The consequences of neural degeneration regarding optimal cochlear implant position in scala tympani: a model approach

Understanding the impact of modiolus porosity on stimulation of spiral ganglion neurons by cochlear implants

Moderate-to-profound sensorineural hearing loss in humans is treatable by electrically stimulating the auditory nerve (AN) with a cochlear implant (CI). In the cochlea, the modiolus presents a porous bony interface between the CI electrode and the AN. New bone growth caused by the presence of the CI electrode or neural degeneration inflicted by ageing or otological diseases might change the effective porosity of the modiolus and, thereby, alter its electrical material properties. Using a volume conductor description of the cochlea, with the aid of a 'mapped conductivity' method and an ad-hoc 'regionally kinetic' equation system, we show that even a slight variation in modiolus porosity or pore distribution can disproportionately affect AN stimulation. Hence, because of porosity changes, an inconsistent CI performance might occur if neural degeneration or new bone growth progress after implantation. Appropriate electrical material properties in accordance with modiolar morphology and pathology should be considered in patient-specific studies. The present first-of-its-kind in-silico study advocates for contextual experimental studies to further explore the utility of modiolus porous morphology in optimising the CI outcome.

Full-array channel discrimination in cochlear implants: validation and clinical application

OBJECTIVE

We sought to validate our proposed tool for estimating channel discrimination of cochlear implant (CI) users along the full electrode array and to assess associations between place-pitch discrimination and speech perception.

DESIGN

In two tests, participants identified one stimulus (probe) as the odd-one-out compared with two reference stimuli. Probe stimuli were evoked using dual electrode stimulation characterised by the current steering coefficient α. The first test measured psychometric functions (PFs) on pre-defined contacts, with just a noticeable difference (JNDα) as the outcome variable. The second test estimated channel discrimination on the full electrode array, yielding a discrimination score of Dα. We measured speech perception as free-field consonant-vowel-consonant phoneme recognition scores.

STUDY SAMPLE

We included 25 adults with at least 6 months of CI experience.

RESULTS

JNDα and Dα scores measured on the same contact correlated significantly (rs = 0.64, p < 0.001). Mean JNDα and speech perception scores showed significant relationships in quiet and in noise.

CONCLUSIONS

Dα correlated strongly with JNDα scores obtained with the PFs. For poor performers, the full-array test may underestimate JNDα. The full-array pitch discrimination test could be a helpful clinical tool, such as for fitting regions of lesser pitch discrimination ability.

Intra-cochlear differences in the spread of excitation between biphasic and triphasic pulse stimulation in cochlear implants: A modeling and experimental study

Triphasic pulse stimulation can prevent unpleasant facial nerve stimulation in cochlear implant users. Using electromyographic measurements on facial nerve effector muscles, previous studies have shown that biphasic and triphasic pulse stimulations produce different input-output functions. However, little is known about the intracochlear effects of triphasic stimulation and how these may contribute to the amelioration of facial nerve stimulation. The present study used a computational model of implanted human cochleae to investigate the effect of pulse shape on the intracochlear spread of excitation. Biphasic and triphasic pulse stimulations were simulated from three different cochlear implant electrode contact positions. To validate the model results, experimental spread of excitation measurements were conducted with biphasic and triphasic pulse stimulation from three different electrode contact positions in 13 cochlear implant users. The model results depict differences between biphasic and triphasic pulse stimulations depending on the position of the stimulating electrode contact. While biphasic and triphasic pulse stimulations from a medial or basal electrode contact caused similar extents of neural excitation, differences between the pulse shapes were observed when the stimulating contact was located in the cochlear apex. In contrast, the experimental results showed no difference between the biphasic and triphasic initiated spread of excitation for any of the tested contact positions. The model was also used to study responses of neurons without peripheral processes to mimic the effect of neural degeneration. For all three contact positions, simulated degeneration shifted the neural responses towards the apex. Biphasic pulse stimulation showed a stronger response with neural degeneration compared to without degeneration, while triphasic pulse stimulation showed no difference. As previous measurements have demonstrated an ameliorative effect of triphasic pulse stimulation on facial nerve stimulation from medial electrode contact positions, the results imply that a complementary effect located at the facial nerve level must be responsible for reducing facial nerve stimulation.

