Electrophysiologic Evaluation of the Cochlear Implant Patient

Electrically evoked amplitude modulation following response in cochlear implant candidates: comparison with auditory nerve response telemetry, subjective electrical stimulation, and speech perception

OBJECTIVE

To establish the objective, noninvasive recording of the electrically evoked amplitude modulation following response (EAMFR) for the assessment of auditory nerve function in cochlear implant candidates.

STUDY DESIGN

Prospective clinical study from 2007 to 2010.

SETTING

Cochlear Implant Programme at the Charité-Universitätsmedizin Berlin (Germany).

PATIENTS

Thirty-eight patients with severe-to-total bilateral sensorineural hearing impairment.

INTERVENTION

Diagnostic.

MAIN OUTCOME MEASURES

The EAMFR thresholds were correlated with the mean thresholds of the intraoperative electrically evoked compound action potential (ECAP) derived by auditory nerve response telemetry and with the subjective electrical stimulation test. The intraindividual left-right similarity of the EAMFR and ECAP thresholds was investigated in 9 bilaterally implanted patients. Additionally, the correlation between auditory performance and EAMFR thresholds was investigated.

RESULTS

The EAMFR auditory nerve function test produced clear responses in all patients. The EAMFR thresholds correlated significantly with the mean ECAP thresholds (r = 0.58, p < 0.01) and the subjective electrical stimulation test (r = 0.32, p < 0.05). In the bilaterally implanted patients, there was either no side difference, or the ear with the lower preoperative EAMFR threshold also was the one with the lower intraoperative mean ECAP threshold. No correlation was found between EAMFR thresholds and postoperative speech recognition scores.

CONCLUSION

These novel results support the notion that the EAMFR auditory nerve function test is a useful objective and noninvasive tool to provide information about the responsiveness of the auditory nerve to electrical stimulation in cochlear implant candidates.

Development of brainstem-evoked responses in congenital auditory deprivation

To compare the development of the auditory system in hearing and completely acoustically deprived animals, naive congenitally deaf white cats (CDCs) and hearing controls (HCs) were investigated at different developmental stages from birth till adulthood. The CDCs had no hearing experience before the acute experiment. In both groups of animals, responses to cochlear implant stimulation were acutely assessed. Electrically evoked auditory brainstem responses (E-ABRs) were recorded with monopolar stimulation at different current levels. CDCs demonstrated extensive development of E-ABRs, from first signs of responses at postnatal (p.n.) day 3 through appearance of all waves of brainstem response at day 8 p.n. to mature responses around day 90 p.n.. Wave I of E-ABRs could not be distinguished from the artifact in majority of CDCs, whereas in HCs, it was clearly separated from the stimulus artifact. Waves II, III, and IV demonstrated higher thresholds in CDCs, whereas this difference was not found for wave V. Amplitudes of wave III were significantly higher in HCs, whereas wave V amplitudes were significantly higher in CDCs. No differences in latencies were observed between the animal groups. These data demonstrate significant postnatal subcortical development in absence of hearing, and also divergent effects of deafness on early waves II–IV and wave V of the E-ABR.

Evaluation of a novel, noninvasive, objective test of auditory nerve function in cochlear implant candidates

OBJECTIVE

To investigate whether the objective noninvasive recording of the electrically evoked amplitude modulation following response (EAMFR) can be applied for the assessment of auditory nerve function before cochlear implant surgery.

STUDY DESIGN

Prospective clinical study from January 2005 to August 2008.

SETTING

Cochlear Implant Program at the Charité University Hospital (Berlin, Germany).

PATIENTS

One hundred twenty-one patients with severe to total bilateral sensorineural hearing impairment.

INTERVENTION

Diagnostic.

MAIN OUTCOME MEASURES

All EAMFR thresholds were correlated with the mean intraoperative electrically evoked compound action potential (ECAP) thresholds. In a subgroup of 16 patients, the objective thresholds of the EAMFR were compared with the subjective auditory thresholds for the electrical stimuli applied. The intraindividual left-right concordance of the EAMFR and ECAP thresholds was investigated in 22 patients with bilateral implants.

