[How does a cochlear implant speech processor work?]

Cochlear implants have become a standard treatment modality for sensorineural hearing loss. In this review article, assembly and function of a cochlear implant are described. Cochlear implants replace the normal inner ear by transforming acoustic sound signals into electric stimuli and deliver these to the auditory nerve. Speech processors translate the acoustic signal of the microphone into one that fits electrostimulation of the auditory system. In multiple steps, the signal has to be analyzed and processed to fit the demands of electrical stimulation. The speech processor then sends commands and the energy for stimulation to the implanted parts via a transcutaneous high frequency radio link. The implant refers the information as electrical stimuli to each electrode contact.

Evaluating cochlear implant trauma to the scala vestibuli

OBJECTIVES

Placement of cochlear implant electrodes into the scala vestibuli may be intentional, e.g. in case of blocked scala tympani or unintentional as a result of trauma to the basilar membrane or erroneous location of the cochieostomy. The aim of this study was to evaluate the morphological consequences and cochlear trauma after implantation of different cochlear implant electrode arrays in the scala vestibuli.

DESIGN

Human temporal bone study with histological and radiological evaluation.

SETTING

Twelve human cadaver temporal bones were implanted with different cochlear implant electrodes. Implanted bones were processed using a special method to section undecalcified bone.

MAIN OUTCOME MEASURES

Cochlear trauma and intracochlear positions.

RESULTS

All implanted electrodes were implanted into the scala vestibuli using a special approach that allows direct scala vestibuli insertions. Fractures of the osseous spiral lamina were evaluated in some bones in the basal cochlear regions. In most electrodes, delicate structures of the organ of Corti were left intact, however, Reissner's membrane was destroyed in all specimens and the electrode lay upon the tectorial membrane. In some bones the organ of Corti was destroyed.

CONCLUSIONS

Scala vestibuli insertions did not cause severe trauma to osseous or neural structures, thus preserving the basis for electrostimulation of the cochlea. However, destruction of Reissner's membrane and impact on the Organ of Corti can be assumed to destroy residual hearing.

Kochleaimplantat mit Tieftonrestgehörerhalt

BACKGROUND

The aim of the present paper is to evaluate the clinical parameters in patients implanted for combined, ipsilateral electric-acoustic stimulation of the auditory system.

METHODS

A total of 18 patients with residual deep frequency hearing were implanted with a Combi 40+cochlear implant (MED-EL, Austria). Insertion depths ranged from 18 to 22 mm (360 degrees ). A modified surgical technique should contribute to hearing preservation in low frequency regions of the cochlea. Pure-tone audiometric thresholds were measured pre- and postoperatively. A speech audiometric evaluation was performed on two subjects.

RESULTS

Utilizing adapted surgical procedures, the preservation of low frequency hearing was accomplished in 16 of 18 subjects (88.9%). Seven (38.9%) patients had complete and nine (50.0%) partial preservation of residual hearing. The speech discrimination scores of two patients documented an increase in sentence intelligibility when compared with only the cochlear implant.

CONCLUSIONS

Hearing preservation in cochlear implant surgery is possible. Insertions of 360 degrees provide a full functioning cochlear implant to stimulate sufficient neural structures for above average discrimination scores with the implant alone. A synergistic effect of the electric and the acoustic stimulation modes leads to high discrimination scores in background noise.

Normative findings of electrically evoked compound action potential measurements using the neural response telemetry of the Nucleus CI24M cochlear implant system

One hundred and forty-seven adult recipients of the Nucleus 24 cochlear implant system, from 13 different European countries, were tested using neural response telemetry to measure the electrically evoked compound action potential (ECAP), according to a standardised postoperative measurement procedure. Recordings were obtained in 96% of these subjects with this standardised procedure. The group results are presented in terms of peak amplitude and latency, slope of the amplitude growth function and ECAP threshold. The effects of aetiological factors and the duration of deafness on the ECAP were also studied. While large intersubject variability and intrasubject variability (across electrodes) were found, results fell within a consistent pattern and a normative range of peak amplitudes and latencies was established. The aetiological factors had little effect on the ECAP characteristics. However, age affected ECAP amplitude and slope of the amplitude growth function significantly; i.e., the amplitude is higher in the lowest age category (15-30 years). Principal component analysis of the ECAP thresholds shows that the thresholds across 5 electrodes can be described by two factors accounting for 92% of the total variance. The two factors represent the overall level of the threshold profiles ('shift') and their slopes across the electrode array ('tilt'). Correlation between these two factors and the same factors describing the T- and C-levels appeared to be moderate, in the range of 0.5-0.6.

Evaluation eines Elektrodendesigns für die kombinierte elektrisch-akustische Stimulation

BACKGROUND

The objective of this study was to assess the intracochlear position and the extent of trauma to cochlear structures using the C40(+) M electrode (MED-EL, Innsbruck, Austria), which was especially designed for the combined electric acoustic stimulation.

