Lina A. J. Reiss

A neuronal representation of the location of nearby sounds

Humans can accurately perceive the location of a sound source—not only the direction, but also the distance. Sounds near the head, within ducking or reaching distance, have a special saliency. However, little is known about this perception of auditory distance. The direction to a sound source can be determined by interaural differences, and the mechanisms of direction perception have been studied intensively; but except for studies on echolocation in the bat, little is known about how neurons encode information on auditory distance. Here we describe neurons in the brain of macaque monkeys (Macaca fascicularis) that represent the auditory space surrounding the head, within roughly 30 cm. These neurons, which are located in the ventral premotor cortex, have spatial receptive fields that extend a limited distance outward from the head.

Hybrid 10 clinical trial: preliminary results.

Acoustic plus electric (electric-acoustic) speech processing has been successful in highlighting the important role of articulation information in consonant recognition in those adults that have profound high-frequency hearing loss at frequencies greater than 1500 Hz and less than 60% discrimination scores. Eighty-seven subjects were enrolled in an adult Hybrid multicenter Food and Drug Administration clinical trial. Immediate hearing preservation was accomplished in 85/87 subjects. Over time (3 months to 5 years), some hearing preservation was maintained in 91% of the group. Combined electric-acoustic processing enabled most of this group of volunteers to gain improved speech understanding, compared to their preoperative hearing, with bilateral hearing aids. Most have preservation of low-frequency acoustic hearing within 15 dB of their preoperative pure tone levels. Those with greater losses (>30 dB) also benefited from the combination of electric-acoustic speech processing. Postoperatively, in the electric-acoustic processing condition, loss of low-frequency hearing did not correlate with improvements in speech perception scores in quiet. Sixteen subjects were identified as poor performers in that they did not achieve a significant improvement through electric-acoustic processing. A multiple regression analysis determined that 91% of the variance in the poorly performing group can be explained by the preoperative speech recognition score and duration of deafness. Signal-to-noise ratios for speech understanding in noise improved more than 9 dB in some individuals in the electric-acoustic processing condition. The relation between speech understanding in noise thresholds and residual low-frequency acoustic hearing is significant (r = 0.62; p < 0.05). The data suggest that, in general, the advantages gained for speech recognition in noise by preserving residual hearing exist, unless the hearing loss approaches profound levels. Preservation of residual low-frequency hearing should be considered when expanding candidate selection criteria for standard cochlear implants. Duration of profound high-frequency hearing loss appears to be an important variable when determining selection criteria for the Hybrid implant.

Combined Acoustic and Electric Hearing: Preserving Residual Acoustic Hearing

The topic of this review is the strategy of preserving residual acoustic hearing in the implanted ear to provide combined electrical stimulation and acoustic hearing as a rehabilitative strategy for sensorineural hearing loss. This chapter will concentrate on research done with the Iowa/Nucleus 10 mm Hybrid device, but we will also attempt to summarize strategies and results from other groups around the world who use slightly different approaches. A number of studies have shown that preserving residual acoustic hearing in the implanted ear is a realistic goal for many patients with severe high-frequency hearing loss. The addition of the electric stimulation to their existing acoustic hearing can provide increased speech recognition for these patients. In addition, the preserved acoustic hearing can offer considerable advantages, as compared to a traditional cochlear implant, for tasks such as speech recognition in backgrounds or appreciation of music and other situations where the poor frequency resolution of electric stimulation has been a disadvantage.

Spectral edge sensitivity in neural circuits of the dorsal cochlear nucleus.

