Current focusing and steering: modeling, physiology, and psychophysics

Cochlear implants

Cochlear implants are the first example of a neural prosthesis that can substitute a sensory organ: they bypass the malfunctioning auditory periphery of profoundly-deaf people to electrically stimulate their auditory nerve. The history of cochlear implants dates back to 1957, when Djourno and Eyriès managed, for the first time, to elicit sound sensations in a deaf listener using an electrode implanted in his inner ear. Since then, considerable technological and scientific advances have been made. Worldwide, more than 300,000 deaf people have been fitted with a cochlear implant; it has become a standard clinical procedure for born-deaf children and its success has led over the years to relaxed patient selection criteria; for example, it is now not uncommon to see people with significant residual hearing undergoing implantation. Although the ability to make sense of sounds varies widely among the implanted population, many cochlear implant listeners can use the telephone and follow auditory-only conversations in quiet environments.

Spatial characteristics of evoked potentials elicited by a MEMS microelectrode array for suprachoroidal-transretinal stimulation in a rabbit

BACKGROUND

Suprachoroidal-transretinal stimulation (STS) can potentially restore vision. This study investigated the spatial characteristics of cortical electrical evoked potentials (EEPs) elicited by STS.

METHODS

A 4 × 4 thin-film platinum microelectrode stimulating array (200 μm electrode diameter and 400 μm center-to-center distance) was fabricated by a micro-electro-mechanical systems (MEMS) techniques and implanted into the suprachoroidal space of albino rabbits.

RESULTS

The current threshold to elicit reliable EEPs by a single electrode was 41.6 ± 12.6 μA, corresponding to a 66.2 ± 20.1 μC · cm(-2) charge density per phase, which was lower than the reported safety limits. Spatially differentiated cortical responses could be evoked by STS through different rows or columns of electrical stimulation; furthermore, shifts in the location of the maximum cortical activities were consistent with cortical visuotopic maps; increasing the number of simultaneously stimulating electrodes increased the response amplitudes of EEPs and expanded the spatial spread as well. In addition, long-term implantation and electrical stimulation of the MEMS electrode array in suprachoroidal space are necessary to evaluate systematically the safety and biocompatibility of this approach.

CONCLUSIONS

This study indicates that the STS approach by a MEMS-based platinum electrode array is a feasible alternative for visual restoration, and relatively high spatial discrimination may be achieved.

Perceptual interactions between electrodes using focused and monopolar cochlear stimulation

In today's cochlear implant (CI) systems, the monopolar (MP) electrode configuration is the most commonly used stimulation mode, requiring only a single current source. However, with an implant that will allow simultaneous activation of multiple independent current sources, it is possible to implement an all-polar (AP) stimulation mode designed to create a focused electrical field. The goal of this experiment was to study the potential benefits of this all-polar mode for reducing uncontrolled electrode interactions compared with the monopolar mode. The five participants who took part in the study were implanted with a research device that was connected via a percutaneous connector to a benchtop stimulator providing 22 independent current sources. The perceptual effects of the AP mode were tested in three experiments. In Experiment 1, the current level difference between loudness-matched sequential and simultaneous stimuli composed of 2 spatially separated pulse trains was measured as function of the electrode separation. Results indicated a strong current-summation interaction for simultaneous stimuli in the MP mode for separations up to at least 4.8 mm. No significant interaction was found in the AP mode beyond a separation of 2.4 mm. In Experiment 2, a forward-masking paradigm was used with fixed equally loud probes in AP and MP modes, and AP maskers presented on different electrode positions. Results indicated a similar spatial masking pattern between modes. In Experiment 3, subjects were asked to discriminate between across-electrode temporal delays. It was hypothesized that discrimination would decrease with electrode separation faster in AP compared to MP modes. However, results showed no difference between the two modes. Overall, the results indicated that the AP mode produced less current spread than MP mode but did not lead to a significant advantage in terms of spread of neuronal excitation at equally loud levels.

Using speech sounds to test functional spectral resolution in listeners with cochlear implants

In this study, spectral properties of speech sounds were used to test functional spectral resolution in people who use cochlear implants (CIs). Specifically, perception of the /ba/-/da/ contrast was tested using two spectral cues: Formant transitions (a fine-resolution cue) and spectral tilt (a coarse-resolution cue). Higher weighting of the formant cues was used as an index of better spectral cue perception. Participants included 19 CI listeners and 10 listeners with normal hearing (NH), for whom spectral resolution was explicitly controlled using a noise vocoder with variable carrier filter widths to simulate electrical current spread. Perceptual weighting of the two cues was modeled with mixed-effects logistic regression, and was found to systematically vary with spectral resolution. The use of formant cues was greatest for NH listeners for unprocessed speech, and declined in the two vocoded conditions. Compared to NH listeners, CI listeners relied less on formant transitions, and more on spectral tilt. Cue-weighting results showed moderately good correspondence with word recognition scores. The current approach to testing functional spectral resolution uses auditory cues that are known to be important for speech categorization, and can thus potentially serve as the basis upon which CI processing strategies and innovations are tested.

Factors limiting vocal-tract length discrimination in cochlear implant simulations

Perception of voice characteristics allows normal hearing listeners to identify the gender of a speaker, and to better segregate speakers from each other in cocktail party situations. This benefit is largely driven by the perception of two vocal characteristics of the speaker: The fundamental frequency (F0) and the vocal-tract length (VTL). Previous studies have suggested that cochlear implant (CI) users have difficulties in perceiving these cues. The aim of the present study was to investigate possible causes for limited sensitivity to VTL differences in CI users. Different acoustic simulations of CI stimulation were implemented to characterize the role of spectral resolution on VTL, both in terms of number of channels and amount of channel interaction. The results indicate that with 12 channels, channel interaction caused by current spread is likely to prevent CI users from perceiving VTL differences typically found between male and female speakers.

Current focussing in cochlear implants: an analysis of neural recruitment in a computational model

Several multipolar current focussing strategies are examined in a computational model of the implanted human cochlea. The model includes a realistic spatial distribution of cell bodies of the auditory neurons throughout Rosenthal's canal. Simulations are performed of monopolar, (partial) tripolar and phased array stimulation. Excitation patterns, estimated thresholds, electrical dynamic range, excitation density and neural recruitment curves are determined and compared. The main findings are: (I) Current focussing requires electrical field interaction to induce spatially restricted excitation patterns. For perimodiolar electrodes the distance to the neurons is too small to have sufficient electrical field interaction, which results in neural excitation near non-centre contacts. (II) Current focussing only produces spatially restricted excitation patterns when there is little or no excitation occurring in the peripheral processes, either because of geometrical factors or due to neural degeneration. (III) The model predicts that neural recruitment with electrical stimulation is a three-dimensional process; regions of excitation not only expand in apical and basal directions, but also by penetrating deeper into the spiral ganglion. (IV) At equal loudness certain differences between the spatial excitation patterns of various multipoles cannot be simulated in a model containing linearly aligned neurons of identical morphology. Introducing a form of variability in the neurons, such as the spatial distribution of cell bodies in the spiral ganglion used in this study, is therefore essential in the modelling of spread of excitation. This article is part of a Special Issue entitled <Lasker Award>.

