Dynamic Current Focusing: A Novel Approach to Loudness Coding in Cochlear Implants

Objectives: In an attempt to improve spectral resolution and speech intelligibility, several current focusing methods have been proposed to increase spatial selectivity by decreasing intracochlear current spread. For example, tripolar stimulation administers current to a central electrode and uses the two flanking electrodes as the return pathway, creating a narrower intracochlear electrical field and hence increases spectral resolution when compared with monopolar (MP) stimulation. However, more current is required, and in some patients, specifically the ones with high electrode impedances, full loudness growth cannot be supported because of compliance limits. The present study describes and analyses a new loudness encoding approach that uses tripolar stimulation near threshold and gradually broadens the excitation (by decreasing compensation coefficient σ) to increase loudness without the need to increase overall current. It is hypothesized that this dynamic current focusing (DCF) strategy increases spatial selectivity, especially at lower loudness levels, while maintaining maximum selectivity at higher loudness levels, without reaching compliance limits. Design: Eleven adult cochlear implant recipients with postlingual hearing loss, with at least 9 months of experience with their HiRes90K implant, were selected to participate in this study. Baseline performance regarding speech intelligibility in noise (Dutch matrix sentence test), spectral ripple discrimination at 45 and 65 dB, and temporal modulation detection thresholds were assessed using their own clinical program, fitted on a Harmony processor. Subsequently, the DCF strategy was fitted on a research Harmony processor. Threshold levels were determined with σ = 0.8, which means 80% of current is returned to the flanking electrodes and the remaining 20% to the extracochlear ground electrode. Instead of increasing overall pulse magnitude, σ was decreased to determine most comfortable loudness. After 2 to 3 hr of adaptation to the research strategy, the same psychophysical measures were taken. Results: At 45 dB, average spectral ripple scores improved significantly from 2.4 ripples per octave with their clinical program to 3.74 ripples per octave with the DCF strategy (p = 0.016). Eight out of 11 participants had an improved spectral resolution at 65 dB. Nevertheless, no significant difference between DCF and MP was observed at higher presentation levels. Both speech-in-noise and temporal modulation detection thresholds were equal for MP and DCF strategies. Subjectively, 2 participants preferred the DCF strategy over their own clinical program, 2 preferred their own strategy, while the majority of the participants had no preference. Battery life was decreased and ranged from 1.5 to 4 hr. Conclusions: The DCF strategy gives better spectral resolution, at lower loudness levels, but equal performance on speech tests. These outcomes warrant for a longer adaptation period to study long-term outcomes and evaluate if the outcomes in the ripple tests transfer to the speech scores. Further research, for example, with respect to fitting rules and reduction of power consumption, is necessary to make the DCF strategy suitable for routine clinical application. ACKNOWLEDGMENTS: This research was supported by nonrestrictive research funding from Advanced Bionics. The authors have no conflicts of interest to declare. Address for correspondence: Johan H. M. Frijns, ENT Department, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, The Netherlands. E-mail: J.H.M.Frijns@lumc.nl Received October 2, 2017; accepted March 13, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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