Cochlear wall titanium implants for auditory nerve stimulation

Preservation of auditory brainstem response thresholds after cochleostomy and titanium microactuator implantation in the lateral wall of cat scala tympani

HYPOTHESIS

The safety of implanting a titanium microactuator into the lateral wall of cat scala tympani was assessed by comparing preoperative and postoperative auditory brainstem response (ABR) thresholds for 1 to 3 months.

BACKGROUND

The safety of directly stimulating cochlear perilymph with an implantable hearing system requires maintaining preoperative hearing levels. This cat study is an essential step in the development of the next generation of fully implantable hearing devices for humans.

METHODS

Following GLP surgical standards, a 1-mm cochleostomy was drilled into the lateral wall of the scala tympani, and a nonfunctioning titanium anchor/microactuator assembly was inserted in 8 cats. The scala media was damaged in the 1 cat. ABR thresholds with click and 4- and 8-kHz stimuli were measured preoperatively and compared with postoperative thresholds at 1, 2, and 3 months. Nonimplanted ear thresholds were also measured to establish statistical significance for threshold shifts (>28.4 dB). Two audiologists independently interpreted thresholds.

RESULTS

Postoperatively, 7 cats implanted in the scala tympani demonstrated no significant ABR threshold shift for click stimulus; one shifted ABR thresholds to 4- and 8-kHz stimuli. The eighth cat, with surgical damage to the scala media, maintained stable click threshold but had a significant shift to 4- and 8-kHz stimuli.

CONCLUSION

This cat study provides no evidence of worsening hearing thresholds after fenestration of the scala tympani and insertion of a titanium anchor/microactuator, provided there is no surgical trauma to the scala media and the implanted device is securely anchored in the cochleostomy. These 2 issues have been resolved in the development of a fully implantable hearing system for humans. The long-term hearing stability (combined with histologic studies) reaffirm that the microactuator is well tolerated by the cat cochlea.

Frequency tuning curves derived from auditory steady state evoked potentials: a proof-of-concept study

OBJECTIVES

Assess the feasibility of drawing tuning curves from the masking function of steady state potentials. Develop a noninvasive tool for research applications on cochlear frequency selectivity in sedated animals. Obtain pilot human data validating auditory steady state evoked potential-derived (ASSEP) tuning curves against psychophysical data.

DESIGN

ASSEP tuning curves were drawn in 10 Beagle puppies and six human adults using amplitude-modulated probes. Two probe frequencies (1 and 2 kHz) were used in dogs and only one (2 kHz) in humans. The modulation rates of the two probes were set to 81 and 88 Hz, respectively. Psychophysical tuning curves were obtained in 12 normal human subjects using the same maskers and either a pure-tone or an amplitude-modulated probe to verify if the latter had a specific effect on tuning curve parameters. Six of these 12 subjects participated in the electrophysiologic measurements. For each tuning curve, the intensity of the narrowband masker required just to mask the fixed probe was plotted for different masker center frequencies. Masker center frequencies extended to about half an octave above and an octave below the probe frequencies in 100-Hz steps. Tuning curve width (Q10 dB values), high- and low-frequency slopes (in dB/octave) and the masker frequency yielding the lowest masking threshold (maximal masker frequency) were computed. Canine Q10 dB values obtained were compared with those published for several species with other techniques. For humans, ASSEP and psychophysical tuning curves were directly compared in the same subjects and with published data.

RESULTS

In dogs, the ASSEP method yielded reproducible tuning curves with qualitative and quantitative parameters similar to other physiologic measures of tuning obtained in various animals. Q10 dB values were greater at 2 than at 1 kHz, reflecting the well-known correlation between sharpness of tuning and central frequency. In humans, ASSEP Q10 dB values were slightly smaller than the psychophysical ones, but were greater by a factor of 2 than those obtained with previously published electrophysiologic procedures. In both species, detuning-a shift of the tip of the curve away from the probe frequency-was frequently observed as upward shifts with a maximal value of 200 Hz. Human psychophysical tuning curves also showed a certain amount of upward detuning. The intraindividual comparison of the two types of probes performed on human subjects with the psychophysical method did not indicate a specific effect of the amplitude-modulated probe on the curve parameters. Neither did the intraindividual comparisons indicate that an amplitude-modulated probe per se promoted detuning. Detuning has been observed with several other techniques and is usually attributed to nonlinear interactions between masker and probe in simultaneous masking.

CONCLUSIONS

The results demonstrate the feasibility of measuring realistic ASSEP tuning curves in sedated dogs and in sleeping human adults. The ASSEP tuning curves exhibit a series of classical features similar to those obtained with time-honored methods. These results pave the way for the development of a noninvasive electrophysiologic method for tuning curve recording and its applications in noncooperative experimental animals or clinical subjects.

