Graeme Clark Collection
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ItemPhysiological and histopathological effects of chronic intracochlear electrical stimulation(Monash University Press, 1983)Direct and r.f. currents are known to result in destruction of neural tissue. However, it is now apparent that non-destructive electrical stimulation can be achieved by the use of biphasic pulsatile stimuli (Lilly, 1960; Mortimer et al., 1970; Hughes et al., 1980). Although maximum biologically safe stimulation regimes have yet to be clearly defined, the evidence of a number of investigators suggests that charge density per phase and charge injection per phase are important parameters when establishing biologically safe levels of electrical stimulation (Pudenz et al., 1975; Pudenz et al., 1977; Brown et al., 1977; Babb et al., 1977). Furthermore, considerable attention has been given to ensure that the stimulus is not producing adverse electrochemical reactions that could result in physical or toxic injury to the biological environment. Brummer et al. (1977) have defined the upper limit of electrochemically safe electrical stimulation for platinum electrodes as charge balanced biphasic pulses at a maximum charge density of 300 ?C/cm2 geom./phase.
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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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ItemDirect current measurements in cochlear implants: an in vivo and in vitro study( 1998)Direct current (DC) was measured both in vivo and in vitro in cochlear implant electrodes with stimulation at moderate to high pulse rates in monopolar and bipolar modes. In vivo DC was approximately 2-3 times higher than that measured in vitro. In vivo DC levels were <100 nA even at very high rates, although DC levels increased as a function of stimulus rate and charge intensity. DC levels were lower: in the monopolar than in the bipolar stimulation condition. Stimulation with a monopolar capacitively coupled extracochlear electrode showed even lower DC levels in the intracochlear .electrodes. Our results indicated that the Nucleus electrode shorting system is able to maintain a low level of DC during very high rate stimulation for both monopolar and bipolar modes.
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ItemPeri-modiolar electrode arrays: a comparison of electrode position n the human temporal bone(Monduzzi Editore, 1997)This paper describes a radiologic evaluation of three types of peri-modiolar arrays, comparing their trajectory within the scala tympani with a standard Mini-22 electrode. All peri-modiolar arrays were found to lie closer to the modiolus for much of their insertion length compared with the standard array. While one design showed evidence for the potential of increased insertion trauma, two designs produced satisfactory results. Although further electrode development, temporal bone and histopathologic studies arE required, it would appear that the benefits of peri-modiolar electrode arrays will be realised clinically.
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ItemElectrical stimulation of the auditory nerve: the influence of electrode position on neural excitation(Kugler & Ghendini, 1990)Improved speech recognition among cochlear implant patients would appear to be dependent on a number of factors including improved speech processing strategies and an improvement in the effectiveness of electrically stimulating residual auditory nerve fibers (i.e. lower thresholds, wider dynamic ranges and more localized current spread). Previous human temporal bone studies have shown that free fit scala tympani electrode arrays generally lay along the outer wall of the scala tympani. Therefore, there is a relatively large distance between the electrode array and the residual neural elements within Rosenthal's canal. In the present study, we systematically varied the location of the electrode within the scala tympani to examine the influence of electrode position on neural excitation.
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ItemThe influence of electrode geometry on the electrically evoked auditory brain stem response( 1988)The electrically-evoked auditory brainstem response (EABR) consists of a series of far-field potentials that reflect synchronous neural activity within the auditory brainstem in response to a transient electrical stimulus. The EABR appears relatively simply organized in terms of its amplitude and latency behaviour. The growth in amplitude of wave IV of the EABR, for example, reflects changes in the amplitude of the electrically-evoked VIII nerve compound action potential as a function of stimulus intensity. In addition, single unit population studies have shown a monotonic relationship between the growth in EABR amplitude and the number of nerve fibres being stimulated (Merzenich and White, 1977). The EABR can therefore, provide an insight into the response of the auditory nerve to electrical stimulation. We have used this technique to investigate the efficacy of electrical stimulation of the auditory nerve using a variety of stimulating electrode geometries.
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ItemElectrical stimulation of the auditory nerve: stimulus induced reductions in neural excitability [Abstract]( 1987)Electrical stimulation of the auditory nerve elicits highly synchronised neural activity (Javel et al., in press). As the stimulus current is increased the neural response becomes highly deterministic with every current pulse eliciting a spike even at stimulus rates of 600-800 pulses per second (pps). Our previous acute experimental studies have shown that high stimulus rates (> 200 pps) and high stimulus currents (> 1.0 mA) can result in temporary and sometimes permanent reductions in the excitability of the auditory nerve (Shepherd and Clark, 1986). The present study was designed to examine the mechanisms underlying these stimulus induced reductions in excitability. These results will have implications for the maximum safe and effective stimulus rates that can be employed in cochlear implants.
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ItemHistopathology following electrode insertion and chronic electrical stimulation(Raven Press, 1985)We have examined a number of safety issues associated with cochlear implants. This work has been primarily designed to evaluate the histopathological effects of intracochlear electrode implantation and chronic electrical stimulation. The results of these studies may be summarized as follows: 1) The insertion of the banded free-fit scala tympani array into human cadaver temporal bones produces minimal damage, occurring primarily to a localized region of the spiral ligament. This damage would not result in significant neural degeneration and thus, would not compromise the efficacy of the multiple channel device; 2) chronic intracochlear electrical stimulation for continuous periods of 500 to 2000 hours, using charge balanced biphasic current pulses developing charge densities of 18-32 }?C/cm2. geom./phase, does not adversely affect the spiral ganglion cell population; 3) labyrinthine infection severely reduces the viable spiral ganglion cell population; 4) the formation of new bone present in approximately half of the animals we have implanted --is not associated with electrical stimulation per se; 5) scanning electron microscope studies of electrodes subjected to long periods of intracochlear electrical stimulation reveals minimal platinum dissolution when compared with unstimulated control electrodes, and electrodes that have been stimulated for similar periods in inorganic saline.