RESULTS

The EAMFR-auditory nerve function test produced clear responses in all patients examined. The threshold of auditory perception for the applied stimuli correlated highly significantly with the EAMFR threshold (r = 0.89, p < 0.01). The correlation between the EAMFR and mean ECAP thresholds was again highly significant (r = 0.49, p < 0.01). In all patients with bilateral implants, the ear with the lower preoperative EAMFR threshold was also the one with the lower intraoperative mean ECAP threshold.

CONCLUSION

These results indicate that the objective noninvasive recording of EAMFR seems to be a useful diagnostic tool for the evaluation of the auditory nerve function in cochlear implant candidates, especially in children or in adult patients who require objective examination.

Optical stimulation of auditory neurons: effects of acute and chronic deafening

In developing neural prostheses, particular success has been realized with cochlear implants. These devices bypass damaged hair cells in the auditory system and electrically stimulate the auditory nerve directly. In contemporary cochlear implants, however, the injected electric current spreads widely along the scala tympani and across turns. Consequently, stimulation of spatially discrete spiral ganglion cell populations is difficult. In contrast to electrical stimulation, it has been shown that extremely spatially selective stimulation is possible using infrared radiation (e.g. [Izzo, A.D., Su, H.S., Pathria, J., Walsh Jr., J.T., Whitlon, D.S., Richter, C.-P., 2007a. Selectivity of neural stimulation in the auditory system: a comparison of optic and electric stimuli. J. Biomed. Opt. 12, 1-7]). Here, we explore the correlation between surviving spiral ganglion cells, following acute and chronic deafness induced by neomycin application into the middle ear, and neural stimulation using optical radiation and electrical current. In vivo experiments were conducted in gerbils. Before the animals were deafened, acoustic thresholds were obtained and neurons were stimulated with optical radiation at various pulse durations, radiation exposures, and pulse repetition rates. In one group of animals, measurements were made immediately after deafening, while the other group was tested at least four weeks after deafening. Deafness was confirmed by measuring acoustically evoked compound action potentials. Optically and electrically evoked compound action potentials and auditory brainstem responses were determined for different radiation exposures and for different electrical current amplitudes, respectively. After completion of the experiments, the animals were euthanized and the cochleae were harvested for histology. Acoustically evoked compound action potential thresholds were elevated by more than 40 dB after neomycin application in acutely deaf and more than 60 dB in chronically deaf animals. Compound action potential thresholds, which were determined with optical radiation pulses, were not significantly elevated in acutely deaf animals. However, in chronically deaf animals optically evoked CAP thresholds were elevated. Changes correlated with the number of surviving spiral ganglion cells and the optical parameters that were used for stimulation.

Effects of auditory pathway anatomy and deafness characteristics? Part 2: On electrically evoked late auditory responses

The purpose of this study was to distinguish the effects of different parameters on latencies of wave N1, wave P2, and inter-peak interval N1-P2 of electrical late auditory responses (ELARs). ELARs were recorded from four intra-cochlear electrodes in fourteen adult HiRes90K cochlear implant users who had at least three months of experience. The relationship between latencies and stimulation sites in the cochlea was characterized to assess the influence of the auditory pathway anatomy on ELARs, i.e., whether the speed of neural propagation varies according to the place that is activated in the cochlea. Audiograms before implantation, duration of deafness, and psychophysics at first fitting were used to describe the influence of deafness characteristics on latencies. The stimulation sites were found to have no effect on ELAR latency and, while there was no influence of psychophysics on latency, a strong relationship was shown with duration of deafness and the pre-implantation audiogram. Thus, ELAR latency was longer for poorer audiograms and longer durations of deafness and this relationship appeared to be independent of stimulation parameters such as stimulation site. Comparison between these findings and those from the equivalent study on EABR waves IIIe and Ve latency [Guiraud, J., Gallego, S., Arnold, L., Boyle, P., Truy, E., Collet, L., 2007. Effects of auditory pathway anatomy and deafness characteristics? (1): On electrically evoked auditory brainstem responses. Hear. Res. 223 (1-2), 48-60] shows that, while ELAR and EABR latencies are related with parameters that reflect the integrity of the auditory pathway, ELAR latency is less dependent on stimulation parameters than EABR latency.

