Graeme Clark Collection
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ItemNo Preview AvailableFast inhibition alters first spike timing in auditory brainstem neurons(AMER PHYSIOLOGICAL SOC, 2004-10)Within the first processing site of the central auditory pathway, inhibitory neurons (D stellate cells) broadly tuned to tonal frequency project on narrowly tuned, excitatory output neurons (T stellate cells). The latter is thought to provide a topographic representation of sound spectrum, whereas the former is thought to provide lateral inhibition that improves spectral contrast, particularly in noise. In response to pure tones, the overall discharge rate in T stellate cells is unlikely to be suppressed dramatically by D stellate cells because they respond primarily to stimulus onset and provide fast, short-duration inhibition. In vivo intracellular recordings from the ventral cochlear nucleus (VCN) showed that, when tones were presented above or below the characteristic frequency (CF) of a T stellate neuron, they were inhibited during depolarization. This resulted in a delay in the initial action potential produced by T stellate cells. This ability of fast inhibition to alter the first spike timing of a T stellate neuron was confirmed by electrically activating the D stellate cell pathway that arises in the contralateral cochlear nucleus. Delay was also induced when two tones were presented: one at CF and one outside the frequency response area of the T stellate neuron. These findings suggest that the traditional view of lateral inhibition within the VCN should incorporate delay as one of its principle outcomes.
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ItemOptimizing dynamic range in children using the nucleus cochlear implant(LIPPINCOTT WILLIAMS & WILKINS, 2004-06)OBJECTIVE: The aim of this study was to investigate the benefits of the preprocessing scheme "Adaptive Dynamic Range Optimization" (ADRO) in children using Nucleus cochlear implants. Previous research with adults indicates improved speech perception in quiet and improved sound quality in everyday listening environments with the ADRO scheme. DESIGN: Children were given 4 wk of take-home experience with ADRO, with a minimum of 2 wk in which ADRO was "locked-in." After 1 wk of ADRO use and again after 4 wk of ADRO use, Bench-Kowal-Bamford (BKB) sentence perception in quiet at a low input level of 50 dB SPL (unweighted root mean square) and sentence perception in noise were compared with the child's everyday (Standard) program and the ADRO program. Children also rated the loudness of a variety of environmental sounds and indicated which program provided the best hearing in a variety of everyday listening situations. RESULTS: On average, BKB sentence perception in quiet at 50 dB SPL was significantly better with the ADRO program compared with the Standard program. The group mean improvement was 8.60%. Similarly, group mean scores for BKB sentences presented at 65 dB SPL in multitalker babble were significantly higher with the ADRO program (an improvement of 6.87%). The ADRO program was the preferred program in 46% of the listening situations, whereas the Standard program was preferred in 26% of situations. Everyday sounds were not unacceptably loud with ADRO. CONCLUSIONS: There was an ADRO benefit for this group of children in quiet and in noise. These findings suggest that young children would benefit from the ADRO programming option being locked in along with other processor settings in the SPrint processor once their MAP levels have stabilized. Some older children and teenagers may choose to use ADRO selectively for specific listening situations.
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ItemMeningitis after cochlear implantation: the risk is low, and preventive measures can reduce this further( 2007)Since the 1980s, more than 80 000 people have received cochlear implants worldwide. These implants are designed to enable people who are severely or profoundly deaf to experience sound and speech. Since 1990, implantation has become standard treatment for people who cannot communicate effectively despite well fitted hearing aids. Children who are deaf when they are born can perceive sound and learn to speak if they receive cochlear implants at a young age (ideally under 18 months). The use of cochlear implants has been thought to be safe. But since 2002 the number of patients with meningitis related to cochlear implantation has increased worldwide. Mortality and neurological complications after meningitis are high. We need to investigate the reasons for this and look at measures to reduce them.
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ItemThreshold shift: effects of cochlear implantation on the risk of pneumococcal meningitis( 2007)Unavailable due to copyright.
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ItemEffects of inner ear trauma on the risk of pneumococcal meningitis( 2007)Objective: To examine the risk of pneumococcal meningitis in healthy rats that received a severe surgical trauma to the modiolus and osseous spiral lamina or the standard insertion technique for acute cochlear implantation. Design: Interventional animal studies. Subjects: Fifty-four otologically normal adult Hooded- Wistar rats. Interventions: Fifty-four rats (18 of which received a cochleostomy alone; 18, a cochleostomy and acute cochlear implantation using standard surgical techniques; and 18, a cochleostomy followed by severe inner ear trauma) were infected 4 weeks after surgery with Streptococcus pneumoniae via 3 different routes (hematogenous, middle ear, and inner ear) to represent all potential routes of bacterial infection from the upper respiratory tract to the meninges in cochlear implant recipients with meningitis. Results: Severe trauma to the osseous spiral lamina and modiolus increased the risk of pneumococcal meningitis when the bacteria were given via the middle or inner ear (Fisher exact test, P<.05). However, the risk of meningitis did not change when the bacteria were given via the hematogenous route. Acute electrode insertion did not alter the risk of subsequent pneumococcal meningitis for any route of infection. Conclusions: Severe inner ear surgical trauma to the osseous spiral lamina and modiolus can increase the risk of pneumococcal meningitis. Therefore, every effort should be made to ensure that cochlear implant design and insertion technique cause minimal trauma to the bony structures of the inner ear to reduce the risk of pneumococcalmeningitis.
