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Assessing Auditory Nerve Condition by Tone Decay in Deaf Subjects with a Cochlear Implant

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Assessing Auditory Nerve Condition by Tone Decay in Deaf Subjects with a Cochlear Implant International Journal of Audiology ISSN: 1499-2027 (Print) 1708-8186 (Online) Journal homepage: https://www.tandfonline.com/loi/iija20 Assessing auditory nerve condition by tone decay in deaf subjects with a cochlear implant Jan-Willem A. Wasmann, Ruben H. M. van Eijl, Huib Versnel & Gijsbert A. van Zanten To cite this article: Jan-Willem A. Wasmann, Ruben H. M. van Eijl, Huib Versnel & Gijsbert A. van Zanten (2018) Assessing auditory nerve condition by tone decay in deaf subjects with a cochlear implant, International Journal of Audiology, 57:11, 864-871, DOI: 10.1080/14992027.2018.1498598 To link to this article: https://doi.org/10.1080/14992027.2018.1498598 © 2018 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society. Published by Informa UK Limited, trading as Taylor & Francis Group. Published online: 27 Sep 2018. Submit your article to this journal Article views: 182 View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=iija20 INTERNATIONAL JOURNAL OF AUDIOLOGY 2018, VOL. 57, NO. 11, 864–871 https://doi.org/10.1080/14992027.2018.1498598 ORIGINAL ARTICLE Assessing auditory nerve condition by tone decay in deaf subjects with a cochlear implant Jan-Willem A. Wasmanna,b, Ruben H. M. van Eijla,c, Huib Versnela,c and Gijsbert A. van Zantena,c aDepartment of Otorhinolaryngology and Head & Neck Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; bDepartment of Otorhinolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands; cBrain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands ABSTRACT ARTICLE HISTORY The condition of the auditory nerve is a factor determining hearing performance of cochlear implant (CI) Received 8 June 2016 recipients. Abnormal loudness adaptation is associated with poor auditory nerve survival. We examined Revised 26 June 2018 which stimulus conditions are suitable for tone decay measurements to differentiate between CI recipi- Accepted 2 July 2018 ents with respect to their speech perception. Tone decay was defined here as occurring when the per- KEYWORDS cept disappears before the stimulus stops. We measured the duration of the percept of a 60-s pulse train. Cochlear implant; Current levels ranged from below threshold up to maximum acceptable loudness, pulse rates from 250 behavioural measures; to 5000 pulses/s, and duty cycles (percentages of time the burst of pulses is on) from 10% to 100%. Ten speech perception; adult CI recipients were included: seven with good and three with poor speech perception. Largest differ- psychoacoustics/hear- ences among the subjects were found at 5000 pulses/s and 100% duty cycle. The well performing sub- ing science jects had a continuous percept of the 60-s stimulus within 3 dB above threshold. Two poorly performing subjects showed abnormal loudness adaptation, that is, no continuous percept even at levels greater than 6 dB above threshold. We conclude that abnormal loudness adaptation can be detected via an elec- tric tone decay test using a high pulse rate and 100% duty cycle. Introduction stimulation compared to normal (Shepherd and Javel 1997; Sly et al. 2007). We assume that this leads to abnormal loudness Profound sensorineural hearing loss or deafness is usually caused adaptation, which is also referred to as marked or abnormal tone by loss of sensory hair cells in the cochlea. In many cases, it is decay (Huss and Moore 2003). treated by cochlear implantation. A cochlear implant (CI) In the early years of cochlear implantation, an electrical ana- bypasses the hair cells and stimulates the auditory nerve via elec- logue of the tone decay test was used for CI recipients by trical currents. This provides auditory perception, and in the Brimacombe and Eisenberg (1984). Three out of seventeen sub- most successful cases leads to almost normal speech perception jects exhibited abnormal loudness adaptation even at maximum in low-noise acoustic conditions (Wilson and Dorman 2008; acceptable loudness. Those three subjects became deaf at an ear- Blamey et al. 2013). However, not all recipients experience such lier age, had more years of profound hearing loss and shorter a successful outcome; the variability in speech perception out- experience with cochlear implant and hearing aid use than the come among CI recipients is large (Blamey et al. 2013). Auditory other subjects (Brimacombe and Eisenberg 1984). Sennaroglu nerve degeneration, occurring as a result of severe hair cell loss et al. (2001) investigated the effect of electric pulse rate on loud- (Spoendlin 1975; Versnel et al. 2007), is one of many variables ness adaptation in seven CI recipients. They expected stronger identified to affect