Graeme Clark Collection
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ItemHearing restoration with the multichannel auditory brainstem implant( 1997)Restoration of useful hearing is now possible in patients with bilateral acoustic neuromas by direct electrical stimulation of the cochlear nucleus. Our first experience with the Multichannel Auditory Brainstem Implant is reported. A forty four year old female with bilateral acoustic neuromas and a strong family history of Neurofibromatosis Type II presented with profound bilateral hearing impairment. Translabyrinthine removal of the right tumour was performed with placement of the Nucleus eight electrode Auditory Brainstem Implant. Intraoperative electrically evoked auditory brainstem response monitoring successfully confirmed placement over the cochlear nucleus. Postoperatively, auditory responses were obtained on stimulation of all electrodes with minimal non-auditory sensations. The patient now receives useful auditory sensations using the "SPEAK" speech processing strategy. Auditory brainstem Implantation should be considered for patients with Neurofibromatosis Type II in whom hearing preservation tumour removal is not possible.
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ItemElectrical stimulation of the auditory nerve with a cochlear implant and the temporal coding of sound frequencies: a brief review( 1997)There is considerable evidence that the brain translates (encodes) the frequency of a sound into both place of excitation (place encoding), and the pattern of intervals between action potentials (temporal encoding). Furthermore, temporal encoding is now thought to be due to a temporal as well as spatial pattern of action potentials in a small group of neurons. This pattern needs to be reproduced with a cochlear implant for improved speech processing. Our recent research has also demonstrated that the timing of excitatory postsynaptic potentials seen with intracellular recordings from brain cells, rather than extracellularly recorded action potentials, correlates better with the frequency of sound. These excitatory postsynaptic potentials are likely to be the link between the patterns of action potentials arriving at nerve cells and the biomolecular activity in the cell. This response also needs to be replicated with improved speech processing strategies.
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ItemSpeech results with a bilateral multi-channel cochlear implant subject for spatially separated signal and noise( 1999)Speech tests in noise were administered to a bilaterally implanted cochlear implant subject. Performance for simultaneous use of two identical implants, with the same speech processing strategy on two independent standard clinical processors, was compared with that of the better performing monaural side alone. Speech was presented at an angle of 45 degrees toward one ear, with noise at 45 degrees toward the contralateral side. Tests were also administered for speech and noise reversed in location. When the speech signal was on the same side as the subject's better performing ear, monaural and binaural tests resulted in similar scores. When the speech was on the opposite side, however, the binaural condition showed significantly better speech scores. The results indicate that binaural implants can provide improved performance in noise when speech and noise arc spatially separated.
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ItemThe effects of stochastic neural activity in a model predicting intensity perception with cochlear implants: low-rate stimulation( 1999)Most models of auditory nerve response to electrical stimulation are deterministic, despite significant physiological evidence for stochastic activity. Furthermore, psychophysical models and analyses of physiological data using deterministic descriptions do not accurately predict many psychophysical phenomena. In this paper we investigate whether inclusion of stochastic activity in neural models improves such predictions. To avoid the complication of interpulse interactions and to enable the use of a simpler and faster auditory nerve model we restrict our investigation to single pulses and low-rate (<200 pulses/s) pulse trains. We apply signal detection theory to produce direct predictions of behavioural threshold, dynamic range and intensity difference limen. Specifically, we investigate threshold versus pulse duration (the strength-duration characteristics), threshold and uncomfortable loudness (and the corresponding dynamic range) versus phase duration, the effects of electrode configuration on dynamic range and on strength-duration, threshold versus number of pulses (the temporal-integration characteristics), intensity difference limen as a function of loudness, and the effects of neural survival on these measures. For all psychophysical measures investigated, the inclusion of stochastic activity in the auditory nerve model was found to produce more accurate predictions.
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ItemA stochastic model of the electrically stimulated auditory nerve: pulse-train response( 1999)The single-pulse model of the companion paper [1] is extended to describe responses to pulse trains by introducing a phenomenological refractory mechanism. Comparisons with physiological data from cat auditory nerve fibers are made for pulse rates between 100 and 800 pulses/s. First, it is shown that both the shape and slope of mean discharge rate curves are better predicted by the stochastic model than by the deterministic model. Second, while interpulse effects such as refractory effects do indeed increase the dynamic range at higher pulse rates, both the physiological data and the model indicate that much of the dynamic range for pulse-train stimuli is due to stochastic activity. Third, it is shown that the stochastic model is able to predict the general magnitude and behavior of variance in discharge rate as a function of pulse rate, while the deterministic model predicts no variance at all.