Effects of Degrees of Degeneration on the Electrical Excitation of Human Spiral Ganglion Neurons Based on a High-Resolution Computer Model

After hearing loss retrograde degeneration of spiral ganglion neurons (SGNs) has been described. Studies modeling the effects of degeneration mostly omitted peripheral processes (dendrites). Recent experimental observations indicated that degenerating SGNs manifested also a reduced diameter of their dendrites. We simulated populations of 400 SGNs inside a high resolution cochlear model with a cochlear implant, based on μCT scans of a human temporal bone. Cochlear implant stimuli were delivered as biphasic pulses in a monopolar configuration. Three SGN situations were simulated, based on our previous measurements of human SGN dendrites: (A) SGNs with intact dendrites (before degeneration), (B) degenerating SGNs, dendrites with a smaller diameter but original length, (C) degenerating SGNs, dendrites omitted. SGN fibers were mapped to characteristic frequency, and place pitch was estimated from excitation profiles. Results from degenerating SGNs (B, C) were similar. Most action potentials were initiated in the somatic area for all cases (A, B, C), except for areas near stimulating electrodes in the apex with intact SGNs (A), where action potentials were initiated in the distal dendrite. In most cases, degenerating SGNs had lower thresholds than intact SGNs (A) (down to -2 dB). Excitation profiles showed increased ectopic activation, i.e., activation of unintended neuronal regions, as well as similar neuronal regions excited by different apical electrodes, for degenerating SGNs (B, C). The estimated pitch showed cases of pitch reversals in apical electrodes for intact SGNs (A), as well as mostly identical pitches evoked by the four most apical electrodes for degenerating SGNs (B, C). In conclusion, neuronal excitation profiles to electrical stimulation exhibited similar traits in both ways of modeling SGN degeneration. Models showed degeneration of dendrites caused increased ectopic activation, as well as similar excitation profiles and pitch evoked by different apical electrodes. Therefore, insertion of electrodes beyond approximately 450° may not provide any benefit if SGN dendrites are degenerated.

Model-based prediction of optogenetic sound encoding in the human cochlea by future optical cochlear implants

When hearing fails, electrical cochlear implants (eCIs) partially restore hearing by direct stimulation of spiral ganglion neurons (SGNs). As light can be better confined in space than electrical current, optical CIs (oCIs) provide more spectral information promising a fundamental improvement of hearing restoration by cochlear implants. Here, we turned to computer modelling for predicting the outcome of optogenetic hearing restoration by future oCIs in humans. We combined three-dimensional reconstruction of the human cochlea with ray-tracing simulation of emission from LED or laser-coupled waveguide emitters of the oCI. Irradiance was read out at the somata of SGNs. The irradiance values reached with waveguides were about 14 times higher than with LEDs, at the same radiant flux of the emitter. Moreover, waveguides outperformed LEDs regarding spectral selectivity. oCIs with either emitter type showed greater spectral selectivity when compared to eCI. In addition, modeling the effects of the source-to-SGN distance, orientation of the sources and impact of scar tissue further informs the development of optogenetic hearing restoration.

A phenomenological computational model of the evoked action potential fitted to human cochlear implant responses

There is a growing interest in biomedical engineering in developing procedures that provide accurate simulations of the neural response to electrical stimulus produced by implants. Moreover, recent research focuses on models that take into account individual patient characteristics.

We present a phenomenological computational model that is customized with the patient’s data provided by the electrically evoked compound action potential (ECAP) for simulating the neural response to electrical stimulus produced by the electrodes of cochlear implants (CIs). The model links the input currents of the electrodes to the simulated ECAP.

Potentials and currents are calculated by solving the quasi-static approximation of the Maxwell equations with the finite element method (FEM). In ECAPs recording, an active electrode generates a current that elicits action potentials in the surrounding auditory nerve fibers (ANFs). The sum of these action potentials is registered by other nearby electrode. Our computational model emulates this phenomenon introducing a set of line current sources replacing the ANFs by a set of virtual neurons (VNs). To fit the ECAP amplitudes we assign a suitable weight to each VN related with the probability of an ANF to be excited. This probability is expressed by a cumulative beta distribution parameterized by two shape parameters that are calculated by means of a differential evolution algorithm (DE). Being the weights function of the current density, any change in the design of the CI affecting the current density produces changes in the weights and, therefore, in the simulated ECAP, which confers to our model a predictive capacity.