Simulating the dual-peak excitation pattern produced by bipolar stimulation of a cochlear implant: effects on speech intelligibility

Several electrophysiological and psychophysical studies have shown that the spatial excitation pattern produced by bipolar stimulation of a cochlear implant (CI) can have a dual-peak shape. The perceptual effects of this dual-peak shape were investigated using noise-vocoded CI simulations in which synthesis filters were designed to simulate the spread of neural activity produced by various electrode configurations, as predicted by a simple cochlear model. Experiments 1 and 2 tested speech recognition in the presence of a concurrent speech masker for various sets of single-peak and dual-peak synthesis filters and different numbers of channels. Similarly as results obtained in real CIs, both monopolar (MP, single-peak) and bipolar (BP + 1, dual-peak) simulations showed a plateau of performance above 8 channels. The benefit of increasing the number of channels was also lower for BP + 1 than for MP. This shows that channel interactions in BP + 1 become especially deleterious for speech intelligibility when a simulated electrode acts both as an active and as a return electrode for different channels because envelope information from two different analysis bands are being conveyed to the same spectral location. Experiment 3 shows that these channel interactions are even stronger in wide BP configuration (BP + 5), likely because the interfering speech envelopes are less correlated than in narrow BP + 1. Although the exact effects of dual- or multi-peak excitation in real CIs remain to be determined, this series of experiments suggest that multipolar stimulation strategies, such as bipolar or tripolar, should be controlled to avoid neural excitation in the vicinity of the return electrodes.

Performance optimization of current focusing and virtual electrode strategies in retinal implants

The electrode configuration in an implanted visual prosthesis array affects the spatial electric field distribution within the retina, contributing to current focusing and virtual electrode (VE) stimulation strategies. In this paper, a finite element model incorporating various electrode configurations was used to study the interaction between electrode size and electrode-to-cell distance in current focusing and VE stimulation paradigms. The electrode array unit comprises an active electrode, six flanking return electrodes and a distant monopolar return. A quasi-monopolar (QMP) fraction is defined as the proportion of current which can be preferentially returned through the distant return, in comparison with the more adjacent flanking electrodes. The simulation results indicate that current focusing and VE strategies can be optimized by tuning the QMP fraction. The QMP fraction is adjusted to optimize the electric field spread based on retinal ganglion cell (RGC) density in the degenerate retina, thereby offsetting the effect of inhomogeneous distribution of surviving RGCs and leading to a uniform stimulation paradigm across electrodes. Importantly, there is negligible difference in functional performance across electrode configurations for distances less than the electrode diameter, implying that the stimulation mode does not significantly affect activation threshold or activated retinal area for electrode diameters greater than the retinal thickness. Furthermore, the QMP fraction has a significant effect on VE performance, defined by activation threshold and activated retinal area, when threshold current is evenly divided between two adjacent active electrodes.

Sensitivity to pulse phase duration in cochlear implant listeners: effects of stimulation mode

The objective of this study was to investigate charge-integration at threshold by cochlear implant listeners using pulse train stimuli in different stimulation modes (monopolar, bipolar, tripolar). The results partially confirmed and extended the findings of previous studies conducted in animal models showing that charge-integration depends on the stimulation mode. The primary overall finding was that threshold vs pulse phase duration functions had steeper slopes in monopolar mode and shallower slopes in more spatially restricted modes. While the result was clear-cut in eight users of the Cochlear Corporation(TM) device, the findings with the six user of the Advanced Bionics(TM) device who participated were less consistent. It is likely that different stimulation modes excite different neuronal populations and/or sites of excitation on the same neuron (e.g., peripheral process vs central axon). These differences may influence not only charge integration but possibly also temporal dynamics at suprathreshold levels and with more speech-relevant stimuli. Given the present interest in focused stimulation modes, these results have implications for cochlear implant speech processor design and protocols used to map acoustic amplitude to electric stimulation parameters.

Spatially patterned electrical stimulation to enhance resolution of retinal prostheses

Retinal prostheses electrically stimulate neurons to produce artificial vision in people blinded by photoreceptor degenerative diseases. The limited spatial resolution of current devices results in indiscriminate stimulation of interleaved cells of different types, precluding veridical reproduction of natural activity patterns in the retinal output. Here we investigate the use of spatial patterns of current injection to increase the spatial resolution of stimulation, using high-density multielectrode recording and stimulation of identified ganglion cells in isolated macaque retina. As previously shown, current passed through a single electrode typically induced a single retinal ganglion cell spike with submillisecond timing precision. Current passed simultaneously through pairs of neighboring electrodes modified the probability of activation relative to injection through a single electrode. This modification could be accurately summarized by a piecewise linear model of current summation, consistent with a simple biophysical model based on multiple sites of activation. The generalizability of the piecewise linear model was tested by using the measured responses to stimulation with two electrodes to predict responses to stimulation with three electrodes. Finally, the model provided an accurate prediction of which among a set of spatial stimulation patterns maximized selective activation of a cell while minimizing activation of a neighboring cell. The results demonstrate that tailored multielectrode stimulation patterns based on a piecewise linear model may be useful in increasing the spatial resolution of retinal prostheses.

Abnormal pitch perception produced by cochlear implant stimulation

Contemporary cochlear implants with multiple electrode stimulation can produce good speech perception but poor music perception. Hindered by the lack of a gold standard to quantify electric pitch, relatively little is known about the nature and extent of the electric pitch abnormalities and their impact on cochlear implant performance. Here we overcame this obstacle by comparing acoustic and electric pitch perception in 3 unilateral cochlear-implant subjects who had functionally usable acoustic hearing throughout the audiometric frequency range in the non-implant ear. First, to establish a baseline, we measured and found slightly impaired pure tone frequency discrimination and nearly perfect melody recognition in all 3 subjects' acoustic ear. Second, using pure tones in the acoustic ear to match electric pitch induced by an intra-cochlear electrode, we found that the frequency-electrode function was not only 1-2 octaves lower, but also 2 times more compressed in frequency range than the normal cochlear frequency-place function. Third, we derived frequency difference limens in electric pitch and found that the equivalent electric frequency discrimination was 24 times worse than normal-hearing controls. These 3 abnormalities are likely a result of a combination of broad electric field, distant intra-cochlear electrode placement, and non-uniform spiral ganglion cell distribution and survival, all of which are inherent to the electrode-nerve interface in contemporary cochlear implants. Previous studies emphasized on the "mean" shape of the frequency-electrode function, but the present study indicates that the large "variance" of this function, reflecting poor electric pitch discriminability, is the main factor limiting contemporary cochlear implant performance.

Loudness summation using focused and unfocused electrical stimulation

With a cochlear implant, when stimulation from multiple channels is interleaved, the perceived loudness is greater than the loudness associated with any of the individual channels presented in isolation. This phenomenon is known as loudness summation. This study examined if loudness summation with monopolar and tripolar stimulation were equivalent at two loudnesses and two spacing configurations. Results suggest that loudness summation is similar for monopolar and tripolar modes. However, larger summation differences were observed for softer sounds and louder sounds with a larger spatial separation. The results are consistent with the idea that loudness summation is dependent on channel interaction and have implications for implementing current-focused processing strategies.