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ItemIntracochlear factors contributing to psychophysical percepts following cochlear implantation( 1998)The performance of cochlear implant patients may be related to intracochlear, histopathological factors. We have performed detailed post-mortem examinations of five human, implanted cochleas and for each electrode correlated the psychophysical threshold, comfortable level and dynamic range with spiral ganglion cell survival, presence of fibrous tissue and/or new bone, and distance between the centers of the electrode bands and Rosenthal’s canal. The psychophysical parameters were strongly interrelated. Threshold and comfort levels correlated with the distance between the electrodes and Rosenthal’s canal. Threshold levels also correlated with the presence of intracochlear fibrous tissue and new bone, especially with the former. The dynamic range showed a negative correlation with intracochlear pathology, especially with new bone. Comfort levels and dynamic range were related to spiral ganglion cell survival. The distance between the electrodes and the modiolus increased with increasing levels of fibrous tissue and new bone. Spiral ganglion cell survival was decreased with increasing levels of fibrous tissue and new bone.
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ItemSpeech perception in implanted children: influence of preoperative residual hearing on outcomes [Abstract]( 1998)Since the first child was implanted with the Nucleus 22-channel prosthesis in Melbourne in 1985, several thousand children world-wide have now benefitted from this technology. More effective paediatric assessment and management procedures have now been developed, allowing cochlear implants to be offered to children under the age of 2 years. Improvements in speech processing strategy have also been implemented in the Nucleus implant system, resulting in increased mean speech perception benefits for implanted adults. Although a range of performance on formal measures of hearing, speech or language has been reported for children using implants, results from the first decade of implant experience consistently show that significant benefits are available to children receiving their implant at an early age. Reported speech perception results for implanted children show that a considerable proportion (60%) of paediatric patients in the Melbourne and Sydney clinics are able to understand some open-set speech using electrical stimulation alone. These results, and the upward trend of mean speech perception benefits shown for postlinguistically deafened adults have raised questions as to whether severely, or severely-to-profoundly deaf children currently using hearing aids would in fact benefit more from a cochlear implant. To investigate the potential influence of the degree of preoperative residual hearing on postoperative speech perception, results for all implanted children in the Melbourne and Sydney cochlear implant programs were analysed. Results showed that as a group, children with higher levels of preoperative residual hearing were consistently more likely to achieve open-set speech perception benefits. Potential factors in this finding could be higher levels of ganglion cell survival or greater patterning of the auditory pathways using conventional hearing aids prior to implantation. Conversely, children with the least preoperative residual hearing were less predictable, with some children achieving open-set perception, and others showing more limited closed-set benefits to perception. For these children, it is likely that preoperative residual hearing is of less significance than other factors in outcomes.
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ItemAnalysis of integrate and fire neurons: synchronization of synaptic input and spike output( 1999)A new technique for analysing the probability distribution of output spikes for the integrate-and-fire model is presented. This technique enables us to investigate models with arbitrary synaptic response functions that incorporate both leakage across the membrane and a rise time of the postsynaptic potential. The results, which are compared with numerical simulations, are exact in the limit of a large number of small-amplitude inputs. This method is applied to the synchronization problem, in which we examine the relationship between the spread in arrival times of the inputs (the temporal jitter of the synaptic input) and the resultant spread in the times at which the output spikes are generated (output jitter). The results of previous studies, which indicated that the ratio of the output jitter to the input jitter is consistently less than one and that it decreases for increasing numbers of inputs, are confirmed for three classes of the integrate-and-fire model. In addition to the previously identified factors of axonal propagation times and synaptic jitter, we identify the variation in the number of active inputs as being important factors that determine the timing jitter in layered networks. Previously observed phase differences between optimally and suboptimally stimulated neurons may be understood in terms of the relative time taken to reach threshold.
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ItemA stochastic model of the electrically stimulated auditory nerve: single-pulse response( 1999)Most models of neural response to electrical stimulation, such as the Hodgkin-Huxley equations, are deterministic, despite significant physiological evidence for the existence of stochastic activity. For instance, the range of discharge probabilities measured in response to single electrical pulses cannot be explained at all by deterministic models. Furthermore, there is growing evidence that the stochastic component of auditory nerve response to electrical stimulation may be fundamental to functionally significant physiological and psychophysical phenomena. In this paper we present a simple and computationally efficient stochastic model of single-fiber response to single biphasic electrical pulses, based on a deterministic threshold model of action potential generation. Comparisons with physiological data from cat auditory nerve fibers are made, and it is shown that the stochastic model predicts discharge probabilities measured in response to single biphasic pulses more accurately than does the equivalent deterministic model. In addition, physiological data show an increase in stochastic activity with increasing pulse width of anodic/cathodic biphasic pulses, a phenomenon not present for monophasic stimuli. These and other data from the auditory nerve are then used to develop a population model of the total auditory nerve, where each fiber is described by the single-fiber model.
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