Effects of electrode configuration and place of stimulation on speech perception with cochlear prostheses.

Recent research and clinical experience with cochlear implants suggest that subjects' speech recognition with monopolar or broad bipolar stimulation might be equal to or better than that obtained with narrow bipolar stimulation or other spatially restricted electrode configurations. Furthermore, subjects often prefer the monopolar configurations. The mechanisms underlying these effects are not clear. Two hypotheses are (a) that broader configurations excite more neurons resulting in a more detailed and robust neural representation of the signal and (b) that broader configurations achieve a better spatial distribution of the excited neurons. In this study we compared the effects of electrode configuration and the effects of longitudinal placement and spacing of the active electrodes on speech recognition in human subjects. We used experimental processor maps consisting of 11 active electrodes in a 22-electrode scala tympani array. Narrow bipolar (BP), wide bipolar (BP + 6), and monopolar (MP2) configurations were tested with various locations of active electrodes. We tested basal, centered, and apical locations (with adjacent active electrodes) and spatially distributed locations (with every other electrode active) with electrode configuration held constant. Ten postlingually deafened adult human subjects with Nucleus prostheses were tested using the SPEAK processing strategy. The effects of electrode configuration and longitudinal place of stimulation on recognition of CNC phonemes and words in quiet and CUNY sentences in noise (+10 dB S/N) were similar. Both independent variables had large effects on speech recognition and there were interactions between these variables. These results suggest that the effects of electrode configuration on speech recognition might be due, in part, to differences among the various configurations in the spatial location of stimulation. Correlations of subjective judgments of sound quality with speech-recognition ability were moderate, suggesting that the mechanisms contributing to subjective quality and speech-recognition ability do not completely overlap.

Cochlear implant thresholds: comparison of middle latency responses with psychophysical and cortical-spike-activity thresholds.

The electrically evoked middle latency response (EMLR) is a potentially useful measure of activation of the auditory system by a cochlear prosthesis. The present study compared cochlear prosthesis thresholds determined using EMLR with thresholds determined for psychophysical detection and for spike activity in cortical neurons. In systemically deafened guinea pigs, the difference between EMLR and psychophysical threshold level varied, with differences ranging from -4.6 dB (EMLR threshold more sensitive) to +10.7 dB (psychophysical threshold more sensitive) across animals and phase durations. Threshold differences between EMLR and auditory cortex neural spike responses were similar in magnitude and range (-6 to +15 dB) to those seen for EMLR vs. psychophysical thresholds. These ranges are comparable to the behavioral operating range for a given condition. In 3 of 12 subjects, the EMLR was absent for some or all electrode configurations tested, even at levels well above the threshold for psychophysical detection or cortical neuronal response. These results suggest that neither the EMLR thresholds nor cortical neuronal spike thresholds are an adequate substitute for psychophysical measures of threshold. While not sufficient for use in place of psychophysical measures, EMLR threshold level is strongly correlated with psychophysical threshold level across subjects (R(2)=0.82). Interestingly, plots of thresholds vs. phase duration were roughly parallel for psychophysical and EMLR thresholds, in contrast to the divergence of psychophysical and more peripheral (e.g., electrically evoked auditory brainstem response) evoked neural threshold vs. phase duration functions.

Effects of time after deafening and implantation on guinea pig electrical detection thresholds.

Changes in detection threshold level as a function of time after deafening and implantation have been described previously in macaque [Pfingst, 1990] and human [Skinner et al., 1995] cochlear implant subjects. Characterization of the mechanisms underlying these changes will contribute to our understanding of the anatomical and physiological factors affecting electrical stimulus detection. In addition, understanding the time course of early threshold changes is essential to the interpretation of acute physiological studies of cochlear implants. To better characterize time-dependent threshold changes, we monitored changes in guinea pig psychophysical electrical detection thresholds with time after deafening and cochlear implantation. Threshold levels for 100 Hz sinusoidal bursts were initially unstable over the first 30 days post-surgery (DPS), after which thresholds stabilized. At longer intervals (>100 DPS), increases (>10 dB) in threshold level were observed for 100 Hz sinusoids in three of 11 cases. These changes were transient in one case and long-term in two cases. The time course of threshold change, both early and late, could not be explained on the basis of changes in spiral ganglion cell survival. The guinea pig seems to be an ideal preparation for studies of this nature, because threshold changes are similar in type, but accelerated in time course, relative to those observed in primates.

