Physiological basis for cochlear and auditory brainstem implants.

Cochlear implants bypass functions of the cochlea that have been regarded to be fundamental for discrimination of the frequency (or spectrum). Frequency discrimination is essential for discrimination of sounds, including speech sounds, and the normal auditory system is assumed to make use of both (power) spectral and temporal information for frequency discrimination. Spectral information is represented by the place on the basilar membrane that generates the largest amplitude of vibration on the basilar membrane. Evidence has been presented that the temporal representation of frequency is more robust than the place representation and thus regarded more important for speech discrimination. The fact that some cochlear implants provide good speech discrimination using only information about the energy in a few spectral bands seems to contradict these studies. In that way, frequency discrimination may be similar to trichromatic color vision, which is based on the energy in only three different spectral bands of light, accomplished by different color-sensitive pigments in the cones of the retina. Cochlear nucleus implants (ABIs) also bypass the auditory nerve, which does not perform any processing. Therefore, it may be expected that ABIs are equally efficient as cochlear implants. However, experience from the use of ABIs in patients with bilateral vestibular schwannoma has not been encouraging, but recent studies of the use of ABIs in patients with other causes of injuries to the auditory nerve have shown similar speech discrimination as achieved with modern cochlear implants. Cochlear implants and ABIs are successful in providing speech discrimination because of redundancy in the processing in the ear, redundancy of the speech signal and because the auditory nervous system has a high degree of plasticity. Expression of neural plasticity makes the auditory nervous system adapt to the change in demands of processing of the information provided by cochlear implants.