Relation Between Neural Response Telemetry Thresholds, T- and C-Levels, and Loudness Judgments in 12 Adult Nucleus 24 Cochlear Implant Recipients

OBJECTIVE: The primary purpose of this study was to determine if the contour of visual (vNRT) or predicted (tNRT) neural response telemetry (NRT) thresholds across electrodes could predict the contour of behaviorally programmed T-levels (minimum stimulation) and/or C-levels (maximum stimulation) across electrodes for well-fit MAPs. The secondary purpose was to determine the relation between NRT thresholds and loudness judgments obtained at the subject's MAP rate (250, 900, 1200, or 1800 pulses per second pps) and the NRT stimulus rate (80 pps). DESIGN: Twelve adult Nucleus 24 cochlear implant recipients participated in the study. The T- and C-levels from a preferred MAP, which had been worn for a minimum of 3 mo, were used in this study. Electrically evoked compound action potentials were measured on 11 active electrodes with NRT software (v3.0). Ascending loudness judgments from first hearing to maximum acceptable loudness were completed on these electrodes with the subject's preferred MAP rate stimulus, using the R126 (v.2.0) software and with an 80 pps rate stimulus, using the NRT software (v3.0). All measures were repeated approximately 1 mo later to determine their reliability. RESULTS: The reliability of the behavioral and objective measures was very high from the first to the second half of the study. The mean tNRT thresholds had a lower reliability (r = 0.73) than vNRT thresholds (r = 0.91). The loudness judgment dynamic range was notably different between rates. The NRT rate (80 pps) stimulus resulted in the narrowest dynamic range followed by increasingly wider dynamic range as the MAP rate increased. The NRT thresholds had a stronger correlation with loudness judgments made with the NRT rate stimulus than with the MAP rate stimulus. The group mean NRT thresholds were significantly correlated with C-levels (vNRT r = 0.69) (tNRT r = 0.66) but not T-levels. The relation between NRT thresholds and T- and C-levels varied for different MAP rates, with the NRT thresholds being closest to the C-levels for the 250 pps MAP rate. Each subject's vNRT thresholds and MAP levels were examined by fitting a third-order polynomial to the data. This analysis revealed significant variability demonstrating that no one fit predicts T- and C-levels well for all subjects. CONCLUSIONS: The results of this study provide important insight into the relation between NRT thresholds and loudness judgments for different stimulation rates and T- and C-levels at various MAP rates. The loudness judgment dynamic range and MAP dynamic range (T- and C-levels) varied notably for different stimulation rates. As a result, the relation of NRT thresholds to these measures also varied with stimulation rate. Overall, the mean vNRT thresholds fell higher in the loudness judgment dynamic range than the tNRT thresholds. Mean NRT thresholds fell between the judgments of medium soft and maximum acceptable loudness for all stimulation rates. Mean vNRT thresholds fell above C-levels, whereas almost half of tNRT thresholds fell just below C-levels. However, the relation between NRT thresholds and C-levels varied substantially for different MAP stimulation levels. In addition, there is substantial individual variability in the relation between NRT thresholds and MAP levels that is not reflected in the group data. The prediction of the contour of T- and C-levels from the contour of NRT thresholds across electrodes would not be appropriate for half of the subjects. Therefore, great care should be taken when applying a fitting rule that incorporates NRT thresholds without considering these individual differences. For adults who can provide appropriate loudness judgments and threshold responses it appears to be most efficient to primarily use behavioral measures to create MAPs.