Effects of electrode configuration and stimulus level on rate and level discrimination with cochlear implants.

Recent studies have demonstrated that speech perception with cochlear implants can be significantly affected by electrode configuration. Contrary to expectations, broader configurations (monopolar or broad bipolar) produced equal or better speech recognition compared with narrower configurations (narrow bipolar or common ground). One hypothesis that would account for these results is that broader configurations excite larger populations of neurons providing a more robust representation of information on each channel of the prosthesis. It is known that the number of neurons excited by an electrical stimulus increases considerably as the stimulus level increases. Furthermore, many types of discrimination improve as a function of stimulus level. If the discrimination improvements seen with increasing stimulus level are due to increasing the size of the neural population carrying the signal, and if broadening the electrode configuration also increases the size of the activated neural population, then one would expect level and electrode configuration to affect discrimination in similar ways. To test this hypothesis, we studied several types of discrimination as a function of level and electrode configuration in four nonhuman primates with cochlear implants. We tested electrode configurations that produced current fields ranging from very restricted (tripolar) to broad (parallel monopolar). For each configuration, pulse-rate discrimination, amplitude-modulation-frequency discrimination, and level discrimination were tested at current levels spanning much of the psychophysical dynamic range. Results showed large effects of current level on discrimination in many cases. However, effects of electrode configuration at comparable levels within the dynamic range were smaller or absent. Furthermore, the effect of level on discrimination was independent of electrode configuration in most cases even though the rate of spread of neural activation with level is expected to depend on electrode configuration. Possible interpretations of these results are that (1) the current level adjustments necessary to achieve comparable loudness for the various configurations significantly countered any effects of electrode configuration on the size of the activated neural population, or (2) the effects of level on discrimination do not result from its effects on the spatial extent of neural activation.

Across-species comparisons of psychophysical detection thresholds for electrical stimulation of the cochlea: II. Strength-duration functions for single, biphasic pulses.

This paper compares psychophysical detection threshold data (new and previously published) for pulsatile electrical stimulation of the deafened inner ear, obtained from different human and nonhuman subjects. Subjects were grouped according to species. Other variables, however, such as the electrode array type and method of deafening, varied within and across species. Detection threshold levels and slopes of threshold versus phase duration functions for presentations of single, biphasic pulsatile stimuli (strength-duration functions) were compared for humans, macaques, cats, and guinea pigs. For bipolar stimulation, statistically significant differences in threshold level were observed between human subjects and all other species. The species difference did not depend on the phase duration tested. For monopolar stimulation, only nonhuman species were tested. Effects of electrode configuration on both the level and slope of psychophysical strength-duration functions were statistically significant across nonhuman species, but there was not a statistically significant interaction between species and electrode configuration. The similarity in function shape and relative paucity of significant differences in psychophysical functions across species support the continued use of multiple species for cochlear implant research.

Across-species comparisons of psychophysical detection thresholds for electrical stimulation of the cochlea: I. Sinusoidal stimuli.

