Interpreting the Effect of Stimulus Parameters on the Electrically Evoked Compound Action Potential and on Neural Health Estimates.

Variations in the condition of the neural population along the length of the cochlea can degrade the spectral and temporal representation of sounds conveyed by CIs, thereby limiting speech perception. One measurement that has been proposed as an estimate of neural survival (the number of remaining functional neurons) or neural health (the health of those remaining neurons) is the effect of stimulation parameters, such as the interphase gap (IPG), on the amplitude growth function (AGF) of the electrically evoked compound action potential (ECAP). The extent to which such measures reflect neural factors, rather than non-neural factors (e.g. electrode orientation, electrode-modiolus distance, and impedance), depends crucially upon how the AGF data are analysed. However, there is currently no consensus in the literature for the correct method to interpret changes in the ECAP AGF due to changes in stimulation parameters. We present a simple theoretical model for the effect of IPG on ECAP AGFs, along with a re-analysis of both animal and human data that measured the IPG effect. Both the theoretical model and the re-analysis of the animal data suggest that the IPG effect on ECAP AGF slope (IPG slope effect), measured using either a linear or logarithmic input-output scale, does not successfully control for the effects of non-neural factors. Both the model and the data suggest that the appropriate method to estimate neural health is by measuring the IPG offset effect, defined as the dB offset between the linear portions of ECAP AGFs for two stimuli differing only in IPG.