Multiple-channel stimulation of the cochlear nucleus

Prosthetic Stimulation of the Auditory System with Intraneural Electrodes

Prosthetic electrical stimulation of the auditory system is presently accomplished either via scala tympani electrode arrays or via cochlear nucleus surface electrode arrays. Many of the early cochlear implant studies, however, used electrode arrays placed within the auditory nerve itself — either within the modiolus or within the trunk of the nerve. For many reasons, such intraneural electrode arrays were abandoned in favor of intrascalar arrays. There remain, however, several theoretical and practical reasons why intraneural arrays might be advantageous, and recent developments in electrode technology solve many of the problems posed by early attempts at intraneural stimulation. In this article, we review the history and current status of intraneural auditory stimulation, and present some preliminary results of this mode of stimulation in an animal model.

Decision making in acoustic neuroma management: the only hearing ear

Patients with acoustic neuroma in their only hearing ear are not frequently seen in clinical practice. Managing this group of patients is a challenge to both patient and surgeon. In this study we report on five cases of acoustic neuroma in an only hearing ear. Our decision for nonsurgical management of those patients with regular follow-up using auditory brainstem responses and magnetic resonance imaging is discussed. Other management options currently available are considered as well.

Neuronal activity evoked in the inferior colliculus of the cat by surface macroelectrodes and penetrating microelectrodes implanted in the cochlear nucleus

Persons lacking functional auditory nerves cannot benefit from cochlear implants, but an auditory brainstem implant (ABI) utilizing stimulating electrodes adjacent to or on their cochlear nucleus (CN) can restore some hearing. We are investigating the feasibility of supplementing these surface electrodes with penetrating microstimulating electrodes within the ventral CN (VCN), and how the two types of electrodes can be used synergistically. Multiunit neuronal responses evoked by VCN electrical stimulation with surface electrodes and microelectrodes were recorded in the inferior colliculus (ICC) of five cats. The findings are consistent with those from patients with type II neurofibromatosis who received ABIs with both surface and microelectrodes. The patients described percepts from their microelectrodes as more similar to pure tones than those from their surface electrodes, consistent with the greater tonotopic selectivity of microelectrodes in the cats' VCN. Also, the patients describe percepts from their surface electrodes as louder than those from the microelectrodes, while in the cat, the neuronal activity evoked in the ICC by the surface electrodes tended to be greater. This concordance helps to validate our cat model as a means of investigating the synergistic use of surface and penetrating electrodes in a clinical ABI.

Electrical stimulation of the dorsal cochlear nucleus induces hearing in rats

Auditory brainstem implants (ABIs) restore hearing by electrical stimulation of the cochlear nucleus (CN). Depending on the physiological condition, duration of the pre-existing deafness, extent of damage to the CN, and the number of channels accessible to the tonotopic frequency gradients of the CN, ABIs improve speech understanding to varying degrees. Although the ventral cochlear nucleus, a mainstream auditory structure, has been considered a logic target for ABI stimulation, it is not yet clear how the dorsal cochlear nucleus (DCN) contributes to patients' hearing during ABI stimulation. To better understand the mechanisms underlying ABIs, we tested if electrical stimulation of the rat DCN induces hearing using a novel electrical prepulse inhibition (ePPI) of startle reflex behavior model. Our results showed that bipolar electrical stimulation of all channels in the DCN induced behavioral manifestation of hearing and that electrical stimulation of certain channels in the DCN induced robust neural activity in auditory cortex channels that responded to acoustic stimulation and demonstrated well-defined frequency tuning curves. This suggests that the DCN plays an important role in electrical hearing and should be further pursued in designing new ABIs. The novel ePPI behavioral paradigm may potentially be developed into an efficient method for testing hearing in animals with an implantable prosthesis.