Several species have been, and continue to be, used as subjects in studies of electrical stimulation of the cochlea. Few attempts, however, have been made to determine if data obtained from different species are quantitatively or qualitatively similar. The present work compares psychophysical absolute detection threshold vs. frequency functions for sinusoidal stimuli obtained from humans, nonhuman primates, cats, and guinea pigs. Threshold data for monopolar and bipolar electrode configurations from both previously published and unpublished studies are compared. In general, within all four species, significant intersubject variation in detection threshold level was found, but slopes of threshold vs. frequency functions were relatively well conserved within a species, under the conditions studied. With one exception (cat bipolar stimulation), threshold functions reached a minimum at or near 100 Hz across species and electrode configurations. In all cases, thresholds were significantly lower for monopolar, as compared with bipolar, configurations. Statistically, there were no significant differences in absolute threshold level across species. Threshold levels increased with frequency above 100 Hz at a rate of 3.0-7.9 dB/octave, depending on both electrode configuration and species. Slopes were steeper for monopolar than for bipolar configurations. When slopes were averaged between 200 and 2000 Hz, no statistically significant differences in overall slopes were found, nor was there a significant interaction between electrode configuration and species. There were, however, consistent species differences within more restricted regions of the function. Human functions for both monopolar and bipolar stimulation were steeper than all animal functions in the range of 100-300 Hz. Within this range, the differences between slopes for human and nonhuman subjects were statistically significant. In addition, differences were noted in the frequency at which slope decreased, with slopes for nonhuman subjects showing the decrease at higher frequencies than did those for human subjects. These differences may be true species differences, or may reflect the influence of confounding variables associated with each experimental-subject model.

Effects of stimulus level on electrode-place discrimination in human subjects with cochlear implants.

Effects of stimulus level on discrimination of one stimulation site from another were examined in 15 human subjects with Nucleus-22 cochlear implant systems. Bipolar stimulation was used in all cases with electrodes in the bipolar pair separated by 1.5 mm (center to center). Subjects were first tested at a medium loudness level, using an adaptive tracking procedure, to determine the regions of the electrode array where electrode-place discrimination was best and the regions where it was poorest. Electrode-place discrimination was then tested at three regions distributed throughout the array, which included the regions of best and poorest discrimination. At each region, electrode-place discrimination was tested at three levels: 25%, 50%, and 75% of the dynamic range. For each of these nine conditions (3 sites x 3 levels), the test-electrode pairs were loudness balanced with the reference-electrode pairs. A two-interval forced-choice same-different procedure was then used to determine discriminability of the reference-electrode pair from the nearest, apical, test-electrode pair. If P(C)max was <0.707 at all three levels, additional testing was done using the next, more apical, electrode pair as the test-electrode pair. A tendency toward better discrimination at more apical regions of the array was observed. Electrode pairs with poor discrimination typically had smaller dynamic ranges than those with good discrimination. There was a weak tendency toward better discrimination at higher levels of stimulation. However, effects of level on electrode-place discrimination were less pronounced and less consistent than previously observed effects of level on temporal discriminations. These results suggest interactions between current spread and the condition of the implanted cochlea as underlying mechanisms.

Fos-like immunoreactivity in the auditory brainstem evoked by bipolar intracochlear electrical stimulation: effects of current level and pulse duration.