One possible function of the dorsal cochlear nucleus (DCN) is discrimination of head-related transfer functions (HRTFs), spectral cues used for vertical sound localization. Recent psychophysical and physiological studies suggest that steep, rising spectral edges may be the features used to identify HRTFs. Here we showed, using notch noise and noise band stimuli presented over a range of frequencies, that a subclass of DCN type IV neurons responded with a response peak when the rising spectral edge of a notch or band was aligned near best frequency (BF). This edge sensitivity was correlated with weak or inhibited responses to broadband noise and inhibition in receptive fields at frequencies below BF. Some aspects of the inhibition shaping the response peak, namely inhibition to rising edges below BF and to falling edges at BF, could be explained by the properties of type II interneurons with BFs below those of the type IV neurons. However, many type IV neurons also showed inhibitory responses with the rising spectral edge just above BF, and these responses could not be reproduced by current models of DCN circuitry. Therefore, a new component of the DCN circuit is needed to fully explain the responses to rising spectral edges. This shaping of edge sensitivity by inhibition to rising spectral edges both below and above BF suggests the specialization of DCN for spectral edge coding along the tonotopic gradient.

Impact of hair cell preservation in cochlear implantation: combined electric and acoustic hearing.

Objective: This article reviews some of the potential benefits of preserving low-frequency residual hearing using a short-electrode cochlear implant. Both the status of the inner ear and acoustic characteristics of speech cues are important factors. How does the magnitude of the potential benefits depend on the candidacy criteria for implantation with a hearing-preservation electrode? Background: Previous research has demonstrated that preserving residual hearing in cochlear implantation can provide significant advantages for the understanding of speech in background noise as well as for the aesthetic qualities of music and other sounds. Developing optimal candidacy guidelines for these devices is a current goal. Methods: In a large group of patients with Hybrid (acoustic + electric) cochlear implant, performance in the recognition of speech in background of other talkers is measured and compared with patients with traditional long-electrode implant. In addition, a number of patient characteristics are compared to success with the short-electrode implant. Results: Age and duration of hearing loss are found to be predictive factors for the success of the short-electrode approach. Conclusion: Optimal criterion for candidacy for the use of the short-electrode versus a traditional long electrode can improve the outlook for patients with severe-to-profound high-frequency hearing loss.

Cochlear implant speech processor frequency allocations may influence pitch perception.

Objective: To investigate the effects of assigning cochlear implant speech processor frequencies normally associated with more apical cochlear locations to the shallow insertion depths of the Iowa/Nucleus Hybrid electrode. Study Design: Subjects using the Hybrid implant for more than 1 year were tested on speech recognition with Consonant-Nucleus-Consonant words and consonant stimuli. Pitch sensations of individual electrodes were also measured electrically through the implant and acoustically in the contralateral ear. Setting: Tertiary care center. Results: Most subjects showed large improvements in speech recognition within 12 months after implantation. Furthermore, after longer periods of 24-plus months, some individuals were able to achieve high levels of consonant discrimination with electric-only processing comparable to long-electrode patients with deeper electrode insertions. Pitch perceptions obtained from individual electrodes in these subjects were closer to the frequency map assigned an electrode than the place-frequency predicted from cochlear location. Conclusion: These results suggest that over time, pitch sensations may be determined more by the implant map than by cochlear location. In other words, the brain may adapt to spectral mismatches by remapping pitch. Furthermore, patients can perform well with shifted frequency allocations for speech recognition. The successful application of shifted frequency allocations also supports the idea of shallower insertions and greater preservation of residual hearing for all cochlear implants, regardless of the patients frequency range of usable residual hearing.

Plasticity in human pitch perception induced by tonotopically mismatched electro-acoustic stimulation.