A simulation of current focusing and steering with penetrating optic nerve electrodes

OBJECTIVE

Current focusing and steering are both widely used to shape the electric field and increase the number of distinct perceptual channels in neural stimulation, yet neither technique has been used for an optic nerve (ON)-based visual prosthesis. In order to evaluate the effects of current focusing and steering in penetrative stimulation, we built an integrated computational model to simulate and investigate the influence of stimulating parameters on ON fibre recruitment.

APPROACH

Finite element models with extremely fine meshes were first established to compute the 3D electric potential distribution under different stimulating parameters. Then the external electric potential was fed to randomized multi-compartment cable models to predict the distribution of fibres generating an action potential. Finally a statistical process was conducted to quantify the recruitment region.

MAIN RESULTS

The simulation results show that a two-electrode mode is superior to a three-electrode mode in current steering. The three-electrode mode performs poorly in current focusing, albeit the localized recruitment from both configurations implies that current focusing might be unnecessary in penetrative ON stimulation.

SIGNIFICANCE

This study provides useful information for the optimized design of penetrating ON electrodes and stimulating strategies. The Monte Carlo style computation paradigm is designed to simulate neural responses of an ensemble of ON fibres, which can be immediately transferred to other similar problems.

ECAP spread of excitation with virtual channels and physical electrodes

The primary goal of this study was to evaluate physiological spatial excitation patterns for stimulation of adjacent physical electrodes and intermediate virtual channels. Two experiments were conducted that utilized electrically evoked compound action potential (ECAP) spread-of-excitation (SOE) functions obtained with the traditional forward-masking subtraction method. These two experiments examined spatial excitation patterns for virtual-channel maskers and probes, respectively. In Experiment 1, ECAP SOE patterns were obtained for maskers applied to physical electrodes and virtual channels to determine whether virtual-channel maskers yield SOE patterns similar to those predicted from physical electrodes. In Experiment 2, spatial separation of SOE functions was compared for two adjacent physical probe electrodes and the intermediate virtual channel to determine the extent to which ECAP SOE patterns for virtual-channel probes are spatially separate from those obtained with physical electrodes. Data were obtained for three electrode regions (basal, middle, apical) for 35 ears implanted with Cochlear (N = 16) or Advanced Bionics (N = 19) devices. Results from Experiment 1 showed no significant difference between predicted and measured ECAP amplitudes for Advanced Bionics subjects. Measured ECAP amplitudes for virtual-channel maskers were significantly larger than the predicted amplitudes for Cochlear subjects; however, the difference was <2 μV and thus is likely not clinically significant. Results from Experiment 2 showed that the probe set in the apical region demonstrated the least amount of spatial separation amongst SOE functions, which may be attributed to more uniform nerve survival patterns, closer electrode spacing, and/or the tapered geometry of the cochlea. As expected, adjacent physical probes demonstrated greater spatial separation than for comparisons between each physical probe and the intermediate virtual channel. Finally, the virtual-channel SOE functions were generally weighted toward the basal electrode in the pair.

Infrared Neural Stimulation: Influence of Stimulation Site Spacing and Repetition Rates on Heating

A model to simulate heating as a result of pulse repetitions during infrared neural stimulation (INS), with both single- and multiple-emitters is presented. This model allows the temperature increases from pulse trains rather than single pulses to be considered. The model predicts that using a stimulation rate of 250 Hz with typical laser parameters at a single stimulation site results in a temperature increase of 2.3°C. When multiple stimulation sites are used in analogy to cochlear implants, the temperature increases further depending upon the spacing between emitters. However, when the light is more localized at multiple stimulation sites the temperature increase is reduced.

Threshold levels of dual electrode stimulation in cochlear implants

Simultaneous stimulation on two contacts (current steering) creates intermediate pitches between the physical contacts in cochlear implants. All recent studies on current steering have focused on Most Comfortable Loudness levels and not at low stimulation levels. This study investigates the efficacy of dual electrode stimulation at lower levels, thereby focusing on the requirements to correct for threshold variations. With a current steered signal, threshold levels were determined on 4 different electrode pairs for 7 different current steering coefficients (α). This was done psychophysically in twelve postlingually deafened cochlear implant (HiRes90K, HiFocus1J) users and, in a computer model, which made use of three different neural morphologies. The analysis on the psychophysical data taking all subjects into account showed that in all conditions there was no significant difference between the threshold level of the physical contacts and the intermediate created percepts, eliminating the need for current corrections at these very low levels. The model data showed unexpected drops in threshold in the middle of the two physical contacts (both contacts equal current). Results consistent with this prediction were obtained for a subset of 5 subjects for the apical pair with wider spacing (2.2 mm). Further analysis showed that this decrease was only observed in subjects with a long duration of deafness. For current steering on adjacent contacts, the results from the psychophysical experiments were in line with the results from computational modelling. However, the dip in the threshold profile could only be replicated in the computational model with surviving peripheral processes without an unmyelinated terminal. On the basis of this result, we put forward that the majority of the surviving spiral ganglion cells in the cochlea in humans with a long duration of deafness still retain peripheral processes, but have lost their unmyelinated terminals.

Masking patterns for monopolar and phantom electrode stimulation in cochlear implants

Phantom electrode (PE) stimulation consists of out-of-phase stimulation of two electrodes. When presented at the apex of the electrode array, phantom stimulation is known to produce a lower pitch sensation than monopolar (MP) stimulation on the most apical electrode. The ratio of the current between the primary electrode (PEL) and the compensating electrode (CEL) is represented by the coefficient σ, which ranges from 0 (monopolar) to 1 (full bipolar). The exact mechanism by which PE stimulation produces a lower pitch sensation is unclear. In the present study, unmasked and masked thresholds were obtained using a forward masking paradigm to estimate the spread of current for MP and PE stimulation. Masked thresholds were measured for two phantom electrode configurations (1) PEL = 4, CEL = 5 (lower pitch phantom) and (2) PEL = 4, CEL = 3 (higher pitch phantom). The unmasked thresholds were subtracted from the masked thresholds to obtain masking patterns which were normalized to their peak. The masking patterns reveal (1) differences in the spread of excitation that are consistent with the direction of pitch shift produced by PE stimulation, and (2) narrower spread of electrical excitation for PE stimulation relative to MP stimulation.

Improving speech perception in noise with current focusing in cochlear implant users

Cochlear implant (CI) users typically have excellent speech recognition in quiet but struggle with understanding speech in noise. It is thought that broad current spread from stimulating electrodes causes adjacent electrodes to activate overlapping populations of neurons which results in interactions across adjacent channels. Current focusing has been studied as a way to reduce spread of excitation, and therefore, reduce channel interactions. In particular, partial tripolar stimulation has been shown to reduce spread of excitation relative to monopolar stimulation. However, the crucial question is whether this benefit translates to improvements in speech perception. In this study, we compared speech perception in noise with experimental monopolar and partial tripolar speech processing strategies. The two strategies were matched in terms of number of active electrodes, microphone, filterbanks, stimulation rate and loudness (although both strategies used a lower stimulation rate than typical clinical strategies). The results of this study showed a significant improvement in speech perception in noise with partial tripolar stimulation. All subjects benefited from the current focused speech processing strategy. There was a mean improvement in speech recognition threshold of 2.7 dB in a digits in noise task and a mean improvement of 3 dB in a sentences in noise task with partial tripolar stimulation relative to monopolar stimulation. Although the experimental monopolar strategy was worse than the clinical, presumably due to different microphones, frequency allocations and stimulation rates, the experimental partial-tripolar strategy, which had the same changes, showed no acute deficit relative to the clinical.

