Electric and Acoustic Stimulation in the Same Ear
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1 EXZELLENZCLUSTER IM Electric and Acoustic Stimulation in the Same Ear Waldo Nogueira, Benjamin Krüger, Marina Imsiecke, Andreas Büchner, Medizinische Hochschule Hannover, Cluster of Excellence Hearing4all, Hannover, Germany Director: Prof. Prof. h.c. Dr. med. Thomas Lenarz
2 EAS/Hybrid-Cochlear Implant
3 Electrc-acoustic interaction Gap (Old Implantation Criteria) Electrode Array Hair Cells Continuous (Current Implantation Criteria) Electrode Array Hair Cells Overlapping (Next Generation Implantation Criteria) Electrode Array Hair Cells
4 Electric-Acoustic Frequency Difference Krüger, Büchner, Nogueira, HearRes (2017, Under Review) 4
5 Results Results show increased threshold elevations with smaller distance between electric and acoustic stimulation mean threshold elevation of 9.38 %DR (or 2.02 db). Significant threshold elevation for acoustic masking condition (p <.001) using One-Sample Wilcoxon Signed Rank Test was observed Krüger, Büchner, Nogueira, HearRes (2017) (Under Review) Krüger, Büchner, Nogueira, HearRes (2017, Under Review)
6 Discussion I It is unknown how electric and acoustic hearing interact with each other How can EAS interaction be characterized/measured? Which interactions are foreseen between electric and acoustic stimulation? Can these interactions impact speech performance?
7 Speech Understanding with EAS People with relatively large residual hearing in the low frequencies benefit a lot from cochlear implants Speech Performance in quiet Speech Performance in Noise 10 db SNR
8 Discussion II Electric Acoustic stimulation (EAS) implantation criteria is getting closer to the typical hearing loss related to age Dubno et al., 2013 Can the implantation for EAS be extended? e.g. for presbyacusis? EAS Dubno,
9 Any Question?
10 Minisymposia on Computational Modelling of Neuroprosthetics Bob Carlyon Cognition and Brain Sciences Unit Cambridge, England Waldo Nogueira Marco-Domenico Caversaccio Head and Neck Surgery University Hospital ENT Bern, Switzerland Johan H.M. Frijns Department of ORL-HNS Leiden University Medical Centre, The Netherlands Manuel Manrique Rodríguez Department of Otolaryngology University Hospital Navarra, Spain
11 Threshold Elevation Stimuli Masker: Electric Probe: Acoustic 1000 Hz 750 Hz 500 Hz 250 Hz %DR = Ө m Ө u MCL Ө u basal apical
12 Threshold Elevation Stimuli Masker: Acoustic Probe: Electric apical basal El. 22 El. 21 El. 20 El. 19 El. 17 %DR = Ө m Ө u MCL Ө u
13 Results Significant threshold elevation for acoustic masking condition (p <.001) using One-Sample Wilcoxon Signed Rank Test was observed mean threshold elevation of %DR (9.45 CU) no relation between threshold elevation and tested stimulation sites, threshold elevation can be observed throughout the distance range
14 Conclusions - Psychophysical Ipsilateral electric and acoustic stimulation masked each other. Electric masking on acoustic stimulation depends on the electric-acoustic frequency difference. The amount of masking increases exponentially with smaller distance between stimulation sites. Acoustic masking on electric stimulation has a broad effect in threshold elevation. A relation between acoustic masking and distance of stimulation sites could not be determined. Electric masking and acoustic masking effects are asymmetrical
15 Method Psychometric Masking Experiment 3-IFC (interval forced choice) Measurement Threshold in quiet (probe only) Masking experiment (probe + masker) Threshold elevation Stimuli Electric: unmodulated pulse trains Acoustic: pure tones Masker Most comfortable level (MCL) 500 ms Condition 1: electric masker acoustic probe Condition 2: acoustic masker - electric probe Probe Adaptive level 200 ms
16 Electrophysiological Test Setup Software / PC Electric Stimulation Clinical Programming Interface CPI-2 Portable Speech Processor Head Piece Acoustic Stimulation National Instruments (DAQ) Headphone Amplifier Insert Earphone Microphone Amplifier Probe Microphone
17 Electrocochleography (ECochG) / Cochlear Microphonics Stimulus Acoustic Acoustic+Electric Electric Derived Acoustic = (Acoustic+Electric) Electric (K. Koka et al. 2015, CIAP) Response (CM) FFT Method adapted from: Electrocochleography in Cochlear Implant Recipients With Residual Hearing: Comparison With Audiometric Thresholds (K. Koka et al. 2016, Ear and Hear) The electrophysiological measures consisted of measuring the auditory nerve activity using intracochlear electrodes for an acoustic tone (A), electric pulse train (E), an acoustic and an electric tone (A+E) presented simultaneously Derived measure (D) was obtained substracting the responses between the A+E and the E responses. Finally the interaction is estimated substracting the D and the A responses
18 Results - Electrophysiological apical basal
19 Conclusions - Electrophysiological Electric acoustic interaction was observed only in CI users having large residual hearing using both the psychophysical and the electrophysiological response. Electrophysiologically, an interaction of 3 db at 500 Hz and 5 db at 750 Hz was observed. From these results we conclude that the interaction between electric and acoustic stimulation can be measured electrophysiologically The sensitivity of this measure underestimates the threshold elevations observed psychophysically
20 EXZELLENZCLUSTER IM Thank you
21 Electrocochleography (ECochG) / Cochlear Microphonics ECochG Based Measurement Test setup Stimulus Acoustic Acoustic+Electric Electric Derived Acoustic = (Acoustic+Electric) Electric Software / PC Clinical Programming Interface CPI-2 Portable Speech Processor Electric Stimulation Head Piece Acoustic Stimulation Response (CM) National Instruments (DAQ) Headphone Amplifier Insert Earphone FFT Microphone Amplifier Probe Microphone (K. Koka et al. 2015, CIAP) Method adapted from: Electrocochleography in Cochlear Implant Recipients With Residual Hearing: Comparison With Audiometric Thresholds (K. Koka et al. 2016, Ear and Hear) The electrophysiological measures consisted of measuring the auditory nerve activity using intracochlear electrodes for an acoustic tone (A) electric pulse train (E) an acoustic and an electric tone (A+E) presented simultaneously derived measure (D) was obtained substracting the responses between the A+E and the E responses. Finally the interaction is estimated substracting the D and the A responses
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