speech perception in CI recipients (Cosetti adaptation with a higher rate, but they did not find an effect. and Waltzman 2012; Seyyedi et al, 2014). The extent of nerve Current subjective clinical tests for CI recipients, such as degeneration varies widely among patients (Fayad and Linthicum measurements of threshold and maximum acceptable loudness 2006; Seyyedi et al. 2013). (MAL) or speech reception tests, do not provide a measure of Loudness adaptation reflects a reduction in loudness during the condition of the auditory nerve. Before the era of auditory continued exposure to a stationary sound with constant level. brainstem response (ABR) and MRI for assessment of the audi- For people with normal hearing, acoustic loudness adaptation tory nerve, the tone decay test was one of the tests in the coch- occurs at levels close to the threshold (within 5 dB) and is more lear-retrocochlear differentiation test battery (Clemis and Gee, prominent at frequencies above 1000 Hz (Bray et al. 1973; 1979). We hypothesise that a tone decay test provides such a Hellman et al. 1997). Tone decay is a specific type of loudness measure in CI recipients and that a recipient’s speech perception adaptation in which the loudness is reduced to no-percept, that performance is inversely related to the degree of tone decay. is, “silence” (Owens 1964). A degenerated auditory nerve may This is based on the assumption that tone decay reflects auditory cause a more rapid decrease of neural response to steady nerve degeneration and that tone decay increases with extent of CONTACT Jan-Willem A. Wasmann [email protected] Department of Otorhinolaryngology, Radboud University Medical Center, Philips van Leydenlaan 15, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands ß 2018 British Society of Audiology, International Society of Audiology, and Nordic Audiological Society. Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. INTERNATIONAL JOURNAL OF AUDIOLOGY 865 nerve degeneration. Therefore, we conducted an exploratory Helsinki (version 2013, Fortaleza) and the Medical Research method-finding study to find parameters for a test that might Involving Human Subjects Act (WMO). The study was approved link loudness adaptation measures with speech perception by the Medical Research Ethics Committee of the UMC Utrecht performance. (protocol number 13-648/D) and informed consent was obtained from all subjects. Methods Equipment Subjects Tests were performed using a stand-alone personal computer Ten profoundly deaf adults with a multichannel CI participated (PC) with a built-in data acquisition card (National Instruments in the study. Subjects were recruited from the outpatient clinic NI PCI-6533), which was connected to a Research Interface Box of the UMC Utrecht. All subjects used a SONATAti100 or 2 (RIB2) that in turn was connected to the implant by means of PULSARci100 device manufactured by MED-EL. Each subject an electrical coil with the common radio frequency link. The had at least 6 months of experience with the CI. Six subjects had RIB2 developed by the Leopold-Franzens-University of suffered progressive hearing loss, one with onset of hearing loss Innsbruck ensured the electrical isolation of computer and sub- in childhood. Two subjects had experienced sudden deafness, ject and enabled control of the implant by the computer one in childhood. Two subjects were congenitally deaf. Table 1 (Bahmer et al. 2010). The experiments were written in MATLAB summarises subject characteristics. (version 7.12.0.635; Mathworks, Natick, MA, USA), using the The MAL level, which is the highest current level on a spe- cific electrode for a certain pulse rate that is still comfortably Psychophysics toolbox (version 3.0.11; Brainard 1997) and the loud, for each electrode was taken from the patients’ clinical RIB2.dll (version 1.12). records. As a measure of speech perception performance, con- sonant-vowel-consonant (CVC) phoneme recognition scores Stimuli were collected in quiet. Seven subjects, C1–C6 and C13, were considered good performers since their CVC scores were above All stimuli consisted of (a series of concatenated) 700-ms long 70%, and three subjects with scores below 50% were considered basic time frames. A basic time frame started with a number (N) poor performers (see Table 1). of repeated pulses at amplitude (A), that is, a pulse train, and The experiment consisted of two test sessions in which elec- the rest of the time frame contained no stimulation (Figure 1). tric detection thresholds and tone decay were measured as The percentage of the time the burst is on is referred to as the reported by the subject, with at least one week in between ses- duty cycle. The duty cycle was varied from 10% to 100%. With sions. Testing was in accordance with the Declaration of duty cycles less than 100% the effect of a silent gap on tone Table 1.
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