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ItemAssessment of the protective effect of pneumococcal vaccination in preventing meningitis after cochlear implantation( 2007)Objectives: To examine if a 23-valent pneumococcal capsular polysaccharide vaccine (PPV23) reduces the risk of meningitis in healthy rats after cochlear implantation. Design: Interventional animal study. Interventions: Thirty-six rats (18 immunized and 18 unimmunized) received cochlear implantations and were then infected with Streptococcus pneumoniae via 3 different routes (hematogenous, middle ear, and inner ear) in numbers sufficient to induce meningitis. Results: The rats with implants that received PPV23 were protected from meningitis when the bacteria were delivered via the hematogenous and middle-ear routes (Fisher exact test P<.05). However, the protective effect of the vaccine in the rats with implants was only moderate when the bacteria were inoculated directly into the inner ear. Conclusions: Our animal model clearly demonstrates that immunization can protect healthy rats with a cochlear implant from meningitis caused by a vaccine-covered serotype. This finding supports the notion that all current and future implant recipients should be vaccinated against S pneumoniae.
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ItemImplant design and development(Wiley - John Wiley & Sons, 2006)
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ItemNeurotrophin survival effects on auditory neurons in vivo [Abstract]( nd)Neurotrophic factors, in particular the neurotrophins brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) are well known to be important for the development and maintenance of the auditory system and have also been reported to act as survival factors for auditory neurons in animal models of deafness. Indeed, numerous studies have demonstrated that intracochlear application of neurotrophins shortly following deafening can prevent auditory neuron degeneration. Following on from these findings, we have investigated two aspects of the time-course of neurotrophin-induced auditory neuron survival. Firstly, we tested the longevity of the survival effects of BDNF on auditory neurons in deaf guinea pigs; specifically we aimed to determine if the survival effects of BDNF are maintained beyond the period of treatment, or if sustained delivery is required. Results from this study indicated that while BDNF prevents auditory neuron degeneration during the treatment period, cessation of the trophic support leads to a rapid loss of survival effects. These findings suggest ongoing neurotrophin treatment may be required for maintained auditory neuron survival. Secondly, we examined the effects of delayed neurotrophin treatment on auditory neuron survival following deafness. Results from this study demonstrated that each of the members of the neurotrophin family BDNF, NT-3, neurotrophin 4/5 (NT-4/5) and nerve growth factor (NGF) - can rescue auditory neurons from degeneration after a two-week period of deafness. These findings show that neurotrophins can be effective survival agents even when the degenerative processes are well underway. The results of these studies provide further support to the theory that neurotrophic factors may ultimately be able to be used as therapeutic agents for the benefit of the hearing impaired community, but suggest that ongoing treatment, or combined use of alternative therapies, may be necessary.
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ItemExpression of the guidance molecule netrin-1 in the postnatal rat cochlea [Abstract]( nd)Purpose: Neurotrophic factors have been demonstrated to stimulate axonal growth from auditory neurons in both in vitro and in vivo animal models of deafness. These findings may be important to improving cochlear implant performance via an enhanced electro-neural interface, or ultimately for a regenerated auditory system. Numerous molecules exist which are involved in axon guidance during embryogenesis for the construction of a functional neural network. The netrins are a family of such guidance molecules, and are expressed within the developing cochlea. It remains to be determined, however, if these molecules are expressed in the developed mammalian cochlea, and therefore if they may be of potential use for guiding regenerated axons within the mammalian auditory system. This study seeks to investigate the expression patterns of the netrin-l protein in postnatal rats. Methods: Cochlear tissue samples were taken from rats at postnatal day I (PI), P3, P5, P7, Pl0, Pl5 and P22. Samples from each age group were separated using SDS-PAGE and protein expression was determined by western immunoblot analysis. Results: Preliminary findings suggest that the netrin-l protein may be present in the postnatal cochlea, however not in its full form. Spinal cord samples, used as positive controls, reveal an ~75kD immunoreactive band, consistent with the molecular weight (MW) of netrin-l. Cochlear samples displayed bands at a slightly lower MW, and may therefore represent proteolytic fragments of the full-length netrin-l protein. The signal showed decreasing intensity following P7, with no signal seen at P22. Conclusions: These results suggest that netrin-l may be present in the postnatal cochlea, and in decreasing levels with increasing age. Netrin-l may therefore have the potential to control new axonal growth in the adult mammalian cochlea. Further studies investigating the expression patterns of the netrin-l receptors, DCC and neogenin, will give a greater indication of the presence and role of this guidance cue within the damaged auditory system.
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ItemNeurotrophins support auditory neuron survival in vivo following an extended period of deafness [Abstract]( nd)Neurotrophic factors are important for the development and maintenance of the auditory system, and have also been reported to act as survival factors for auditory neurons in animal deafness models. Indeed, studies have demonstrated that application of neurotrophins into the inner ear shortly following deafening can prevent auditory neuron degeneration. However, little is known about the survival effects of delayed neurotrophin treatment, which is a clinically more realistic model. This study examined the capacity of various neurotrophins to support auditory neuron survival after an extended period of deafness in vivo. Specifically, we aimed to determine if the neurotrophins BDNF, NT-3, NT-4/5 and NGF could rescue neurons from degeneration after a two-week period of deafness. Normal hearing guinea pigs were bilaterally deafened; two weeks later the left cochleae were implanted with a mini-osmotic pump, which delivered 200µl of neurotrophin (62.5µg/ml) over a period of 28 days. The right cochleae acted as deafened and untreated internal controls. For all surgical procedures, guinea pigs were anaesthetised using ketamine (40mg/kg) and xylazil (4mg/kg). Delayed treatment with each of the four neurotrophins halted the degeneration of auditory neurons that is normally seen following loss of hair cells, resulting in neuronal survival rates of between 79-87% of normal hearing animals, as compared to only 52% survival in deafened, untreated controls. These results indicate that neurotrophins have the capacity to rescue auditory neurons from degeneration following an extended period of deafness. These findings suggest that neurotrophins may play a role as therapeutic agents in long-term deaf patients.