Chronic electrical stimulation of the auditory nerve using non-charge-balanced stimuli

Effects of pulse shape on pitch sensitivity of cochlear implant users

Contemporary cochlear implants (CIs) use cathodic-leading symmetric biphasic (C-BP) pulses for electrical stimulation. It remains unclear whether asymmetric pulses emphasizing the anodic or cathodic phase may improve spectral and temporal coding with CIs. This study tested place- and temporal-pitch sensitivity with C-BP, anodic-centered triphasic (A-TP), and cathodic-centered triphasic (C-TP) pulse trains on apical, middle, and basal electrodes in 10 implanted ears. Virtual channel ranking (VCR) thresholds (for place-pitch sensitivity) were measured at both a low and a high pulse rate of 99 (Experiment 1) and 1000 (Experiment 2) pulses per second (pps), and amplitude modulation frequency ranking (AMFR) thresholds (for temporal-pitch sensitivity) were measured at a 1000-pps pulse rate in Experiment 3. All stimuli were presented in monopolar mode. Results of all experiments showed that detection thresholds, most comfortable levels (MCLs), VCR thresholds, and AMFR thresholds were higher on more basal electrodes. C-BP pulses had longer active phase duration and thus lower detection thresholds and MCLs than A-TP and C-TP pulses. Compared to C-TP pulses, A-TP pulses had lower detection thresholds at the 99-pps but not the 1000-pps pulse rate, and had lower MCLs at both pulse rates. A-TP pulses led to lower VCR thresholds than C-BP pulses, and in turn than C-TP pulses, at the 1000-pps pulse rate. However, pulse shape did not affect VCR thresholds at the 99-pps pulse rate (possibly due to the fixed temporal pitch) or AMFR thresholds at the 1000-pps pulse rate (where the overall high performance may have reduced the changes with different pulse shapes). Notably, stronger polarity effect on VCR thresholds (or more improvement in VCR with A-TP than with C-TP pulses) at the 1000-pps pulse rate was associated with stronger polarity effect on detection thresholds at the 99-pps pulse rate (consistent with more degeneration of auditory nerve peripheral processes). The results suggest that A-TP pulses may improve place-pitch sensitivity or spectral coding for CI users, especially in situations with peripheral process degeneration.

NeurostimML: a machine learning model for predicting neurostimulation-induced tissue damage

Objective. The safe delivery of electrical current to neural tissue depends on many factors, yet previous methods for predicting tissue damage rely on only a few stimulation parameters. Here, we report the development of a machine learning approach that could lead to a more reliable method for predicting electrical stimulation-induced tissue damage by incorporating additional stimulation parameters.Approach. A literature search was conducted to build an initial database of tissue response information after electrical stimulation, categorized as either damaging or non-damaging. Subsequently, we used ordinal encoding and random forest for feature selection, and investigated four machine learning models for classification: Logistic Regression, K-nearest Neighbor, Random Forest, and Multilayer Perceptron. Finally, we compared the results of these models against the accuracy of the Shannon equation.Main Results. We compiled a database with 387 unique stimulation parameter combinations collected from 58 independent studies conducted over a period of 47 years, with 195 (51%) categorized as non-damaging and 190 (49%) categorized as damaging. The features selected for building our model with a Random Forest algorithm were: waveform shape, geometric surface area, pulse width, frequency, pulse amplitude, charge per phase, charge density, current density, duty cycle, daily stimulation duration, daily number of pulses delivered, and daily accumulated charge. The Shannon equation yielded an accuracy of 63.9% using akvalue of 1.79. In contrast, the Random Forest algorithm was able to robustly predict whether a set of stimulation parameters was classified as damaging or non-damaging with an accuracy of 88.3%.Significance. This novel Random Forest model can facilitate more informed decision making in the selection of neuromodulation parameters for both research studies and clinical practice. This study represents the first approach to use machine learning in the prediction of stimulation-induced neural tissue damage, and lays the groundwork for neurostimulation driven by machine learning models.

A 14-Bit, 12 V-to-100 V Voltage Compliance Electrical Stimulator with Redundant Digital Calibration

Electrical stimulation is an important technique for modulating the functions of the nervous system through electrical stimulus. To implement a more competitive prototype that can tackle the domain-specific difficulties of existing electrical stimulators, three key techniques are proposed in this work. Firstly, a load-adaptive power saving technique called over-voltage detection is implemented to automatically adjust the supply voltage. Secondly, redundant digital calibration (RDC) is proposed to improve current accuracy and ensure safety during long-term electrical stimulation without costing too much circuit area and power. Thirdly, a flexible waveform generator is designed to provide arbitrary stimulus waveforms for particular applications. Measurement results show the stimulator can adjust the supply voltage from 12 V to 100 V automatically, and the measured effective resolution of the stimulation current reaches 14 bits in a full range of 6.5 mA. Without applying charge balancing techniques, the average mismatch between the cathodic and anodic current pulses in biphasic stimulus is 0.0427%. The proposed electrical stimulator can generate arbitrary stimulus waveforms, including sine, triangle, rectangle, etc., and it is supposed to be competitive for implantable and wearable devices.

Neurostimulators for high-resolution artificial retina: ASIC design challenges and solutions

Objective.Neurostimulator is one of the most important part in artificial retina design. In this paper, we discuss the main challenges in the design of application-specific integrated circuit for high-resolution artificial retina and suggest corresponding solutions.Approach. Problems in the design of the neurostimulator for the existing artificial retina have not been solved yet are analyzed and solutions are presented. For verification of the solutions, mathematical proof, MATLAB and Ansys simulations are used.Main results. The drawbacks of resorting to a high-voltage complementary metal oxide semiconductor (CMOS) process to deal with the large voltage compliance demanded by the stimulator output stage are pointed out, and an alternative approach based on a circuit that switches the voltage of the common reference electrode is proposed to overcome. The necessity of an active discharge circuit to remove the residual charge of electrodes caused by an unbalanced stimulus is investigated. We present a circuit analysis showing that the use of a passive discharge circuit is sufficient to suppress problematic direct current in most situations. Finally, possible restrictions on input and output (I/O) count are investigated by estimating the resistive-capacitive delay caused by the interconnection between the I/O pad and the microelectrode array.Significance. The results of this paper clarified the problems currently faced by neurostimulator design for the artificial retina. Through the solutions presented in this study, circuits with more competitiveness in power and area consumption can be designed.