METHODS

Five human temporal bones were implanted using a standard cochlear implant procedure featuring mastoidectomy, posterior tympanotomy, and promontory cochleostomy. For the cochleostomy, an inferior approach with preservation of the endosteum of the cochlea was used to contribute to hearing preservation in the in vivo condition.

RESULTS

All insertions of the new electrode array were performed into the scala tympani of the cochlea. The average insertion depth was 288 degrees. Apically, 4 of the 5 implantations were completely atraumatic. One bone showed a rupture of the basilar membrane only at the tip of the electrode. However, 4 of the 5 arrays produced severe trauma to basal cochlear structures. Two pathomechanisms, the direct traumatization through drilling of the cochleostomy or the indirect traumatization via buckling of the array could be distinguished.

CONCLUSIONS

Due to the reduced contact spacing and its flexible body, the C40(+) M electrode is suitable for cochlear implantations with hearing preservation and combined electric and acoustic stimulation of the auditory system. Modifications of the surgical pathway to the cochlea should help to minimize the risk of basal cochlear trauma.

Mutation induction in haploid yeast after split-dose radiation exposure. II. Combination of UV-irradiation and X-rays

Split-dose protocols can be used to investigate the kinetics of recovery from radiation damage and to elucidate the mechanisms of cell inactivation and mutation induction. In this study, a haploid strain of the yeast, Saccharomyces cerevisiae, wild-type with regard to radiation sensitivity, was irradiated with 254-nm ultraviolet (UV) light and then exposed to X-rays after incubation for 0-6 hr. The cells were incubated either on nutrient medium or salt agar between the treatments. Loss of reproductive ability and mutation to canavanine resistance were measured. When the X-ray exposure immediately followed UV-irradiation, the X-ray survival curves had the same slope irrespective of the pretreatment, while the X-ray mutation induction curves were changed from linear to linear quadratic with increasing UV fluence. Incubations up to about 3 hr on nutrient medium between the treatments led to synergism with respect to cell inactivation and antagonism with respect to mutation, but after 4-6 hr the two treatments acted independently. Incubation on salt agar did not cause any change in the survival curves, but there was a strong suppression of X-ray-induced mutation with increasing UV fluence. On the basis of these results, we suggest that mutation after combined UV and X-ray exposure is affected not only by the induction and suppression of DNA repair processes, but also by radiation-induced modifications of cell-cycle progression and changes in the expression of the mutant phenotype.

DNA synthesis-dependent relief of repression of transcription from the adenovirus type 2 IVa(2) promoter by a cellular protein

The promoter of the human adenovirus type 2 IVa(2) gene, which becomes active only during the late phase of infection, is built largely from sequences spanning, and downstream of, the sites of initiation of transcription. These sequences comprise an initiator, an intragenic sequence necessary for efficient transcription from the promoter by RNA polymerase II, and an intragenic binding site for a cellular repressor of IVa(2) transcription. The properties of the latter protein, which is termed IVa(2)-RF, suggested that it might account for the viral DNA synthesis-dependent activation of IVa(2) transcription during the adenoviral productive cycle. Here we report the results of experiments to assess the contributions of DNA template concentration and IVa(2)-RF binding to the activity of the IVa(2) promoter using a transient expression system. When a IVa(2)-EGFP reporter gene was introduced into HeLa cells, in which IVa(2)-RF was identified, no EFGP synthesis could be detected. In contrast, in IVa(2)-RF-containing cells in which the plasmid carrying the chimeric gene replicated, synthesis of both the EGFP protein and the IVa(2)-EGFP mRNA was readily detected. A vector mutation that blocked plasmid replication reduced IVa(2) promoter activity to undetectable levels. In contrast, a IVa(2) promoter substitution that impaired binding of IVa(2)-RF increased IVa(2) promoter activity under all conditions examined. Furthermore, introduction of DNA containing the IV-RF binding site with the chimeric reporter genes resulted in increased transcription from the IVa(2) promoter in the absence of plasmid replication. These properties are consistent with the hypothesis that the relative concentration of the IVa(2) promoter and of the cellular repressor that binds to it governs transcription from this adenoviral promoter.

[Test set for the evaluation of hearing and speech development after cochlear implantation in children]

BACKGROUND

Since autumn 1998 the multicenter interdisciplinary study group "Test Materials for CI Children" has been compiling a uniform examination tool for evaluation of speech and hearing development after cochlear implantation in childhood.

METHODS USED

After studying the relevant literature, suitable materials were checked for practical applicability, modified and provided with criteria for execution and break-off. For data acquisition, observation forms for preparation of a PC-version were developed.

