<p>The cochlear implant (CI) has been labeled the most successful neural
prosthesis. Despite this success, a significant number of CI recipients
experience poor speech understanding, and, even among the best
performers, restoration to normal auditory fidelity is rare. While
significant research efforts have been devoted to improving stimulation
strategies, few developments have led to significant hearing improvement
over the past two decades. We have recently introduced image processing
techniques that open a new direction for advancement in this field by
making it possible, for the first time, to determine the position of
implanted CI electrodes relative to the nerves they stimulate using
computed tomography images. In this article, we present results of an
image-guided, patient-customized approach to stimulation that utilizes
the electrode position information our image processing techniques
provide. This approach allows us to identify electrodes that cause
overlapping stimulation patterns and to deactivate them from a patient's
map. This individualized mapping strategy yields significant
improvement in speech understanding in both quiet and noise as well as
improved spectral resolution in the 68 adult CI recipients studied to
date. Our results indicate that image guidance can improve hearing
outcomes for many existing CI recipients without requiring additional
surgery or the use of ‘experimental' stimulation strategies, hardware or
software.</p
