Across-frequency combination of interaural time difference in bilateral cochlear implant listeners

The current study examined how cochlear implant (CI) listeners combine temporally interleaved envelope-ITD information across two sites of stimulation. When two cochlear sites jointly transmit ITD information, one possibility is that CI listeners can extract the most reliable ITD cues available. As a result, ITD sensitivity would be sustained or enhanced compared to single-site stimulation. Alternatively, mutual interference across multiple sites of ITD stimulation could worsen dual-site performance compared to listening to the better of two electrode pairs. Two experiments used direct stimulation to examine how CI users can integrate ITDs across two pairs of electrodes. Experiment 1 tested ITD discrimination for two stimulation sites using 100-Hz sinusoidally modulated 1000-pps-carrier pulse trains. Experiment 2 used the same stimuli ramped with 100 ms windows, as a control condition with minimized onset cues. For all stimuli, performance improved monotonically with increasing modulation depth. Results show that when CI listeners are stimulated with electrode pairs at two cochlear sites, sensitivity to ITDs was similar to that seen when only the electrode pair with better sensitivity was activated. None of the listeners showed a decrement in performance from the worse electrode pair. This could be achieved either by listening to the better electrode pair or by truly integrating the information across cochlear sites

Sound localization and interaural time sensitivity with bilateral cochlear implants

Thesis (Ph. D.)--Harvard-MIT Division of Health Sciences and Technology, 2006.Includes bibliographical references.Bilateral cochlear implantation is becoming more common as clinicians attempt to provide better sound-source localization and speech reception in noise for cochlear implant (CI) users. While some improvement over the abilities of monolateral implantees has been documented, bilateral performance for CI users is far from that achieved with normal hearing. Identifying factors that limit bilateral performance has been difficult because little is understood about CI listeners' localization abilities, their sensitivity to interaural cues, and the relationships between them. To better understand bilateral electric hearing, five bilateral CI users' abilities to locate sound sources and their sensitivities to interaural time difference (ITD) were studied in this thesis. Unlike past studies, monolateral and bilateral performance was recorded before and after exposure to daily, bilateral-CI listening using constant- and roving-level stimuli. For constant-level stimuli, increasing bilateral-listening experience improved all subjects' bilateral performance but degraded two subjects' monolateral performance. Using roving-level stimuli, increasing bilateral-listening experience also improved bilateral performance but did not alter monolateral performance.(cont.) Our results show that depending on the method of evaluation, the benefit of bilateral CIs over monolateral CI could be overstated for some subjects. A simple decision model was used to predict subjects' localization performance based on their sensitivity to interaural time and level differences (TD and ILD) measured through their sound processors. The predicted performance indicated that the measured performance could be accounted for by subjects' ILD sensitivity but not by their ITD sensitivity alone. Poor ITD sensitivity may be one reason that bilateral CI users' localization performance is poor compared to that of normal-hearing (NH) listeners. To improve ITD sensitivity, a first step is to characterize ITD sensitivity on single, interaural electrode pairs because data in the literature is incomplete. In particular, the dependence of ITD sensitivity on the repetition rate and the number of pulses in the unmodulated pulse trains was studied. Just noticeable difference (JND) of ITD was measured with four subjects on their most ITD-sensitive, interaural electrode pair. At low rate (50 pps), ITD JND improved with increasing number of pulses, indicating integration of ongoing ITD cues. The best ITD JNDs were 85 - 354 pts. Using 800-pps trains, two subjects' ITD JND degraded with increasing number of pulses.(cont.) Two subjects were insensitive to ITD up to 2 ms for 800-pps trains. To begin studying the impact of CI processing on ITD sensitivity, ITD JND was also measured using low-rate (50 pps) pulse trains delivered to the external input of the subjects' sound processors. ITD JND improved with increasing number of pulses. While subjects were insensitive to ongoing ITD in unmodulated, high-rate pulse trains delivered to single, interaural electrode pairs, they were sensitive to ongoing ITDs in the low-frequency modulator of high-rate pulse trains in the through-processor case. A next step toward greater understanding of bilateral electric hearing is to fully investigate the degree to which subjects are sensitive to ITD using modulated pulse trains. The results of this thesis show that there is significant localization benefit with bilateral CIs even though performance is not at the level of NL listeners. Further studies to improve ITD sensitivity may improve localization ability, which will further justify the risks and cost associated with bilateral implantation.by Becky Bikkei Poon.Ph.D

Effects of Training on Lateralization for Simulations of Cochlear Implants and Single-Sided Deafness