Neuromodulation for brain disorders: challenges and opportunities

The field of neuromodulation encompasses a wide spectrum of interventional technologies that modify pathological activity within the nervous system to achieve a therapeutic effect. Therapies including deep brain stimulation, intracranial cortical stimulation, transcranial direct current stimulation, and transcranial magnetic stimulation have all shown promising results across a range of neurological and neuropsychiatric disorders. While the mechanisms of therapeutic action are invariably different among these approaches, there are several fundamental neuroengineering challenges that are commonly applicable to improving neuromodulation efficacy. This paper reviews the state-of-the-art of neuromodulation for brain disorders and discusses the challenges and opportunities available for clinicians and researchers interested in advancing neuromodulation therapies.

Current steering with partial tripolar stimulation mode in cochlear implants

The large spread of excitation is a major cause of poor spectral resolution for cochlear implant (CI) users. Partial tripolar (pTP) mode has been proposed to reduce current spread by returning an equally distributed fraction (0.5 × σ) of current to two flanking electrodes and the rest to an extra-cochlear ground. This study tested the efficacy of incorporating current steering into pTP mode to add spectral channels. Different proportions of current [α × σ and (1 - α) × σ] were returned to the basal and apical flanking electrodes respectively to shape the electric field. Loudness and pitch perception with α from 0 to 1 in steps of 0.1 was simulated with a computational model of CI stimulation and tested on the apical, middle, and basal electrodes of six CI subjects. The highest σ allowing for full loudness growth within the implant compliance limit was chosen for each main electrode. Pitch ranking was measured between pairs of loudness-balanced steered pTP stimuli with an α interval of 0.1 at the most comfortable level. Results demonstrated that steered pTP stimuli with α around 0.5 required more current to achieve equal loudness than those with α around 0 or 1, maybe due to more focused excitation patterns. Subjects usually perceived decreasing pitches as α increased from 0 to 1, somewhat consistent with the apical shift of the center of gravity of excitation pattern in the model. Pitch discrimination was not better with α around 0.5 than with α around 0 or 1, except for some subjects and electrodes. For three subjects with better pitch discrimination, about half of the pitch ranges of two adjacent main electrodes overlapped with each other in steered pTP mode. These results suggest that current steering with focused pTP mode may improve spectral resolution and pitch perception with CIs.

Progress toward development of a multichannel vestibular prosthesis for treatment of bilateral vestibular deficiency

This article reviews vestibular pathology and the requirements and progress made in the design and construction of a vestibular prosthesis. Bilateral loss of vestibular sensation is disabling. When vestibular hair cells are injured by ototoxic medications or other insults to the labyrinth, the resulting loss of sensory input disrupts vestibulo-ocular reflexes (VORs) and vestibulo-spinal reflexes that normally stabilize the eyes and body. Affected individuals suffer poor vision during head movement, postural instability, chronic disequilibrium, and cognitive distraction. Although most individuals with residual sensation compensate for their loss over time, others fail to do so and have no adequate treatment options. A vestibular prosthesis analogous to cochlear implants but designed to modulate vestibular nerve activity during head movement should improve quality of life for these chronically dizzy individuals. We describe the impact of bilateral loss of vestibular sensation, animal studies supporting feasibility of prosthetic vestibular stimulation, the current status of multichannel vestibular sensory replacement prosthesis development, and challenges to successfully realizing this approach in clinical practice. In bilaterally vestibular-deficient rodents and rhesus monkeys, the Johns Hopkins multichannel vestibular prosthesis (MVP) partially restores the three-dimensional (3D) VOR for head rotations about any axis. Attempts at prosthetic vestibular stimulation of humans have not yet included the 3D eye movement assays necessary to accurately evaluate VOR alignment, but these initial forays have revealed responses that are otherwise comparable to observations in animals. Current efforts now focus on refining electrode design and surgical technique to enhance stimulus selectivity and preserve cochlear function, optimizing stimulus protocols to improve dynamic range and reduce excitation-inhibition asymmetry, and adapting laboratory MVP prototypes into devices appropriate for use in clinical trials.

Monopolar intracochlear pulse trains selectively activate the inferior colliculus

Previous cochlear implant studies using isolated electrical stimulus pulses in animal models have reported that intracochlear monopolar stimulus configurations elicit broad extents of neuronal activation within the central auditory system-much broader than the activation patterns produced by bipolar electrode pairs or acoustic tones. However, psychophysical and speech reception studies that use sustained pulse trains do not show clear performance differences for monopolar versus bipolar configurations. To test whether monopolar intracochlear stimulation can produce selective activation of the inferior colliculus, we measured activation widths along the tonotopic axis of the inferior colliculus for acoustic tones and 1,000-pulse/s electrical pulse trains in guinea pigs and cats. Electrical pulse trains were presented using an array of 6-12 stimulating electrodes distributed longitudinally on a space-filling silicone carrier positioned in the scala tympani of the cochlea. We found that for monopolar, bipolar, and acoustic stimuli, activation widths were significantly narrower for sustained responses than for the transient response to the stimulus onset. Furthermore, monopolar and bipolar stimuli elicited similar activation widths when compared at stimulus levels that produced similar peak spike rates. Surprisingly, we found that in guinea pigs, monopolar and bipolar stimuli produced narrower sustained activation than 60 dB sound pressure level acoustic tones when compared at stimulus levels that produced similar peak spike rates. Therefore, we conclude that intracochlear electrical stimulation using monopolar pulse trains can produce activation patterns that are at least as selective as bipolar or acoustic stimulation.

A point process framework for modeling electrical stimulation of the auditory nerve

Model-based studies of responses of auditory nerve fibers to electrical stimulation can provide insight into the functioning of cochlear implants. Ideally, these studies can identify limitations in sound processing strategies and lead to improved methods for providing sound information to cochlear implant users. To accomplish this, models must accurately describe spiking activity while avoiding excessive complexity that would preclude large-scale simulations of populations of auditory nerve fibers and obscure insight into the mechanisms that influence neural encoding of sound information. In this spirit, we develop a point process model of individual auditory nerve fibers that provides a compact and accurate description of neural responses to electric stimulation. Inspired by the framework of generalized linear models, the proposed model consists of a cascade of linear and nonlinear stages. We show how each of these stages can be associated with biophysical mechanisms and related to models of neuronal dynamics. Moreover, we derive a semianalytical procedure that uniquely determines each parameter in the model on the basis of fundamental statistics from recordings of single fiber responses to electric stimulation, including threshold, relative spread, jitter, and chronaxie. The model also accounts for refractory and summation effects that influence the responses of auditory nerve fibers to high pulse rate stimulation. Throughout, we compare model predictions to published physiological data of response to high and low pulse rate stimulation. We find that the model, although constructed to fit data from single and paired pulse experiments, can accurately predict responses to unmodulated and modulated pulse train stimuli. We close by performing an ideal observer analysis of simulated spike trains in response to sinusoidally amplitude modulated stimuli and find that carrier pulse rate does not affect modulation detection thresholds.

