Graeme Clark Collection
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ItemApplication of advanced radiographic technology in cochlear implant research( 2001)The effective development of peri-modiolar or other advanced electrode arrays for cochlear implants requires detailed analysis of the insertion procedure and electrode positioning in the cochlea. Routine x-ray techniques cannot provide sufficient detail to meet this need. A new micro-focus x-ray imaging system has been built for our research. The system consists of a x-ray tube with a sub 10-micron focal spot mounted below an adjustable work surface and an image intensifier placed approximately 100 cm above the x-ray aperture. A variety of intracochlear electrode arrays and human temporal bones were studied using this system. The micro-focus x-ray imaging system allows for micro-fluoroscopy to visualise the real time implantation procedure. It also enables capturing of images onto reusable phosphor imaging plates or films for subsequent viewing or analysis. Images are produced at up to 95 times magnification with superior resolution and enhanced contrast. This new radiographic technology plays an important role in development of safe and effective advanced intracochlear electrode arrays.
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ItemChronic monopolar high rate simulation of the auditory nerve: physiological and histopathological effects(Kugler Publications, 2001)There is clinical interest in the development of high rate speech processing strategies, since there are indications that these might enhance speech perception due to an improved representation of the rapid variations in amplitude of speech. Significant improvement in speech perception using high rate stimulation has been demonstrated in cochlear implant recipients. However, it is important that the long-term safety of high rate stimulation is clearly established prior to its general clinical application. This is especially important, since acute animal studies have shown that high rate stimulation can induce a reduction in the excitability of the auditory nerve. This was also associated with an increase in both threshold and latency of the electrically evoked auditory brainstem response (EABR). However, while a chronic stimulation study indicated that monopolar electrical stimulation of the auditory nerve at rates of 1000 pulses per second (pps)/channel (three channels) had no adverse effects on the spiral ganglion cell density (SGCO),5 there is limited data concerning higher rates. In the present study, we evaluated the electrophysiological and histopathological effects of chronic monopolar electrical stimulation of the auditory nerve using considerably higher stimulus rates than have been used in previous studies.
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ItemDevelopment of safe and effective electrodes: a risk management approach [Abstract]( 1999)Results from studies on experimental animals, computer modelling and preliminary psychophysical studies with three patients, have confirmed the potential for subjective improvement with electrode arrays which lie closer to the modiolus than does the Nucleus straight array. Results of psychophysical studies with three cochlear implant patients, using developmental pre-curved arrays, confirm the feasibility of improving patients' performance through improvements in electrode design. In particular, it was found in psychophysical tests, with patients using a developmental pre-curved electrode array, that both maximum comfortable level and threshold reduced with decreasing distance of a stimulated electrode from the modiolus, and that the dynamic range increased. More intense neural excitation patterns were obtained with the closer electrodes. From this it is inferred that the development of more sophisticated electrode arrays, positioned closer to the modiolus than is currently the case with the Nucleus standard array, will enable the development of improved speech processing strategies. There are technical constraints in the design of a peri-modiolar array, and currently a number of approaches to this problem have been investigated. Whilst the goal of the design is that it be effective for sophisticated and variable manners of stimulus delivery, a primary constraint is safety.
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ItemInsertion study using new peri-modiolar electrode array designs [Abstract]( 1999)Intracochlear multi-channel cochlear implants have been shown to successfully provide auditory information for profoundly deaf patients by electrically stimulating discrete populations of auditory nerve fibers via a scala tympani (ST) electrode array. Histological and radiological examination of implanted human temporal bones showed that the current straight Nucleus® array is usually positioned against the outer wall of the ST. An electrode array close to the modiolus could be expected to reduce stimulation thresholds and result in a more localized neural excitation pattern.
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ItemPhysiological and histopathological effects of chronic monopolar high rate stimulation of the auditory nerve [Abstract]( 1999)Speech processing strategies based on high rate electrical stimulation have been associated with improvements in speech perception among cochlear implant users. The present study was designed to evaluate the electrophysiological and histopathological effects of long-term intracochlear monopolar stimulation at the maximum stimulus rate of the current Nucleus Cochlear implant system (14493 pulses/s) as part of our ongoing investigations of safety issues associated with cochlear implants.