Evaluation of hearing and auditory nerve function by combining ABR, DPOAE and eABR tests into a single recording session

In this article, we describe an efficient method for testing both auditory receptor and auditory nerve function in a single recording session. Auditory receptor function is tested in response to pure tone, tone burst and click acoustic stimuli (i.e. distortion products of otoacoustic emissions, DPOAE; and auditory-evoked brainstem responses, ABR). The function of the auditory neurons and nerve is measured in response to direct electric current stimulation (i.e. electrically evoked auditory brainstem responses, eABR). All measurements were obtained from anesthetized laboratory rats during single recording sessions using hardware and software stimulation and analysis programs developed by Intelligent Hearing Systems, Miami, FL.

Neurophysiology of cochlear implant users II: comparison among speech perception, dynamic range, and physiological measures

OBJECTIVE

The overall objective of this study was to relate electrically evoked potentials recorded from different levels of the auditory pathway with behavioral measures obtained from adult cochlear implant subjects. The hypothesis was that adult recipients of cochlear implants who have open-set speech perception and those recipients with no open-set speech perception would differ in their neurophysiologic responses recorded at one or more levels of the auditory pathway.

DESIGN

The subjects were 11 adults implanted with the Clarion cochlear implant. The electrical auditory brainstem response (EABR, Wave V), electrical auditory middle latency response (EAMLR, Na-Pa complex), and the electrical late auditory response (ELAR, N1-P2 complex), were recorded from three intra-cochlear electrodes. The stimuli used to record the evoked potentials varied in rate and amplitude. Behavioral measures (between threshold and upper limit of comfortable loudness) were used to define the subject's dynamic range at the different stimulus rates. Word and sentence recognition tests evaluated subjects' speech perception in quiet and noise. Evoked potential and behavioral measures were examined for statistical significance using analysis of variance for repeated measures and correlational analyses.

RESULTS

Subjects without open-set speech recognition demonstrated 1) poorly formed or absent evoked potential responses, 2) reduced behavioral dynamic ranges, 3) lack of change in the size of the dynamic range with a change in stimulus rate, and 4) longer periods of auditory deprivation. The variables that differentiated the best performers included 1) presence of responses at all three levels of the auditory pathway, with large normalized amplitudes for the EAMLR, 2) lower evoked potential thresholds for the Na-Pa complex, 3) relatively large dynamic ranges, and 4) changes in the size of the dynamic range with changes in stimulus rate.

CONCLUSIONS

In this study, the inability to follow changes in the temporal characteristics of the stimulus was associated with poor speech perception performance. Results also illustrate that variability in speech perception scores of cochlear implant recipients relates to neurophysiologic responses at higher cortical levels of the auditory pathway. Presumably, limited neural synchrony for elicitation of electrophysiologic responses underlies limited speech perception. Results confirm that neural encoding with electrical stimulation must provide sufficient physiologic responses of the central nervous system to perceive speech through a cochlear implant.

