Objectives: Phantom electrode stimulation was developed for cochlear implant (CI) systems to provide a lower pitch percept by stimulating more apical regions of the cochlea, without inserting the... Show moreObjectives: Phantom electrode stimulation was developed for cochlear implant (CI) systems to provide a lower pitch percept by stimulating more apical regions of the cochlea, without inserting the electrode array deeper into the cochlea. Phantom stimulation involves simultaneously stimulating a primary and a compensating electrode with opposite polarity, thereby shifting the electrical field toward the apex and eliciting a lower pitch percept. The current study compared the effect sizes (in shifts of place of excitation) of multiple phantom configurations by matching the perceived pitch with phantom stimulation to that perceived with monopolar stimulation. Additionally, the effects of electrode location, type of electrode array, and stimulus level on the perceived pitch were investigated. Design: Fifteen adult advanced bionics CI users participated in this study, which included four experiments to eventually measure the shifts in place of excitation with five different phantom configurations. The proportions of current delivered to the compensating electrode, expressed as sigma, were 0.5, 0.6, 0.7, and 0.8 for the symmetrical biphasic pulses (SBC0.5, SBC0.6, SBC0.7, and SBC0.8) and 0.75 for the pseudomonophasic pulse shape (PSA(0.75)). A pitch discrimination experiment was first completed to determine which basal and apical electrode contacts should be used for the subsequent experiments. An extensive loudness balancing experiment followed where both the threshold level (T-level) and most comfortable level (M-level) were determined to enable testing at multiple levels of the dynamic range. A pitch matching experiment was then performed to estimate the shift in place of excitation at the chosen electrode contacts. These rough shifts were then used in the subsequent experiment, where the shifts in place of excitation were determined more accurately. Results: Reliable data were obtained from 20 electrode contacts. The average shifts were 0.39, 0.53, 0.64, 0.76, and 0.53 electrode contacts toward the apex for SBC0.5, SBC0.6, SBC0.7, SBC0.8, and PSA(0.75), respectively. When only the best configurations per electrode contact were included, the average shift in place of excitation was 0.92 electrode contacts (range: 0.25 to 2.0). While PSA(0.75)leads to equal results as the SBC configurations in the apex, it did not result in a significant shift at the base. The shift in place of excitation was significantly larger at the apex and with lateral wall electrode contacts. The stimulus level did not affect the shift. Conclusions: Phantom stimulation results in significant shifts in place of excitation, especially at the apical part of the electrode array. The phantom configuration that leads to the largest shift in place of excitation differs between subjects. Therefore, the settings of the phantom electrode should be individualized so that the phantom stimulation is optimized for each CI user. The real added value to the sound quality needs to be established in a take-home trial. Show less
With commonly used monopolar or __single electrode stimulation__ (SES) in cochlear implants the perceived pitch depends on the place in the cochlea of the stimulated contact. When two contacts are... Show moreWith commonly used monopolar or __single electrode stimulation__ (SES) in cochlear implants the perceived pitch depends on the place in the cochlea of the stimulated contact. When two contacts are stimulated simultaneously, __dual electrode stimulation__(DES), intermediate pitches can be elicited. The place and precise pitch can be adjusted by varying the current ratio between these two contacts. In this thesis the mechanism of DES is investigated psychophysically, electrophysiologically and in a computational model of the cochlea. It was concluded that DES and SES are indistinguishable in terms of spread of excitation and sequential channel interaction, while with DES the pitch depends linearly on the current ratio. On adjacent contacts, DES turned out to be effective for the entire dynamic range without the need for any current correction to equalize loudness between pitches. DES is also feasible on non-adjacent contacts (__spanning__) up till 4.4 mm, but with increasing distance between the contacts, such a current correction becomes mandatory, while also the number of discriminable pitches decreases. Finally, spanning was implemented in a speech coding strategy and tested in a take-home trial, which demonstrated that even with two groups of three adjacent defective contacts, speech perception and sound quality were retained. Show less