A tripolar current-steering stimulator ASIC for field shaping in deep brain stimulation

A significant problem with clinical deep brain stimulation (DBS) is the high variability of its efficacy and the frequency of side effects, related to the spreading of current beyond the anatomical target area. This is the result of the lack of control that current DBS systems offer on the shaping of the electric potential distribution around the electrode. This paper presents a stimulator ASIC with a tripolar current-steering output stage, aiming at achieving more selectivity and field shaping than current DBS systems. The ASIC was fabricated in a 0.35-μ m CMOS technology occupying a core area of 0.71 mm(2). It consists of three current sourcing/sinking channels. It is capable of generating square and exponential-decay biphasic current pulses with five different time constants up to 28 ms and delivering up to 1.85 mA of cathodic current, in steps of 4 μA, from a 12 V power supply. Field shaping was validated by mapping the potential distribution when injecting current pulses through a multicontact DBS electrode in saline.

Advances in auditory prostheses

PURPOSE OF REVIEW

Auditory prostheses use electric currents on multiple electrodes to stimulate auditory neurons and recreate auditory sensations in deaf people. Cochlear implants have restored hearing in more than 200  000 deaf adults and children to a level that allows most to understand speech. Here we review the reasons underlying these results and describe new directions in restoring hearing to additional patient populations and the design of new devices.

RECENT FINDINGS

From their early development about 50 years ago, cochlear implants have been well received and beneficial to people who had lost their hearing. Although those first implants did not allow high levels of speech understanding, they provided auditory information that worked synergistically with lip reading to improve communication. Present day cochlear implants provide excellent speech understanding in children and in postlingually deafened adults. Research is focused on improved signal processing and new electrode designs. Electric stimulation of the auditory brainstem can also produce excellent hearing in some children and adults.

SUMMARY

Auditory prostheses, both at the level of the sensory nerve and at the brainstem, can restore patterns of neural activation that are sufficient for high levels of speech understanding. These prostheses are not only clinically successful but also important tools for understanding sensory processing in the brain.

Midbrain responses to micro-stimulation of the cochlea using high density thin-film arrays

A broader activation of auditory nerve fibres than normal using a cochlear implant contributes to poor frequency discrimination. As cochlear implants also deliver a restricted dynamic range, this hinders the ability to segregate sound sources. Better frequency coding and control over amplitude may be achieved by limiting current spread during electrical stimulation of the cochlea and positioning electrodes closer to the modiolus. Thin-film high density microelectrode arrays and conventional platinum ring electrode arrays were used to stimulate the cochlea of urethane-anaesthetized rats and responses compared. Neurophysiological recordings were taken at 197 multi-unit clusters in the central nucleus of the inferior colliculus (CIC), a site that receives direct monaural innervation from the cochlear nucleus. CIC responses to both the platinum ring and high density electrodes were recorded and differences in activity to changes in stimulation intensity, thresholds and frequency coding of neural activation were examined. The high density electrode array elicited less CIC activity at nonspecific frequency regions than the platinum ring electrode array. The high density electrode array produced significantly lower thresholds and larger dynamic ranges than the platinum ring electrode array when positioned close to the modiolus. These results suggest that a higher density of stimulation sites on electrodes that effectively 'aim' current, combined with placement closer to the modiolus would permit finer control over charge delivery. This may equate to improved frequency specific perception and control over amplitude when using future cochlear implant devices.

Place-pitch manipulations with cochlear implants

Pitch can be conveyed to cochlear implant listeners via both place of excitation and temporal cues. The transmission of place cues may be hampered by several factors, including limitations on the insertion depth and number of implanted electrodes, and the broad current spread produced by monopolar stimulation. The following series of experiments investigate several methods to partially overcome these limitations. Experiment 1 compares two recently published techniques that aim to activate more apical fibers than produced by monopolar or bipolar stimulation of the most apical contacts. The first technique (phantom stimulation) manipulates the current spread by simultaneously stimulating two electrodes with opposite-polarity pulses of different amplitudes. The second technique manipulates the neural spread of excitation by using asymmetric pulses and exploiting the polarity-sensitive properties of auditory nerve fibers. The two techniques yielded similar results and were shown to produce lower place-pitch percepts than stimulation of monopolar and bipolar symmetric pulses. Furthermore, combining these two techniques may be advantageous in a clinical setting. Experiment 2 proposes a method to create place pitches intermediate to those produced by physical electrodes by using charge-balanced asymmetric pulses in bipolar mode with different degrees of asymmetry.

Reducing current spread using current focusing in cochlear implant users

Cochlear implant performance in difficult listening situations is limited by channel interactions. It is known that partial tripolar (PTP) stimulation reduces the spread of excitation (SOE). However, the greater the degree of current focusing, the greater the absolute current required to maintain a fixed loudness. As current increases, so does SOE. In experiment 1, the SOE for equally loud stimuli with different degrees of current focusing is measured via a forward-masking procedure. Results suggest that at a fixed loudness, some but not all patients have a reduced SOE with PTP stimulation. Therefore, it seems likely that a PTP speech processing strategy could improve spectral resolution for only those patients with a reduced SOE. In experiment 2, the ability to discriminate different levels of current focusing was measured. In experiment 3, patients subjectively scaled verbal descriptors of stimuli of various levels of current focusing. Both discrimination and scaling of verbal descriptors correlated well with SOE reduction, suggesting that either technique have the potential to be used clinically to quickly predict which patients would receive benefit from a current focusing strategy.

Cochlear-implant spatial selectivity with monopolar, bipolar and tripolar stimulation

Sharp spatial selectivity is critical to auditory performance, particularly in pitch-related tasks. Most contemporary cochlear implants have employed monopolar stimulation that produces broad electric fields, which presumably contribute to poor pitch and pitch-related performance by implant users. Bipolar or tripolar stimulation can generate focused electric fields but requires higher current to reach threshold and, more interestingly, has not produced any apparent improvement in cochlear-implant performance. The present study addressed this dilemma by measuring psychophysical and physiological spatial selectivity with both broad and focused stimulations in the same cohort of subjects. Different current levels were adjusted by systematically measuring loudness growth for each stimulus, each stimulation mode, and in each subject. Both psychophysical and physiological measures showed that, although focused stimulation produced significantly sharper spatial tuning than monopolar stimulation, it could shift the tuning position or even split the tuning tips. The altered tuning with focused stimulation is interpreted as a result of poor electrode-to-neuron interface in the cochlea, and is suggested to be mainly responsible for the lack of consistent improvement in implant performance. A linear model could satisfactorily quantify the psychophysical and physiological data and derive the tuning width. Significant correlation was found between the individual physiological and psychophysical tuning widths, and the correlation was improved by log-linearly transforming the physiological data to predict the psychophysical data. Because the physiological measure took only one-tenth of the time of the psychophysical measure, the present model is of high clinical significance in terms of predicting and improving cochlear-implant performance.