Penetrating multichannel stimulation and recording electrodes in auditory prosthesis research

Microelectrode arrays offer the auditory systems physiologists many opportunities through a number of electrode technologies. In particular, silicon substrate electrode arrays offer a large design space including choice of layout plan, range of surface areas for active sites, a choice of site materials and high spatial resolution. Further, most designs can double as recording and stimulation electrodes in the same preparation. Scala tympani auditory prosthesis research has been aided by mapping electrodes in the cortex and the inferior colliculus to assess the CNS responses to peripheral stimulation. More recently silicon stimulation electrodes placed in the auditory nerve, cochlear nucleus and the inferior colliculus have advanced the exploration of alternative stimulation sites for auditory prostheses. Multiplication of results from experimental effort by simultaneously stimulating several locations, or by acquiring several streams of data synchronized to the same stimulation event, is a commonly sought after advantage. Examples of inherently multichannel functions which are not possible with single electrode sites include (1) current steering resulting in more focused stimulation, (2) improved signal-to-noise ratio (SNR) for recording when noise and/or neural signals appear on more than one site and (3) current source density (CSD) measurements. Still more powerful are methods that exploit closely-spaced recording and stimulation sites to improve detailed interrogation of the surrounding neural domain. Here, we discuss thin-film recording/stimulation arrays on silicon substrates. These electrode arrays have been shown to be valuable because of their precision coupled with reproducibility in an ever expanding design space. The shape of the electrode substrate can be customized to accommodate use in cortical, deep and peripheral neural structures while flexible cables, fluid delivery and novel coatings have been added to broaden their application. The use of iridium oxide as the neural interface site material has increased the efficiency of charge transfer for stimulation and lowered impedance for recording electrodes.

Cochlear nucleus auditory prostheses

Persons who lack an auditory nerve cannot benefit from cochlear implants, but a prosthesis utilizing an electrode array implanted on the surface of the cochlear nucleus can restore some hearing. Worldwide, more than 500 persons have received these "auditory brainstem implants," most commonly after removal of the tumors that occur with Type 2 Neurofibromatosis (NF2). Typically, the ABIs provide these individuals with improved speech perception when combined with lip-reading and useful perception of environmental sounds, but little open-set speech recognition. The feasibility of supplementing the array of surface electrodes with penetrating microstimulating electrodes has been investigated in animal studies, and 10 persons with NF2 have received implants that include a surface array and an array of penetrating microelectrodes. Their speech perception is not significantly better than that of the NF2 patients who have only the surface arrays, but the findings do validate the concept of intranuclear stimulation and suggest how such prostheses might be improved by modifying the microstimulating array and also by optimizing the sound processing strategies. Recent publications have described ABI patients with deafness of etiologies other than NF2 who have achieved open-set speech recognition. This suggests that the cochlear nuclei of the NF2 patients are damaged by the disease process or during surgical removal of the tumor.

Performance of multisite silicon microprobes implanted chronically in the ventral cochlear nucleus of the cat

A central auditory prosthesis based on microstimulation within the ventral cochlear nucleus (VCN) offers a means of restoring hearing to persons whose auditory nerve has been destroyed bilaterally and cannot benefit from cochlear implants. Arrays of silicon probes with 16 stimulating sites were implanted into the VCN of adult cats, for up to 314 days. Compound neuronal responses evoked from the sites in the VCN were recorded periodically in the central nucleus of the contralateral inferior colliculus (ICC). The threshold and growth of most of the responses were stable for at least 250 days after implantation of the arrays. The responses evoked from the deepest and shallowest electrode sites did exhibit some changes over time but none of the thresholds exceeded 10 microA. The thresholds and growth of the compound responses from most of the stimulating sites were very stable over time, and comparable to those of chronically implanted single-site iridium microelectrodes. Multiunit neuronal activity evoked from the stimulating sites in the VCN was recorded along the dorsolateral-ventromedial (DLVM) axis of the ICC. The distribution, span and degree of overlap of the multiunit activity demonstrated the utility of the multisite, multishank array configuration as a means of accessing the neuronal populations in the VCN that encode various acoustic frequencies. These findings are encouraging for the prospects of developing an auditory prosthesis employing multi-site silicon microprobes.

Changes of Postoperative Impedances in Cochlear Implant Patients

OBJECTIVE

The objective of this study was to investigate the effect of intraoperative application of steroid suspension and coating of the electrode contacts with a thin film of iridium oxide on the short-term, time-dependent development of the intracochlear impedance in adults implanted with the Nucleus 24 Contour electrode.

STUDY DESIGN

The time-dependent development of intracochlear impedances was investigated in four different groups of adult patients at daily and later weekly intervals until the first fitting. The four groups were as follows: 1) standard Nucleus 24 Contour (control, n = 7); 2) standard Nucleus 24 Contour with intraoperative application of steroids (Group S, n = 6); 3) iridium-coated Nucleus 24 Contour control (Group I, n = 8); and 4) iridium-coated Nucleus 24 Contour with intraoperative application of steroids (Group I + S, n = 5). All patients had postlinguistic onset of severe to profound sensorineural hearing loss and no or little benefit of conventional hearing aids. Absence of ossification or any other cochlear anomaly and also absence of signs of retrocochlear or central origin to the hearing impairment bilaterally had to be confirmed preoperatively.