Fos-like immunoreactivity was used to compare the auditory brain stem excitation elicited by bipolar electrical stimulation of the cochlea at various current levels relative to the electrically evoked auditory brain stem response threshold for a 50-micros/phase monophasic pulse. Fos-like immunoreactive cells were labeled in primary auditory brain stem regions. The distribution of labeled cells was restricted to regions known to be cochleotopically related to the stimulated region of the scala tympani. Some labeled cells were observed at 2x electrically evoked auditory brain stem response threshold. The number, density and spatial distribution of labeled cells were quantified in the dorsal cochlear nucleus and inferior colliculus, and found to increase with increasing level of stimulation. For 50-micros pulses, the location of labeled neurons remained reasonably restricted to narrow bands within each region until the 1Ox level of stimulation (20 dB above electrically evoked auditory brain stem response threshold) was reached. While a monotonic increase in Fos-like immunoreactivity with increasing stimulus level was observed in most nuclei, for cells of the superficial layer of the dorsal cochlear nucleus, a non-monotonic change with increasing stimulus level was seen. This dorsal cochlear nucleus non-monotonicity may indicate that, at higher levels of stimulation, a secondary indirect inhibitory input, probably associated with activation of deep layer dorsal cochlear nucleus cells, reduces excitatory responses at the superficial layer of the dorsal cochlear nucleus. Electrically evoked auditory brain stem response and Fos expression showed parallel changes as a function of stimulus level and pulse duration. The data indicate that discrete activation of cell populations within the central auditory pathways can occur with bipolar electrical stimulation to the highest levels of stimulation typically useful in humans. The data also indicate a close, but not identical, quantitative relationship between Fos-like immunoreactivity and electrophysiological response amplitude. These findings support the view that a study of Fos-like immunoreactivity can provide a powerful and quantitative tool for study of the dynamic response characteristics of cells of the central auditory system to electrical stimulation at suprathreshold levels. The data suggest that there is a monotonic increase in the number of neurons responsive to intracochlear electrical stimulation as a function of stimulus level, at least through the upper half of the dynamic range, but that this increase does not result in a complete loss of spatial selectivity. Coupled with previous psychophysical studies, these results suggest that the increase in the number of activated neurons is functionally beneficial, resulting in improved discrimination of changes in the electrical signals.

Effects of stimulus configuration on psychophysical operating levels and on speech recognition with cochlear implants.

Effects of electrode configuration and pulse duration on operating levels and on speech recognition performance were studied in a group of 14 adult postlingually deaf human subjects with Nucleus cochlear implants. The operating levels (based on detection threshold and maximum comfortable loudness levels) for narrowly spaced bipolar (BP) stimulation were found to be about 11 dB higher on average than those for widely spaced bipolar (BP+6) or monopolar (MP1) stimulation. Operating levels for common ground (CG) stimulation fell between those for BP and BP+6; the difference between BP and CG detection thresholds depended on pulse duration. Variation in detection thresholds and maximum comfortable loudness levels across the electrode array (electrodes 1-15) was larger for BP and CG stimulation than for BP+6 or MP1 stimulation, suggesting narrower spread of activation for the BP and CG configurations despite the higher current levels. Speech recognition performance was tested using experimental processor configurations. Among the experimental electrode configurations tested (BP, CG, and BP+6), the highest speech recognition scores were obtained with the BP+6 configuration in many subjects. Effects of pulse duration on speech recognition were less consistent and usually smaller than the effects of electrode configuration. The results indicate that electrode configuration is an important variable determining speech recognition performance and suggest that restriction of the size of neural population activated by individual channels of the prosthesis is not necessarily advantageous.

Interactions between pulse separation and pulse polarity order in cochlear implants.

Interactions between pulse separation and pulse polarity order were examined using psychophysical studies of electrical detection thresholds in nonhuman primates. Subjects were trained using acoustic stimuli, then deafened in one ear and implanted with an electrode array for electrical stimulation of the cochlea. Threshold vs pulse separation functions for trains of biphasic electrical pulses were compared for constant and alternating leading phase polarity. When leading phase polarity was held constant, threshold vs pulse separation functions were nonmonotonic (U-shaped). Small polarity-dependent (cathodic vs anodic leading phase) differences in absolute thresholds were observed at long pulse separations, but function shape was independent of leading phase. When leading phase polarity alternated, there was a pronounced reduction in thresholds at short pulse separations (below about 1 ms), resulting in monotonically increasing threshold vs pulse separation functions. At long pulse separations, functions for alternating and constant polarity stimuli were similar. Polarity effects were most apparent for longer duration trains (20 pulses) at long pulse durations (1-2 ms/phase). For stimuli consisting of only two biphasic pulses, alternating polarity effects depended on whether cathodic or anodic phases were adjacent. The neural mechanisms underlying these effects probably include refractory properties and/or residual potentials.

Effects of pulse separation on detection thresholds for electrical stimulation of the human cochlea.