Auditory steady-state evoked potentials (ASSEPs): a study of optimal stimulation parameters for frequency-specific threshold measurement in dogs

OBJECTIVE

To define the optimal stimulation parameters (AM/FM vs AM alone and modulation rate) for frequency-specific threshold measurements using ASSEPs in dogs. Dependent variables were thresholds and recording times needed to obtain a response at threshold. To compare the ASSEP threshold results obtained with the optimal stimulation parameters to those obtained with the Tone-Burst/Auditory Brainstem Response (TB/ABR) combination.

METHODS

Thirty-two sedated Beagle puppies were tested at 5 audiometric frequencies (0.5-8 kHz) and 6 ASSEP modulation rates (21-199 Hz).

RESULTS

The ASSEP threshold-modulation rate functions had a high-pass profile with corner frequencies of 101 Hz for 0.5, 1 and 2 kHz carriers and of 151 Hz for 4 and 8 kHz carriers. AM stimuli did not yield higher thresholds than the AM/FM ones except at 1 kHz. Modulation type had no effect on testing duration. Audiometric profiles were obtained much more rapidly with ASSEPs than with TB/ABRs (mean: 50 vs 135 min). Both ASSEP and TB/ABR provided thresholds estimates characterized by low intersubject variability.

CONCLUSIONS

ASSEPs are a valid and rapid method for audiometric assessment in sedated dogs.

SIGNIFICANCE

ASSEPs offer a new, competitive tool for frequency-specific assessment of hearing in the canine species.

Inner ear histopathology in “nervous Pointer dogs” with severe hearing loss

Ten puppy dogs (82, 131 or 148 days-old) from a Pointer cross-colony, exhibiting a juvenile severe hearing loss transmitted as an autosomal recessive trait, were used for histopathological characterization of the inner ear lesion. Immunostaining with calbindin, Na,K-ATPase, cytokeratins, S100, S100A1 and S100A6 antisera were helpful in identifying the different cell types in the degenerated cochleae. Lesions, restricted to the Corti's organ and spiral ganglion, were bilateral but sometimes slightly asymmetrical. Mild to severe lesions of the Corti's organ were unevenly distributed among the different parts of the middle and basal cochlear turns while the apical turn remained unaffected at 148 days. In 82 day-old puppies (n = 2), severe lesions of the Corti's organ, meaning that it was replaced by a layer of unidentifiable cells, involved the lower middle and upper basal turns junction area, extending in the upper basal turn. Mild lesions of the Corti's organ, with both hair and supporting cells abnormalities, involved the lower middle turn and extended from the rest of upper basal turn into the lower basal turn. The outer hair cells (ohc) were more affected than the inner hair cell (ihc). The lesions extended towards the basal end of the cochlea in the 131 (n = 5) and 148 (n = 3) day-old puppies. Additionally, the number of spiral ganglion neurons was reduced in the 131 and 148 day-old puppies; it is earlier than observed in most other canine hereditary deafness. These lesions were interpreted as a degeneration of the neuroepithelial type. This possible animal model might provide information about progressive juvenile hereditary deafness and neuronal retrograde degeneration investigations in human.

An original inner ear neuroepithelial degeneration in a deaf Rottweiler puppy

Histopathological investigation was conducted on both inner ears from a 4.5-month-old Rottweiler puppy with electrophysiologically confirmed bilateral deafness. The lesions were restricted to the organ of Corti and spiral ganglion that both displayed severe degenerative changes. The outer hair cells were less affected than the inner hair cells. The number of spiral ganglion neurons was reduced, and remaining neurons were altered. The basal and middle cochlear turns were more affected than the apical one. The vestibules were normal. Immunostaining with calbindin, calretinin, S100A1 and S100A6 polyclonal antisera was helpful in identifying different cell-types in the degenerated cochlea. The early and severe spiral ganglion cell degeneration is an uncommon finding no matter the species. Such lesions bear significance within the frame of cochlear implants technology for deaf infants.

Implantation of the lateral cochlear wall for auditory nerve stimulation

Although cochlear implants now regularly achieve gratifying results, traditional intrascalar implants have certain limitations. Extraluminal implants may offset some of these problems by accessing neurons subserving a wider tonotopic range, avoiding intracochlear insertion trauma, and offering alternatives when cochlear obliteration is present. We have investigated the utility of a lateral cochlear wall implant in a normal-hearing cat model with implants at the middle and basal turns, and found successful activation of the auditory nerve at thresholds of 28.1 and 40.6 microA, respectively. No adventitial stimulation of the facial nerve was noted within the dynamic range. Maximum responsiveness was observed with implants of the middle turn of the cochlea, an area that is not reliably approached with current intrascalar implants. These observations support and extend prior observations of the feasibility of extraluminal stimulation of the auditory nerve.