Sensorineural hearing loss during development: morphological and physiological response of the cochlea and auditory brainstem

We have investigated the effects of sensorineural hearing loss on the cochlea and central auditory system of profoundly deafened cats. Seventeen adult cats were used: four had normal hearing; 12 were deafened neonatally for periods of < 2.5 years (five bilaterally, seven unilaterally); and one animal had a long-term (approximately 8 years) profound bilateral hearing loss. Bipolar scala tympani stimulating electrodes were bilaterally implanted in each animal, and electrically evoked auditory brainstem responses (EABRs) were recorded in an acute study to evaluate the basic physiologic response properties of the deafened auditory pathway. The cochleae and cochlear nuclei (CN) of each animal were examined with light microscopy. Spiral ganglion cell density in neonatally deafened cochleae was 17% of normal, and only 1.5% of normal in the long-term deaf animal. There was a 46% reduction in total CN volume in neonatally deafened animals compared to normal, and a 60% reduction in the long-term deaf animal. Neural density in the anteroventral CN of bilaterally deafened animals was 37% higher than normal; 44% higher in the long-term deaf animal. Significantly, however, we saw no evidence of a loss of neurones within the anteroventral CN in any deafened animal. There was a significant increase in EABR threshold and wave IV latency in the deafened animals, and a significant decrease in response amplitude and input/output function gradient. Again, these changes were more extensive in the long-term deaf animal. These data show that a sensorineural hearing loss can evoke significant morphological and physiological changes within the cochlea and auditory brainstem, and these changes become greater with duration of deafness. It remains to be seen whether these changes can be reversed following the introduction of afferent activity via chronic electrical stimulation of the auditory nerve.

Intra- and interindividual correlations between auditory evoked potentials and speech perception in cochlear implant users

Several electrophysiological techniques have been used to supplement behavioural measurements in the evaluation of the benefit of cochlear implantation, namely the electrically evoked auditory brainstem response (EABR), electrically evoked middle latency response (EMLR) and electrically evoked late latency response (EALR). To study the interdependence of these responses, the present paper deals with a combination of EABR, EMLR and EALR measurements obtained from 15 postlingually deaf subjects implanted with the Nucleus multichannel device at the University Hospital Nijmegen. In particular, we investigated whether there were intercorrelations between amplitude and latencies of the evoked potential peaks and/or correlations with long-term speech perception scores. Significant correlations were found between the peak V amplitude of the EABR and the NaPa and NbPb amplitudes of the EMLR. No significant correlation was found between the EABR and EMLR amplitudes on the one hand and EALR peak amplitudes on the other. In addition, no significant correlations were found between any of the EABR or EMLR peak amplitudes and speech perception test results. A moderate but significant relation was found between the EALR peak amplitude and speech perception test results. Unlike latencies of earlier peaks, the latency of the EALR peak P2 was significantly related to the speech perception scores.

Electrical stimulation of the auditory nerve. I. Correlation of physiological responses with cochlear status

The purpose of the present study was to evaluate evoked potential and single fibre responses to biphasic current pulses in animals with varying degrees of cochlear pathology, and to correlate any differences in the physiological response with status of the auditory nerve. Six cats, whose cochleae ranged from normal to a severe neural loss (< 5% spiral ganglion survival), were used. Morphology of the electrically evoked auditory brainstem response (EABR) was similar across all animals, although electrophonic responses were only observed from the normal animal. In animals with extensive neural pathology, EABR thresholds were elevated and response amplitudes throughout the dynamic range were moderately reduced. Analysis of single VIIIth nerve fibre responses were based on 207 neurons. Spontaneous discharge rates among fibres depended on hearing status, with the majority of fibres recorded from deafened animals exhibiting little or no spontaneous activity. Electrical stimulation produced a monotonic increase in discharge rate, and a systematic reduction in response latency and temporal jitter as a function of stimulus intensity for all fibres examined. Short-duration current pulses elicited a highly synchronous response (latency < 0.7 ms), with a less well synchronized response sometimes present (0.7-1.1 ms). There were, however, a number of significant differences between responses from normal and deafened cochleae. Electrophonic activity was only present in recordings from the normal animal, while mean threshold, dynamic range and latency of the direct electrical response varied with cochlear pathology. Differences in the ability of fibres to follow high stimulation rates were also observed; while neurons from the normal cochlea were capable of 100% entrainment at high rates (600-800 pulses per second (pps)), fibres recorded from deafened animals were often not capable of such entrainment at rates above 400 pps. Finally, a number of fibres in deafened animals showed evidence of 'bursting', in which responses rapidly alternated between high entrainment and periods of complete inactivity. This bursting pattern was presumably associated with degenerating auditory nerve fibres, since it was not recorded from the normal animal. The present study has shown that the pathological response of the cochlea following a sensorineural hearing loss can lead to a number of significant changes in the patterns of neural activity evoked via electrical stimulation. Knowledge of the extent of these changes have important implications for the clinical application of cochlear implants.

