Tinnitus is a phantom sensation of sound in the absence of external stimulation. However, external stimulation, particularly electric stimulation via a cochlear implant, has been shown to suppress tinnitus. Different from traditional methods of delivering speech sounds or high-rate (>2,000 Hz) stimulation, the present study found a unique unilaterally-deafened cochlear implant subject whose tinnitus was completely suppressed by a low-rate (<100 Hz) stimulus, delivered at a level softer than tinnitus to the apical part of the cochlea. Taking advantage of this novel finding, the present study compared both event-related and spontaneous cortical activities in the same subject between the tinnitus-present and tinnitus-suppressed states. Compared with the results obtained in the tinnitus-presentstate, the low-rate stimulus reduced cortical N100 potentials while increasing the spontaneous alpha power in the auditory cortex. These results are consistent with previous neurophysiological studies employing subjects with and without tinnitus and shed light on both tinnitus mechanism and treatment.

Sharp spatial selectivity is critical to auditory performance, particularly in pitch related tasks. Most contemporary cochlear implants have employed monopolar stimulation that produces broad electric fields, which presumably contribute to poor pitch and pitch-related performance by implant users. Bipolar or tripolar stimulation can generate focused electric fields but requires higher current to reach threshold and, more interestingly, has not produced any apparent improvement in cochlear implant performance. The present study addressed this dilemma by measuring psychophysical and physiological spatial selectivity with both broad and focused stimulations in the same cohort of subjects. Different current levels were adjusted by systematically measuring loudness growth for each stimulus, each stimulation mode, and in each subject. Both psychophysical and physiological measures showed that, although focused stimulation produced significantly sharper spatial tuning than monopolar stimulation, it could shift the tuning position or even split the tuning tips. The altered tuning with focused stimulation is interpreted as a result of poor electrode-to-neuron interface in the cochlea, and is suggested to be mainly responsible for the lack of consistent improvement in implant performance. A linear model could satisfactorily quantify the psychophysical and physiological data and derive the tuning width. Significant correlation was found between the individual physiological and psychophysical tuning widths, and the correlation was improved by log-linearly transforming the physiological data to predict the psychophysical data. Because the physiological measure took only one-tenth of the time of the psychophysical measure, the present model is of high clinical significance in terms of predicting and improving cochlear implant performance.

The modern multi-channel cochlear implant is widely considered to be the most successful neural prosthesis for its ability to restore partial hearing to post-lingually deafened adults and to allow essentially normal language development in pre-lingually deafened children. However, the implant performance varies greatly in individuals and is still limited in background noise, tonal language understanding, and music perception. One main cause for the individual variability and the limited performance in cochlear implants is spatial channel interaction from the stimulating electrodes to the auditory nerve and brain. Here we systematically examined spatial channel interactions at the physical, physiological, and perceptual levels in the same 5 modern cochlear implant subjects. The physical interaction was examined using an electric field imaging technique, which measured voltage distribution as a function of electrode position in the cochlea in response to stimulation of a single electrode. The physiological interaction was examined by recording electrically evoked compound action potentials as a function of electrode position in response to stimulation of the same single electrode position. The perceptual interactions were characterized by changes in detection threshold as well as loudness summation in response to in-phase or out-of-phase dual-electrode stimulation. To minimize potentially confounding effects of temporal factors on spatial channel interactions, stimulus rates were limited to 100 Hz or lower in all measures. Several quantitative channel interaction indexes were developed to define and compare the width, slope, and symmetry of the spatial excitation patterns derived from these physical, physiological, and perceptual measures. The electric field imaging data revealed a broad but uniformly asymmetrical intracochlear electric field pattern, with the apical side producing wider half-width and shallower slope than the basal side. On the contrary, the evoked compound action potential and perceptual channel interaction data showed much greater individual variability. It is likely that actual reduction in neural and higher level interactions, instead of simple sharpening of electric current field, would be the key to predict and hopefully improve the variable cochlear implant performance. The present results are obtained with auditory prostheses but can be applied to other neural prostheses, in which independent spatial channels, rather than high stimulation rate, are critical to their performance.

Despite high prevalence of tinnitus and its impact on quality life, there is no cure for tinnitus at present. Here, we report an effective means to temporarily suppress tinnitus by amplitude- and frequency-modulated tones. We systematically explored the interaction between subjective tinnitus and 17 external sounds in 20 chronic tinnitus sufferers. The external sounds included traditionally used unmodulated stimuli such as pure tones and white noise and dynamically modulated stimuli known to produce sustained neural synchrony in the central auditory pathway. All external sounds were presented in a random order to all subjects and at a loudness level that was just below tinnitus loudness. We found some tinnitus suppression in terms of reduced loudness by at least one of the 17 stimuli in 90% of the subjects, with the greatest suppression by amplitude-modulated tones with carrier frequencies near the tinnitus pitch for tinnitus sufferers with relatively normal loudness growth. Our results suggest that, in addition to a traditional masking approach using unmodulated pure tones and white noise, modulated sounds should be used for tinnitus suppression because they may be more effective in reducing hyperactive neural activities associated with tinnitus. The long-term effects of the modulated sounds on tinnitus and the underlying mechanisms remain to be investigated.