RESULTS

The evaluation set contains forms for master data with supplements relating to postoperative processes. The hearing tests check supra-threshold hearing with loudness scaling for children, speech comprehension in silence (Mainz and Göttingen Test for Speech Comprehension in Childhood) and phonemic differentiation (Oldenburg Rhyme Test for Children), the central auditory processes of detection, discrimination, identification and recognition (modification of the "Frankfurt Functional Hearing Test for Children") and audiovisual speech perception (Open Paragraph Tracking, Kiel Speech Track Program). The materials for speech and language development comprise phonetics-phonology, lexicon and semantics (LOGO Pronunciation Test), syntax and morphology (analysis of spontaneous speech), language comprehension (Reynell Scales), communication and pragmatics (observation forms). The MAIS and MUSS modified questionnaires are integrated.

CONCLUSIONS

The evaluation set serves quality assurance and permits factor analysis as well as controls for regularity through the multicenter comparison of long-term developmental trends after cochlear implantation.

Space radiation research in the new millenium--from where we come and where we go

Space radiation research had a significant impact in the past. The physical interaction of heavy charged particles with living matter and the development of models, including microdosimetry, were stimulated by problems encountered in space. New phenomena were discovered. Advanced dosimetric techniques had to be developed and computational methods to describe the radiation field in space. The understanding of the radiobiology of heavy ions, necessary for a well-founded risk assessment and prompted by space radiation research, constitutes also the basis for heavy ion radiotherapy. So far unknown areas like the interaction of microgravity and radiation were opened. The space station will give even more opportunities. For the first time it will be possible to investigate animals for a longer time under the influence of both microgravity and radiation. Living systems can be exposed under well defined conditions with parallel physical measurements. Solar particle events are still an unsolved problem. Significant improvement in their predictability and quantitative description can be expected. All this will not only give exciting opportunities for research but will also translate into immediate benefit for human beings. This paper will attempt to give an overview of the past achievements and glance into the future.

DNA double strand break induction in yeast

The induction of DNA double strand breaks (DSBs) by accelerated heavy ions was systematically measured in diploid yeast cells. Particles were provided by the accelerators at GSI, Darmstadt, and HMI, Berlin. DNA was separated using pulsed field gel electrophoresis and the intensity of the largest bands used to determine the loss of molecular weight. Since the DNA content of each chromosome is exactly known absolute values for DSB induction can be measured without calibration procedures. Ions used range from protons to uranium with LET values between 2 and about 15,000 keV.micron-1. Induction cross sections increase in the lower LET region approaching a plateau around 200 keV.micron-1. With higher LET values the dependence can no longer be described by a common curve with each ion showing a specific behaviour. With very heavy particles the influence of the penumbra becomes obvious: cross sections decrease with LET because of the reduced penumbra extensions. Classical target theory would predict cross sections to follow a simple saturation function which is not substantiated by the data. Track structure analysis as introduced by Butts and Katz in 1967 is also not able to predict the experimental results. A semi-empirical fit indicates a linear-quadratic dependence of induction cross sections on LET up to about 1000 keV.micron-1. RBE for DSB induction rises above unity reaching a maximum of about 2.5 around 200 keV.micron-1. This is different from many experiments in mammalian cells and is presumably due to differences in chromatin structure since yeast cells seem to lack a functional III histone.

Mutations in mammalian cells induced by heavy charged particles: an indicator for risk assessment in space

Induction of mutations at the HPRT locus in V79 Chinese hamster cells by heavy charged particles is reviewed. A unique dependence of mutation induction cross sections on LET or any other physical parameter of the particles cannot be found. There is, however, a general trend showing an increase up to about 100 keV/microm and an indication of a saturation with higher LET. An empirical expression is given approximating the data which may be useful for practical purposes. On the basis of this expression, it is suggested that the formula used by the ICRP for the quality factor overestimates the risk for very heavy particles. This may have implications for the assessment of the risk of exposure to iron ions in space.

Tumor necrosis factor alpha sensitizes low epidermal growth factor receptor (EGFR)-expressing carcinomas for anti-EGFR therapy

Analysis of 1,060 xenotransplants derived from cancer cell lines as wel as spontaneously occurring tumors from the larynx, pharynx, mammary gland, uterine cervix, and vulva revealed that tumor regression induced by treatment with monoclonal antibodies (EMD 55900 and EMD 72000 against the epidermal growth factor receptor (EGFR) could be enhanced by tumor necrosis factor alpha (TNF-alpha) treatment in vivo. Moreover, tumor that primarily do not respond to antibody treatment can be made suscep tible by additional TNF-alpha treatment. To investigate the in vivo effects of monoclonal antibodies, we treated tumors derived from cell lines (A431 and Detroit 562) as well as spontaneously occurring squamous cell carci nomas and adenocarcinomas (transplanted on NMRI-nu/nu mice) gener ally with EMD 55900 (40 microg/g mouse) and its humanized version EMD 72000 (40 microg/g mouse). When treated with EMD 55900 and EMD 72000 carcinomas with an EGFR concentration of > or = 70 fmol/mg protein showed significant reduction in tumor size compared with untreated controls. The degree of tumor regression correlated with the EGFR concentration of the tumor. In mice treated with TNF-alpha (0.5 microg/g mouse) and EMD 55900 72000 simultaneously, we observed enhanced antitumor effects up to complete tumor eradication. Carcinomas with an EGFR concentration <70 fmol/mg protein could be made susceptible to treatment with EMD 55900 and EMD 72000 by simultaneous treatment with TNF-alpha, resulting in a significant reduction in tumor size.