The results of the validation with ECAP data from two patients are presented, achieving a satisfactory fit of the experimental data with those provided by the proposed computational model.

The cochlea, found in the inner ear, is the organ where the sound is transformed into an electrical pulse to be transmitted by the neurons to the auditory cortex. Hearing loss can be caused by damage to the hair cells, in which case neuronal excitation is impaired. CIs are devices that replace the normal function of the impaired/damaged Organ of Corti. Computational models allow a better understanding of the mechanisms involved in the electrical stimulation of the auditory nerve. These models can help biomedical engineers to develop new CIs with improved auditory performance. One important aspect of our model is its customization with the patient’s data provided by the recording of the evoked compound action potential (the synchronous firing of a population of electrically stimulated auditory nerve fibers). This phenomenological model allows us to predict the registers of neural stimulation produced when the auditory nerve is stimulated with the CIs. We have validated the proposed model with real data obtained from two patients with CIs.

Estimating health of the implanted cochlea using psychophysical strength-duration functions and electrode configuration

It is generally believed that the efficacy of cochlear implants is partly dependent on the condition of the stimulated neural population. Cochlear pathology is likely to affect the manner in which neurons respond to electrical stimulation, potentially resulting in differences in perception of electrical stimuli across cochlear implant recipients and across the electrode array in individual cochlear implant users. Several psychophysical and electrophysiological measures have been shown to predict cochlear health in animals and were used to assess conditions near individual stimulation sites in humans. In this study, we examined the relationship between psychophysical strength-duration functions and spiral ganglion neuron density in two groups of guinea pigs with cochlear implants who had minimally-overlapping cochlear health profiles. One group was implanted in a hearing ear (N = 10) and the other group was deafened by cochlear perfusion of neomycin, inoculated with an adeno-associated viral vector with an Ntf3-gene insert (AAV.Ntf3) and implanted (N = 14). Psychophysically measured strength-duration functions for both monopolar and tripolar electrode configurations were then compared for the two treatment groups. Results were also compared to their histological outcomes. Overall, there were considerable differences between the two treatment groups in terms of their psychophysical performance as well as the relation between their functional performance and histological data. Animals in the neomycin-deafened, neurotrophin-treated, and implanted group (NNI) exhibited steeper strength-duration function slopes; slopes were positively correlated with SGN density (steeper slopes in animals that had higher SGN densities). In comparison, the implanted hearing (IH) group had shallower slopes and there was no relation between slopes and spiral ganglion density. Across all animals, slopes were negatively correlated with ensemble spontaneous activity levels (shallower slopes with higher ensemble spontaneous activity levels). We hypothesize that differences in strength-duration function slopes between the two treatment groups were related to the condition of the inner hair cells, which generate spontaneous activity that could affect the across-fiber synchrony and/or the size of the population of neural elements responding to electrical stimulation. In addition, it is likely that spiral ganglion neuron peripheral processes were present in the IH group, which could affect membrane properties of the stimulated neurons. Results suggest that the two treatment groups exhibited distinct patterns of variation in conditions near the stimulating electrodes that altered detection thresholds. Overall, the results of this study suggest a complex relationship between psychophysical detection thresholds for cochlear implant stimulation and nerve survival in the implanted cochlea. This relationship seems to depend on the characteristics of the electrical stimulus, the electrode configuration, and other biological features of the implanted cochlea such as the condition of the inner hair cells and the peripheral processes.