Multichannel stimulation module as a tool for animal studies on cortical neural prostheses

Intracortical microstimulation to the visual cortex is thought to be a feasible technique for inducing localized phosphenes in patients with acquired blindness, and thereby for visual prosthesis. In order to design effective stimuli for the prosthesis, it is important to elucidate relationships between the spatio-temporal patterns of stimuli and the resulting neural responses and phosphenes through pre-clinical animal studies. However, the physiological basis of effective spatial patterns of the stimuli for the prosthesis has been little investigated in the literature, at least partly because that the previously developed multi-channel stimulation systems were designed specifically for the clinical use. In the present, a 64-channel stimulation module was developed as a scalable tool for animal experiments. The operations of the module were verified by not only dry-bench tests but also physiological animal experiments in vivo. The results demonstrated its usefulness for examining the stimulus-response relationships in a quantitative manner, and for inducing the multi-site neural excitations with a multi-electrode array. In addition, this stimulation module could be used to generate spatially patterned stimuli with up to 4,096 channels in a dynamic way, in which the stimulus patterns can be updated at a certain frame rate in accordance with the incoming visual scene. The present study demonstrated that our stimulation module is applicable to the physiological and other future studies in animals on the cortical prostheses.

Predicting Cochlear Implant Electrode Placement Using Monopolar, Three-Point and Four-Point Impedance Measurements

OBJECTIVE

This study aimed to investigate the relationship between cochlear implant (CI) electrode distances to the cochleas inner wall (the modiolus) and electrical impedance measurements made at the CIs electrode contacts. We introduced a protocol for three-point impedances in which we recorded bipolar impedances in response to monopolar stimulation at a neighboring electrode. We aimed to assess the usability of three-point impedances and two existing CI impedance measurement methods (monopolar and four-point impedances) for predicting electrode positioning during CI insertion.

METHODS

Impedances were recorded during stepwise CI electrode array insertions in cadaveric human temporal bones. The positioning of the electrodes with respect to the modiolus was assessed at each step using cone beam computed tomography. Linear mixed regression analysis was performed to assess the relationship between the impedances and electrode-modiolar distances. The experimental results were compared to clinical impedance data and to an existing lumped-element model of an implanted CI.

RESULTS

Three-point and four-point impedances strongly correlated with electrode-modiolar distance. In contrast, monopolar impedances were only minimally affected by changes in electrode positioning with respect to the modiolus. An overall model specificity of 62% was achieved when incorporating all impedance parameters. This specificity could be increased beyond 73% when prior expectations of electrode positioning were incorporated in the model.

CONCLUSION

Three-point and four-point impedances are promising measures to predict electrode-modiolar distance in real-time during CI insertion.

SIGNIFICANCE

This work shows how electrical impedance measurements can be used to predict the CIs electrode positioning in a biologically realistic model.

Real-Time Localization of Cochlear-Implant Electrode Arrays Using Bipolar Impedance Sensing

OBJECTIVE

Surgeons have no direct objective feedback on cochlear-implant electrode array (EA) positioning during insertion, yet optimal hearing outcomes are contingent on placing the EA as close as feasible to viable neural endings. This paper describes a system to non-invasively determine intracochlear positioning of an EA, without requiring any modifications to existing commercial EAs themselves.

METHODS

Electrical impedance has been suggested as a way to measure EA proximity to the inner wall of the cochlea that houses auditory nerve endings-the modiolus. In this paper, we extend prior work and demonstrate for the first time the relationship between bipolar access resistance and proximity of the EA to the modiolus (E-M proximity). We also evaluate two methods for producing direct, real-time estimates of E-M proximity from bipolar impedance measurements.

RESULTS

We show that bipolar access resistance is highly correlated with E-M proximity and can be approximately modeled by a power law function. This one dimensional model is shown to be capable of producing accurate real-time estimates of E-M proximity, but its simplicity also limits the potential for future improvement. To address this challenge, we propose a new prediction approach based on a recurrent neural network, which generated an overall prediction accuracy of 93.7%.

CONCLUSION

Bipolar access resistance is highly correlated with E-M proximity, and can be used to estimate EA positioning.

SIGNIFICANCE

This work shows how impedance sensing can be used to localize an EA during insertion into the small, enclosed cochlear environment, without requiring any modifications to existing clinically used EAs.

Electrochemical microelectrode degradation monitoring: in situ investigation of platinum corrosion at neutral pH

OBJECTIVE

The stability of platinum and other noble metal electrodes is critical for neural implants, electrochemical sensors, and energy sources. Beyond the acidic or alkaline environment found in most electrochemical studies, the investigation of electrode corrosion in neutral pH and chloride containing electrolytes is essential, particularly regarding the long-term stability of neural interfaces, such as brain stimulation electrodes or cochlear implants. In addition, the increased use of microfabricated devices demands the investigation of thin-film electrode stability.

APPROACH

We developed a procedure of electrochemical methods for continuous tracking of electrode degradation in situ over the complete life cycle of platinum thin-film microelectrodes in a unique combination with simultaneous chemical sensing. We used chronoamperometry and cyclic voltammetry to measure electrode surface and analyte redox processes, together with accelerated electrochemical degradation.

MAIN RESULTS

We compared degradation between thin-film microelectrodes and bulk electrodes, neutral to acidic pH, different pulsing schemes, and the presence of the redox active species oxygen and hydrogen peroxide. Results were confirmed by mechanical profilometry and microscopy to determine material changes on a nanometer scale. We found that electrode degradation is mainly driven by repeated formation and removal of the platinum surface oxide, also within the electrochemical stability window of water. There was no considerable difference between thin-film micro- and macroscopic bulk electrodes or in the presence of reactive species, whereas acidic pH or extending the potential window led to increased degradation.

SIGNIFICANCE

Our results provide valuable fundamental information on platinum microelectrode degradation under conditions found in biomedical applications. For the first time, we deployed a unified method to report quantitative data on electrode degradation up to a defined endpoint. Our method is a widely applicable framework for comparative long-term studies of sensor and neural interface stability.