Chronic electrical stimulation of the auditory nerve at high stimulus rates: a physiological and histopathological study

A major factor associated with recent improvements in the clinical performance of cochlear implant patients has been the development of speech-processing strategies based on high stimulation rates. While these processing strategies show clear clinical advantage, we know little of their long-term safety implications. The present study was designed to evaluate the physiological and histopathological effects of long-term intracochlear electrical stimulation using these high rates. Thirteen normal-hearing adult cats were bilaterally implanted with scala tympani electrode arrays and unilaterally stimulated for periods of up to 2100 h using either two pairs of bipolar or three monopolar stimulating electrodes. Stimuli consisted of short duration (25-50 microseconds/phase) charge-balanced biphasic current pulses presented at 1000 pulses per second (pps) per channel for monopolar stimulation, and 2000 pps/channel for bipolar stimulation. The electrodes were shorted between current pulses to minimize any residual direct current, and the pulse trains were presented using a 50% duty cycle (500 ms on; 500 ms off) in order to simulate speech. Both acoustic (ABR) and electrical (EABR) auditory brainstem responses were recorded periodically during the chronic stimulation program. All cochleas showed an increase in the click-evoked ABR threshold following implant surgery; however, recovery to near-normal levels occurred in approximately half of the stimulated cochleas 1 month post-operatively. The use of frequency-specific stimuli indicated that the most extensive hearing loss generally occurred in the high-frequency basal region of the cochlea (12 and 24 kHz) adjacent to the stimulating electrode. However, thresholds at lower frequencies (2, 4 and 8 kHz), appeared at near-normal levels despite long-term electrode implantation and electrical stimulation. Our longitudinal EABR results showed a statistically significant increase in threshold in nearly 40% of the chronically stimulated electrodes evaluated; however, the gradient of the EABR input/output (I/O) function (evoked potential response amplitude versus stimulus current) generally remained quite stable throughout the chronic stimulation period. Histopathological examination of the cochleas showed no statistically significant difference in ganglion cell densities between cochleas using monopolar and bipolar electrode configurations (P = 0.67), and no evidence of cochlear damage caused by high-rate electrical stimulation when compared with control cochleas. Indeed, there was no statistically significant relationship between spiral ganglion cell density and electrical stimulation (P = 0.459), or between the extent of loss of inner (IHC, P = 0.86) or outer (OHC, P = 0.30) hair cells and electrical stimulation. Spiral ganglion cell loss was, however, influenced by the degree of inflammation (P = 0.016) and electrode insertion trauma. These histopathological findings were consistent with the physiological data. Finally, electrode impedance, measured at completion of the chronic stimulation program, showed close correlation with the degree of tissue response adjacent to the electrode array. These results indicated that chronic intracochlear electrical stimulation, using carefully controlled charge-balanced biphasic current pulses at stimulus rates of up to 2000 pps/channel, does not appear to adversely affect residual auditory nerve elements or the cochlea in general. This study provides an important basis for the safe application of improved speech-processing strategies based on high-rate electrical stimulation.

Electric response audiometry in young children before cochlear implantation: a short latency component

OBJECTIVE

Evaluation of a short latency component (SLC) observed in profoundly deaf young children during recordings of the auditory brain stem response (ABR) before cochlear implantation.