Effects of pulse separation on detection of electrical stimulation of the cochlea were studied in 12 profoundly deaf human subjects with Nucleus 22 cochlear implants. Biphasic symmetric pulses were used. Pulse separation is the time from offset of one biphasic pulse to the onset of the next biphasic pulse in the train. Effects of pulse separation were studied in the context of different covariables in four stages of the experiment. Effects of pulse separation seen in the different stages were similar, despite the different covariables. Both pulse separation and the total number of pulses per stimulus seem to be important variables affecting stimulus detection. For 0.5 ms/phase pulses, thresholds were lowest at the shortest pulse separations tested (0.2-1.1 ms) and increased as a function of pulse separation. For 2 ms/phase pulses, detection thresholds were lowest at pulse separations around 7.5 ms, in most cases, and higher at both longer and shorter pulse separations. These results suggest that interactions among adjacent pulses can either hinder or facilitate detection of the signal depending on the magnitudes of pulse separation and phase duration. Pulse separations at which thresholds measured for 2 ms/phase pulses were minimum were fairly consistent across subjects and did not correlate well with speech recognition scores. However, significant variation in this measure across species has been seen.

Stimulus features affecting psychophysical detection thresholds for electrical stimulation of the cochlea. III. Pulse polarity.

Effects of initial-phase polarity on psychophysical detection thresholds for electrical stimulation of the cochlea were examined in four nonhuman primates using trains of biphasic and triphasic charge-balanced pulses. Initial-phase polarity had small but consistent effects on the levels and slopes of threshold versus phase duration functions. These effects were consistent with the hypothesis that the initial-phase polarity affects the site of action potential initiation. Thresholds for biphasic pulses were lower than those for triphasic pulses, suggesting that the system is responsive to both positive and negative phases of the stimulus. Interactions between initial-phase polarity, pulse waveform, and phase duration were observed.

Functional responses from guinea pigs with cochlear implants. II. Changes in electrophysiological and psychophysical measures over time.

This study, the second of a two-part investigation, assessed changes over time in functional measures of the electrically stimulated auditory system following ototoxic deafening. Guinea pigs were trained to respond behaviorally to threshold level acoustic stimuli and then unilaterally deafened and implanted with a bipolar pair of electrodes within the cochlea and a single extracochlear electrode. Using pulsatile stimuli, thresholds for the electrically evoked auditory brainstem response (EABR) and psychophysical detection were repeatedly collected from the same animals over 3-month post-implantation periods. Thresholds were obtained as a function of stimulus phase duration primarily using bipolar intracochlear stimulation. As in earlier studies, the threshold measures exhibited both intra- and intersubject variability. Analysis of group data failed to show any statistically significant changes over time in either EABR or psychophysical threshold at any fixed pulse duration. However, significant changes over time were found in the slopes of the strength-duration functions for both measures. Slopes became shallower with time, suggesting a reduction in the efficiency of stimulus current integration, a trend presumed to occur with neural degeneration. This result suggests that strength-duration functions could be useful as a clinical diagnostic measure.

Functional responses from guinea pigs with cochlear implants. I. Electrophysiological and psychophysical measures.

We examined electrophysiological and psychophysical measures of the electrically stimulated auditory system of guinea pigs implanted with chronic intracochlear electrodes. Guinea pigs were trained to detect low-level acoustic stimuli and then unilaterally deafened and implanted with one extracochlear and two intracochlear electrodes. Electrically evoked auditory brainstem responses (EABRs) and psychophysical detection thresholds were obtained from the same animals using pulsatile stimuli. Supplementary EABR data were obtained from additional, untrained, animals. Thresholds were obtained as a function of stimulus phase duration and monopolar and longitudinal-bipolar electrode configurations. The slopes of the EABR and psychophysical functions for bipolar stimulation, averaged across subjects within 1 month after implantation, were -5.25 and -6.18 dB per doubling of pulse duration, respectively. These slopes were obtained with pulse durations ranging from 20 to 400 microseconds/phase; slope was reduced at longer pulse durations. Strength-duration slope also varied as a function of electrode configuration: monopolar stimulation produced steeper functions than did bipolar stimulation. Differences between EABR and psychophysical strength-duration measures suggest the existence of central mechanisms of stimulus integration in addition to that occurring at the level of the auditory nerve. Differences observed with variation of stimulus parameters (e.g., monopolar vs. bipolar stimulation modes) suggest that the specific mode of intracochlear electrical stimulation can influence stimulus integration. Such observations may be useful in the design of prosthetic devices and furthering our understanding of electrical excitation of the auditory system.

