As the most successful neural prosthesis, cochlear implants have provided partial hearing to more than 120000 persons worldwide; half of which being pediatric users who are able to develop nearly normal language. Biomedical engineers have played a central role in the design, integration and evaluation of the cochlear implant system, but the overall success is a result of collaborative work with physiologists, psychologists, physicians, educators, and entrepreneurs. This review presents broad yet in-depth academic and industrial perspectives on the underlying research and ongoing development of cochlear implants. The introduction accounts for major events and advances in cochlear implants, including dynamic interplays among engineers, scientists, physicians, and policy makers. The review takes a system approach to address critical issues in cochlear implant research and development. First, the cochlear implant system design and specifications are laid out. Second, the design goals, principles, and methods of the subsystem components are identified from the external speech processor and radio frequency transmission link to the internal receiver, stimulator and electrode arrays. Third, system integration and functional evaluation are presented with respect to safety, reliability, and challenges facing the present and future cochlear implant designers and users. Finally, issues beyond cochlear implants are discussed to address treatment options for the entire spectrum of hearing impairment as well as to use the cochlear implant as a model to design and evaluate other similar neural prostheses such as vestibular and retinal implants.

Cochlear Implants: System Design, Integration, and Evaluation

http://web.mit.edu/hst.723/www/ThemePapers/Implants/WilsonDormanReview2008.pdf

Cochlear implants: a remarkable past and a brilliant future

Objectives/Hypothesis: This study documents the importance of preserving residual low-frequency acoustic hearing as those with more residual hearing are selected for cochlear implantation. Surgical strategies used for hearing preservation with a short hybrid cochlear implant are outlined. The benefits of preserved residual low-frequency hearing, improved word understanding in noise, and music appreciation are described. Study Design: Multicenter, prospective, single-subject design. Methods: Records were reviewed of 21 individuals participating in an Food and Drug Administration (FDA) feasibility clinical trial who have received an Iowa/Nucleus 10 mm electrode. A second group of subjects receiving implants at the University of Iowa that have used the 10 mm device between 2 years and 6 months were also reviewed. Outcome measures included standardized tests of monosyllabic word understanding, spondees in noise, and common melody recognition. Results: Lowfrequency hearing was maintained in all individuals immediately postoperative. One subject lost hearing at 2.5 months postoperative after a viral infection. The group has averaged a loss of 9 dB low-frequency acoustic hearing between 125 and 1,000 Hz. Monosyllabic word understanding scores at 6 months for a group being followed for an FDA clinical trial using the implant plus hearing aids was 69% correct. For the long-term group receiving implants at Iowa, monosyllabic word understanding in those who have used the device between 6 months and 2 years is 79%. Other important findings include improved recognition of speech in noise (9 dB improvement) as compared with standard cochlear implant recipients who were matched for speech recognition in quiet and near normal recognition of common melodies. Conclusion: The surgical strategies outlined have been successful in preservation of low-frequency hearing in 96% of individuals. Combined electrical and acoustical speech processing has enabled this group of volunteers to gain improved word understanding as compared with their preoperative hearing with bilateral hearing aids and a group of individuals receiving a standard cochlear implant with similar experience with their device. The improvement of speech in noise and melody recognition is attributed to the ability to distinguish fine pitch differences as the result of preserved residual low-frequency acoustic hearing. Preservation of low-frequency acoustic hearing is important for improving speech in noise and music appreciation for the hearing impaired, both of which are important in real-life situations. Key Words: Hearing Preservation, cochlear implant, hybrid cochlear implant, hearing in noise. Laryngoscope, 115:796–802, 2005

Preservation of Hearing in Cochlear Implant Surgery: Advantages of Combined Electrical and Acoustical Speech Processing

Integration of information from face and voice plays a central role in our social interactions. It has been mostly studied in the context of audiovisual speech perception: integration of affective or identity information has received comparatively little scientific attention. Here, we review behavioural and neuroimaging studies of face-voice integration in the context of person perception. Clear evidence for interference between facial and vocal information has been observed during affect recognition or identity processing. Integration effects on cerebral activity are apparent both at the level of heteromodal cortical regions of convergence, particularly bilateral posterior superior temporal sulcus (pSTS), and at 'unimodal' levels of sensory processing. Whether the latter reflects feedback mechanisms or direct crosstalk between auditory and visual cortices is as yet unclear.