While cochlear implantation has benefitted many patients with single-sided deafness (SSD), there is great variability in cochlear implant (CI) outcomes and binaural performance remains poorer than that of normal-hearing (NH) listeners. Differences in sound quality across ears—temporal fine structure (TFS) information with acoustic hearing vs. coarse spectro-temporal envelope information with electric hearing—may limit integration of acoustic and electric patterns. Binaural performance may also be limited by inter-aural mismatch between the acoustic input frequency and the place of stimulation in the cochlea. SSD CI patients must learn to accommodate these differences between acoustic and electric stimulation to maximize binaural performance. It is possible that training may increase and/or accelerate accommodation and further improve binaural performance. In this study, we evaluated lateralization training in NH subjects listening to broad simulations of SSD CI signal processing. A 16-channel vocoder was used to simulate the coarse spectro-temporal cues available with electric hearing; the degree of inter-aural mismatch was varied by adjusting the simulated insertion depth (SID) to be 25 mm (SID25), 22 mm (SID22) and 19 mm (SID19) from the base of the cochlea. Lateralization was measured using headphones and head-related transfer functions (HRTFs). Baseline lateralization was measured for unprocessed speech (UN) delivered to the left ear to simulate SSD and for binaural performance with the acoustic ear combined with the 16-channel vocoders (UN+SID25, UN+SID22 and UN+SID19). After completing baseline measurements, subjects completed six lateralization training exercises with the UN+SID22 condition, after which performance was re-measured for all baseline conditions. Post-training performance was significantly better than baseline for all conditions (p < 0.05 in all cases), with no significant difference in training benefits among conditions. Given that there was no significant difference between the SSD and the SSD CI conditions before or after training, the results suggest that NH listeners were unable to integrate TFS and coarse spectro-temporal cues across ears for lateralization, and that inter-aural mismatch played a secondary role at best. While lateralization training may benefit SSD CI patients, the training may largely improve spectral analysis with the acoustic ear alone, rather than improve integration of acoustic and electric hearing

Neural Correlates of Binaural Interaction Using Aggregate-System Stimulation in Cochlear Implantees