The relation between polarity sensitivity and neural degeneration in a computational model of cochlear implant stimulation

The main aim of this computational modelling study was to test the validity of the hypothesis that sensitivity to the polarity of cochlear implant stimulation can be interpreted as a measure of neural health. For this purpose, the effects of stimulus polarity on neural excitation patterns were investigated in a volume conduction model of the implanted human cochlea, which was coupled with a deterministic active nerve fibre model based on characteristics of human auditory neurons. The nerve fibres were modelled in three stages of neural degeneration: intact, with shortened peripheral terminal nodes and with complete loss of the peripheral processes. The model simulated neural responses to monophasic, biphasic, triphasic and pseudomonophasic pulses of both polarities. Polarity sensitivity was quantified as the so-called polarity effect (PE), which is defined as the dB difference between cathodic and anodic thresholds. Results showed that anodic pulses mostly excited the auditory neurons in their central axons, while cathodic stimuli generally excited neurons in their peripheral processes or near their cell bodies. As a consequence, cathodic thresholds were more affected by neural degeneration than anodic thresholds. Neural degeneration did not have a consistent effect on the modelled PE values, though there were notable effects of electrode contact insertion angle and distance from the modiolus. Furthermore, determining PE values using charge-balanced multiphasic pulses as approximations of monophasic stimuli produced different results than those obtained with true monophasic pulses, at a degree that depended on the specific pulse shape; in general, pulses with lower secondary phase amplitudes showed polarity sensitivities closer to those obtained with true monophasic pulses. The main conclusion of this study is that polarity sensitivity is not a reliable indicator of neural health; neural degeneration affects simulated polarity sensitivity, but its effect is not consistently related to the degree of degeneration. Polarity sensitivity is not simply a product of the state of the neurons, but also depends on spatial factors.

Spike-rate adaptation in a computational model of human-shaped spiral ganglion neurons

OBJECTIVES

The purpose of this study is to develop a biophysical model of human spiral ganglion neurons (SGNs) that includes voltage-gated hyperpolarization-activated cation (HCN) channels and low-threshold potassium voltage-gated, delayed-rectifier low-threshold potassium (KLT) channels, providing for a more complete simulation of spike-rate adaptation, a feature of most spiking neurons in which spiking activity is reduced in response to sustained stimulation.

METHODS

Our model incorporates features of spike-rate adaptation reported from in vivo studies, whilst also displaying similar behaviour to existing models of human SGNs, including the dependence of electrically evoked thresholds on the polarity of electrical pulses.

RESULTS

Hypothesizing that the mode of stimulation intracellular or extracellular predicts features of spike-rate adaptation similar to in vivo studies, including the influence of stimulus intensity and pulse-rate, we find that the mode of stimulation alters features of spike-rate adaptation. In particular, the reduction in spiking over time with sustained input was generally greater for extracellular, compared to intracellular, stimulation, when simulating a multi-compartment SGN with human morphological features. In contrast, time-constants of spike-rate adaption reported for in vivo data did not fit our predicted responses, highlighting the need for a more complete physiological understanding of the factors contributing to spike-rate adaptation in electrically stimulated human SGNs.

CONCLUSION

Our model extends previous computational models of SGNs with human morphology with ionic channels accounting for features of spike-rate adaptation.

SIGNIFICANCE

The significance of this work resides in the ability to improve the modeling of cochlear implant (CI) stimulation and its effects on neural responses. This will help develop novel, and perhaps personalised, stimulation strategies to reduce variability in CI user outcomes.

Dendritic Degeneration of Human Auditory Nerve Fibers and Its Impact on the Spiking Pattern Under Regular Conditions and During Cochlear Implant Stimulation

Due to limitations of human in vivo studies, detailed computational models enable understanding the neural signaling in the degenerated auditory system and cochlear implants (CIs). Four human cochleae were used to quantify hearing levels depending on dendritic changes in diameter and myelination thickness from type I of the auditory nerve fibers (ANFs). Type I neurons transmit the auditory information as spiking pattern from the inner hair cells (IHCs) to the cochlear nucleus. The impact of dendrite diameter and degree of myelination on neural signal transmission was simulated for (1) synaptic excitation via IHCs and (2) stimulation from CI electrodes. An accurate three-dimensional human cochlear geometry, along with 30 auditory pathways, mimicked the CI environment. The excitation properties of electrical potential distribution induced by two CI were analyzed. Main findings: (1) The unimodal distribution of control dendrite diameters becomes multimodal for hearing loss cases; a group of thin dendrites with diameters between 0.3 and 1 μm with a peak at 0.5 μm appeared. (2) Postsynaptic currents from IHCs excite such thin dendrites easier and earlier than under control conditions. However, this advantage is lost as their conduction velocity decreases proportionally with the diameter and causes increased spike latency and jitter in soma and axon. Firing probability reduces through the soma passage due to the low intracellular current flow in thin dendrites during spiking. (3) Compared with dendrite diameter, variations in myelin thickness have a small impact on spiking performance. (4) Contrary to synaptic excitation, CIs cause several spike initiation sites in dendrite, soma region, and axon; moreover, fiber excitability reduces with fiber diameter. In a few cases, where weak stimuli elicit spikes of a target neuron (TN) in the axon, dendrite diameter reduction has no effect. However, in many cases, a spike in a TN is first initiated in the dendrite, and consequently, dendrite degeneration demands an increase in threshold currents. (5) Threshold currents of a TN and co-stimulation of degenerated ANFs in other frequency regions depend on the electrode position, including its distance to the outer wall, the cochlear turn, and the three-dimensional pathway of the TN.

