Perception and coding of interaural time differences with bilateral cochlear implants.

Bilateral cochlear implantation is increasingly becoming the standard in the clinical treatment of bilateral deafness. The main motivation is to provide users of bilateral cochlear implants (CIs) access to binaural cues essential for localizing sound sources and understanding speech in environments of interfering sounds. One of those cues, interaural level differences, can be perceived well by CI users to allow some basic left versus right localization. However, interaural time differences (ITDs) which are important for localization of low-frequency sounds and spatial release from masking are not adequately represented by clinical envelope-based CI systems. Here, we first review the basic ITD sensitivity of CI users, particularly their dependence on stimulation parameters like stimulation rate and place, modulation rate, and envelope shape in single-electrode stimulation, as well as stimulation level, electrode spacing, and monaural across-electrode timing in multiple-electrode stimulation. Then, we discuss factors involved in ITD perception in electric hearing including the match between highly phase-locked electric auditory nerve response properties and binaural cell properties, the restricted stimulation of apical tonotopic pathways, channel interactions in multiple-electrode stimulation, and the onset age of binaural auditory input. Finally, we present clinically available CI stimulation strategies and experimental strategies aiming at improving listeners' access to ITD cues. This article is part of a Special Issue entitled <Lasker Award>.