The importance of binaural cues in auditory stream formation and sound source differentiation is widely accepted. When treating one ear with a cochlear implant (CI) the peripheral auditory system gets partially replaced and processing delays get added potentially, thus important interaural time encoding gets altered. This is a crucial problem because factors like the interaural time delay between the receiving ears are known to be responsible for facilitating such cues, e.g., sound source localization and separation. However, these effects are not fully understood, leaving a lack of systematic binaural fitting strategies with respect to an optimal binaural fusion. To gain new insights into such alterations, we suggest a novel method of free-field evoked auditory brainstem response (ABR) analysis in CI users. As a result, this method does not bypass the technically induced intrinsic delays of the hearing device while leaving the complete electrode array active, thus the most natural way of stimulation is provided and the comparable testing of real world stimuli gets facilitated. Unfortunately, ABRs acquired in CI users are additionally affected by the prominent artifact caused by their electrical stimulation, which severely distorts the desired neural response, thus challenging their analysis. To circumvent this problem, we further introduce a novel narrowband filtering CI artifact removal technique capable of obtaining neural correlates of ABRs in CI users. Consequently, we were able to compare brainstem-level responses collected of 12 CI users and 12 normal hearing listeners using two different stimuli (i.e., chirp and click) at four different intensities each, what comprises an adaption of the prominent brainstem evoked response audiometry serving as an additional evaluation criterion. We analyzed the responses using the average of 2,000 trials in combination with synchronized regularizations across them and found consistent results in their deflections and latencies, as well as in single trial relationships between both groups. This method provides a novel and unique perspective into the natural CI users’ brainstem-level responses and can be practical in future research regarding binaural interaction and fusion. Furthermore, the binaural interaction component (BIC), i.e., the arithmetical difference between the sum of both monaurally evoked ABRs and the binaurally evoked ABR, has been previously shown to be an objective indicator for binaural interaction. This component is unfortunately known to be rather fragile and as a result, a reliable, objective measure of binaural interaction in CI users does not exist to the present date. It is most likely that implantees would benefit from a reliable analysis of brainstem-level and subsequent higher-level binaural interaction, since this could objectively support fitting strategies with respect to a maximization of interaural integration. Therefore, we introduce a novel method capable of obtaining neural correlates of binaural interaction in bimodal CI users by combining recent advances in the field of fast, deconvolution-based ABR acquisitions with the introduced narrowband filtering technique. The proposed method shows a significant improvement in the magnitude of resulting BICs in 10 bimodal CI users and a control-group of 10 normal hearing subjects when compensating the interaural latency difference caused by the technical devices. In total, both proposed studies objectively demonstrate technical-driven interaural latency mismatches. Thus, they strongly emphasize potential benefits when balancing these interaural delays to improve binaural processing by significant increases in associated neural correlates of successful binaural interaction. These results and also the estimated latency differences should be investigated in larger group sizes to further consolidate the results, but confirm the demand for rather binaural solutions than treating hearing losses in an isolated monaural manner.Zusammenfassung Die Notwendigkeit binauraler Verarbeitungsprozesse in der auditorischen Wahrnehmung ist weitestgehend akzeptiert. Bei der Therapie eines Ohres mit einem Cochlea-Implantat (engl. cochlear implant (CI)) wird das periphere auditorische System teilweise ersetzt und verändert, sodass natürliche, interaurale Zeitauflösungen beeinflusst werden. Dieses Problem ist entscheidend, denn Faktoren wie interaurale Laufzeitunterschiede zwischen den aufnehmenden Ohren sind verantwortlich für die Umsetzung der erwähnten binauralen Verarbeitungsprozesse, z.B. Schallquellenlokalisation und -separation. Allerdings sind diese Effekte nicht ausreichend verstanden, weshalb bis heute binaurale Anpassstrategien mit Rücksicht auf eine optimale Fusionierung fehlen. Um neue Einsichten in solche zeitlichen Verzerrungen zu erhalten, schlagen wir ein neues Verfahren der Freifeld evozierten auditorischen Hirnstammpotentiale (engl. auditory brainstem response (ABR)) in CI-Nutzern vor. Diese Methode beinhaltet explizit technisch-induzierte Laufzeiten verwendeter Hörhilfen, sodass eine natürliche Stimulation unter Verwendung von realitätsnahen Stimuli ermöglicht wird. Unglücklicherweise sind ABRs von CI-Nutzern zusätzlich mit Stimulationsartefakten belastet, wodurch benötigte neurale Antworten weiter verzerrt werden und eine entsprechende Analyse der Signale deutlich erschwert wird. Um dieses Problem zu umgehen, schlagen wir eine neue Artefakt- Reduktionstechnik vor, welche auf spektraler Schmalbandfilterung basiert und somit den Erhalt entsprechender, neuraler ABR Korrelate ermöglicht. Diese Methoden erlaubten die Interpretation neuraler Korrelate auf Hirnstammebene unter Verwendung von zwei verschiedenen Stimuli (Chirps und Klicks) unter vier verschiedenen Lautstärken in 12 CI-Nutzern und 12 normalhörenden Probanden. Die beschriebene Prozedur adaptiert somit die weitläufig bekannte Hirnstammaudiometrie (engl. brainstem evoked response audiometry (BERA)), deren Ergebnisse zur zusätzlichen Evaluation des vorgestellten Verfahrens dienten. Die Untersuchung der aus 2000 Einzelantworten erhaltenen Mittelwerte in Kombination mit der Analyse synchronisierter Regularitäten über den Verlauf der Einzelantworten ergab dabei konsistente Beobachtungen in gefundenen Amplituden, Latenzen sowie in Abhängigkeiten zwischen Einzelantworten in beiden Gruppen. Das vorgestellte Verfahren erlaubt somit auf einzigartige Weise neue und ungesehene Einsichten in natürliche, neurale Antworten auf Hirnstammebene von CI-Nutzern, welche in zukünftigen Studien verwendet werden können, um binaurale Interaktionen und Fusionen weiter untersuchen zu können. Interessanterweise hat sich, die auf ABRs basierende, binaurale Interaktionskomponente (engl. binaural interaction component (BIC)) als objektiver Indikator binauraler Integration etabliert. Diese Komponente (d.h. die arithmetische Differenz zwischen der Summe der monauralen Antworten und der binauralen Antwort) ist leider sehr fragil, wodurch ein sicherer und objektiver Nachweis in CI-Nutzern bis heute nicht existiert. Dabei ist es sehr wahrscheinlich, dass gerade Implantatsträger von einer entsprechenden Analyse auf Hirnstammebene und höherrangigen Ebenen deutlich profitieren würden, da dies objektiv Anpassstrategien mit Rücksicht auf eine bestmögliche binaurale Integration ermöglichen könnte. Deshalb stellen wir ein weiteres, neuartiges Verfahren zum Erhalt von neuralen Korrelaten binauraler Interaktion in bimodal versorgten CI-Trägern vor, welches jüngste Erfolge im Bereich der schnellen, entfalltungsbasierten ABR Akquisition und der bereits vorgestellten Schmalband- filterung zur Reduktion von Stimulationsartefakten kombiniert. Basierend auf diesem Verfahren konnten signifikante Verbesserungen in der BIC-Amplitude in 10 bimodal versorgten Patienten sowie 10 normalhörenden Probanden, basierend auf umgesetzte, interaurale Laufzeitkompensationen technischer Hörhilfen, aufgezeigt werden. Insgesamt demonstrieren beide vorgestellten Studien technisch-induzierte, interaurale Laufzeitunterschiede und betonen demnach sehr deutlich potenzielle Vorteile in assoziierten neuralen Korrelaten binauraler Interaktionen, wenn solche Missverhältnisse zeitlich ausgeglichen werden. Die aufgezeigten Ergebnisse sowie die getätigte Abschätzungen technischer Laufzeiten sollte in größeren Gruppen weiter untersucht werden, um die Aussagekraft weiter zu steigern. Dennoch unterstreichen diese Einsichten das Verlangen nach binauralen Lösungsansätzen in der zukünftigen Hörrehabilitation, statt bisheriger isolierter und monauraler Therapien

Physiology, Psychoacoustics and Cognition in Normal and Impaired Hearing

otorhinolaryngology; neurosciences; hearin