Integrating Face and Voice in Person Perception

This study investigated the effects of simulated cochlear-implant processing on speech reception in a variety of complex masking situations. Speech recognition was measured as a function of target-to-masker ratio, processing condition (4, 8, 24 channels, and unprocessed) and masker type (speech-shaped noise, amplitude-modulated speech-shaped noise, single male talker, and single female talker). The results showed that simulated implant processing was more detrimental to speech reception in fluctuating interference than in steady-state noise. Performance in the 24-channel processing condition was substantially poorer than in the unprocessed condition, despite the comparable representation of the spectral envelope. The detrimental effects of simulated implant processing in fluctuating maskers, even with large numbers of channels, may be due to the reduction in the pitch cues used in sound source segregation, which are normally carried by the peripherally resolved low-frequency harmonics and the temporal fine structure. The results suggest that using steady-state noise to test speech intelligibility may underestimate the difficulties experienced by cochlear-implant users in fluctuating acoustic backgrounds.

Effects of simulated cochlear-implant processing on speech reception in fluctuating maskers

Speech recognition was measured as a function of spectral resolution (number of spectral channels) and speech-to-noise ratio in normal-hearing (NH) and cochlear-implant(CI) listeners. Vowel, consonant, word, and sentence recognition were measured in five normal-hearing listeners, ten listeners with the Nucleus-22 cochlear implant, and nine listeners with the Advanced Bionics Clarion cochlear implant. Recognition was measured as a function of the number of spectral channels (noise bands or electrodes) at signal-to-noise ratios of +15, +10, +5, 0 dB, and in quiet. Performance with three different speech processing strategies (SPEAK, CIS, and SAS) was similar across all conditions, and improved as the number of electrodes increased (up to seven or eight) for all conditions. For all noise levels, vowel and consonant recognition with the SPEAK speech processor did not improve with more than seven electrodes, while for normal-hearing listeners, performance continued to increase up to at least 20 channels. Speech recognition on more difficult speech materials (word and sentence recognition) showed a marginally significant increase in Nucleus-22 listeners from seven to ten electrodes. The average implant score on all processing strategies was poorer than scores of NH listeners with similar processing. However, the best CI scores were similar to the normal-hearing scores for that condition (up to seven channels). CI listeners with the highest performance level increased in performance as the number of electrodes increased up to seven, while CI listeners with low levels of speech recognition did not increase in performance as the number of electrodes was increased beyond four. These results quantify the effect of number of spectral channels on speech recognition in noise and demonstrate that most CI subjects are not able to fully utilize the spectral information provided by the number of electrodes used in their implant.

/pdf/speech-recognition-in-noise-as-a-function-of-the-number-of-2e0j71t121.pdf

Speech recognition in noise as a function of the number of spectral channels: Comparison of acoustic hearing and cochlear implants

Phoneme and speech recognition were measured as a function of stimulation pulse rate in 12 listeners with three types of cochlear implants. Identification of consonants and vowels and recognition of words and sentences were measured in 5 Clarion C1 subjects fit with continuous interleaved sampling (CIS) processors having 4 or 8 electrodes, 4 Nucleus 24 subjects fit with CIS processors having 4, 8, 12 or 16 electrodes and 3 Clarion C2 subjects fit with CIS processors with 4, 8, 12 and 16 electrodes. Stimulation rates ranged from 200 to more than 5000 Hz per electrode, depending on the device, number of electrodes used and stimulation strategy. Listeners were also tested on the same materials with their original processor prior to receiving the experimental processors. All testing was done in quiet listening conditions with essentially no practice with the experimental processor prior to data collection. Listeners scored the highest with their original processor. Little difference in speech understanding was observed for listener scores with processors using different stimulation rates. Speech recognition was significantly poorer only at the lowest stimulation rate and at high rates that used noninterleaved pulses. Speech recognition was similar for processors using 8, 12 or 16 electrodes. Only 4-electrode processors produced a significantly poorer performance. These results suggest that patients with present commercial implants are not able to make full use of the number of channels of spectral information delivered by the present speech processors. In addition, the results show no significant change in performance as a function of stimulation rate, suggesting that high stimulation rates do not result in improved access to temporal cues in speech, at least under quiet listening conditions.

