title: Effects of programming threshold and maplaw settings on acoustic thresholds and speech discrimination with the MED-EL COMBI 40+ cochlear implant.
abstract: OBJECTIVE
  The principal task in the programming of a cochlear implant (CI) speech processor is the setting of the electrical dynamic range (output) for each electrode, to ensure that a comfortable loudness percept is obtained for a range of input levels. This typically involves separate psychophysical measurement of electrical threshold ([theta] e) and upper tolerance levels using short current bursts generated by the fitting software. Anecdotal clinical experience and some experimental studies suggest that the measurement of [theta]e is relatively unimportant and that the setting of upper tolerance limits is more critical for processor programming. The present study aims to test this hypothesis and examines in detail how acoustic thresholds and speech recognition are affected by setting of the lower limit of the output ("Programming threshold" or "PT") to understand better the influence of this parameter and how it interacts with certain other programming parameters.
  
  
  METHODS
  Test programs (maps) were generated with PT set to artificially high and low values and tested on users of the MED-EL COMBI 40+ CI system. Acoustic thresholds and speech recognition scores (sentence tests) were measured for each of the test maps. Acoustic thresholds were also measured using maps with a range of output compression functions ("maplaws"). In addition, subjective reports were recorded regarding the presence of "background threshold stimulation" which is occasionally reported by CI users if PT is set to relatively high values when using the CIS strategy.
  
  
  RESULTS
  Manipulation of PT was found to have very little effect. Setting PT to minimum produced a mean 5 dB (S.D. = 6.25) increase in acoustic thresholds, relative to thresholds with PT set normally, and had no statistically significant effect on speech recognition scores on a sentence test. On the other hand, maplaw setting was found to have a significant effect on acoustic thresholds (raised as maplaw is made more linear), which provides some theoretical explanation as to why PT has little effect when using the default maplaw of c = 500. Subjective reports of background threshold stimulation showed that most users could perceive a relatively loud auditory percept, in the absence of microphone input, when PT was set to double the behaviorally measured electrical thresholds ([theta]e), but that this produced little intrusion when microphone input was present.
  
  
  CONCLUSIONS
  The results of these investigations have direct clinical relevance, showing that setting of PT is indeed relatively unimportant in terms of speech discrimination, but that it is worth ensuring that PT is not set excessively high, as this can produce distracting background stimulation. Indeed, it may even be set to minimum values without deleterious effect.
authors.affiliation: Human Communication and Deafness Group, School of Psychological Sciences, University of Manchester, United Kingdom. paul.boyd@manchester.ac.uk
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Boyd
mesh_terms: D000161:Acoustic Stimulation; D000328:Adult; D000368:Aged; D001309:Auditory Threshold; D019929:Cochlear Implantation; D003054:Cochlear Implants; D004867:Equipment Design; D005260:Female; D034381:Hearing Loss / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012984:Software; D013063:Speech Discrimination Tests; D013067:Speech Perception; D016896:Treatment Outcome