Comparison of speech recognition with different speech coding strategies (SPEAK, CIS, and ACE) and their relationship to telemetric measures of compound action potentials in the nucleus CI 24M cochlear implant system

Speech understanding and subjective preference for three different speech coding strategies (spectral peak coding [SPEAK], continuous interleaved sampling [CIS], and advanced combination encoders [ACE]) were investigated in 11 post-lingually deaf adult subjects, using the Nucleus CI 24M cochlear implant system. Subjects were randomly assigned to two groups in a balanced crossover study design. The first group was initially fitted with SPEAK and the second group with CIS. The remaining strategies were tested sequentially over 8 to 10 weeks with systematic variations of number of channels and rate of stimulation. Following a further interval of 3 months, during which subjects were allowed to listen with their preferred strategy, they were tested again with all three strategies. Compound action potentials (CAPs) were recorded using neural response telemetry. Input/output functions in relation to increasing stimulus levels and inter-stimulus intervals between masker and probe were established to assess the physiological status of the cochlear nerve. Objective results and subjective rating showed significant differences in favour of the ACE strategy. Ten of the 11 subjects preferred the ACE strategy at the end of the study. The estimate of the refractory period based on the inter-stimulus interval correlated significantly with the overall performance with all three strategies, but CAP measures could not be related to individual preference of strategy or differences in performance between strategies. Based on these results, the ACE strategy can be recommended as an initial choice specifically for the Nucleus CI 24M cochlear implant system. Nevertheless, access to the other strategies may help to increase performance in individual patients.

Comparison of the TEMPO+ ear-level speech processor and the cis pro+ body-worn processor in adult MED-EL cochlear implant users

A study was conducted to compare the new MED-EL TEMPO+ ear-level speech processor with the CIS PRO+ body-worn processor in the COMBI 40/COMBI 40+ implant system. Speech tests were performed in 46 experienced subjects in two test sessions approximately 4 weeks apart. Subjects were switched over from the CIS PRO+ to the TEMPO+ in the first session and used only the TEMPO+ in the time between the two sessions. Speech tests included monosyllabic word tests and sentence tests via the telephone. An adaptive noise method was used to adjust each subject's scores to approximately 50%. Additionally, subjects had to complete a questionnaire based on their 4 weeks of experience with the TEMPO+. The speech test results showed a statistically significant improvement in the monosyllabic word scores with the TEMPO+. In addition, in the second session, subjects showed a significant improvement when using the telephone with the TEMPO+, indicating some learning in this task. In the questionnaire, the vast majority of subjects found that the TEMPO+ allows equal or better speech understanding and rated the sound quality of the TEMPO+ higher. All these objective and subjective results indicate the superiority of the TEMPO+ and are mainly attributed to a new coding strategy called CIS+ and its implementation in the TEMPO+. In other words, based on the results of this study, it appears that after switching over from the CIS PRO+ to the TEMPO+, subjects are able to maintain or even improve their own speech understanding capability.

Perimodiolar electrodes in cochlear implant surgery

Perimodiolar-positioned cochlear implant electrodes have been developed in order to bring the electrode contacts as close as possible to the spiral ganglion cells, which are the target of electrostimulation. This results in lower electrical thresholds, higher dynamic ranges and less channel interaction when compared with normal implant electrodes which are usually located peripherally within the scala tympani. In this study we evaluated 4 different types of perimodiolar electrode: the Clarion Preformed electrode, the Clarion Preformed electrode with positioner, the Nucleus Contour electrode and the Med-El Perimodiolar Combi 40 electrode. These devices require different approaches to achieve a perimodiolar electrode position. The electrodes were inserted in fresh human temporal bones. After processing these bones with the electrodes in situ by employing a sawing, grinding and polishing technique, the inner ear structures as well as the electrode positions could be evaluated in detail. All electrode types studied had a more or less perimodiolar position; however, each type produced a certain amount of trauma to cochlear structures which is discussed in relation to mechanical properties. Further human temporal bone studies with improved perimodiolar cochlear implant electrodes are necessary in order to find an optimized type of electrode.