Effects of Stimulation Rate on Speech Recognition with Cochlear Implants

Cochlear implants, besides restoring hearing sensation to otherwise deaf individuals, provide an excellent tool with which to investigate how the human central nervous system (CNS) processes complex patterns of sensory information. Throughout the lifetime of normal-hearing persons, the auditory CNS has been continually trained to extract meaningful speech (and other meaningful sounds) from a constant barrage of auditory sensory information. The CNS establishes networks to process auditory sensory information; for complex pattern recognition tasks, these networks can take as long as 10 to 12 years to fully develop (see Hartmann and Kral, Chapter 6). Once these networks are fully mature, auditory pattern recognition is highly robust to degradations in the sensory signal, as revealed by decades of speech perception research. For example, military cryptologists in the 1940s searched for a type of signal degradation that would render speech unintelligible during transmission (but could be decoded at the receiving end by reversing the degradation, thereby restoring intelligibility). To their amazement, even severe alterations to the speech signal did not destroy its intelligibility. One of the most well-known examples is the work of Licklider and Pollack (1948), who eliminated all amplitude information of the speech signal by means of “infinite clipping” (the signal waveform was simply absent or present, according to an amplitude threshold).

/pdf/speech-perception-with-cochlear-implants-b4i77bj0by.pdf

Speech Perception with Cochlear Implants

Hypothesis Phoneme recognition performance in patients implanted with the Nucleus 22 cochlear implant is affected by the frequency-to-electrode assignment. Background Multiple electrodes in modern cochlear implants are intended to deliver frequency-specific information to different tonotopic locations along the cochlea. However, the relation between the electrode locations, distribution of frequency information, and performance has not been explored thoroughly. Methods Ten listeners were tested on vowel and consonant identification tasks immediately after receiving each of the 15 speech processors. Experimental processors were created with 4, 7, and 20 activated electrodes. Five different frequency allocations were tested with all electrode conditions. Results For 7- and 20-electrode maps, best vowel recognition performance was obtained with frequency tables 7 and 9, with subjects showing best performance with the table with which they were most familiar. With 4-electrode maps, no change in vowel recognition performance was observed as a function of the frequency allocation. Consonant scores showed only a small effect of frequency allocation across all processors. Results were similar across listeners with different electrode insertion depths. Conclusion The allocation of frequency ranges to electrodes in the Nucleus-22 cochlear implant can affect vowel recognition, when more than four electrodes are used, but is less important for consonant recognition. The allocation of frequency ranges to electrodes is an important factor in multichannel implants with more than four electrodes. The similarity of results across implant listeners with different electrode insertion depths implies that the optimal frequency allocation is one that best matches the allocation to which they've become accustomed, rather than one that matches the original tonotopic location of the electrodes.

The effect of frequency allocation on phoneme recognition with the nucleus 22 cochlear implant.

Speech recognition performance was measured as a function of electrode in two experiments with the Nucleus-22 cochlear implant using 4-electrode SPEAK speech processors. In experiment 1, the four stimulated electrode pairs were shifted in 0.75-mm steps over 3 mm in the apical-basal direction. In experiment 2, the four electrodes were closely spaced and positioned apically, medially, or basally. An additional condition spaced the four electrodes as widely as possible. In experiment 1, City University of New York sentence scores showed a significant decrease in performance as the electrodes were shifted basally; no other speech measures showed a significant change with electrode location. For experiment 2, all scores were the best with the processor that had the electrodes spaced as widely as possible. In both experiments, all 4-electrode SPEAK processors produced significantly poorer speech recognition than the subject's own 20-electrode processor. These results indicate that the location of electrodes is an important factor in implant performance.

Lendra M. Friesen

Papers

Speech recognition in noise as a function of the number of spectral channels: Comparison of acoustic hearing and cochlear implants

Effects of Stimulation Rate on Speech Recognition with Cochlear Implants

Speech Perception with Cochlear Implants

The effect of frequency allocation on phoneme recognition with the nucleus 22 cochlear implant.

Effects of electrode location on speech recognition with the Nucleus-22 cochlear implant.