Considerations for Fitting Cochlear Implants Bimodally and to the Single-Sided Deaf.

When listening with a cochlear implant through one ear and acoustically through the other, binaural benefits and spatial hearing abilities are generally poorer than in other bilaterally stimulated configurations. With the working hypothesis that binaural neurons require interaurally matched inputs, we review causes for mismatch, their perceptual consequences, and experimental methods for mismatch measurements. The focus is on the three primary interaural dimensions of latency, frequency, and level. Often, the mismatch is not constant, but rather highly stimulus-dependent. We report on mismatch compensation strategies, taking into consideration the specific needs of the respective patient groups. Practical challenges typically faced by audiologists in the proposed fitting procedure are discussed. While improvement in certain areas (e.g., speaker localization) is definitely achievable, a more comprehensive mismatch compensation is a very ambitious endeavor. Even in the hypothetical ideal fitting case, performance is not expected to exceed that of a good bilateral cochlear implant user.

Effects of electrical pulse polarity shape on intra cochlear neural responses in humans: Triphasic pulses with anodic and cathodic second phase.

Modern cochlear implants employ charge-balanced biphasic and triphasic pulses. However, the effectiveness of electrical pulse shape and polarity is still a matter of debate. For this purpose, a previous study (Bahmer & Baumann, 2013) conducted electrophysiological and psychophysical measurements following triphasic pulse stimulation with constant cathodic second phase and varying anodic first and third phases. Pulse stimulation with constant anodic second phase was not investigated. Therefore, in this study, pulse stimulation with cathodic and anodic second phase was applied for the recording of electrically evoked compound action potentials (ECAPs) as well as for psychophysical thresholds in cochlear implant (CI) recipients. First it was investigated whether the temporal polarity distribution has a different effect on neuronal stimulation when the second phase is cathodic or anodic; second, whether the electrophysiological and psychophysical results show a comparable difference between triphasic stimulation with anodic and cathodic second phases. The results showed that variation of the temporal polarity distribution of the triphasic pulse had a smaller effect on the ECAP response when the second phase was anodic compared to when it was cathodic, whereas for psychophysical detection thresholds this variation had a similar effect for both polarities. While electrophysiological responses and psychophysical detection thresholds showed a high correlation for variations of the triphasic pulse with cathodic second phase, the results for variations of the triphasic pulse with anodic second phase showed only moderate correlation. Furthermore, the difference between triphasic stimulation with cathodic and anodic second phases did not correlate between the electrophysiological and psychophysical results. In summary, after stimulation with different configurations of triphasic pulses used in the present study, the polarity of the second phase has an effect on electrophysiological response at suprathreshold level but not on the psychophysical detection thresholds. Thus, at different stimulation levels a possible substitution of the psychophysical test by an electrophysiological measurement (e.g. neural health measurement of the cochlea) could not be corroborated by the present results.

Loudness Perception and Dynamic Range Depending on Interphase Gaps of Biphasic Pulses in Cochlear Implants.

OBJECTIVES: The human auditory nerve can be electrically stimulated by cochlear implants (CIs) with pulse trains consisting of biphasic pulses with small interphase gaps (IPGs). In animal experiments, lower electrically evoked compound action potential (ECAP) thresholds in implanted animals were found for increasing IPGs (2.1, 10, 20, 30 µs). ECAP thresholds may correlate with loudness thresholds. Therefore, in this study, the IPG effect on loudness and dynamic range was investigated in nine CI subjects. DESIGN: A loudness-matching procedure was designed with three different IPGs (2.1, 10, 30 µs) at three different pulse rates (200, 600, 1000 pps). An adaptive loudness-balancing test was performed at the 50% stimulus amplitude level of the dynamic range and most comfortable loudness level (MCL). RESULTS: Increasing the IPG or increasing the pulse rate led to a significant decrease in stimulus amplitude for 50% level and MCL in the adaptive test. Because the stimulus amplitudes for 50% level and MCL decreased in a different manner, the calculated upper dynamic range between MCL and 50% level significantly decreased for increasing IPG between 0.24 and 0.38 dB. This decrease in the upper dynamic range was observed for all pulse rates. CONCLUSIONS: It is possible to reduce the stimulus amplitude level for the same loudness impression using larger IPGs in CIs; however, larger IPGs decrease the dynamic range. These findings could help during the fitting process of CIs to find the balance between saving battery and a proper dynamic range.

Rate pitch discrimination in cochlear implant users with the use of double pulses and different interpulse intervals.

The rate pitch discrimination ability of cochlear implant (CI) users is poor compared to normal-hearing (NH) listeners. At low pulse rates, the just noticeable difference (JND) is on average 20% of the base rate, while NH listeners can discriminate small frequency differences of 0.2% at 1 kHz. Recent investigations suggest that double pulses with short interpulse intervals (IPIs) may have a beneficial effect on rate pitch discrimination in CI users. In a first experiment psychophysical tests were carried out to establish whether rate pitch in CI users could be improved by applying double pulses with equal amplitude and short IPIs. Pulse trains with base rates of 200 and 400 pps, composed of either single pulses or double pulses with IPIs of 15, 50, and 150 µs were presented. In a second experiment pairwise comparisons were carried out between pitch of a pulse train composed of alternating double and single pulses with pitch of pulse trains composed of single pulses. The alternating pulse train had a base rate of 400 pps, the pulse trains with solely single pulses had base rates of 200, 300, and 400 pps. The loudness and pitch perception of the different stimulus types were evaluated and compared. A significant loudness difference was found between single and double pulses for both pulse rates. The JND for pitch discrimination between double-pulse IPIs had a high inter-subject variability, and no significant group effect was found. No subject reported a pitch change between double pulse and single pulse stimulation. In contrast, most of the subjects recognized a change in pitch between single-pulse trains and pulse trains with alternating double and single pulses. The latter was lower in pitch than the single-pulse train stimulation. To conclude, using (equal amplitude) double pulses instead of single pulses in a pulse train does not effect pitch perception. Instead, loudness differs between double pulses and single pulses with the same amplitude.