DESIGN

Seventy young children (ages 2 to 11 yr) were investigated as part of their routine audiologic and diagnostic assessment, before cochlear implantation. The ABR was evoked using click stimuli and tone pips (500 Hz and 1 kHz) at intensity levels up to 105 dB nHL. The incidence of the SLC arising at a latency of 3 msec with high level click stimuli, in addition to residual ABR waves, was assessed.

RESULTS

An SLC was observed in a total of 18 of the 70 children investigated. It was present in 15 out of 31 congenitally deaf children (48%) compared with only 2 out of 33 children deafened after meningitis (6%). A chi-squared test employing a 2 x 2 contingency table shows that this dependency on etiology of deafness is highly statistically significant (p < 0.001). The presence of the SLC in the congenitally deaf children is related to age at the time of the Electric Response Audiometry test and is more likely to be observed in the younger child (p < 0.01).

CONCLUSIONS

Interpretation of the ABR in profoundly deaf children should take into consideration the possible presence of the SLC. An evoked potential arising from stimulation of the vestibular system, particularly the vestibular nuclei, is proposed as a likely origin for this component. Damage to sensory cells in the vestibular portion of the labyrinth might explain why an SLC is seen rarely in cases of deafness after meningitis.

Functional responses from guinea pigs with cochlear implants. II. Changes in electrophysiological and psychophysical measures over time

This study, the second of a two-part investigation, assessed changes over time in functional measures of the electrically stimulated auditory system following ototoxic deafening. Guinea pigs were trained to respond behaviorally to threshold level acoustic stimuli and then unilaterally deafened and implanted with a bipolar pair of electrodes within the cochlea and a single extracochlear electrode. Using pulsatile stimuli, thresholds for the electrically evoked auditory brainstem response (EABR) and psychophysical detection were repeatedly collected from the same animals over 3-month post-implantation periods. Thresholds were obtained as a function of stimulus phase duration primarily using bipolar intracochlear stimulation. As in earlier studies, the threshold measures exhibited both intra- and intersubject variability. Analysis of group data failed to show any statistically significant changes over time in either EABR or psychophysical threshold at any fixed pulse duration. However, significant changes over time were found in the slopes of the strength-duration functions for both measures. Slopes became shallower with time, suggesting a reduction in the efficiency of stimulus current integration, a trend presumed to occur with neural degeneration. This result suggests that strength-duration functions could be useful as a clinical diagnostic measure.

Electrically evoked auditory brainstem response in peripherally myelin-deficient mice

The integrity of the myelin sheath is important for normal electrophysiological function and survival of neurons that make up the auditory nerve. It is hypothesized that myelin deficiency of the auditory nerve may change the electrophysiologic characteristics of the auditory system, especially the temporal properties. In this study, the electrically evoked auditory brainstem response (EABR) was systematically evaluated in TrJ and Po-DT-A mice. Both of these mice have a deficit of their peripheral myelin. Correlation between the EABR and degree of myelin deficiency was also evaluated. The EABR in both strains of poorly myelinated mice exhibited prolonged latency, decreased amplitude, elevated threshold of wave I evoked by short-duration stimuli (20 microseconds/phase). A 2-pulse stimulation paradigm was used to evaluate refractory properties. Myelin-deficient mice exhibited slower recovery from the refractory state than controls. Long-duration stimuli (4 ms/phase) were used to assess integration properties. Myelin-deficient mice demonstrated prolonged wave I latency and more gradual latency changes with current level. Myelin thickness showed a strong correlation with EABR threshold for short-duration stimulation (r = -0.784), maximum wave I latency (r = -0.778) and the time constant of the wave I latency-current level function (r = -0.736) for long-duration stimulation and normalized wave I recovery functions (r = -0.718). These findings suggest that EABR measurement may be a promising tool to assess the electrically stimulated properties of auditory neurons, particularly related to the status of myelin sheath.