Sensitivity to binaural temporal-envelope beats with single-sided deafness and a cochlear implant as a measure of tonotopic match (L)

For cochlear-implant users with near-normal contralateral hearing, a mismatch between the frequency-to-place mapping in the two ears could produce a suboptimal performance. This study assesses tonotopic matches via binaural interactions. Dynamic interaural time-difference sensitivity was measured using bandpass-filtered pulse trains at different rates in the acoustic and implanted ear, creating binaural envelope beats. Sensitivity to beats should peak when the same tonotopic region is stimulated in both ears. All nine participants detected dynamic interaural timing differences and demonstrated some frequency selectivity. This method provides a guide to frequency-to-place mapping without compensation for inherent latency differences between the acoustic and implanted ears.

Imaging Bioluminescent Exogenous Stem Cells in the Intact Guinea Pig Cochlea

Stem-cell-based therapy may be used to replace damaged or lost neurons in the cochlear nerve of patients suffering from severe-to-profound sensorineural hearing loss. In order to achieve functional recovery in future clinical trials, knowledge about survival of grafted cells and their differentiation into functional neurons is a prerequisite. This calls for non-invasive in vivo visualization of cells and long-term monitoring of their survival and fate after cochlear transplantation. We have investigated if molecular optical imaging enables visualization of exogenous cells in the intact cochlea of guinea pig cadaver heads. Transduced (stem) cells, stably co-expressing fluorescent (copGFP) and bioluminescent (Luc2) reporter molecules, were injected into the internal auditory meatus or directly into the cochlea through the round window. After injection of the cells into the internal auditory meatus, a bright bioluminescent signal was observed in the cavum conchae of the auricle, indicating that light generated by Luc2 is passing through the tympanic membrane and the external auditory meatus. Similar results were obtained after injection of the cells through the round window membrane, either directly into the scala tympani or in Rosenthal's canal within the modiolus of the basal cochlear turn. Imaging of the auditory bulla demonstrated that the bioluminescent signal passes through the tympanic membrane and crevices in the bony wall of the bulla. After opening the auditory bulla, the bioluminescent signal was emanating from the round window. This is the first study demonstrating that bioluminescence imaging enables visualization of luciferase-expressing cells injected into the intact guinea pig cochlea. Anat Rec, 303:427-440, 2020. © 2019 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.

Computational Simulation Expands Understanding of Electrotransfer-Based Gene Augmentation for Enhancement of Neural Interfaces

The neural interface is a critical factor in governing efficient and safe charge transfer between a stimulating electrode and biological tissue. The interface plays a crucial role in the efficacy of electric stimulation in chronic implants and both electromechanical properties and biological properties shape this. In the case of cochlear implants, it has long been recognized that neurotrophins can stimulate growth of the target auditory nerve fibers into a favorable apposition with the electrode array, and recently such arrays have been re-purposed to enable electrotransfer (electroporation)-based neurotrophin gene augmentation to improve the "bionic ear." For both this acute bionic array-directed electroporation and for chronic conventional cochlear implant arrays, the electric fields generated in target tissue during pulse delivery are central to efficacy, but are challenging to map. We present a computational model for predicting electric fields generated by array-driven DNA electrotransfer in the cochlea. The anatomically realistic model geometry was reconstructed from magnetic resonance images of the guinea pig cochlea and an eight-channel electrode array embedded within this geometry. The model incorporates a description of both Faradaic and non-Faradaic mechanisms occurring at the electrode-electrolyte interface with frequency dependency optimized to match experimental impedance spectrometry measurements. Our simulations predict that a tandem electrode configuration with four ganged cathodes and four ganged anodes produces three to fourfold larger area in target tissue where the electric field is within the range for successful gene transfer compared to an alternate paired anode-cathode electrode configuration. These findings matched in vivo transfection efficacy of a green fluorescent protein (GFP) reporter following array-driven electrotransfer of the reporter-encoding plasmid DNA. This confirms utility of the developed model as a tool to optimize the safety and efficacy of electrotransfer protocols for delivery of neurotrophin growth factors, with the ultimate aim of using gene augmentation approaches to improve the characteristics of the electrode-neural interfaces in chronically implanted neurostimulation devices.