Effects of electrical pulse polarity shape on intra cochlear neural responses in humans: Triphasic pulses with anodic and cathodic second phase

Modern cochlear implants employ charge-balanced biphasic and triphasic pulses. However, the effectiveness of electrical pulse shape and polarity is still a matter of debate. For this purpose, a previous study (Bahmer & Baumann, 2013) conducted electrophysiological and psychophysical measurements following triphasic pulse stimulation with constant cathodic second phase and varying anodic first and third phases. Pulse stimulation with constant anodic second phase was not investigated. Therefore, in this study, pulse stimulation with cathodic and anodic second phase was applied for the recording of electrically evoked compound action potentials (ECAPs) as well as for psychophysical thresholds in cochlear implant (CI) recipients. First it was investigated whether the temporal polarity distribution has a different effect on neuronal stimulation when the second phase is cathodic or anodic; second, whether the electrophysiological and psychophysical results show a comparable difference between triphasic stimulation with anodic and cathodic second phases. The results showed that variation of the temporal polarity distribution of the triphasic pulse had a smaller effect on the ECAP response when the second phase was anodic compared to when it was cathodic, whereas for psychophysical detection thresholds this variation had a similar effect for both polarities. While electrophysiological responses and psychophysical detection thresholds showed a high correlation for variations of the triphasic pulse with cathodic second phase, the results for variations of the triphasic pulse with anodic second phase showed only moderate correlation. Furthermore, the difference between triphasic stimulation with cathodic and anodic second phases did not correlate between the electrophysiological and psychophysical results. In summary, after stimulation with different configurations of triphasic pulses used in the present study, the polarity of the second phase has an effect on electrophysiological response at suprathreshold level but not on the psychophysical detection thresholds. Thus, at different stimulation levels a possible substitution of the psychophysical test by an electrophysiological measurement (e.g. neural health measurement of the cochlea) could not be corroborated by the present results.

On the DC Offset Current Generated during Biphasic Stimulation: Experimental Study

This paper deals with the DC offset currents generated by a platinum electrode matrix during biphasic stimulation. A fully automated test bench evaluates the nanoampere range DC offset currents in a realistic and comprehensive scenario by using platinum electrodes in a saline solution as a load for the stimulator. Measurements are performed on different stimulation patterns for single or dual hexagonal stimulation sites operating simultaneously and alternately. The effectiveness of the return electrode presence in reducing the DC offset current is considered. Experimental results show how for a defined nominal injected charge, the generated DC offset currents differ depending on the stimulation patterns, frequency, current amplitude, and pulse width of a biphasic signal.

The development of neural stimulators: a review of preclinical safety and efficacy studies

OBJECTIVE

Given the rapid expansion of the field of neural stimulation and the rigorous regulatory approval requirements required before these devices can be applied clinically, it is important that there is clarity around conducting preclinical safety and efficacy studies required for the development of this technology.

APPROACH

The present review examines basic design principles associated with the development of a safe neural stimulator and describes the suite of preclinical safety studies that need to be considered when taking a device to clinical trial.

MAIN RESULTS

Neural stimulators are active implantable devices that provide therapeutic intervention, sensory feedback or improved motor control via electrical stimulation of neural or neuro-muscular tissue in response to trauma or disease. Because of their complexity, regulatory bodies classify these devices in the highest risk category (Class III), and they are therefore required to go through a rigorous regulatory approval process before progressing to market. The successful development of these devices is achieved through close collaboration across disciplines including engineers, scientists and a surgical/clinical team, and the adherence to clear design principles. Preclinical studies form one of several key components in the development pathway from concept to product release of neural stimulators. Importantly, these studies provide iterative feedback in order to optimise the final design of the device. Key components of any preclinical evaluation include: in vitro studies that are focussed on device reliability and include accelerated testing under highly controlled environments; in vivo studies using animal models of the disease or injury in order to assess efficacy and, given an appropriate animal model, the safety of the technology under both passive and electrically active conditions; and human cadaver and ex vivo studies designed to ensure the device's form factor conforms to human anatomy, to optimise the surgical approach and to develop any specialist surgical tooling required.

SIGNIFICANCE

The pipeline from concept to commercialisation of these devices is long and expensive; careful attention to both device design and its preclinical evaluation will have significant impact on the duration and cost associated with taking a device through to commercialisation. Carefully controlled in vitro and in vivo studies together with ex vivo and human cadaver trials are key components of a thorough preclinical evaluation of any new neural stimulator.

The effect of polarity order and electrode-activation order on loudness in cochlear implant users

This study examined the interaction between polarity and electrode-activation order on loudness in cochlear implant users. Pulses were presented with the polarity of the leading phase alternating or constant across channels. Electrode-activation order was either consecutive or staggered. Staggered electrode-activation orders required less current for equal loudness than consecutive orders with constant polarity. Consecutive electrode-activation orders required less current than staggered orders with alternating polarity. The results support the hypothesis that crosstalk between channels can interfere with or facilitate neuronal activation depending on polarity.

Utilization of Nerve Integrity Monitor for Promontory Stimulation Testing Prior to Cochlear Implant

OBJECTIVE

To demonstrate the feasibility of a nerve integrity monitor as a tool for promontory stimulation testing in patients with profound sensorineural hearing loss considering cochlear implantation.

PATIENTS

Adult patients considered for cochlear implantation with no auditory response on audiometric testing INTERVENTION:: Promontory stimulation testing using the nerve integrity monitor.

MAIN OUTCOME MEASURE

By using a facial nerve stimulator and the nerve integrity monitor, transtympanic promontory stimulation testing was performed to assess auditory nerve function and determine candidacy for cochlear implantation. Patients indicated if they heard the stimulus.

RESULTS

Of the four patients completing the promontory stimulation tests, three patients heard the stimulus and one patient did not hear the stimulus. Of the three patients with a positive stimulation test, two patients have a history of progressive profound sensorineural hearing loss and one patient had a history of severe blunt temporal bone trauma. Two of these patients proceeded with cochlear implantation. The patient who had a negative promontory stimulation test has a history of neurofibromatosis type 2.

CONCLUSION

The nerve integrity monitor is a convenient tool that can be used in the clinic setting to perform promontory stimulation tests and aid in determining cochlear implant candidates, specifically in those patients who require verification of auditory nerve function. This tool is a feasible and reasonable method for promontory stimulation testing.

A High-Voltage-Tolerant and Precise Charge-Balanced Neuro-Stimulator in Low Voltage CMOS Process

This paper presents a 4 × V_DD neuro-stimulator in a 0.18- μm 1.8 V/3.3 V CMOS process. The self-adaption bias technique and stacked MOS configuration are used to prevent transistors from the electrical overstress and gate-oxide reliability issue. A high-voltage-tolerant level shifter with power-on protection is used to drive the neuro-stimulator The reliability measurement of up to 100 million periodic cycles with 3000- μA biphasic stimulations in 12-V power supply has verified that the proposed neuro-stimulator is robust. Precise charge balance is achieved by using a novel current memory cell with the dual calibration loops and leakage current compensation. The charge mismatch is down to 0.25% over all the stimulus current ranges (200-300 μA) The residual average dc current is less than 6.6 nA after shorting operation.