Contemporary cochlear implants with multiple electrode stimulation can produce good speech perception but poor music perception. Hindered by the lack of a gold standard to quantify electric pitch, relatively little is known about the nature and extent of the electric pitch abnormalities and their impact on cochlear implant performance. Here we overcame this obstacle by comparing acoustic and electric pitch perception in 3 unilateral cochlear-implant subjects who had functionally usable acoustic hearing throughout the audiometric frequency range in the non-implant ear. First, to establish a baseline, we measured and found slightly impaired pure tone frequency discrimination and nearly perfect melody recognition in all 3 subjects’ acoustic ear. Second, using pure tones in the acoustic ear to match electric pitch induced by an intra-cochlear electrode, we found that the frequency-electrode function was not only 1–2 octaves lower, but also 2 times more compressed in frequency range than the normal cochlear frequency-place function. Third, we derived frequency difference limens in electric pitch and found that the equivalent electric frequency discrimination was 24 times worse than normal-hearing controls. These 3 abnormalities are likely a result of a combination of broad electric field, distant intra-cochlear electrode placement, and non-uniform spiral ganglion cell distribution and survival, all of which are inherent to the electrode-nerve interface in contemporary cochlear implants. Previous studies emphasized on the “mean” shape of the frequency-electrode function, but the present study indicates that the large “variance” of this function, reflecting poor electric pitch discriminability, is the main factor limiting contemporary cochlear implant performance.

The present study is aimed to evaluate and compare loudness adaptation between normal hearing and cochlear-implant subjects. Loudness adaptation for 367-s pure tones was measured in five normal-hearing subjects at three frequencies (125, 1,000, and 8,000 Hz) and three levels (30, 60, and 90 dB SPL). In addition, loudness adaptation for 367-s pulse trains was measured in five Clarion cochlear-implant subjects at three stimulation rates (100, 991, and 4,296 Hz), three levels (10, 50, and 90% of the electric dynamic range), three stimulation positions (apical, middle and basal), and two stimulation modes (monopolar and bipolar). The method of successive magnitude estimation was used to quantify loudness adaptation. Similar to the previous results, we found that loudness adaptation in normal-hearing subjects increases with decreasing level and increasing frequency. However, we also found a small but significant loudness enhancement at 90 dB SPL in acoustic hearing. Despite large individual variability, we found that loudness adaptation in cochlear-implant subjects increases with decreasing levels, but is not significantly affected by the rate, place and mode of stimulation. A phenomenological model was proposed to predict loudness adaptation as a function of stimulus frequency and level in acoustic hearing. The present results were not fully compatible with either the restricted excitation hypothesis or the neural adaptation hypothesis. Loudness adaptation may have a central component that is dependent on the peripheral excitation pattern.

ABSTRACT:RESULTS :Educational Objective: The participants should be able to understand the potential role of individualized electrical stimulation of the auditory system in the suppression of tinnitus in patients with cochlear implants.Objectives: Tinnitus is a debilitating condition in which one perceives sound in the absence of external stimuli. Most treatments consist of masking the tinnitus with an external sound that is louder than the tinnitus. We hypothesize that there exists a characteristic tinnitus signature map in each individual that, when found, can be utilized to suppress their tinnitus at a level that is significantly softer than the tinnitus itself.Study Design: Prospective randomized single blinded study in a unique individual with a unilateral cochlear implant in an ear with persistent tinnitus and normal hearing in the non-implanted ear.Methods: Monopolar electrical stimulation at rates from 40 Hz to 10 kHz, stimulation levels from threshold to the tinnitus mixing point, and stimulation placement from apex to base were administered over a time period of 3 to 10 minutes. Successful suppression was defined as the complete elimination of the subject's tinnitus.

Objective 1) Customize amplitude-modulated (AM) and frequency-modulated (FM) acoustic stimuli to suppress tinnitus. 2) Understand the theoretical mechanisms underlying tinnitus suppression. Methods A double-staircase adaptive procedure was utilized to match both the frequency and intensity of the tinnitus. Minimal masking levels for both noise and pure tones were acquired. In a double-blinded procedure, sinusoidally amplitude- and frequency-modulated stimuli were administered. Pre- and post-stimulation tinnitus loudness levels were compared to quantify the effects of suppression and residual inhibition of tinnitus. Multivariate analysis was performed to evaluate independent predictors of tinnitus suppression. Different types and severity of tinnitus and hearing loss were correlated with the effective sounds. Results At present, 18 patients aged 35 to 75 (mean 58.3) with Tinnitus Handicap Index (THI) scores ranging from 12 to 90 (mean 52.6) have been evaluated. Significant associations were found between the duration of the AM and FM stimuli and the effect on tinnitus suppression. 10 out of 18 (56%) patients had a reduction in their tinnitus loudness by 30% or more. Upon comparison with the masking level, reduction in the subjects’ tinnitus was observed when a lower intensity of the modulated stimuli was presented. Subject characteristics that correlated with a significant reduction of the tinnitus will be discussed in detail. Conclusions AM and FM stimuli can decrease the percept of tinnitus significantly. It is postulated that AM and FM stimuli produce synchronized cortical responses to more efficiently compete against tinnitus-induced synchrony.