Auditory brain-stem responses evoked by electrical stimulation of the cochlear nucleus in human subjects

When auditory nerve function is lost due to surgical removal of bilateral acoustic tumors, a sense of hearing may be restored by means of an auditory brain-stem implant (ABI), which electrically stimulates the auditory pathway at the level of the cochlear nucleus. Placement of the stimulating electrodes during surgical implantation may be aided by electrically evoked auditory brain-stem responses (EABRs) recorded intra-operatively. To establish preliminary standards for human EABRs evoked by electrical stimulation of the cochlear nucleus, short-latency evoked potentials were recorded from 6 ABI patients who were either already implanted or undergoing implantation surgery. Neural responses were distinguished from stimulus artifact and equipment artifact by their properties during stimulus polarity reversal and amplitude variation. Other properties contributed to further identification of the evoked potentials as auditory responses (EABRs). The response waveforms generally had 2 or 3 waves. The peak latencies of these waves (approximately 0.3, 1.3, and 2.2 msec) and the brain-stem localization of the region from which they could be elicited are consistent with auditory brain-stem origin.

The use of long-duration current pulses to assess nerve survival

This study investigated the usefulness of long-duration current pulses in assessing the status of the auditory nerve in ears with various degrees of retrograde neural degeneration. Guinea pigs were deafened with aminoglycosides prior to acute implantation of the cochlea and collection of electrically evoked auditory brainstem responses (EABRs). Analysis of wave I evoked with long-duration current pulses suggests that this evoked response is sensitive to degeneration of the peripheral processes of the auditory nerve. Correlations with spiral ganglion cell density show that EABR measures obtained with long-duration pulses are comparable to those previously established for estimating nerve survival. Further analysis indicates that this measure may provide unique information about the degenerative state of the nerve. Threshold EABR measures using long-duration pulses are evidently more place-specific than other measures. Also, results suggest that long-duration pulses may be sensitive to two phases of the degenerative process: degradation of the peripheral processes and subsequent degeneration of neural processes central to the spiral ganglion.

Spatio-temporal source modeling of evoked potentials to acoustic and cochlear implant stimulation

Spatio-temporal source modeling (STSM) of event-related potentials was used to estimate the loci and characteristics of cortical activity evoked by acoustic stimulation in normal hearing subjects and by electrical stimulation in cochlear implant (CI) subjects. In both groups of subjects, source solutions obtained for the N1/P2 complex were located in the superior half of the temporal lobe in the head model. Results indicate that it may be possible to determine whether stimulation of different implant channels activates different regions of cochleotopically organized auditory cortex. Auditory system activation can be assessed further by examining the characteristics of the source wave forms. For example, subjects whose cochlear implants provided auditory sensations and normal hearing subjects had similar source activity. In contrast, a subject in whom implant activation evoked eyelid movements exhibited different source wave forms. STSM analysis may provide an electrophysiological technique for guiding rehabilitation programs based on the capabilities of the individual implant user and for disentangling the complex response patterns to electrical stimulation of the brain.

Cochlear pathology following chronic electrical stimulation of the auditory nerve. I: Normal hearing kittens

The present study examines the histopathological effects of long-term intracochlear electrical stimulation in young normal hearing animals. Eight-week old kittens were implanted with scala tympani electrode arrays and stimulated for periods of up to 1500 h using charge balanced biphasic current pulses at charge densities in the range 21-52 microC cm-2 geom. per phase. Both click and electrically evoked auditory brainstem responses were periodically recorded to monitor the status of the hair cell and spiral ganglion cell populations. In addition, the impedance of the stimulating electrodes was measured daily to monitor their electrical characteristics during chronic implantation. Histopathological examination of the cochleas showed no evidence of stimulus induced damage to cochlear structures when compared with implanted, unstimulated control cochleas. Indeed, there was no statistically significant difference in the ganglion cell density adjacent to the stimulating electrodes when compared with a similar population in implanted control cochleas. In addition, hair cell loss, which was restricted to regions adjacent to the electrode array, was not influenced by the degree of electrical stimulation. These histopathological findings were consistent with the evoked potential recordings. Finally, electrode impedance data correlated well with the degree of tissue growth observed within the scala tympani. The present findings indicate that the young mammalian cochlea is no more susceptible to cochlear pathology following chronic implantation and electrical stimulation than is the adult.