RESULTS

Steroid application reduced impedances significantly (Groups S and I + S), whereas iridium coating lowered variance of the impedance among patients but did not reduce the impedance significantly. The steroid-induced reduction is more pronounced at basal electrode contacts. Furthermore, there is some indication that the tissue growth could be faster in patients having the iridium-coated Contour electrode.

CONCLUSION

Provided that the reduction of electrode impedances with application of steroids is persisting, intracochlear application of steroids can be considered on a regular basis. Iridium coating of the electrode contacts seems not to be justified to be included as standard procedure.

Selective electrical interfaces with the nervous system

To achieve selective electrical interfacing to the neural system it is necessary to approach neuronal elements on a scale of micrometers. This necessitates microtechnology fabrication and introduces the interdisciplinary field of neurotechnology, lying at the juncture of neuroscience with microtechnology. The neuroelectronic interface occurs where the membrane of a cell soma or axon meets a metal microelectrode surface. The seal between these may be narrow or may be leaky. In the latter case the surrounding volume conductor becomes part of the interface. Electrode design for successful interfacing, either for stimulation or recording, requires good understanding of membrane phenomena, natural and evoked action potential generation, volume conduction, and electrode behavior. Penetrating multimicroelectrodes have been produced as one-, two-, and three-dimensional arrays, mainly in silicon, glass, and metal microtechnology. Cuff electrodes circumvent a nerve; their selectivity aims at fascicles more than at nerve fibers. Other types of electrodes are regenerating sieves and cone-ingrowth electrodes. The latter may play a role in brain-computer interfaces. Planar substrate-embedded electrode arrays with cultured neural cells on top are used to study the activity and plasticity of developing neural networks. They also serve as substrates for future so-called cultured probes.

Bilateral acoustic neuromas

This article reviews 12 patients with bilateral acoustic neuromas. The sex incidence was equal and the mean age at diagnosis was 26.2 years. The family history was positive in nine of the patients. Five patients have had incomplete surgical removal of acoustic neuromas on both sides. Two of them are completely deaf and the other three have severe sensorineural hearing loss in one ear and no hearing in the other ear. In five patients the tumour on one side has been operated on and the other side is being observed with at least short-term preservation of good hearing. The remaining two patients died of intra-cranial complications, one of them post-operatively. Four patients developed facial palsy immediately following surgery and one developed facial weakness 6 months after surgery. Guidelines are discussed for the care of these patients including the timing of surgery and alternative treatment options (observation, radio-surgery and chemotherapy). This is essentially a group of young individuals who have had multiple operations for bilateral acoustic tumours and associated manifestations and for whom the disease and the sequelae of treatment can be tragic.

Evaluation of a silicon-substrate modiolar eighth nerve implant in a guinea pig

The availability of thin-film multichannel electrodes provides new possibilities for implantation and direct stimulation of the modiolar portion of the auditory nerve. Electrodes in direct contact with the auditory nerve should be functional at lower thresholds and might require fewer remaining neurons for stimulation compared to electrodes in the scala tympani. This strategy would also provide close contact with neural elements subserving a greater frequency range. Implantation of the eighth nerve may also be advantageous in profoundly deaf subjects who lack an implantable scala tympani. In this study we evaluated the effect of surgical implantation and chronic placement of a silicon substrate implant in the modiolar portion of the auditory nerve of the guinea pig. Of six chronically implanted ears, five showed changes limited to the loss of spiral ganglion cells in the canal of Rosenthal, immediately adjacent to the implant. The sixth ear showed more extensive cochlear alteration in a pattern suggestive of vascular injury. In separate acute experiments, implants were placed in the modiolar portion of the auditory nerve and electrophysiologic analysis was performed. Middle latency responses with good morphology were obtained at thresholds below those found with scala tympani implants. Input-output functions exhibited a plateau in response amplitude at stimulus levels below thresholds for seventh or vestibular portion of the eighth nerve. Further modifications of the modiolar portion of the auditory nerve electrode design will include development of an electrode interconnect that will allow chronic implantation with stimulation.