Assessing the placement of a cochlear electrode array by multidimensional scaling

Correct placement of the electrode is crucial for cochlear implantation (CI) surgery. It determines the access to the auditory nerve and subsequent hearing performance. Here, we propose an objective measures tool that can partially verify the electrode position. The intracochlear spread of the electrical fields is measured and analyzed by means of multidimensional scaling resulting in an intuitive visual representation. The user can then detect major issues, such as electrode foldover or ossification. Other implantation issues, such as electrode migration into the scala vestibuli, may not significantly alter the electrical conduction pattern and remain undetected. Still, as the measurement is quick and readily available, it may be a valuable intraoperative verification tool.

Discrimination between sequential and simultaneous virtual channels with electrical hearing

In cochlear implants (CIs), simultaneous or sequential stimulation of adjacent electrodes can produce intermediate pitch percepts between those of the component electrodes. However, it is unclear whether simultaneous and sequential virtual channels (VCs) can be discriminated. In this study, CI users were asked to discriminate simultaneous and sequential VCs; discrimination was measured for monopolar (MP) and bipolar + 1 stimulation (BP + 1), i.e., relatively broad and focused stimulation modes. For sequential VCs, the interpulse interval (IPI) varied between 0.0 and 1.8 ms. All stimuli were presented at comfortably loud, loudness-balanced levels at a 250 pulse per second per electrode (ppse) stimulation rate. On average, CI subjects were able to reliably discriminate between sequential and simultaneous VCs. While there was no significant effect of IPI or stimulation mode on VC discrimination, some subjects exhibited better VC discrimination with BP + 1 stimulation. Subjects' discrimination between sequential and simultaneous VCs was correlated with electrode discrimination, suggesting that spatial selectivity may influence perception of sequential VCs. To maintain equal loudness, sequential VC amplitudes were nearly double those of simultaneous VCs, presumably resulting in a broader spread of excitation. These results suggest that perceptual differences between simultaneous and sequential VCs might be explained by differences in the spread of excitation.

Design and performance of a multichannel vestibular prosthesis that restores semicircular canal sensation in rhesus monkey

In normal individuals, the vestibular labyrinths sense head movement and mediate reflexes that maintain stable gaze and posture. Bilateral loss of vestibular sensation causes chronic disequilibrium, oscillopsia, and postural instability. We describe a new multichannel vestibular prosthesis (MVP) intended to restore modulation of vestibular nerve activity with head rotation. The device comprises motion sensors to measure rotation and gravitoinertial acceleration, a microcontroller to calculate pulse timing, and stimulator units that deliver constant-current pulses to microelectrodes implanted in the labyrinth. This new MVP incorporates many improvements over previous prototypes, including a 50% decrease in implant size, a 50% decrease in power consumption, a new microelectrode array design meant to simplify implantation and reliably achieve selective nerve-electrode coupling, multiple current sources conferring ability to simultaneously stimulate on multiple electrodes, and circuitry for in vivo measurement of electrode impedances. We demonstrate the performance of this device through in vitro bench-top characterization and in vivo physiological experiments with a rhesus macaque monkey.

Electrically evoked compound action potential measures for virtual channels versus physical electrodes

OBJECTIVES

The number of distinct pitch percepts for cochlear implant (CI) listeners is somewhat limited by the number of physical electrodes in the array. Newer-generation CIs have the capability to potentially increase this number by stimulating areas of the cochlea between the physical electrodes. Currently, this is achieved by electrically coupling adjacent electrodes or by simultaneously activating two electrodes with independent current sources (i.e., current steering). Presumably, either type of dual-electrode stimulation will generate neural excitation patterns that are intermediate to those generated by either physical electrode alone (henceforth termed virtual channel). However, it is not clear whether virtual-channel stimulation yields neural recruitment patterns with similar shapes and rates of growth as compared with each physical electrode alone. The purpose of this study was to compare basic electrically evoked compound action potential (ECAP) measures for physical electrodes and virtual channels to determine whether properties of the respective excitation patterns were similar.

DESIGN

Data were collected for 12 adult CI recipients (six Nucleus Freedom CI24RE, two Advanced Bionics HiResolution 90K, and four Advanced Bionics CII). ECAP responses were measured for a set of three adjacent physical electrodes and two corresponding intermediate virtual channels (e.g., physical electrodes 4, 5, and 6 and virtual channels 4 + 5 and 5 + 6) at three positions along the electrode array (basal, middle, and apical). Virtual channels for Nucleus subjects were produced via electrical coupling of adjacent electrode pairs (dual-electrode mode). For Advanced Bionics subjects, virtual channels were produced via simultaneous, in-phase stimulation of adjacent electrode pairs with 50% of the total current delivered to each electrode in the pair. Specific ECAP measures were as follows: (1) threshold and slope of the input/output functions, (2) amplitude for a masker-probe interval of 1500 μsecs (measure of refractory recovery), and (3) relative location of spread of excitation (SOE) functions among virtual channels and adjacent physical electrodes. Measures for virtual channels were compared with those for the flanking physical electrodes using a multivariate analysis of variance.

RESULTS

There were no statistically significant differences between physical electrodes and virtual channels for ECAP thresholds, slope of the input/output function, or refractory recovery. On average, SOE functions for the virtual channels were spatially located approximately halfway between SOE functions for the adjacent physical electrodes.

CONCLUSIONS

Results from this study suggest that virtual channels produce neural recruitment patterns with properties similar to those elicited by the adjacent physical electrodes.

The vestibular implant: quo vadis?

Objective: To assess the progress of the development of the vestibular implant (VI) and its feasibility short-term. Data sources: A search was performed in Pubmed, Medline, and Embase. Key words used were “vestibular prosth*” and “VI.” The only search limit was language: English or Dutch. Additional sources were medical books, conference lectures and our personal experience with per-operative vestibular stimulation in patients selected for cochlear implantation. Study selection: All studies about the VI and related topics were included and evaluated by two reviewers. No study was excluded since every study investigated different aspects of the VI. Data extraction and synthesis: Data was extracted by the first author from selected reports, supplemented by additional information, medical books conference lectures. Since each study had its own point of interest with its own outcomes, it was not possible to compare data of different studies. Conclusion: To use a basic VI in humans seems feasible in the very near future. Investigations show that electric stimulation of the canal nerves induces a nystagmus which corresponds to the plane of the canal which is innervated by the stimulated nerve branch. The brain is able to adapt to a higher baseline stimulation, while still reacting on a dynamic component. The best response will be achieved by a combination of the optimal stimulus (stimulus profile, stimulus location, precompensation), complemented by central vestibular adaptation. The degree of response will probably vary between individuals, depending on pathology and their ability to adapt.

