Neural Response Telemetry Reconsidered: II. The Influence of Neural Population on the ECAP Recovery Function and Refractoriness

Objective: The Neural Response Telemetry (NRT™) recovery function measures the electrically evoked compound action potential (ECAP) in response to a second biphasic pulse (the probe) after masking by a first pulse (the masker). The masker-probe interval is varied and the ECAP amplitude is measured at each masker-probe interval, giving an inverse exponential recovery. The prevailing understanding of the recovery function has been that faster recovery indicates a more efficient response to the individual pulses within a pulse sequence. Psychophysical data in the past have not supported this view, and in fact, the opposite result has been observed. This study explores this phenomenon from theoretical and experimental viewpoints. Fundamentally, a distinction is made between the refractoriness of a single fiber and the refractoriness of the whole nerve. The hypothesis is that the size of the neural population heavily influences whole nerve refractoriness: large neural populations operate near threshold and are more susceptible to masking, leading to slower ECAP recovery; however, they maintain temporal responsiveness through greater numbers of nonrefractory neurons. Design: In phase I, the hearing loss durations (indicators of neural survival) of 21 adult Nucleus® Freedom™ implantees were compared with the corresponding median recovery function time-constants (calculated per implant array). The data were separated by implant (nine Contour™, 12 Straight) and the means of these two groups were compared. The Straight array, delivering broader excitation, is expected to engage a larger neural population. In phase II, a computational model of the ECAP recovery function was constructed based on data from the cat auditory nerve. The model allows the neural population size to be manipulated; accordingly, recovery functions from different neural populations were compared. In phase III, ECAP thresholds (via AutoNRT™), ECAP recovery functions, and T- and C-levels were obtained from a subset of 12 subjects. Psychophysical levels were measured using pulse train stimuli at six different stimulation rates, spanning 250 to 3500 Hz. At each electrode, the recovery function time-constant &tgr; was compared with two measures of temporal responsiveness: (i) the gradient of the linear trend in psychophysical levels with stimulation rate; and (ii) the difference between ECAP threshold (a single pulse measure) and 900 Hz T-level (a pulse train measure). Results: In phase I, a trend toward shorter recovery function time-constants with increasing hearing loss durations was observed. The mean recovery function time-constant of the Contour implant group (0.51 msec) was significantly shorter than that of the Straight implant group (0.90 msec). When, in phase II, the recovery functions from the computational model were compared at equal ECAP amplitude, the larger neural population was associated with slower ECAP recovery. In phase III, the recovery function time-constant was significantly correlated with both temporal responsiveness measures, with slower ECAP, recovery associated with greater temporal responsiveness, thus confirming the results of previous studies. Conclusions: Slower ECAP recovery, at equal loudness, is associated with larger neural populations. The collective results suggest that this neural population view of the recovery function explains the observed association between slower ECAP recovery and greater temporal responsiveness.