Graeme Clark Collection
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ItemChronic electrical stimulation of the auditory nerve at high rates: I. Effect on residual hearing [Abstract]( 1996)In addition to direct excitation of auditory nerve fibres, cochlear implant patients with small amounts of residual hearing may receive important additional auditory cues via electrophonic activation of hair cells 1. Before incorporating electrophonic hearing into speech processing strategies, the extent of hair cell survival following cochlear implantation must first be determined. We have recently demonstrated widespread survival of hair cells apical to electrode arrays implanted for periods of up to three years, the present report describes the effects of chronic electrical stimulation on hair cell survival.
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ItemChronic electrical stimulation of the auditory nerve at high rates: II. Cochlear pathophysiology [Abstract]( 1996)A major factor in the improved performance of cochlear implant patients has been the use of high stimulus rate speech processing strategies. While these strategies show clear clinical advantage, we know little of their long-term safety. Indeed, recent studies have indicated that high stimulus rates at intensities above clinical limits, can result in neural damage as a result of prolonged neuronal hyperactivity. The present study was designed to evaluate the effects of chronic electrical stimulation of the auditory nerve at high rates, using intensities within clinical limits.
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ItemPhysiological and histopathological effects of chronic monopolar stimulation on the auditory nerve using very high stimulus rates [Abstract]( 1999)Speech-processing strategies using high stimulus rates are used in some cochlear implant systems. While some data suggests that electrical stimulation of the auditory nerve at rates of 2000 pps per channel is safe, there is little data concerning higher rates. The present study was designed to evaluate the safety of a rate of 5000 pps per channel. Under anaesthesia, (ketamine (20 mg/kg. i.v.) and xylazine (3.8 mg/kg. i.v.)), four normal hearing cats were bilaterally implanted with a three channel platinum (Pt) scala tympani electrode array and a return Pt-electrode placed within the temporalis muscle. Each animal was stimulated unilaterally for durations of up to 2700 h using 25μגs per phase charge-balanced biphasic current pulses. The stimuli were delivered at 5000 pps per channel at mid-dynamic range intensities. Acoustically-evoked auditory brainstem responses (ABRs) were recorded during the stimulation regime to monitor the animals' residual hearing. Electrically-evoked auditory brainstem responses (EABRs) were periodically recorded to monitor the status of the auditory nerve and to ensure stimulus intensity remained above threshold. ABRs typically showed poor recovery in the stimulated ear. Longitudinal EABRs recorded from all animals remained relatively stable for the duration of stimulation. Electrode impedances were calculated from daily monitoring of current and voltage waveforms. Two animals that exhibited the highest electrode impedance throughout the duration of stimulation were found to have significant amounts of new bone growth and fibrous tissue in the basal region of the cochlea. However, as one of these animals showed a similar response in the contralateral, unstimulated, implanted cochlea, this response can not be attributed to electrical stimulation per se. There was no statistically significant difference in spiral ganglion cell density in the stimulated cochleae when compared to corresponding regions in controls (p?0.2, Mann-Whitney Rank. Sum Test). These initial results indicate that chronic monopolar stimulation of the cochlea at a rate of 5000 pps per channel does not have an adverse effect on spiral ganglion cell density.
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ItemChronic electrical stimulation of the auditory nerve using non-charge balanced stimuli [Abstract]( 1998)Cochear implants use charge balanced biphasic current pulses and electrode shorting between current pulses to minimise potentially damaging direct current (DC). In the present study we evaluated the effectiveness of the electrode shorting technique using a non-charge balanced stimulus regime. Under general anaesthesia (ketamine (20 mg/kg. i.m.) and xylazine (3.8 mg/kg. i.m)), eight normal hearing cats were bilaterally implanted with two channel platinum scala tympani electrodes. Each animal was stimulated unilaterally for 500 to 2200 h using 50 μs monophasic current pulses. The stimuli were delivered at rates of 500 or 2000 pulses per channel continuously at mid-dynamic range intensities. Electrically-evoked auditory brainstem responses (EABR) were periodically recorded to monitor the status of the auditory nerve and to ensure stimulus intensity remained above threshold. At a stimulus rate of 500 pulses/s, electrode shorting effectively reduced DC levels to ≤ 0.3µA. Longitudinal EABR's recorded from these animals , remained relatively stable over the stimulus duration. These cochleae showed minimal tissue response and there was no statistically significant difference in spiral ganglion cell density when compared with controls (p=0.21, Mann-Whitney U-test). Chronic stimulation at 2000 pulses/s resulted in increased DC levels (0.6-2.8µA). These cochleae exhibited a highly significant reduction in spiral ganglion cell density when compared with controls (p<0.0001), and their EABR's typically displayed an elevation in threshold as a function of stimulus duration. The present findings indicate that continuous non-charge balanced stimuli at rates of 2000 pulses/s can result in significant loss of spiral ganglion cells, presumably as a result of increased DC levels.
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ItemHigh rate electrical stimulation of the auditory nerve: physiological and pathological results [Abstract]( 1995)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, a number of clinical trials have indicated that speech processing strategies based on high pulse rates (1000 pps and more), can further improve speech perception. In this paper we summarize our results following acute and chronic electrical stimulation of the auditory nerve using high pulse rates.