Spatial channel interactions in cochlear implants

The modern multi-channel cochlear implant is widely considered to be the most successful neural prosthesis owing to its ability to restore partial hearing to post-lingually deafened adults and to allow essentially normal language development in pre-lingually deafened children. However, the implant performance varies greatly in individuals and is still limited in background noise, tonal language understanding, and music perception. One main cause for the individual variability and the limited performance in cochlear implants is spatial channel interaction from the stimulating electrodes to the auditory nerve and brain. Here we systematically examined spatial channel interactions at the physical, physiological, and perceptual levels in the same five modern cochlear implant subjects. The physical interaction was examined using an electric field imaging technique, which measured the voltage distribution as a function of the electrode position in the cochlea in response to the stimulation of a single electrode. The physiological interaction was examined by recording electrically evoked compound action potentials as a function of the electrode position in response to the stimulation of the same single electrode position. The perceptual interactions were characterized by changes in detection threshold as well as loudness summation in response to in-phase or out-of-phase dual-electrode stimulation. To minimize potentially confounding effects of temporal factors on spatial channel interactions, stimulus rates were limited to 100 Hz or less in all measurements. Several quantitative channel interaction indexes were developed to define and compare the width, slope and symmetry of the spatial excitation patterns derived from these physical, physiological and perceptual measures. The electric field imaging data revealed a broad but uniformly asymmetrical intracochlear electric field pattern, with the apical side producing a wider half-width and shallower slope than the basal side. In contrast, the evoked compound action potential and perceptual channel interaction data showed much greater individual variability. It is likely that actual reduction in neural and higher level interactions, instead of simple sharpening of the electric current field, would be the key to predicting and hopefully improving the variable cochlear implant performance. The present results are obtained with auditory prostheses but can be applied to other neural prostheses, in which independent spatial channels, rather than a high stimulation rate, are critical to their performance.

Within-subjects comparison of the HiRes and Fidelity120 speech processing strategies: speech perception and its relation to place-pitch sensitivity

OBJECTIVES

Previous studies have confirmed that current steering can increase the number of discriminable pitches available to many cochlear implant (CI) users; however, the ability to perceive additional pitches has not been linked to improved speech perception. The primary goals of this study were to determine (1) whether adult CI users can achieve higher levels of spectral cue transmission with a speech processing strategy that implements current steering (Fidelity120) than with a predecessor strategy (HiRes) and, if so, (2) whether the magnitude of improvement can be predicted from individual differences in place-pitch sensitivity. A secondary goal was to determine whether Fidelity120 supports higher levels of speech recognition in noise than HiRes.

DESIGN

A within-subjects repeated measures design evaluated speech perception performance with Fidelity120 relative to HiRes in 10 adult CI users. Subjects used the novel strategy (either HiRes or Fidelity120) for 8 wks during the main study; a subset of five subjects used Fidelity120 for three additional months after the main study. Speech perception was assessed for the spectral cues related to vowel F1 frequency, vowel F2 frequency, and consonant place of articulation; overall transmitted information for vowels and consonants; and sentence recognition in noise. Place-pitch sensitivity was measured for electrode pairs in the apical, middle, and basal regions of the implanted array using a psychophysical pitch-ranking task.

RESULTS

With one exception, there was no effect of strategy (HiRes versus Fidelity120) on the speech measures tested, either during the main study (N = 10) or after extended use of Fidelity120 (N = 5). The exception was a small but significant advantage for HiRes over Fidelity120 for consonant perception during the main study. Examination of individual subjects' data revealed that 3 of 10 subjects demonstrated improved perception of one or more spectral cues with Fidelity120 relative to HiRes after 8 wks or longer experience with Fidelity120. Another three subjects exhibited initial decrements in spectral cue perception with Fidelity120 at the 8-wk time point; however, evidence from one subject suggested that such decrements may resolve with additional experience. Place-pitch thresholds were inversely related to improvements in vowel F2 frequency perception with Fidelity120 relative to HiRes. However, no relationship was observed between place-pitch thresholds and the other spectral measures (vowel F1 frequency or consonant place of articulation).

CONCLUSIONS

Findings suggest that Fidelity120 supports small improvements in the perception of spectral speech cues in some Advanced Bionics CI users; however, many users show no clear benefit. Benefits are more likely to occur for vowel spectral cues (related to F1 and F2 frequency) than for consonant spectral cues (related to place of articulation). There was an inconsistent relationship between place-pitch sensitivity and improvements in spectral cue perception with Fidelity120 relative to HiRes. This may partly reflect the small number of sites at which place-pitch thresholds were measured. Contrary to some previous reports, there was no clear evidence that Fidelity120 supports improved sentence recognition in noise.

Electric crosstalk impairs spatial resolution of multi-electrode arrays in retinal implants

Active multi-electrode arrays are used in vision prostheses, including optic nerve cuffs and cortical and retinal implants for stimulation of neural tissue. For retinal implants, arrays with up to 1500 electrodes are used in clinical trials. The ability to convey information with high spatial resolution is critical for these applications. To assess the extent to which spatial resolution is impaired by electric crosstalk, finite-element simulation of electric field distribution in a simplified passive tissue model of the retina is performed. The effects of electrode size, electrode spacing, distance to target cells, and electrode return configuration (monopolar, tripolar, hexagonal) on spatial resolution is investigated in the form of a mathematical model of electric field distribution. Results show that spatial resolution is impaired with increased distance from the electrode array to the target cells. This effect can be partly compensated by non-monopolar electrode configurations and larger electrode diameters, albeit at the expense of lower pixel densities due to larger covering areas by each stimulation electrode. In applications where multi-electrode arrays can be brought into close proximity to target cells, as presumably with epiretinal implants, smaller electrodes in monopolar configuration can provide the highest spatial resolution. However, if the implantation site is further from the target cells, as is the case in suprachoroidal approaches, hexagonally guarded electrode return configurations can convey higher spatial resolution.

Spatial tuning curves from apical, middle, and basal electrodes in cochlear implant users

Forward-masked psychophysical spatial tuning curves (fmSTCs) were measured in 15 cochlear-implant subjects, 10 using monopolar stimulation and 5 using bipolar stimulation. In each subject, fmSTCs were measured at several probe levels on an apical, middle, and basal electrode using a fixed-level probe stimulus and variable-level maskers. Tuning curve slopes and bandwidths did not change significantly with probe level for electrodes located in the apical, middle, or basal region although a few subjects exhibited dramatic changes in tuning at the extremes of the probe level range. Average tuning curve slopes and bandwidths did not vary significantly across electrode regions. Spatial tuning curves were symmetrical and similar in width across the three electrode regions. However, several subjects demonstrated large changes in slope and/or bandwidth across the three electrode regions, indicating poorer tuning in localized regions of the array. Cochlear-implant users exhibited bandwidths that were approximately five times wider than normal-hearing acoustic listeners but were in the same range as acoustic listeners with moderate cochlear hearing loss. No significant correlations were found between spatial tuning parameters and speech recognition; although a weak relation was seen between middle electrode tuning and transmitted information for vowel second formant frequency.

Effects of fine structure and extended low frequencies in pediatric cochlear implant recipients

OBJECTIVE

In recent years, new speech coding strategies have been developed with the aim of improving the transmission of temporal fine structure to cochlear implant recipients. This study reports on the implementation of one such strategy (fine structure processing, FSP) in children.

METHODS

This was a prospective study investigating the upgrade to a new speech processor. The upgrade used a repeated measures design with an alternating order of conditions (A-B-A-B design). Twelve pre- and perilingually deaf children with MED-EL C40+ cochlear implants were enrolled in the study. Patients were upgraded from their Tempo+ speech processor, which used continuous interleaved sampling (CIS) in combination with a frequency spectrum of 200-8500 Hz, to an Opus speech processor, which used FSP with an extended frequency spectrum of 70-8500 Hz. The primary means of testing was an HSM (Hochmair, Schulz and Moser) sentence test at 65 and 80 dB in quiet. In addition, the "Mainzer Kindersprachtest" (Mainz audiometric speech test for children) was applied at 65 and 70 dB.