Capacitive Feedthroughs for Medical Implants

Important technological advances in the last decades paved the road to a great success story for electrically stimulating medical implants, including cochlear implants or implants for deep brain stimulation. However, there are still many challenges in reducing side effects and improving functionality and comfort for the patient. Two of the main challenges are the wish for smaller implants on one hand, and the demand for more stimulation channels on the other hand. But these two aims lead to a conflict of interests. This paper presents a novel design for an electrical feedthrough, the so called capacitive feedthrough, which allows both reducing the size, and increasing the number of included channels. Capacitive feedthroughs combine the functionality of a coupling capacitor and an electrical feedthrough within one and the same structure. The paper also discusses the progress and the challenges of the first produced demonstrators. The concept bears a high potential in improving current feedthrough technology, and could be applied on all kinds of electrical medical implants, even if its implementation might be challenging.

Response profiles of murine spiral ganglion neurons on multi-electrode arrays

OBJECTIVE

Cochlear implants (CIs) have become the gold standard treatment for deafness. These neuroprosthetic devices feature a linear electrode array, surgically inserted into the cochlea, and function by directly stimulating the auditory neurons located within the spiral ganglion, bypassing lost or not-functioning hair cells. Despite their success, some limitations still remain, including poor frequency resolution and high-energy consumption. In both cases, the anatomical gap between the electrode array and the spiral ganglion neurons (SGNs) is believed to be an important limiting factor. The final goal of the study is to characterize response profiles of SGNs growing in intimate contact with an electrode array, in view of designing novel CI devices and stimulation protocols, featuring a gapless interface with auditory neurons.

APPROACH

We have characterized SGN responses to extracellular stimulation using multi-electrode arrays (MEAs). This setup allows, in our view, to optimize in vitro many of the limiting interface aspects between CIs and SGNs.

MAIN RESULTS

Early postnatal mouse SGN explants were analyzed after 6-18 days in culture. Different stimulation protocols were compared with the aim to lower the stimulation threshold and the energy needed to elicit a response. In the best case, a four-fold reduction of the energy was obtained by lengthening the biphasic stimulus from 40 μs to 160 μs. Similarly, quasi monophasic pulses were more effective than biphasic pulses and the insertion of an interphase gap moderately improved efficiency. Finally, the stimulation with an external electrode mounted on a micromanipulator showed that the energy needed to elicit a response could be reduced by a factor of five with decreasing its distance from 40 μm to 0 μm from the auditory neurons.

SIGNIFICANCE

This study is the first to show electrical activity of SGNs on MEAs. Our findings may help to improve stimulation by and to reduce energy consumption of CIs and thereby contribute to the development of fully implantable devices with better auditory resolution in the future.

Tinnitus Suppression by Intracochlear Electrical Stimulation in Single-Sided Deafness: A Prospective Clinical Trial - Part I

Cochlear implantation is a viable treatment option for tinnitus, but the underlying mechanism is yet unclear. Is the tinnitus suppression due to the reversal of the assumed maladaptive neuroplasticity or is it the shift in attention from the tinnitus to environmental sounds and therefore a reduced awareness that reduces tinnitus perception? In this prospective trial, 10 patients with single-sided deafness were fitted with a cochlear implant to investigate the effect of looped intracochlear electrical stimulation (i.e. stimulation that does not encode environmental sounds) on tinnitus, in an effort to find optimal stimulation parameters. Variables under investigation were: amplitude (perceived stimulus loudness), anatomical location inside the cochlea (electrode/electrodes), amplitude modulation, polarity (cathodic/anodic first biphasic stimulation) and stimulation rate. The results suggest that tinnitus can be reduced with looped electrical stimulation, in some cases even with inaudible stimuli. The optimal stimuli for tinnitus suppression appear to be subject specific. However, medium-to-loud stimuli suppress tinnitus significantly better than soft stimuli, which partly can be explained by the masking effect. Although the long-term effects on tinnitus would still have to be investigated and will be described in part II, intracochlear electrical stimulation seems a potential treatment option for tinnitus in this population.

Revisiting the cochlear and central mechanisms of tinnitus and therapeutic approaches

This short review aims at revisiting some of the putative mechanisms of tinnitus. Cochlear-type tinnitus is suggested to result from aberrant activity generated before or at the cochlear nerve level. It is proposed that outer hair cells, through their role in regulating the endocochlear potential, can contribute to the enhancement of cochlear spontaneous activity. This hypothesis is attractive as it provides a possible explanation for cochlear tinnitus of different aetiologies, such as tinnitus produced by acute noise trauma, intense low-frequency sounds, middle-ear dysfunction or temporomandibular joint disorders. Other mechanisms, namely an excitatory drift in the operating point of the inner hair cells and activation of NMDA receptors, are also briefly reported. Central-type tinnitus is supposed to result from aberrant activity generated in auditory centres, i.e. in these patients, the tinnitus-related activity does not pre-exist in the cochlear nerve. A reduction in cochlear activity due to hearing loss is suggested to produce tinnitus-related plastic changes, namely cortical reorganisation, thalamic neuron hyperpolarisation, facilitation of non-auditory inputs and/or increase in central gain. These central changes can be associated with abnormal patterns of spontaneous activity in the auditory pathway, i.e. hyperactivity, hypersynchrony and/or oscillating activity. Therapeutic approaches aimed at reducing cochlear activity and/or tinnitus-related central changes are discussed.

A novel biphasic-current-pulse calibration technique for electrical neural stimulation

One of the major challenge in neural prosthetic device design is to ensure charge-balanced stimulation. This paper presents a new calibration technique to minimize the mismatch between anodic and cathodic current amplitudes. The proposed circuit mainly consists of a digital and an analog calibration, where a successive approximation register (SAR) logic and a comparator are used in digital calibration while a source follower is adopted in analog calibration. With a 0.18 μm high voltage CMOS process, the simulation shows that the maximum current mismatch is 45 nA (<0.05%).