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ItemCochlear implants: high rate stimulation studies and the effect of electrode position [Abstract]( 1996)This paper summarizes our recent findings investigating the safety of high rate electrical stimulation, and reviews the effects of electrode position on auditory excitability. These studies used charge balanced biphasic pulses and electrode shorting between stimuli to minimize any residual charge or direct current. High rate (400-1000 pulses/s) electrical stimulation of the auditory nerve can result in significant stimulus induced reductions in auditory nerve excitability at stimulus levels well above those used clinically (1). The extent of this reduction was dependent on stimulus rate, intensity and duty cycle, implying that such changes were related to the degree of evoked activity.
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Item"Cochlear View" and its application in cochlear implant patients [Abstract]( 1994)Recent advances in multichannel intracochlear implantation have generated interests in correlating individual stimulating electrodes to pitch perception. An appropriate radiographic technique is required to precisely document the location of the implanted intracochlear electrode array. Anatomical studies, including the measurements of the temporal bone using high-resolution CT films and 3D reconstruction from the petrous bone sections, were conducted to define the spatial position of cochlea in the skull. Thus, a "Cochlear View" was designed and introduced for postoperative radiological evaluation of multichannel intracochlear implantation. In this paper, a detailed radiographic method and radiological interpretation of the "Cochlear View" are described. A plain radiograph of the "Cochlear View" was taken of 120 patients who had received the Nucleus multichannel implant. Studies have shown that a plain radiograph of the "Cochlear View" provides sufficient information to correctly evaluate the results of implantation, including the insertion depth and position of individual electrodes. It plays an important role in guiding the management of frequency mapping and acts as a useful reference for further research purposes.
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ItemPhysiological and histopathological response of the cochlea to chronic electrical stimulation of the auditory nerve at high stimulus rates [Abstract]( 1994)Previous research has 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) does not adversely affect the adjacent spiral ganglion population. More recently, a number of clinical trials have suggested that speech processing strategies based on high pulse rates (e.g. 1000 pps), can further improve speech perception. In the present study we evaluated the physiological and histopathological response of the cochlea following long-term stimulation using rates of 1000 pps. Thirteen normal hearing cats were bilaterally implanted with scala tympani electrodes and unilaterally stimulated using 25-50 �s per phase charge balanced biphasic current pulses presented at 1000 pps. Additional charge balance was achieved by shorting the electrodes between current pulses. Each animal was stimulated for periods ranging from 700 - 2100 hours at current levels within its dynamic range. Auditory brainstem responses to both acoustic (ABR) and electrical (EABR) stimuli were periodically recorded throughout the chronic stimulation program. At completion of the program the cochleas were prepared for histological examination. While all animals exhibited an increase in acoustic thresholds following surgery, click evoked ABR's returned to near normal levels in half the animals. Frequency specific stimuli indicated that the most extensive hearing loss occurred adjacent to the array (>12 kHz) while lower frequency thresholds appeared at or near normal Our EABR data showed that the majority of animals exhibited slight increases in threshold, although response amplitudes remained very stable for the duration of the stimulus program. The physiological data reported here will be correlated with cochlear histopathology. These initial findings suggest that chronic intracochlear electrical stimulation at high pulse rates, using a carefully designed charge balanced stimulator, does not appear to adversely affect the implanted cochlea.
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ItemPaediatric cochlear implantation: radiological and histopathological studies of skull growth in the monkey( 1993)The human skull undergoes significant growth within the first two years of life (Dahm et aI, 1992). Therefore, before children under two can be considered candidates for cochlear implantation, the effects of the surgical procedure on subsequent skull growth must be well understood. To evaluate the effects of implantation on skull growth four macaque monkeys were implanted with dummy cochlear implants at six months of age. To model the procedure in the very young child, the bed for the receiver-stimulator was drilled across a calvarial suture down to the underlying dura and an electrode array inserted into the scala tympani via a mastoidectomy and posterior,tympanotomy. Plain skull radiographs were perioqical1y taken to monitor skull growth for periods of up to three years following implantation. Their longitudinal measurements revealed no evidence of asymmetrical skull growth when compared with unimplanted control animals. Computer tomographic scans taken at post-mortem confirmed these findings. Finally, subsequent histopathological evaluation of the receiver-stimulator package bed indicated that it becomes obliterated by hard tissue, resulting in a localized flattening of the vault under the receiver-stimulator. However, this tissue exhibited histological evidence of sutures, indicating that the surgical procedure should not lead to premature sutural closure. In conclusion, the present experimental results suggest that long-term cochlear implantation in very young children will not lead to any significant skull deformity.
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ItemInvestigation of curved intracochlear electrode arrays [Abstract]( 1992)It has been demonstrated that the Melbourne/Cochlear multi-channel cochlear implant is safe and effective for use in profoundly-totally deaf patients. Recent studies have highlighted the importance of deaf insertion and placing the electrodes closer to the spiral ganglion neurons. In order to improve the electrode insertion depth and proximity to the modiolus, we have investigated curved electrode arrays. Prototypes of such arrays and their accessory inserter have been made. Trial insertions were performed on skeletonized cochleae of human temporal bones. The preliminary results showed that, when compared with conventional straight electrode arrays, the curved arrays could be inserted deeper and located closer to the modiolus. These findings indicate that the curved --.~ electrodes currently under investigation should result in a reduction in stimulus threshold and improve pitch perception and may also result in the use of more channels of stimulation.