RESULTS

When the new FSP speech processor was used together with the extended low frequency range, HSM sentence tests at 65 and 80 dB resulted in scores indicating statistically significant improvements of 7.1 and 9.9 percentage points, respectively. Scores in the "Mainzer Kindersprachtest" at 65 and 70 dB indicated statistically significant improvements of 9.3 and 6.1 percentage points, respectively.

CONCLUSIONS

The present study clearly shows that children benefit from the fine structure speech coding strategy in combination with an extended frequency spectrum in the low frequencies, as is offered by the Opus speech processors. This should be taken into consideration when fitting pre- and perilingually deaf children implanted almost a decade previously.

Cochlear implantation using thin-film array electrodes

OBJECTIVE

Current limitations in language perception may stem from an inability to provide high-resolution sound input. Thin-film array technology allows for a greater density of stimulating sites within the limited diameter of the scala tympani. This study examines the use of a flexible carrier to achieve adequate depth of insertion.

STUDY DESIGN

A prospective human cadaveric temporal bone insertion analysis.

SETTING

Academic otolaryngology department and school of electrical and computer engineering collaboration.

METHODS

A prototype thin-film array electrode coupled with an insertion test device (ITD) was manufactured and inserted into 10 human cadaveric temporal bones. As controls, 2 additional temporal bones were implanted with the ITD only and 2 were unimplanted. Radiologic and histologic data were collected.

RESULTS

Ten thin-film array electrodes were successfully implanted into 10 individual temporal bones via round window (5) and cochleostomy (5) approaches. Seventeen millimeters of insertion was noted for each device, with an average angular insertion depth of 292° by radiographic measurements and 392° by histologic sectioning. Electrode distance to the modiolus averaged 0.88 mm by computed tomography and 0.67 mm by histologic measurements. Average percentage trauma was 26% for the ITD-backed arrays compared with 15% and 29% for ITD only and unimplanted temporal bones, respectively.

CONCLUSION

Thin-film array electrodes coupled with an ITD were successfully inserted into the human cochlea with limited trauma. With continued development and testing of this electrode design, the thin-film array may improve the language perception achieved through cochlear implantation.

Cross-axis adaptation improves 3D vestibulo-ocular reflex alignment during chronic stimulation via a head-mounted multichannel vestibular prosthesis

By sensing three-dimensional (3D) head rotation and electrically stimulating the three ampullary branches of a vestibular nerve to encode head angular velocity, a multichannel vestibular prosthesis (MVP) can restore vestibular sensation to individuals disabled by loss of vestibular hair cell function. However, current spread to afferent fibers innervating non-targeted canals and otolith end organs can distort the vestibular nerve activation pattern, causing misalignment between the perceived and actual axis of head rotation. We hypothesized that over time, central neural mechanisms can adapt to correct this misalignment. To test this, we rendered five chinchillas vestibular deficient via bilateral gentamicin treatment and unilaterally implanted them with a head-mounted MVP. Comparison of 3D angular vestibulo-ocular reflex (aVOR) responses during 2 Hz, 50°/s peak horizontal sinusoidal head rotations in darkness on the first, third, and seventh days of continual MVP use revealed that eye responses about the intended axis remained stable (at about 70% of the normal gain) while misalignment improved significantly by the end of 1 week of prosthetic stimulation. A comparable time course of improvement was also observed for head rotations about the other two semicircular canal axes and at every stimulus frequency examined (0.2-5 Hz). In addition, the extent of disconjugacy between the two eyes progressively improved during the same time window. These results indicate that the central nervous system rapidly adapts to multichannel prosthetic vestibular stimulation to markedly improve 3D aVOR alignment within the first week after activation. Similar adaptive improvements are likely to occur in other species, including humans.

Effects of biphasic current pulse frequency, amplitude, duration, and interphase gap on eye movement responses to prosthetic electrical stimulation of the vestibular nerve

An implantable prosthesis that stimulates vestibular nerve branches to restore sensation of head rotation and vision-stabilizing reflexes could benefit individuals disabled by bilateral loss of vestibular (inner ear balance) function. We developed a prosthesis that partly restores normal function in animals by delivering pulse frequency modulated (PFM) biphasic current pulses via electrodes implanted in semicircular canals. Because the optimal stimulus encoding strategy is not yet known, we investigated effects of varying biphasic current pulse frequency, amplitude, duration, and interphase gap on vestibulo-ocular reflex (VOR) eye movements in chinchillas. Increasing pulse frequency increased response amplitude while maintaining a relatively constant axis of rotation. Increasing pulse amplitude (range 0- 325 μA) also increased response amplitude but spuriously shifted eye movement axis, probably due to current spread beyond the target nerve. Shorter pulse durations (range 28- 340 μs) required less charge to elicit a given response amplitude and caused less axis shift than longer durations. Varying interphase gap (range 25- 175 μs) had no significant effect. While specific values reported herein depend on microanatomy and electrode location in each case, we conclude that PFM with short duration biphasic pulses should form the foundation for further optimization of stimulus encoding strategies for vestibular prostheses intended to restore sensation of head rotation.

Current steering and current focusing with a high-density intracochlear electrode array

Creating high-resolution or high-density, intra-cochlear electrode arrays may significantly improve quality of hearing for cochlear implant recipients. Through focused activation of neural populations such arrays may better exploit the cochlea's frequency-to-place mapping, thereby improving sound perception. Contemporary electrode arrays approach high-density stimulation by employing multi-polar stimulation techniques such as current steering and current focusing. In our procedure we compared an advanced high-density array with contemporary arrays employing these strategies. We examined focused stimulation of auditory neurons using an activating function and a neural firing probability model that together enable a first-order estimation of an auditory nerve fiber's response to electrical stimulation. The results revealed that simple monopolar stimulation with a high-density array is more localized than current steering with a contemporary array and requires 25-30% less current. Current focusing with high-density electrodes is more localized than current focusing with a contemporary array; however, a greater amount of current is required. This work illustrates that advanced high-density electrode arrays may provide a low-power, high-resolution alternative to current steering with contemporary cochlear arrays.

Probing the electrode-neuron interface with focused cochlear implant stimulation

Cochlear implants are highly successful neural prostheses for persons with severe or profound hearing loss who gain little benefit from hearing aid amplification. Although implants are capable of providing important spectral and temporal cues for speech perception, performance on speech tests is variable across listeners. Psychophysical measures obtained from individual implant subjects can also be highly variable across implant channels. This review discusses evidence that such variability reflects deviations in the electrode-neuron interface, which refers to an implant channel's ability to effectively stimulate the auditory nerve. It is proposed that focused electrical stimulation is ideally suited to assess channel-to-channel irregularities in the electrode-neuron interface. In implant listeners, it is demonstrated that channels with relatively high thresholds, as measured with the tripolar configuration, exhibit broader psychophysical tuning curves and smaller dynamic ranges than channels with relatively low thresholds. Broader tuning implies that frequency-specific information intended for one population of neurons in the cochlea may activate more distant neurons, and a compressed dynamic range could make it more difficult to resolve intensity-based information, particularly in the presence of competing noise. Degradation of both types of cues would negatively affect speech perception.