Suppression of putative tinnitus-related activity by extra-cochlear electrical stimulation

Studies on animals have shown that noise-induced hearing loss is followed by an increase of spontaneous firing at several stages of the central auditory system. This central hyperactivity has been suggested to underpin the perception of tinnitus. It was shown that decreasing cochlear activity can abolish the noise-induced central hyperactivity. This latter result further suggests that an approach consisting of reducing cochlear activity may provide a therapeutic avenue for tinnitus. In this context, extra-cochlear electric stimulation (ECES) may be a good candidate to modulate cochlear activity and suppress tinnitus. Indeed, it has been shown that a positive current applied at the round window reduces cochlear nerve activity and can suppress tinnitus reliably in tinnitus subjects. The present study investigates whether ECES with a positive current can abolish the noise-induced central hyperactivity, i.e., the putative tinnitus-related activity. Spontaneous and stimulus-evoked neural activity before, during and after ECES was assessed from single-unit recordings in the inferior colliculus of anesthetized guinea pigs. We found that ECES with positive current significantly decreases the spontaneous firing rate of neurons with high characteristic frequencies, whereas negative current produces the opposite effect. The effects of the ECES are absent or even reversed for neurons with low characteristic frequencies. Importantly, ECES with positive current had only a marginal effect on thresholds and tone-induced activity of collicular neurons, suggesting that the main action of positive current is to modulate the spontaneous firing. Overall, cochlear electrical stimulation may be a viable approach for suppressing some forms of (peripheral-dependent) tinnitus.

Direct current contamination of kilohertz frequency alternating current waveforms

Kilohertz frequency alternating current (KHFAC) waveforms are being evaluated in a variety of physiological settings because of their potential to modulate neural activity uniquely when compared to frequencies in the sub-kilohertz range. However, the use of waveforms in this frequency range presents some unique challenges regarding the generator output. In this study we explored the possibility of undesirable contamination of the KHFAC waveforms by direct current (DC). We evaluated current- and voltage-controlled KHFAC waveform generators in configurations that included a capacitive coupling between generator and electrode, a resistive coupling and combinations of capacitive with inductive coupling. Our results demonstrate that both voltage- and current-controlled signal generators can unintentionally add DC-contamination to a KHFAC signal, and that capacitive coupling is not always sufficient to eliminate this contamination. We furthermore demonstrated that high value inductors, placed in parallel with the electrode, can be effective in eliminating DC-contamination irrespective of the type of stimulator, reducing the DC contamination to less than 1 μA. This study highlights the importance of carefully designing the electronic setup used in KHFAC studies and suggests specific testing that should be performed and reported in all studies that assess the neural response to KHFAC waveforms.

A fully intraocular high-density self-calibrating epiretinal prosthesis

This paper presents a fully intraocular self-calibrating epiretinal prosthesis with 512 independent channels in 65 nm CMOS. A novel digital calibration technique matches the biphasic currents of each channel independently while the calibration circuitry is shared among every 4 channels. Dual-band telemetry for power and data with on-chip rectifier and clock recovery reduces the number of off-chip components. The rectifier utilizes unidirectional switches to prevent reverse conduction loss in the power transistors and achieves an efficiency > 80%. The data telemetry implements a phase-shift keying (PSK) modulation scheme and supports data rates up to 20 Mb/s. The system occupies an area of 4.5 ×3.1 mm². It features a pixel size of 0.0169 mm² and arbitrary waveform generation per channel. In vitro measurements performed on a Pt/Ir concentric bipolar electrode in phosphate buffered saline (PBS) are presented. A statistical measurement over 40 channels from 5 different chips shows a current mismatch with μ = 1.12 μA and σ = 0.53 μA. The chip is integrated with flexible MEMS origami coils and parylene substrate to provide a fully intraocular implant.

Penetrating electrode stimulation of the rabbit optic nerve: parameters and effects on evoked cortical potentials

BACKGROUND

Stimulus parameters, in particular pulse shape, are an important consideration in the application of electrical stimulation when experimentally testing a visual prosthesis. We changed the biphasic pulse shape of several asymmetric charge-balanced pulses to investigate their effect on optic nerve (ON) stimulation and the recorded cortical response.

METHODS

Monopolar platinum-iridium electrodes were implanted into the rabbit's ON behind the eyeball. Electrical evoked potentials (EEPs) were recorded with silver ball electrodes placed on the cortex, and the results quantified.

RESULTS

Our results indicate that changing the shape of cathodic-first charge-balanced biphasic pulse (CA) while maintaining charge balance could reduce the current thresholds for stimulation. When stimulated at the same charge density, the stimulus having high-amplitude short-duration (HASD) cathodic phase produced a higher amplitude response, with a larger spatial spread but with a lower current threshold compared with other stimuli. Adding an inter-phase gap between the two phases of the stimulus increased the EEP amplitude, but was saturated at a gap of ∼0.2 ms; this was most obvious with CA stimulation, which was able to elicit a larger cortical response than that elicited by asymmetrical charge-balanced stimulus pulses with HASD cathodic phase, in contrast to CA without a gap. As the stimulating frequency increased, the amplitudes of the EEP components elicited by CA monotonically decreased. The fastest component (P0) was present with stimulating frequencies as high as 80 Hz, while the slower P1 and P2 disappeared with stimulating frequencies higher than 40 and 20 Hz, respectively.

CONCLUSION

A CA stimulus waveform with an inter-phase gap of 0.2 ms was more efficacious for ON stimulation than other stimulus combinations, and therefore should result in less tissue damage, minimal electrode etching, and lower power consumption if used in a visual prosthesis.

Flexible charge balanced stimulator with 5.6 fC accuracy for 140 nC injections

Electrical stimulations of neuronal structures must ensure net injected charges to be zero for biological safety and voltage compliance reasons. We present a novel architecture of general purpose biphasic constant current stimulator that exhibits less than 5.6 fC error while injecting 140 nC charges using 1.4 mA currents. The floating current sources and conveyor switch based system can operate in monopolar or bipolar modes. Anodic-first or cathodic-first pulses with optional inter-phase delays have been demonstrated with zero quiescent current requirements at the analog front-end. The architecture eliminates blocking capacitors, electrode shorting and complex feedbacks. Bench-top and in-vivo measurement results have been presented with emulated electrode impedances (resistor-capacitor network), Ag-AgCl electrodes in saline and in-vivo (acute) peripheral nerve stimulations in anesthetized rats.