Effects of electrical current configuration on stimulus detection.

Psychophysical detection of electrical stimulation of the cochlea was studied as a function of electrical-current configuration. Subjects were postlingually deaf humans with Nucleus 20 + 2, Nucleus 22, and Ineraid cochlear implants and nonhuman primates unilaterally deafened and implanted with a multielectrode array similar to the Nucleus implant. In nonhuman primate and human Ineraid subjects, which had percutaneous connectors, we compared threshold functions for sinusoids and pulse trains for quadrupolar, bipolar, monopolar, and parallel multipolar stimulation. Thresholds decreased across this set of configurations. In some cases, the effects of current configuration were dependent on sinusoidal frequency and pulse duration. Pulse duration-dependent effects were also seen when comparing bipolar, monopolar, and common-ground configurations. Bipolar and monopolar stimulation were compared in Nucleus subjects using pulse trains at 50 microseconds per phase. For bipolar stimulation, thresholds decreased as a function of electrode separation, reaching a level near that for monopolar stimulation at separations of 3.5 to 6.5 mm in most cases. These results may be interpreted in terms of effects of current configuration on the magnitude and shape of electrical-potential fields produced in the cochlea, although more central factors also play a role in determining psychophysical detection thresholds.

Effects of electrical current configuration on potential fields in the electrically stimulated cochlea: field models and measurements.

Potential distributions measured within the scala tympani of the anesthetized guinea pig support the assertion that focusing is possible when currents are appropriately delivered to the electrodes in the scala tympani. Results obtained with a lumped-element model agree with measurements made in the inner ears of monkeys during monopolar and bipolar stimulation. The predictions are closer for potential distributions apical to the stimulating electrode than they are for basal distributions. In one monkey, in which electrodes were implanted in the middle ear as well as in the inner ear, we obtained measurements of the impedance from inside the scala tympani to points within the middle ear. These impedances are smaller that those initially used in the model, in which the round window membrane was assumed to have a relatively high impedance. A model of the common ground configuration was developed using finite electrode impedances. Finite impedances broaden the potential distributions in this model. Potential distributions from the lumped element model are compared with those obtained with an analytical model, to suggest ways in which focused and unfocused stimuli can affect the excitation of neurons in the implanted ear.

Effects of electrode configuration on threshold functions for electrical stimulation of the cochlea.

Psychophysical detection threshold vs frequency functions for sinusoidal electrical stimulation of the deafened cochlea were measured in 18 nonhuman primate subjects. Functions for monopolar or widely-spaced ( > 2.5 mm) bipolar stimulation were lower and usually had steeper slopes than those for more narrowly-spaced ( < 2.0 mm) bipolar stimulation. In 56% of the cases the difference between thresholds for narrowly-spaced bipolar of monopolar stimulation was greater for low frequency stimuli (63 or 100 Hz) than for high frequency stimuli (800 or 1,000 Hz) by 5 dB or more. Two cases were compared in more detail using pulsatile stimuli. For sinusoidal stimuli, one of these cases showed a moderate frequency dependent effect of electrode configuration and the other did not. The case with the frequency dependent effect of electrode configuration for sinusoids also showed a phase-duration dependent effect of electrode configuration for detection of single biphasic pulses: strength-duration curves (detection threshold in decibels vs pulse duration in ms/phase) were steeper for monopolar stimulation than for narrowly-spaced (0.7 mm) bipolar stimulation. This effect was not seen in the case that showed little or no frequency dependence in the effect of electrode configuration for sinusoidal stimuli. Slopes of threshold vs pulse rate functions where pulse duration was held constant at 2 ms/phase were not affected by electrode configuration in either subject.

