External electrical stimulation of the cochlea: clinical, psychophysical, speech-perceptual and histological findings.

Our progress towards the development of a particular form of cochlear implant for the totally deaf is described. A single channel stimulation at the round window or promontory is used. This involves a minimum of surgical intervention and infective risk, preserves the possibility of remission and allows the application of later developments. The signal used for stimulation is designed to be matched both to the deaf lip-reader's needs and to his new, restricted, auditory ability. This is done by concentrating on the acoustic pattern components of speech which carry intonation and voiced-voiceless information. Surgical electrophysical, psychoacoustic and speech perceptual aspects of our work with twelve patients are described. The tests involve responses, for example, relating to: threshold for sinusoids; frequency difference limens; periodic -aperiodic discrimination; stress placement; and consonant labelling using combined visual and electrical inputs. Relatively extensive measurements were made with six patients. Significant individual differences were found and the sets of responses provide an essential basis for an appraisal of the potential usefulness of our work to the individual patient. Possible reasons for the individual differences are discussed. A brief indication is given of the techniques which we have developed for the future speech training and speech production evaluation of patients with electro-cochlear voice monitoring. The final section of our paper mentions our histological investigation of the effects of this type of stimulation in the guinea pig.