Combined Electric and Acoustic Stimulation of the Auditory System: Results of a Clinical Study

Kiefer, Jan; Pok, Marcel; Adunka, Oliver F.; Stürzebecher, Ekkehard; Baumgärtner, Wolfgang; Schmidt, Marcus; Tillein, Jochen; Ye, Qing; Gstœttner, Wolfgang

doi:10.1159/000084023

Cited by 249 publications

(250 citation statements)

References 43 publications

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“…Moreover, the patient indicated that the implant was very valuable in everyday situations. The improvement in performance when electric and acoustic stimulation were combined is consistent with previous reports for patients with residual low-frequency hearing ipsilateral and/or contralateral to an ear with a cochlear implant (e.g., Ching et al 2004;Gantz et al 2005;Kiefer et al 2005;Kong et al 2005;v. Ilberg et al 1999).…”

Section: Discussionsupporting

confidence: 89%

An Electric Frequency-to-place Map for a Cochlear Implant Patient with Hearing in the Nonimplanted Ear

Dorman

Spahr

Gifford

et al. 2007

JARO

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The aim of this study was to relate the pitch of high-rate electrical stimulation delivered to individual cochlear implant electrodes to electrode insertion depth and insertion angle. The patient (CH1) was able to provide pitch matches between electric and acoustic stimulation because he had auditory thresholds in his nonimplanted ear ranging between 30 and 60 dB HL over the range, 250 Hz to 8 kHz. Electrode depth and insertion angle were measured from high-resolution computed tomography (CT) scans of the patient_s temporal bones. The scans were used to create a 3D image volume reconstruction of the cochlea, which allowed visualization of electrode position within the scala. The method of limits was used to establish pitch matches between acoustic pure tones and electric stimulation (a 1,652-pps, unmodulated, pulse train). The pitch matching data demonstrated that, for insertion angles of greater than 450 degrees or greater than approximately 20 mm insertion depth, pitch saturated at approximately 420 Hz. From 20 to 15 mm insertion depth pitch estimates were about one-half octave lower than the Greenwood function. From 13 to 3 mm insertion depth the pitch estimates were approximately one octave lower than the Greenwood function. The pitch match for an electrode only 3.4 mm into the cochlea was 3,447 Hz. These data are consistent with other reports, e.g., Boëx et al. (2006), of a frequency-to-place map for the electrically stimulated cochlea in which perceived pitches for stimulation on individual electrodes are significantly lower than those predicted by the Greenwood function for stimulation at the level of the hair cell.

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Section: Discussionsupporting

confidence: 89%

An Electric Frequency-to-place Map for a Cochlear Implant Patient with Hearing in the Nonimplanted Ear

Dorman

Spahr

Gifford

et al. 2007

JARO

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“…Gstoettner et al (2004) reported speech results for one patient implanted with a 22mm electrode who improved from 38%-recognition of monosyllables in the acoustic-only mode to 90% with the addition of electric stimulation. Kiefer et al (2005) reported monosyllabic word understanding a group of 11 patients with preserved residual hearing. Mean acoustic-alone scores were 7%-correct, and the addition of electric stimulation increased this to over 60%, with several patients showing scores increasing to over 75%.…”

Section: A+e Results For Speech Presented In Quietmentioning

confidence: 99%

“…Gstoettner et al (2004) described full or at least partial preservation of hearing in 18 of 21 patients using this technique. Kiefer et al (2005) reported that at least partial preservation of hearing was accomplished in 11 out of 13 patients. The mean threshold change for those 11 patients was approximately 15 dB at the lower frequencies, while the remaining 2 patients suffered essentially total losses.…”

Section: Preservation Of Hearing Following Cochlear Implant Surgerymentioning

confidence: 99%

Combined acoustic and electric hearing: Preserving residual acoustic hearing

2008

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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 10mm 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.

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“…(This ability is nonexistent or almost nil with a unilateral implant, as noted before.) Combined EAS also provides a substantial benefit for listening to speech in quiet, in noise, in competition with another talker, or in competition with a multi-talker babble, compared with either electric stimulation only or acoustic stimulation only (e.g., von Ilberg et al, 1999;Kiefer et al, 2002Kiefer et al, , 2005Gantz and Turner, 2003;Wilson et al, 2003;Gstoettner et al, 2004Gstoettner et al, , 2006Gantz et al, 2005Gantz et al, , 2006Kong et al, 2005;James et al, 2006;Gifford et al, 2007;Dorman et al, 2007;Turner et al, this issue). Indeed, in some cases the score for combined EAS is greater than the sum of the scores for the electric-only and acoustic-only conditions.…”

Section: Two Recent Advancesmentioning

confidence: 99%

Cochlear implants: A remarkable past and a brilliant future

2008

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The aims of this paper are to (i) provide a brief history of cochlear implants; (ii) present a status report on the current state of implant engineering and the levels of speech understanding enabled by that engineering; (iii) describe limitations of current signal processing strategies and (iv) suggest new directions for research. With current technology the "average" implant patient, when listening to predictable conversations in quiet, is able to communicate with relative ease. However, in an environment typical of a workplace the average patient has a great deal of difficulty. Patients who are "above average" in terms of speech understanding, can achieve 100% correct scores on the most difficult tests of speech understanding in quiet but also have significant difficulty when signals are presented in noise. The major factors in these outcomes appear to be (i) a loss of low-frequency, fine structure information possibly due to the envelope extraction algorithms common to cochlear implant signal processing; (ii) a limitation in the number of effective channels of stimulation due to overlap in electric fields from electrodes, and (iii) central processing deficits, especially for patients with poor speech understanding. Two recent developments, bilateral implants and combined electric and acoustic stimulation, have promise to remediate some of the difficulties experienced by patients in noise and to reinstate low-frequency fine structure information. If other possibilities are realized, e.g., electrodes that emit drugs to inhibit cell death following trauma and to induce the growth of neurites toward electrodes, then the future is very bright indeed.

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Combined Electric and Acoustic Stimulation of the Auditory System: Results of a Clinical Study

Cited by 249 publications

References 43 publications

An Electric Frequency-to-place Map for a Cochlear Implant Patient with Hearing in the Nonimplanted Ear

An Electric Frequency-to-place Map for a Cochlear Implant Patient with Hearing in the Nonimplanted Ear

Combined acoustic and electric hearing: Preserving residual acoustic hearing

Cochlear implants: A remarkable past and a brilliant future

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