Blake S. Wilson

Cochlear implants: current designs and future possibilities.

The cochlear implant is the most successful of all neural prostheses developed to date. It is the most effective prosthesis in terms of restoration of function, and the people who have received a cochlear implant outnumber the recipients of other types of neural prostheses by orders of magnitude. The primary purpose of this article is to provide an overview of contemporary cochlear implants from the perspective of two designers of implant systems. That perspective includes the anatomical situation presented by the deaf cochlea and how the different parts of an implant system (including the users brain) must work together to produce the best results. In particular, we present the design considerations just mentioned and then describe in detail how the current levels of performance have been achieved. We also describe two recent advances in implant design and performance. In concluding sections, we first present strengths and limitations of present systems and then offer some possibilities for further improvements in this technology. In all, remarkable progress has been made in the development of cochlear implants but much room still remains for improvements, especially for patients presently at the low end of the performance spectrum.

Patients utilizing a hearing aid and a cochlear implant: Speech perception and localization

Objective The purpose of this pilot study was to document speech perception and localization abilities in patients who use a cochlear implant in one ear and a hearing aid in the other ear. Design We surveyed a group of 111 cochlear implant patients and asked them whether they used a hearing aid on their unimplanted ear. The first three patients who were available were tested on word and sentence recognition and localization tasks. Speech stimuli were presented from the front in quiet and in noise. In the latter conditions, noise was either from the front, the right, or the left. Localization was tested with noise bursts presented at 45° from the right or left. In addition we asked the patients about their abilities to integrate the information from both devices. Results Speech perception tests in quiet showed a binaural advantage for only one of the three patients for words and none for sentences. With speech and noise both in front of the patient, two patients performed better with both devices than with either device alone. With speech in front and noise on the hearing aid side, no binaural advantage was seen, but with noise on the cochlear implant side, one patient showed a binaural advantage. Localization ability improved with both devices for two patients. The third patient had above-chance localization ability with his implant alone. Conclusions A cochlear implant in one ear and a hearing aid in the other ear can provide binaural advantages. The patient who did not show a clear binaural advantage had the poorest hearing aid alone performance. The absolute and relative levels of performance at each ear are likely to influence the potential for binaural integration.

Models of Neural Responsiveness to Electrical Stimulation

In principle, electrical stimulation of the cochlea is a simple process. Intracochlear electrodes, when stimulated, create electrical field patterns within the cochlea. In the vicinity of the neural elements, these fields appear as extracellular voltage gradients or profiles that are continuous along the entire length of the neurons. These extracellular voltage fields produce current flow into and out of the neural elements depending on the local impedances of the neural membranes. If the neural elements are sufficiently depolarized, action potentials are generated that propagate along each cell’s axon to the cochlear nucleus. Globally these events occur simultaneously, but in varying degree, across a population of nerve cells, producing a group or ensemble of neural responses to the stimulation.

Three-month results with bilateral cochlear implants.

Objectives To evaluate possible binaural listening advantages for speech in quiet, speech in noise, and for localization in a group of postlingually deafened adults with two cochlear implants functioning independently after 3 mo experience. Design Nine postlingually deafened subjects who had received a Cochlear Corporation CI24M implant in each ear were evaluated on a number of tasks. The subjects all had audiometric or biographical (e.g., duration of deafness) differences between the ears. Word and sentence materials were presented to the subjects in quiet and in noise with the signal always in the front and the noise from the front or either side. Results are reported for each ear and for both ears with the noise on either side. This allowed evaluation of head shadow and squelch effects. Additionally, localization ability was assessed for broadband noise presented either to the right or left of center at 45° azimuth. Localization was assessed for each ear and for both ears. Results Results of speech testing in quiet showed a significant advantage for the binaural condition over the better ear in four subjects. In noise, with both signal and noise in front of the subject, a significant advantage of two ears over the better ear was found for four subjects. For noise to one side of the head, when the ear opposite the noise source was added to the ear ipsilateral to the noise, a significant advantage was demonstrated for seven of seven tested subjects. When the ear ipsilateral to the noise was added to the ear contralateral to the noise, a significant advantage was shown for only one of seven (noise on right) and three of seven (noise on left) tested subjects. The localization task showed that all seven tested subjects could discriminate 45° left from 45° right above chance with bilateral stimulation. Three subjects could perform the discrimination above chance with only one ear. However, performance with both ears was significantly better than performance with one ear for two of these latter subjects. Conclusions We conclude that bilateral cochlear implants can provide real advantages, particularly when it is possible to utilize the ear that is away from a noise source, thus taking advantage of the head shadow effect. In addition, localization ability was generally better with two implants than with one.