An energy-efficient, dynamic voltage scaling neural stimulator for a proprioceptive prosthesis

This paper presents an 8 channel energy-efficient neural stimulator for generating charge-balanced asymmetric pulses. Power consumption is reduced by implementing a fully-integrated DC-DC converter that uses a reconfigurable switched capacitor topology to provide 4 output voltages for Dynamic Voltage Scaling (DVS). DC conversion efficiencies of up to 82% are achieved using integrated capacitances of under 1 nF and the DVS approach offers power savings of up to 50% compared to the front end of a typical current controlled neural stimulator. A novel charge balancing method is implemented which has a low level of accuracy on a single pulse and a much higher accuracy over a series of pulses. The method used is robust to process and component variation and does not require any initial or ongoing calibration. Measured results indicate that the charge imbalance is typically between 0.05%-0.15% of charge injected for a series of pulses. Ex-vivo experiments demonstrate the viability in using this circuit for neural activation. The circuit has been implemented in a commercially-available 0.18 μm HV CMOS technology and occupies a core die area of approximately 2.8 mm(2) for an 8 channel implementation.

Safety of multi-channel stimulation implants: a single blocking capacitor per channel is not sufficient after single-fault failure

One reason given for placing capacitors in series with stimulation electrodes is that they prevent direct current flow and therefore tissue damage under fault conditions. We show that this is not true for multiplexed multi-channel stimulators with one capacitor per channel. A test bench of two stimulation channels, two stimulation tripoles and a saline bath was used to measure the direct current flowing through the electrodes under two different single fault conditions. The electrodes were passively discharged between stimulation pulses. For the particular condition used (16 mA, 1 ms stimulation pulse at 20 Hz with electrodes placed 5 cm apart), the current ranged from 38 to 326 μA depending on the type of fault. The variation of the fault current with time, stimulation amplitude, stimulation frequency and distance between the electrodes is given. Possible additional methods to improve safety are discussed.

Required matching accuracy of biphasic current pulse in multi-channel current mode bipolar stimulation for safety

In neural stimulation, a current mode stimulation is preferred to a voltage mode stimulation, as it has more control over injecting charge into tissue. A matched biphasic current pulse is often employed in current mode stimulation. For safe neural stimulation, in other words, to ensure zero-net charge transfer (charge balance) into tissue, it is required to utilise a precisely matched biphasic current pulse. Mismatch in the biphasic current pulse causes residual charge on stimulating electrodes during stimulation, which will induce DC current flowing into tissue, possibly leading to tissue damage. In this paper, we derive mathematical expressions of the required matching accuracy on the biphasic current pulse under 4 different situations to ensure a safe neural stimulation; 1) single channel stimulation without shorting, 2) single channel stimulation with shorting, 3) multi-channel stimulation without shorting and 4) multi-channel stimulation with shorting.

SEIZURE ABATEMENT WITH SINGLE DC PULSES: IS PHASE RESETTING AT PLAY?

Topological approaches for seizure abatement have received scarce attention. The ability to reset the phase of biological oscillations has been widely exploited in cardiology, as evidenced in part by the usefulness of implantable of defibrillators, but not in epileptology. The aim of this work is to investigate the feasibility of seizure blockage using single or brief monophasic (DC) pulse trains.

Single DC or brief (0.1 s) pulse trains were delivered manually or automatically to generalized seizures, induced in rats with the convulsant 3-mercaptoprionic acid, a GABA inhibitor. Treatment outcome (blocked vs. not blocked seizures) was ascertained visually and correlated with the "rhythmicity index", an indirect estimate of neuronal synchrony level.

Blockage using single or brief (0.1 s) DC pulses was consistently achieved for seizures with a rhythmicity index > 0.6, while seizures with levels <0.6 were not, although transient phase changes in their oscillations were effected.

This work reveals that level of neuronal synchronization may be an important factor in determining the probability of seizure blockage. Seizure blockage using single or brief DC pulse trains and its effects on neural tissue merit further investigation. The clinical applicability of this therapeutic modality and means to enhance it are discussed.

[Impedance changes in cochlear implant users]

Impedance measurements are routinely performed during the cochlear implantation. These measurements make possible to check, whether all electrodes work correctly and are useful in the monitoring of implant's functioning during rehabilitation. The analysis of the impedance's changes makes possible to estimate, what processes happen in tissues and liquids of the inner ear around the electrode.

THE AIM OF THE STUDY

The aim of the study was to estimate changes of the electrodes' impedance in cochlear implants users.

MATERIAL AND METHODS

Measurements of the impedance was performed on every electrode introduced into the cochlea. Impedance measurements were investigated in 42 adult persons operated at the Department of Otolaryngology Medical University of Lublin. The impedance of electrodes in cochlear implants users was measured during operation, during the activation of the speech processor and during following settings of the speech processor.

RESULTS

During activation of the speech processor we observed elevated values of the impedance, higher then during intra-operating-measurement. On the second fitting impedances decrease and then were stable at this level during one year follow-up.

CONCLUSIONS

Increasing values of impedance during first fitting of the speech processor support the hypothesis that a layer of fibrous tissue forms around the electrode because of the inflammatory changes or due to exudation of protein. Such changes could be observed after cochlear implantation. Impedance values decrease after first fitting and remain stable. This may suggest that electrical stimulation prevents from adverse changes in the cochlea.

Orientation of spiral ganglion neurite extension in electrical fields of charge-balanced biphasic pulses and direct current in vitro

Cochlear implants function by stimulating residual spiral ganglion neurons (SGNs) with electric current. Promoting the neurites of SGNs to grow towards an electrode array could improve the outcome of cochlear implantation. Several studies have suggested that DC electrical fields (EFs) can affect the direction of neurite extension. To investigate the impact of steady DC EFs, pulsed DC EFs and charge-balanced biphasic pulsed EFs on the direction of SGN neurite extension, we established an SGN culturing and imaging system. SGN explants of newborn Sprague-Dawley rats were cultured on slides. Slides were positioned into the monitoring system with neurite terminals in a certain orientation and location, while the migration of SGN growth cones was monitored by taking serial photos. Deflection angles of neurites at a certain period were measured. In steady or pulsed DC EFs, neurites on laminin-coated slides turned towards the cathode, while those on PDL-coated slides turned towards the anode. The neurites in charge-balanced biphasic pulsed EFs had an obvious orientation of turning away from the electrode rings. This orientation diminished with increasing distance from the electrode rings and followed the nonuniform characteristics of charge-balanced biphasic pulsed EFs.

