Amplitude-Mapping Effects on Speech Intelligibility With Unilateral and Bilateral Cochlear Implants

Abstract

Using higher stimulation levels in amplitude-mapping functions can improve both monaural and binaural speech perception performance in quiet and in noise, even when the slope of the acoustic to electrical amplitude-mapping function is held constant (i.e., when the electrical signal-to-noise ratio remains constant). The results in noise can be understood if we assume that the relation between electrical stimulation levels and loudness grows faster at higher stimulation levels. When comparing the monaural better ear with binaural performance in noise (S0N0) by using the same map, that is to say, when no adjustments were made in the bilateral condition for bilateral loudness summation, an average signal-to-noise ratio benefit of 1.4 dB was found in the bilateral condition. These findings indicate that when fitting bilateral devices clinically, although binaural performance may decrease slightly if levels need to be reduced to compensate for binaural loudness summation, the binaural S0N0 advantage over the better ear will offset this. Consequently, performance with both ears after adjustment is likely to remain at least as good as for the better ear alone without level adjustment, even in the S0N0 condition where binaural advantages are minimized.