Under normal conditions, the acoustic pitch percept of a pure tone is determined mainly by the tonotopic place of the stimulation along the cochlea. Unlike acoustic stimulation, electric stimulation of a cochlear implant (CI) allows for the direct manipulation of the place of stimulation in human subjects. CI sound processors analyze the range of frequencies needed for speech perception and allocate portions of this range to the small number of electrodes distributed in the cochlea. Because the allocation is assigned independently of the original resonant frequency of the basilar membrane associated with the location of each electrode, CI users who have access to residual hearing in either or both ears often have tonotopic mismatches between the acoustic and electric stimulation. Here we demonstrate plasticity of place pitch representations of up to three octaves in Hybrid CI users after experience with combined electro-acoustic stimulation. The pitch percept evoked by single CI electrodes, measured relative to acoustic tones presented to the non-implanted ear, changed over time in directions that reduced the electro-acoustic pitch mismatch introduced by the CI programming. This trend was particularly apparent when the allocations of stimulus frequencies to electrodes were changed over time, with pitch changes even reversing direction in some subjects. These findings show that pitch plasticity can occur more rapidly and on a greater scale in the mature auditory system than previously thought possible. Overall, the results suggest that the adult auditory system can impose perceptual order on disordered arrays of inputs.

Integration of acoustic and electrical hearing

For some individuals with severe high-frequency hearing loss, hearing aids cannot provide a satisfactory improvement in speech recognition. However, these same patients often have too much residual hearing to qualify as candidates for a cochlear implant. Here we describe results with the Iowa/Nucleus Hybrid cochlear implant, which is designed to preserve the patients residual low-frequency hearing while at the same time supplementing their high-frequency hearing through electrical stimulation. The advantages of this approach are presented, including improved speech recognition in competing backgrounds as compared with traditional cochlear implants. The results with the Iowa/Nucleus Hybrid device demonstrate the ability of the auditory system to integrate acoustic and electrical stimulation, even under conditions of severe distortions to the normal cochlear place-frequency mapping.

Risk factors for loss of ipsilateral residual hearing after hybrid cochlear implantation.

Objective Residual low-frequency acoustic hearing benefits cochlear implantees in difficult listening situations such as understanding speech in noise and music appreciation. Most subjects retain functional residual hearing in the operated ear. A small number of patients, however, will lose significant ipsilateral residual hearing after short-electrode cochlear implantation. The objectives of this retrospective series are to determine whether predisposition to hearing loss after implantation exists in a subset of patients and to assess the functional impact of this hearing loss on clinical measures of combined electric and acoustic hearing. Study Design Retrospective case series. Setting Multicenter clinical trial; tertiary care facility. Patients Hearing preservation cochlear implant recipients. Main Outcome Measure Frequency-averaged ipsilateral hearing loss at 1 year after activation. Results Eighty-five patients from the Hybrid S8 FDA trial had serial postoperative audiometric measurements. Twenty-two of these patients, implanted at the home institution, provided additional medical data. Univariate analysis (Pearson’s, Spearman’s, Student’s t test) showed that the severity of hearing loss at 1 year after activation was significantly correlated with age, male gender, and noise-induced hearing loss as the etiology of hearing impairment. A multivariate regression model corroborated these variables. No other medical factors were predictive. Clinical measures of speech perception (Consonant-Nucleus-Consonant and Hearing in Noise Test) worsened with hearing loss in ipsilateral but not bilateral listening conditions. Conclusion Age, male gender, and a history of noise-induced hearing loss correlate with the severity of hearing loss at 1 year after activation. Even the most severely affected patients benefit from bilateral electric and acoustic inputs.

Effects of extreme tonotopic mismatches between bilateral cochlear implants on electric pitch perception: A case study

Objectives: Recent studies suggest that pitch perceived through cochlear implants (CIs) changes with experience to minimize spectral mismatches between electric and acoustic hearing. This study aimed to test whether perceived spectral mismatches are similarly minimized between two electric inputs. Design: Pitch perception was studied in a subject with a 10-mm CI in one ear and a 24-mm CI in the other ear. Both processors were programmed to allocate information from the same frequency range of 188–7938 Hz, despite the large differences in putative insertion depth and stimulated cochlear locations between the CIs. Results: After 2 and 3 years of experience, pitch-matched electrode pairs between CIs were aligned closer to the processor-provided frequencies than to cochlear position. Conclusions: Pitch perception may have adapted to reduce perceived spectral discrepancies between bilateral CI inputs, despite 2–3 octave differences in tonotopic mapping.