Simultaneous masking between electric and acoustic stimulation in cochlear implant users with residual low-frequency hearing.

Ipsilateral electric-acoustic stimulation (EAS) is becoming increasingly important in cochlear implant (CI) treatment. Improvements in electrode designs and surgical techniques have contributed to improved hearing preservation during implantation. Consequently, CI implantation criteria have been expanded toward people with significant residual low-frequency hearing, who may benefit from the combined use of both the electric and acoustic stimulation in the same ear. However, only few studies have investigated the mutual interaction between electric and acoustic stimulation modalities. This work characterizes the interaction between both stimulation modalities using psychophysical masking experiments and cone beam computer tomography (CBCT). Two psychophysical experiments for electric and acoustic masking were performed to measure the hearing threshold elevation of a probe stimulus in the presence of a masker stimulus. For electric masking, the probe stimulus was an acoustic tone while the masker stimulus was an electric pulse train. For acoustic masking, the probe stimulus was an electric pulse train and the masker stimulus was an acoustic tone. Five EAS users, implanted with a CI and ipsilateral residual low-frequency hearing, participated in the study. Masking was determined at different electrodes and different acoustic frequencies. CBCT scans were used to determine the individual place-pitch frequencies of the intracochlear electrode contacts by using the Stakhovskaya place-to-frequency transformation. This allows the characterization of masking as a function of the difference between electric and acoustic stimulation sites, which we term the electric-acoustic frequency difference (EAFD). The results demonstrate a significant elevation of detection thresholds for both experiments. In electric masking, acoustic-tone thresholds increased exponentially with decreasing EAFD. In contrast, for the acoustic masking experiment, threshold elevations were present regardless of the tested EAFDs. Based on the present findings, we conclude that there is an asymmetry between the electric and the acoustic masker modalities. These observations have implications for the design and fitting of EAS sound-coding strategies.