Relationship between gap detection thresholds and loudness in cochlear-implant users.

Gap detection threshold (GDT) is a commonly used measure of temporal acuity in cochlear-implant (CI) recipients. This measure, like other measures of temporal acuity, shows considerable variation across subjects and also varies across stimulation sites within subjects. The aims of this study were (1) to determine whether across-site variation in GDTs would be reduced or maintained with increased stimulation levels; (2) to determine whether across-site variation in GDTs at low stimulation levels was related to differences in loudness percepts at those same levels; and (3) to determine whether matching loudness levels could reduce across-site differences in GDTs. Thresholds and maximum comfortable loudness levels were measured in postlingually deaf adults using all available sites in their electrode arrays. All sites were then surveyed at 30% of the dynamic range (DR) to examine across-site variation. Two sites with the largest difference in GDTs were then selected and for those two sites GDTs were measured at multiple levels of the DR (10%, 30%, 50%, 70%, and 90%). Stimuli consisted of 500 ms trains of symmetric-biphasic pulses, 40 μs/phase, presented at a rate of 1000 pps using a monopolar (MP1+2) electrode configuration. To examine perceptual differences in loudness, the selected sites were loudness-matched at the same levels of the DR. Variations in GDTs and loudness patterns were observed across stimulation sites and across subjects. Variations in GDTs across sites tended to decrease with increasing stimulation levels. For the majority of the subjects, stimuli at a given level in %DR were perceived louder at sites with better GDTs than those presented at the same level in %DR at sites with poorer GDTs. These results suggest that loudness is a contributing factor to across-site variation in GDTs and that CI fittings based on more detailed loudness matching could reduce across-site variation and improve perceptual acuity.