Effects of stimulus level on nonspectral frequency discrimination by human subjects.

Frequency difference limens were determined as a function of reference-stimulus level for pulsatile electrical stimuli in 5 postlingually deaf human subjects with Nucleus-22 cochlear implants and for sinusoidally amplitude-modulated acoustic white noise stimuli in 4 normal-hearing humans. Subjects were tested at levels throughout the dynamic range and extending to the lowest detectable levels. Response stability was measured over the course of 10 sessions. For electrical stimulation in the deaf ears, difference limens decreased as a function of level throughout much or all of the dynamic range of hearing. This result contrasts with the case for nonspectral acoustic stimulation of normal-hearing subjects, where nonspectral frequency difference limens were strongly affected by level only near the detection threshold. These data suggest differences in the acoustic and electrical response spaces that must be considered in the design of auditory prosthesis processors.

Stimulus features affecting psychophysical detection thresholds for electrical stimulation of the cochlea. II: Frequency and interpulse interval.

Psychophysical detection thresholds for electrical stimulation of the cochlea were measured in nonhuman primates (macaques) as part of a series of experiments exploring the stimulus features affecting detection. The monkeys were trained psychophysically using operant conditioning. One ear was treated with neomycin to destroy hair cells, and implanted with electrodes in the scala tympani and/or the cochlear wall. In experiment 1, detection thresholds were measured for trains of fixed-duration pulses and for sinusoids. For long-duration pulses (1 to 2 ms/phase), thresholds decreased as a function of frequency (pulse rate), reaching a minimum at a frequency between 125 and 210 pps, then increased as frequency was further increased. For shorter duration pulses, thresholds usually decreased monotonically as a function of frequency but sometimes showed a slight increase as a function of frequency near the highest frequencies tested. Typically slopes of the threshold versus frequency functions for fixed-duration pulses were equal to or less than slopes of threshold versus frequency functions for sinusoidal signals, where frequency and phase duration covaried. Additional observations on two of the cases were made in experiments 2 and 3. In experiment 2, thresholds for pairs of pulses were measured as a function of interpulse interval. Thresholds decreased as a function of interpulse interval up to intervals of 2 to 4 ms and then increased slightly. In experiment 3, thresholds were measured as a function of stimulus duration at two frequencies.(ABSTRACT TRUNCATED AT 250 WORDS)

Cochlear wall titanium implants for auditory nerve stimulation.

Genetically deaf dalmatian dogs and ototoxically deafened macaque monkeys were implanted with electrodes housed in cochlear wall titanium implants to assess long-term stability, tolerance, and performance. Short-term human implantation, followed by trials of stimulation, was performed in 4 unilaterally deaf patients. In the dog experiments, cochlear wall electrode stimulation produced consistent electrophysiologic thresholds that were higher, by approximately 6 dB, than those obtained with bipolar scala tympani stimulation. Clinical testing revealed electrically evoked middle latency response, auditory brain stem response, and/or behavioral detection responses in 3 of 4 patients, at levels below those for facial nerve activation and pain sensation. Electrode place discrimination studies, with controls for loudness cues, revealed near-perfect discrimination in a monkey subject. Eleven of the 12 animal implants were found to be rigidly fixed in the cochlear bone, with direct contract between bone and implant over 8% to 23% of the implant surface for the 6 implants examined in detail. These results suggest that long-term fixation of titanium cochlear wall implants occurs by virtue of intimate implant-bone contact in restricted areas. This approach to prosthetic stimulation demonstrates encouraging performance characteristics in achieving auditory activation.