrical stimulation of the brainstem produces temporal resolution that does not significantly differ from that of normal listeners when compared in equivalent amplitude units. This implies that the limiting factors for these tasks are more centrally located, and not directly related to threshold mechanisms. Thus, a properly designed speech processor could preserve the important temporal features of speech for these patients.