Variability in speech perception scores among cochlear implant listeners may largely reflect the variable efficacy of implant electrodes to convey stimulus information to the auditory nerve. In the present study, three metrics were applied to assess the quality of the electrode-neuron interface of individual cochlear implant channels: the electrically evoked compound action potential (ECAP), the estimation of electrode position using computerized tomography (CT), and behavioral thresholds using focused stimulation. The primary motivation of this approach is to evaluate the ECAP as a site-specific measure of the electrode-neuron interface in the context of two peripheral factors that likely contribute to degraded perception: large electrode-to-modiolus distance and reduced neural density. Ten unilaterally implanted adults with Advanced Bionics HiRes90k devices participated. ECAPs were elicited with monopolar stimulation within a forward-masking paradigm to construct channel interaction functions (CIF), behavioral thresholds were obtained with quadrupolar (sQP) stimulation, and data from imaging provided estimates of electrode-to-modiolus distance and scalar location (scala tympani (ST), intermediate, or scala vestibuli (SV)) for each electrode. The width of the ECAP CIF was positively correlated with electrode-to-modiolus distance; both of these measures were also influenced by scalar position. The ECAP peak amplitude was negatively correlated with behavioral thresholds. Moreover, subjects with low behavioral thresholds and large ECAP amplitudes, averaged across electrodes, tended to have higher speech perception scores. These results suggest a potential clinical role for the ECAP in the objective assessment of individual cochlear implant channels, with the potential to improve speech perception outcomes.

Standing waves can cause errors during in-the-ear calibration of sound pressure level (SPL), affecting both stimulus magnitude and distortion-product otoacoustic emission (DPOAE) level. Sound intensity level (SIL) and forward pressure level (FPL) are two measurements theoretically unaffected by standing waves. SPL, SIL and FPL in-situ calibrations were compared by determining sensitivity of DPOAE level to probe-insertion depth (deep, “shallow”) for a range of stimulus frequencies (1−8 kHz) and levels (20−60 dB). Probe-insertion depth was manipulated with the intent to shift the frequencies with standing-wave minima at the emission probe, introducing variability during SPL calibration. The absolute difference in DPOAE level between insertions was evaluated after correcting for an incidental change caused by the effect of ear-canal impedance on the emission traveling from the cochlea. A three-way analysis of variance (ANOVA) found significant main effects for stimulus level, stimulus frequency and calibration method, as well as significant interactions involving calibration method. All calibration methods exhibited changes in DPOAE level due to insertion depth, especially above 4 kHz. However, SPL demonstrated the greatest changes across all stimulus levels for frequencies above 2 kHz, suggesting that SIL and FPL provide more consistent measurements of DPOAEs for frequencies susceptible to standing-wave calibration errors.

Objective This report describes results of a series of experiments where we use the neural response telemetry (NRT) system of the Nucleus cochlear implant (CI) to measure the response of the peripheral auditory system to acoustic stimulation in Nucleus Hybrid CI users. Our objectives were to determine whether we could separate responses from hair cells and neurons, and to evaluate the stability of these measures over time. Design Forty-four CI users participated. They all had residual acoustic hearing and used a Nucleus Hybrid S8, S12, or L24 CI or the standard lateral wall CI422 implant. The NRT system of the CI was used to trigger an acoustic stimulus (500 Hz tone burst or click), which was presented at a low stimulation rate (10, 15 or 50 per second) to the implanted ear via an insert earphone and to record the cochlear microphonic (CM), the auditory nerve neurophonic (ANN) and the compound action potential (CAP) from an apical intracochlear electrode. To record acoustically evoked responses, a longer time window than is available with the commercial NRT software is required. This limitation was circumvented by making multiple recordings for each stimulus using different time delays between the onset of stimulation and the onset of averaging. These recordings were then concatenated offline. Matched recordings elicited using positive and negative polarity stimuli were added off line to emphasize neural potentials (SUM) and subtracted off line to emphasize potentials primarily generated by cochlear hair cells (DIF). These assumptions regarding the origin of the SUM and DIF components were tested by comparing the magnitude of these derived responses recorded using various stimulation rates. Magnitudes of the SUM and DIF components were compared to each other and to behavioral thresholds. Results SUM and DIF components were identified for most subjects, consistent with both hair cell and neural responses to acoustic stimulation. For a subset of the study participants, the DIF components grew as stimulus level was increased, but little or no SUM components were identified. Latency of the CAPs in response to click stimuli was long relative to reports in the literature of recordings obtained using extracochlear electrodes. This difference in response latency and general morphology of the CAPs recorded was likely due to differences across subjects in hearing loss configuration. Use of high stimulation rates tended to decrease SUM and CAP components more than DIF components. We suggest this effect reflects neural adaptation. In some individuals, repeated measures were made over intervals as long as 9 months. Changes over time in DIF, SUM and CAP thresholds mirrored changes in audiometric threshold for the subjects who experienced loss of acoustic hearing in the implanted ear. Conclusions The Nucleus NRT software can be used to record peripheral responses to acoustic stimulation at threshold and supra-threshold levels, providing a window into the status of the auditory hair cells and the primary afferent nerve f...