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ItemChronic electrical stimulation of the auditory nerve using high-surface area platinum electrodes [Abstract]( 1999)Electrical stimulation using high surface area (HiQ) platinum (Pt) electrodes exhibit a lower electrode impedance, polarisation and direct current (DC) in vitro compared with standard (ST) Pt electrodes of the same geometric size. In the present study we investigated whether HiQ electrodes maintain these advantages in vivo. This could be important for the development of new arrays with an increased number of smaller electrodes. Under general anaesthesia (Ketamine 20 mg/kg and Xylazine 4mg/kg i.p.) five normal hearing cats were implanted bilaterally with a two-channel Pt scala tympani electrode array (4 HiQ, I ST array). Chronic electrical stimulation using charge balanced biphasic current pulses was delivered unilaterally via a transcutaneous leadwire connected to a backpack-stimulator for periods of up to 2400 hours. DC, stimulus current and electrode voltage waveforms were monitored twice daily and access resistance (Ra), electrode impedance (Zc) and polarisation (Zc-Ra) calculated (kΩ). Mean HiQ data were compared to ST data using Students t-test (*=p<0.05, **=p<0.001). Immediately following implantation both HiQ and ST-electrodes exhibited low impedance values (Ra: 1.06 vs 1.00, Zc: 1.24 vs 2.12*, and Zc-Ra: 0.18 vs 1.08**). Subsequently impedance increased, largely due to a rise in Ra (5.35 vs 6.8: Zc: 6.96 vs 9.80, and Zc-Ra: 1.61 vs 3.00*). At the end of the experiment the array was explanted and tested in saline (Ra: 0.63 vs 0.74*, Zc: 0.73 vs 1.90**, Zc-Ra: 0.10 vs 1.16**). These initial results suggests that intracochlear tissue growth increased the access resistance of both electrode designs. However, HiQ electrodes maintained not only a significantly lower polarisation, they also showed a lower average residual DC (23 vs 130 nA**) throughout the experiment.
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ItemElectrical stimulation of the auditory nerve: chronic monopolar stimulation using very high stimulus rates [Abstract]( 1998)Speech processing strategies based on high rate electrical stimulation have been associated with recent improvements of speech perception among cochlear implant users. In the present study we investigated the effects of chronic monopolar stimulation using very high rates (14493 pulses\s). Under general anaesthesia (ketamine (20 mg/kg) and xylazine (3.8 mg/kg) i.p.) six normal hearing cats were implanted bilaterally with a three channel platinum (Pt) scala tympani electrode array, while a return Pt-electrode was placed outside the bulla. Chronic electrical stimulation using charge-balanced biphasic current pulses was delivered unilaterally via a transcutaneous leadwire connected to a backpack-stimulator for up to 2000 h. The animals hearing status was periodically monitored using acoustically evoked compound action potentials (CAP's) and brainstem responses (ABR's). In addition the electrically evoked ABR (EABR) was also recorded to ensure that the chronic stimulus was above threshold. Stimulus current and electrode voltage waveforms were monitored twice daily and access resistance (Ra) and electrode impedance (Zc) calculated. ABR and CAP thresholds were elevated immediately following implantation, but generally showed evidence of partial recovery (0-40 dB). Further deterioration of thresholds on the stimulated side (10-30 dB) was subsequently observed, while control-thresholds remained more stable. Ra (1.3-1.8 kΩ) and Zc (2.2-3.8Ω) typically increased in the first few weeks of electrical stimulation up to Ra:5.6 kΩ and Zc:8.1 kΩ, before decreasing slightly to a constant plateau. These initial results indicate changes in the electrode-tissue interface and tissue growth within the cochlea. They also indicate that chronic stimulation at these high rates may decrease residual hearing.
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ItemDecrement in auditory nerve function following acute high rate stimulation using various stimulus paradigms in guinea pigs [Abstract]( 1996)Previous experimental studies have shown that chronic electrical stimulation of the auditory nerve using charge balanced biphasic current pulses at rates of up to 500 pulses per second (pps) do not adversely affect the adjacent spiral ganglion population. More recently psychophysical trials have indicated that speech processing strategies based on high pulse rates (1000 pps or more) can improve speech perception in cochlea implant patients. In this paper we summarize the results following acute high rate stimulation using different stimulus paradigms.
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ItemDecrement in auditory nerve function following acute high rate stimulation in guinea pigs [Abstract]( 1995)Cochlear implants have been shown to successfully provide profoundly deaf patients with auditory cues for speech discrimination. Psychophysical studies suggested that speech processing strategies based on stimulus rates of up to 1000 pulses per second (pps) may lead to an improvement in speech perception, due to a better representation of the rapid variations in the amplitude of speech. However, "neural fatigue" has been known to occur following brief periods of electrical stimulation at rates high enough to ensure that stimuli occur within the neurons relative refractory period, and has been shown to depend on stimulus duration and rate of the evoked neural activity. Prolonged electrical stimulation at these high stimulus rates could, therefore, have an adverse effect on the neurons metabolism and result in cellular energy depletion.