Dynamic Current Focusing Compared to Monopolar Stimulation in a Take-Home Trial of Cochlear Implant Users

Abstract

Objectives: This study compared the performance of a dynamic partial tripolar cochlear implant speech encoding strategy termed dynamic current focusing (DCF) to monopolar stimulation (MP) using spectro-temporal, temporal, and speech-in-noise recognition testing.

Design: DCF is a strategy that utilizes tripolar or high partial tripolar stimulation at threshold level and increases loudness by slowly widening current spread towards most comfortable level. Thirteen cochlear implant users were fitted with DCF and a non-steered MP matched on pulse rate, pulse width, and active electrodes. Nine participants completed the single-blinded within-subject crossover trial. Repeated testing consisted of four sessions. Strategies were allocated in a DCF-MP-DCF-MP or MP-DCF-MP-DCF design. Three-week adaptation periods ended with a test session in which speech-in-noise recognition (matrix speech-in-noise sentence test), spectro-temporal ripple tests (SMRT and STRIPES) and a temporal amplitude modulation detection test were conducted. All participants recorded their subjective experiences with both strategies using the Speech, Spatial and Qualities of Hearing Scale questionnaire.

Results: Participants' SMRT thresholds improved 0.40 ripples per octave ( p = 0.02, Bonferroni-corrected: p = 0.1) with DCF over MP at 65 dB SPL. No significant differences between the strategies were found on speech-in-noise recognition at conversational (65 dB SPL) and soft (45 dB SPL) loudness levels, temporal testing, STRIPES, or the SMRT at 45 dB SPL. After Bonferroni correction, a learning effect remained on the matrix speech-in-noise sentence test at both loudness levels (65 dB SPL: p = 0.01; 45 dB SPL: p = 0.02). There was no difference in learning effects over time between DCF and MP. Similarly, no significant differences were found in subjective experience on the Speech, Spatial and Qualities of Hearing Scale questionnaire. DCF reduced average battery life by 48% (5.1 hours) ( p < 0.001) compared to MP.

Conclusions: DCF may improve spectral resolution over MP at comfortable loudness (65 dB SPL) in cochlear implant users. However, the evidence collected in this study was weak and the significant result disappeared after Bonferroni correction. Also, not all spectral tests revealed this improvement. As expected, battery life was reduced for DCF. Although the current study is limited by its small sample size, considering previous studies, DCF does not consistently improve speech recognition in noise over MP strategies.