Objectives The ability to perceive speech is related to the listener’s ability to differentiate among frequencies (i.e., spectral resolution). Cochlear implant (CI) users exhibit variable speech-perception and spectral-resolution abilities, which can be attributed in part to the extent of electrode interactions at the periphery (i.e., spatial selectivity). However, electrophysiological measures of peripheral spatial selectivity have not been found to correlate with speech perception. The purpose of this study was to evaluate auditory processing at the periphery and cortex using both simple and spectrally complex stimuli to better understand the stages of neural processing underlying speech perception. The hypotheses were that (1) by more completely characterizing peripheral excitation patterns than in previous studies, significant correlations with measures of spectral selectivity and speech perception would be observed, (2) adding information about processing at a level central to the auditory nerve would account for additional variability in speech perception, and (3) responses elicited with spectrally complex stimuli would be more strongly correlated with speech perception than responses elicited with spectrally simple stimuli. Design Eleven adult CI users participated. Three experimental processor programs (MAPs) were created to vary the likelihood of electrode interactions within each participant. For each MAP, a subset of 7 of 22 intracochlear electrodes was activated: adjacent (MAP 1), every-other (MAP 2), or every third (MAP 3). Peripheral spatial selectivity was assessed using the electrically evoked compound action potential (ECAP) to obtain channel-interaction functions for all activated electrodes (13 functions total). Central processing was assessed by eliciting the auditory change complex (ACC) with both spatial (electrode pairs) and spectral (rippled noise) stimulus changes. Speech-perception measures included vowel-discrimination and the Bamford-Kowal-Bench Sentence-in-Noise (BKB-SIN) test. Spatial and spectral selectivity and speech perception were expected to be poorest with MAP 1 (closest electrode spacing) and best with MAP 3 (widest electrode spacing). Relationships among the electrophysiological and speech-perception measures were evaluated using mixed-model and simple linear regression analyses. Results All electrophysiological measures were significantly correlated with each other and with speech perception for the mixed-model analysis, which takes into account multiple measures per person (i.e. experimental MAPs). The ECAP measures were the best predictor of speech perception. In the simple linear regression analysis on MAP 3 data, only the cortical measures were significantly correlated with speech; spectral ACC amplitude was the strongest predictor. Conclusions The results suggest that both peripheral and central electrophysiological measures of spatial and spectral selectivity provide valuable information about speech perception. Clinically, it is often desirable to optimize pe...

Quantifying ear-canal sound level in forward pressure has been suggested as a more accurate and practical alternative to sound pressure level (SPL) calibrations used in clinical settings. The mathematical isolation of forward (and reverse) pressure requires defining the Thévenin-equivalent impedance and pressure of the sound source and characteristic impedance of the load; however, the extent to which inaccuracies in characterizing the source and/or load impact forward pressure level (FPL) calibrations has not been specifically evaluated. This study examined how commercially available probe tips and estimates of characteristic impedance impact the calculation of forward and reverse pressure in a number of test cavities with dimensions chosen to reflect human ear-canal dimensions. Results demonstrate that FPL calibration, which has already been shown to be more accurate than in situ SPL calibration, can be improved particularly around standing-wave null frequencies by refining estimates of characteristic impedance. Better estimates allow FPL to be accurately calculated at least through 10 kHz using a variety of probe tips in test cavities of different sizes, suggesting that FPL calibration can be performed in ear canals of all sizes. Additionally, FPL calibration appears a reasonable option when quantifying the levels of extended high-frequency (10-18 kHz) stimuli.