The future of cochlear implants

Remarkable progress has been made in recent years in the design and application of processing strategies for cochlear implants. Most notably, use of the new spectral peak (SPEAK) and continuous interleaved sampling (CIS) strategies have provided large improvements in speech reception performance compared with prior strategies (NIH Consensus Statement, 1995; Skinner et al., 1994a; Wilson et al., 1991). All major manufacturers of multichannel implant systems, including Advanced Bionics Corp., Bionic Systems, Cochlear Pty. Ltd., and Med El, now offer CIS or CIS-like strategies in their speech processors. The SPEAK strategy was developed by Cochlear Pty. Ltd and continues to be one of the options available in that companys devices. The principal purpose of this editorial is to present some of the many possibilities for further improvements in performance. To the extent that such possibilities are realized, implant systems of the future may be quite different from present systems, with different processing strategies, electrode designs, telemetry features, and fitting procedures.

Multicenter U.S. bilateral MED-EL cochlear implantation study: Speech perception over the first year of use

Objective: Binaural hearing has been shown to support better speech perception in normal-hearing listeners than can be achieved with monaural stimulus presentation, particularly under noisy listening conditions. The purpose of this study was to evaluate whether bilateral electrical stimulation could confer similar benefits for cochlear implant listeners. Design: A total of 26 postlingually deafened adult patients with short duration of deafness were implanted at five centers and followed up for 1 yr. Subjects received MED-EL COMBI 40+ devices bilaterally; in all but one case, implantation was performed in a single-stage surgery. Speech perception testing included CNC words in quiet and CUNY sentences in noise. Target speech was presented at the midline (0 degrees), and masking noise, when present, was presented at one of three simulated source locations along the azimuth (−90, 0, and +90 degrees). Results: Benefits of bilateral electrical stimulation were observed under conditions in which the speech and masker were spatially coincident and conditions in which they were spatially separated. Both the “head shadow” and “summation” effects were evident from the outset. Benefits consistent with “binaural squelch” were not reliably observed until 1 yr after implantation. Conclusions: These results support a growing consensus that bilateral implantation provides functional benefits beyond those of unilateral implantation. Longitudinal data suggest that some aspects of binaural processing continue to develop up to 1 yr after implantation. The squelch effect, often reported as absent or rare in previous studies of bilateral cochlear implantation, was present for most subjects at the 1 yr measurement interval.

Echo intensity compensation by echolocating bats.

When mounted on a swinging pendulum, mustache bats, Pteronotus p. parnellii, emit ultrasonic pulses as they move toward and away from fixed targets. During forward swings they systematically decrease the intensity of their emitted pulses and during backward swings they increase the intensity. In this way, echo strength is continuously adjusted and apparently optimized for signal analysis. We have called this behavior echo intensity compensation. Pteronotus simultaneously Doppler and echo intensity compensate during forward swings of the pendulum but during backward swings they only echo intensity compensate. Pteronotus can regulate the intensity of both the constant frequency and frequency modulated components of their pulses; this regulation is independent of vestibular cues, pulse repetition rates, pulse durations and pulse-echo intervals.

Two new directions in speech processor design for cochlear implants.

Two new approaches to the design of speech processors for cochlear implants are described. The first aims to represent “fine structure” or “fine frequency” information in a way that it can be perceived and used by patients, and the second aims to provide a closer mimicking than was previously possible of the signal processing that occurs in the normal cochlea.

Comparative studies of speech processing strategies for cochlear implants

A wide variety of speech processing strategies for multichannel auditory prostheses were compared in studies of two patients implanted with the UCSF electrode array. Each strategy was evaluated using tests of vowel and consonant confusions, with and without lipreading. Included among the strategies were the compressed analog processor of the present UCSF/Storz prosthesis and a group of interleaved pulses processors in which the amplitudes of nonsimultaneous pulses code the spectral variations of speech. For these patients, each with indications of poor nerve survival, test scores were significantly higher with the interleaved pulses processors. We believe this superior performance was a result of 1. the substantial release from channel interactions provided by nonsimultaneous stimuli and 2. a fast enough rotation among the channels to support adequate temporal and spectral resolution of perceived speech sounds.

Design for a Simplified Cochlear Implant System

A simplified cochlear implant (CI) system would be appropriate for widespread use in developing countries. Here, we describe a CI that we have designed to realize such a concept. The system implements 8 channels of processing and stimulation using the continuous interleaved sampling (CIS) strategy. A generic digital signal processing (DSP) chip is used for the processing, and the filtering functions are performed with a fast Fourier transform (FFT) of a microphone or other input. Data derived from the processing are transmitted through an inductive link using pulse width modulation (PWM) encoding and amplitude shift keying (ASK) modulation. The same link is used in the reverse direction for backward telemetry of electrode and system information. A custom receiver-stimulator chip has been developed that demodulates incoming data using pulse counting and produces charge balanced biphasic pulses at 1000 pulses/s/electrode. This chip is encased in a titanium package that is hermetically sealed using a simple but effective method. A low cost metal-silicon hybrid mold has been developed for fabricating an intracochlear electrode array with 16 ball-shaped stimulating contacts