Nov 2018 The JAMA Network

Question:  Is an individualised, image-guided approach to place-pitch cochlear implant programming associated with improved pitch-scaling performance without undermining speech perception accuracy?

Importance:  Cochlear implant users generally display poor pitch perception. Flat-panel computed tomography (FPCT) has recently emerged as a modality capable of localising individual electrode contacts within the cochlea in vivo. Significant place-pitch mismatch between the clinical implant processing settings given to patients and the theoretical maps based on FPCT imaging has previously been noted.

Design, Setting, and Participants:  A prospective cohort study of 17 cochlear implant users with MED-EL electrode arrays was performed from June 2016 to July 2017.

Interventions:  Theoretical place-pitch maps using FPCT secondary reconstructions and 3-dimensional curved planar re-formation software were developed. The clinical map settings (eg, strategy, rate, volume, frequency band range) were modified to keep factors constant between the 2 maps and minimise confounding. The acclimation period to the maps was 30 minutes.

Findings:  In this interventional cohort study of 17 cochlear implant users, significant improvement in pitch-scaling performance with an image-guided approach to post-implantation programming was observed. The greatest association occurred with major pitch reversals (notes spaced 1.65 semitones or greater) in the low- and high-frequency ranges.

Conclusions and Relevance:  An image-based approach toward cochlear implant mapping may improve pitch perception outcomes by reducing place-pitch mismatch. Studies using a longer acclimation period with chronic stimulation over months may help assess the full range of the benefits associated with personalised image-guided cochlear implant mapping.

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