Prediction of behavioral threshold and comfort values for Nucleus 22-channel implant patients from electrical auditory brain stem response test results

We have studied the prediction of behavioral threshold and comfort values for 11 patients who use the Nucleus 22-channel cochlear implant by means of the results of electrical auditory brain stem response (EABR) procedures. For prediction purposes, EABR and behavioral testing were done in the same electrode mode configuration for three specific electrodes. The results of this investigation suggest that EABR threshold current level is consistently near the behavioral comfort current level, rather than the patient's behavioral threshold level.

Estimation of surviving spiral ganglion cells in the deaf rat using the electrically evoked auditory brainstem response

A procedure was developed to record the electrically evoked auditory brainstem response (EABR) in the rat with sufficiently little stimulus artifact to permit systematic measurements of the first positive wave (P1), the compound action potential (CAP) of the auditory nerve. Our principal aim was to verify the theoretical prediction that maximum P1 amplitude is directly proportional to the number of excitable auditory nerve fibers. This was carried out in animals with graded lesions of the spiral ganglion induced by perfusion of the cochlea with different concentrations of neomycin. Two series of observations confirmed the theoretical prediction. Several measures of P1, including maximum amplitude, and slopes of the P1 and P1-N1 growth functions, were highly correlated with the number of surviving spiral ganglion cells. Correlation coefficients (r) ranged from 0.75 to 0.92. Amplitudes of the later waves exhibited much lower correlations with spiral ganglion cell counts. These findings suggest that measurement of the CAP in deaf humans, possibly as wave I of the EABR, should provide quantitative information about the status of the nerve, which could be useful in screening candidates for cochlear implants, prescribing the optimum device for individual patients, and determining how benefits derived from such devices relate to the condition of the auditory nerve.

Estimation of surviving spiral ganglion cells in the deaf rat using the electrically evoked auditory brainstem response

A procedure was developed to record the electrically evoked auditory brainstem response (EABR) in the rat with sufficiently little stimulus artifact to permit systematic measurements of the first positive wave (P1), the compound action potential (CAP) of the auditory nerve. Our principal aim was to verify the theoretical prediction that maximum P1 amplitude is directly proportional to the number of excitable auditory nerve fibers. This was carried out in animals with graded lesions of the spiral ganglion induced by perfusion of the cochlea with different concentrations of neomycin. Two series of observations confirmed the theoretical prediction. Several measures of P1, including maximum amplitude, and slopes of the P1 and P1-N1 growth functions, were highly correlated with the number of surviving spiral ganglion cells. Correlation coefficients (r) ranged from 0.75 to 0.92. Amplitudes of the later waves exhibited much lower correlations with spiral ganglion cell counts. These findings suggest that measurement of the CAP in deaf humans, possibly as wave I of the EABR, should provide quantitative information about the status of the nerve, which could be useful in screening candidates for cochlear implants, prescribing the optimum device for individual patients, and determining how benefits derived from such devices relate to the condition of the auditory nerve.

Evaluation of eighth nerve integrity by the electrically evoked middle latency response

A reliable objective test for estimating the number and distribution of surviving eighth nerve fibers needs to be identified for selection of candidates for cochlear implantation. Kanamycin and ethacrynic acid administration in guinea pigs resulted in graded amounts of eighth nerve degeneration over time. The electrically-induced middle latency response (EMLR) was acutely recorded in these animals at specific post-drug times, followed by the immediate killing of the animals, histologic preparation, and spiral ganglion cell density determination. Significant progressive spiral ganglion cell loss was noted by 4 weeks that increased over time. While EMLR threshold remained stable over time, the slope of the EMLR input/output function decreased with increasing post-drug intervals in a manner directly correlated with reduction in spiral ganglion cell density.