Forward-masking patterns produced by symmetric and asymmetric pulse shapes in electric hearing

Two forward-masking experiments were conducted with six cochlear implant listeners to test whether asymmetric pulse shapes would improve the place-specificity of stimulation compared to symmetric ones. The maskers were either cathodic-first symmetric biphasic, pseudomonophasic (i.e., with a second anodic phase longer and lower in amplitude than the first phase), or "delayed pseudomonophasic" (identical to pseudomonophasic but with an inter-phase gap) stimuli. In experiment 1, forward-masking patterns for monopolar maskers were obtained by keeping each masker fixed on a middle electrode of the array and measuring the masked thresholds of a monopolar signal presented on several other electrodes. The results were very variable, and no difference between pulse shapes was found. In experiment 2, six maskers were used in a wide bipolar (bipolar+9) configuration: the same three pulse shapes as in experiment 1, either cathodic-first relative to the most apical or relative to the most basal electrode of the bipolar channel. The pseudomonophasic masker showed a stronger excitation proximal to the electrode of the bipolar pair for which the short, high-amplitude phase was anodic. However, no difference was obtained with the symmetric and, more surprisingly, with the delayed pseudomonophasic maskers. Implications for cochlear implant design are discussed.

Alternative pulse shapes in electrical hearing

Cochlear implants (CIs) stimulate the auditory nerve with trains of symmetric biphasic (BI) pulses. We review studies showing that more efficient stimulation can be achieved by modifying these pulses by (1) increasing the inter-phase gap (IPG) between the two phases of each pulse, thereby delaying the recovery of charge, (2) increasing the duration and decreasing the amplitude of one phase - so-called "pseudomonophasic (PS)" waveforms, and (3) combining the pseudomonophasic stimulus with an IPG in a "delayed pseudomonophasic" waveform (PS_IPG). These efficiency gains, measured using changes in threshold and loudness, occur at a wide range of pulse rates, including those commonly used in current CI systems. In monopolar mode, dynamic ranges are larger for PS and for long-IPG pulse shapes than for BI pulses, but this increase in DR is not accompanied by a higher number of discriminable loudness steps, and hence, in a better coding of loudness. Moreover, waveforms with relatively short and long interphase gaps do not yield different patterns of excitation despite the relatively large differences in threshold. Two important findings are that, contrary to data obtained in animal experiments, anodic currents are more effective than cathodic stimulation for human CI patients and that the thresholds decrease with increases in IPG over a much longer time course (more than 3 ms) than for animals. In this review it is discussed how these alternative pulse shapes may be beneficial in terms of reducing power consumption and channel interactions, which issues remain to be addressed, and how models contribute to guiding our research.

Effects of steroids and lubricants on electrical impedance and tissue response following cochlear implantation

The present study examined the effects of steroids and lubricants on electrical impedance and tissue response following cochlear implantation in animal models. Guinea pigs were implanted following either no treatment, or intrascalar injection with dexamethasone, triamcinolone, sodium hyaluronate or saline. Cats were implanted following either no treatment, or intrascalar injection with dexamethasone, triamcinolone or a mixture of triamcinolone with sodium hyaluronate. In guinea pigs, impedance changes and intracochlear tissue response were less for the hyaluronate and saline groups. In cats, impedance in the dexamethasone group increased similar to non-treated cats. Impedance of triamcinolone treated cats remained low for about two months after implantation, before increasing to levels similar to the other groups. Significant fibrous tissue growth was observed histologically. The results of the present study indicate that a single intracochlear application of hyaluronate or triamcinolone may postpone, but will ultimately not prevent the rise in impedance following cochlear implantation.

A Low-Power Blocking-Capacitor-Free Charge-Balanced Electrode-Stimulator Chip With Less Than 6 nA DC Error for 1-mA Full-Scale Stimulation

Large dc blocking capacitors are a bottleneck in reducing the size and cost of neural implants. We describe an electrode-stimulator chip that removes the need for large dc blocking capacitors in neural implants by achieving precise charge-balanced stimulation with <6 nA of dc error. For cochlear implant patients, this is well below the industry's safety limit of 25 nA. Charge balance is achieved by dynamic current balancing to reduce the mismatch between the positive and negative phases of current to 0.4%, followed by a shorting phase of at least 1 ms between current pulses to further reduce the charge error. On +6 and -9 V rails in a 0.7-mum AMI high voltage process, the power consumption of a single channel of this chip is 47 muW when biasing power is shared by 16 channels.

Asymmetric pulses in cochlear implants: effects of pulse shape, polarity, and rate

Existing cochlear implants stimulate the auditory nerve with trains of symmetric biphasic (BP) pulses. Recent data have shown that modifying the pulse shape, while maintaining charge balance, may be beneficial in terms of reducing power consumption, increasing dynamic range, and limiting channel interactions. We measured thresholds and most comfortable levels (MCLs) for various 99-pulses-per-second (pps) stimuli. "Pseudomonophasic (PS)" pulses consist of a brief phase of one polarity followed immediately by a longer and lower-amplitude phase of the opposite polarity. We focused on a novel variant of PS pulses, termed the "delayed pseudomonophasic (DPS)" stimulus, in which the longer phase is presented midway between the short phases of two consecutive pulses. DPS pulse trains produced thresholds that were more than 10 dB lower than those obtained with BP pulses. This reduction was much greater than the 0- to 3-dB drop obtained with PS pulses and was still more than 6 dB when a pulse rate of 892 pps was used. A study of the relative contributions of the two phases of DPS suggested that the short, high-amplitude phase dominated the perceived loudness. This study showed major threshold and MCL reductions using a DPS stimulus compared to the widely used BP stimulus. These reductions, which were predicted by a simple linear filter model, might lead to considerable power savings if implemented in a cochlear implant speech processor.

Effect of inter-phase gap on the sensitivity of cochlear implant users to electrical stimulation

Human behavioral thresholds for trains of biphasic pulses applied to a single channel of Nucleus CI24 and LAURA cochlear implants were measured as a function of inter-phase gap (IPG). Experiment 1 used bipolar stimulation, a 100-pps pulse rate, and a 400-ms stimulus duration. In one condition, the two phases of each pulse had opposite polarity. Thresholds continued to drop by 9-10 dB as IPG was increased from near zero to the longest value tested (2900 micros for CI24, 4900 micros for LAURA). This time course is much longer than reported for single-cell recordings from animals. In a second condition, the two phases of each pulse had the same polarity, which alternated from pulse to pulse. Thresholds were independent of IPG, and similar to those in condition 1 at IPG=4900 micros. Experiment 2 used monopolar stimulation. One condition was similar to condition 1 of experiment 1, and thresholds also dropped up to the longest IPG studied (2900 micros). This also happened when the pulse rate was reduced to 20 pps, and when only a single pulse was presented on each trial. Keeping IPG constant at 8 micros and adding an extra biphasic pulse x ms into each period produced thresholds that were roughly independent of x, indicating that the effect of IPG in the other conditions was not due to a release from refractoriness at sites central to the auditory nerve. Experiment 3 measured thresholds at three IPGs, which were less than, equal to, and more than one half of the interval between successive pulses. Thresholds were lowest at the intermediate IPG. The results of all experiments could be fit by a linear model consisting of a lowpass filter based on the function relating threshold to the frequency of sinusoidal electrical stimulation. The data and model have implications for reducing the power consumption of cochlear implants.

Chronically implanted epineural electrodes for repeated assessment of nerve conduction velocity and compound action potential amplitude in rodents

Implanted epineural electrodes were used for the longitudinal assessment of peripheral nerve conduction velocity (NCV) and compound action potential (CAP) amplitude in rats. Custom-fabricated stimulating and recording electrodes were sutured over the tibial and sciatic nerves, respectively, and were used for weekly recordings of CAP latency and amplitude. Intra-day variability of nerve conduction velocity measurements had coefficients of variation of less than 2% for same day recordings from individual subjects. A clear trend in recovery of the NCV values following implant was observed over the 7-week trial period. These results demonstrate that implanted epineural electrodes provide a reliable method for chronic, in vivo monitoring of nerve conduction parameters in rodents.

Chronic electrical stimulation of the auditory nerve using high surface area (HiQ) platinum electrodes

High surface area cochlear implant electrodes with much smaller geometric surface areas than current designs might be used in the future to increase the number of stimulating electrodes along the carrier. Potential problems with an increase in charge density for a common stimulus resulting from decreasing the geometric surface area would be reduced by the enlarged real surface area of such electrodes. Electrochemically modified (HiQ) platinum (Pt) electrodes, with a real surface area approximately 75 times greater than the current standard Pt electrodes of the same geometric size, had shown in vitro a low polarization (Z(pol)) and electrode impedance (Z(e)), as well as a low residual direct current (DC). In this study we examined the chronic performance of HiQ electrodes in cats, which were bilaterally implanted with a two-channel HiQ or standard Pt scala tympani electrode array and unilaterally stimulated for periods of up to 2390 h. Stimuli consisted of 50 micros/phase charge-balanced biphasic current pulses presented at 2000 pulses/s/channel with a 50% duty cycle. Electrode impedance (Z(e)), access resistance (R(a)) and polarization impedance (Z(pol)) were calculated from current and voltage measurements obtained periodically throughout the implantation period. Immediately following implantation HiQ electrodes showed a significantly smaller Z(pol), resulting in a reduced Z(e) (P<0.0001) compared to standard electrodes, while there was no significant difference between R(a) of both electrode designs (P=0.91). Subsequently, Z(e) generally increased mainly due to a rise in R(a), which dominated Z(e) and obliterated the effect of a lower Z(pol) on Z(e) in HiQ electrodes. Peak R(a) levels correlated closely (r=0.85) with the amount of intracochlear fibrous tissue found adjacent to the array. Following explantation of the array, voltage waveforms for both electrode designs recorded in saline were again very similar to those recorded immediately after implantation. Mean DC levels were consistently lower for HiQ electrodes compared with standard electrodes (22.45 nA vs 134.7 nA). Histopathological examination of corresponding cochlear sections comparing the stimulated test side with the unstimulated control side showed no significant difference (P>0.05) for either animals implanted with HiQ electrodes (n=6) or standard electrodes (n=2). Nor were there any significant differences between the spiral ganglion cell density of the basal turn implanted with HiQ or standard electrodes for both the stimulated test (P=0.31) and the unstimulated control side (P=0.84). Although these findings are based on a small group of animals implanted with standard electrodes (n=2), and those negative statistical results could potentially be due to the small sample size, similar spiral ganglion cell survival was found in a previous study of a larger group of animals using standard electrodes stimulated with the same stimulus paradigm as in the present study [Xu et al. (1997) Hear. Res. 105, 1-29]. Our data indicate that while some initial advantages of HiQ electrodes are lost during chronic implantation due to intracochlear fibrous tissue growth, low DC levels and the high surface area appear to be maintained, suggesting that HiQ electrodes may have important clinical applications.

Reduction in excitability of the auditory nerve following electrical stimulation at high stimulus rates: V. Effects of electrode surface area

High rate intracochlear electrical stimulation at high intensities can induce significant reductions in the excitability of the auditory nerve as measured by a decrement in the amplitude of the electrically evoked auditory brainstem response (EABR). Such changes are primarily associated with stimulus induced neuronal activity, although direct current (DC) can also contribute. We examined the extent of stimulus induced change in auditory nerve excitability using large surface area platinum electrodes ('high-Q' electrodes). These electrodes have a surface area approximately 70 times greater than standard Pt electrodes of the same geometric area, resulting in lower DC and charge density (charge/electrode surface area) for a common stimulus. Guinea pigs were bilaterally implanted with either high-Q or standard Pt electrodes, and unilaterally stimulated for 2 h using stimulus intensities of 12 dB or 20-30 dB above EABR threshold (0.34 microC/phase) at stimulus rates of 200, 400, or 1000 pulses per second (pps). EABRs were recorded before and following the acute stimulation. While there were significant reductions in EABR amplitudes and elevated EABR thresholds following stimulation at 12 dB above threshold using 400 and 1000 pps delivered to standard Pt electrodes, there were fewer or no significant changes in the post-stimulus EABR amplitude and threshold using high-Q electrodes under equivalent stimulus conditions. At a higher stimulus intensity (20-30 dB above EABR threshold), no reduction in EABR amplitude was observed at 200 pps for both stimulating electrodes. However, EABRs were reduced significantly at 400 and 1000 pps. There was significantly greater EABR recovery following stimulation using high-Q electrodes compared with standard Pt electrodes at 400 (P<0.05) and 1000 pps (P<0.05). These data indicate that large surface area electrodes can significantly reduce stimulus induced changes in auditory nerve excitability, and may therefore have important clinical application.