Systematic Review of Auditory Training in Pediatric Cochlear Implant Recipients

Objective The purpose of this systematic review is to evaluate the published research in auditory training (AT) for pediatric cochlear implant (CI) recipients. This review investigates whether AT in children with CIs leads to improvements in speech and language development, cognition, and/or quality of life and whether improvements, if any, remain over time post AT intervention. Method A systematic search of 7 databases identified 96 review articles published up until January 2017, 9 of which met the inclusion criteria. Data were extracted and independently assessed for risk of bias and quality of study against a PICOS (participants, intervention, control, outcomes, and study) framework. Results All studies reported improvements in trained AT tasks, including speech discrimination/identification and working memory. Retention of improvements over time was found whenever it was assessed. Transfer of learning was measured in 4 of 6 studies, which assessed generalization. Quality of life was not assessed. Overall, evidence for the included studies was deemed to be of low quality. Conclusion Benefits of AT were illustrated through the improvement in trained tasks, and this was observed in all reviewed studies. Transfer of improvement to other domains and also retention of benefits post AT were evident when assessed, although rarely done. However, higher quality evidence to further examine outcomes of AT in pediatric CI recipients is needed.

On the parameters used in finite element modeling of compound peripheral nerves

OBJECTIVE

Computational modeling is an important tool for developing and optimizing implantable neural stimulation devices, but requires accurate electrical and geometrical parameter values to improve predictive value. We quantified the effects of perineurial (resistive sheath around each fascicle) and endoneurial (within each fascicle) parameter values for modeling peripheral nerve stimulation.

APPROACH

We implemented 3D finite element models of compound peripheral nerves and cuff electrodes to quantify activation and block thresholds of model axons. We also implemented a 2D finite element model of a bundle of axons to estimate the bulk transverse endoneurial resistivity; we compared numerical estimates to an analytical solution.

MAIN RESULTS

Since the perineurium is highly resistive, potentials were approximately constant over the cross section of a fascicle, and the perineurium resistivity, longitudinal endoneurial resistivity, and fascicle diameter had important effects on thresholds. Activation thresholds increased up to ~130% for higher perineurium resistivity (~400 versus 2200 Ω m) and by ~35%-250% for lower longitudinal endoneurial resistivity (3.5 versus 0.75 Ω m), with larger increases for smaller diameter axons and for axons in larger fascicles. Further, thresholds increased by ~30%-180% for larger fascicle radii, yielding a larger increase with higher perineurium resistivity. Thresholds were largely insensitive to the transverse endoneurial resistivity, but estimates of the bulk resistivity increased with extracellular resistivity and axonal area fraction; the numerical and analytical estimates were in strong agreement except at high axonal area fractions, where structured axon placements that achieved tighter packing produced electric field inhomogeneities.

SIGNIFICANCE

We performed a systematic investigation of the effects of values and methods for modeling the perineurium and endoneurium on thresholds for neural stimulation and block. These results provide guidance for future modeling studies, including parameter selection, data interpretation, and comparison to experimental results.

Biomimetic encoding model for restoring touch in bionic hands through a nerve interface

OBJECTIVE

Hand function can be restored in upper-limb amputees by equipping them with anthropomorphic prostheses controlled with signals from residual muscles. The dexterity of these bionic hands is severely limited in large part by the absence of tactile feedback about interactions with objects. We propose that, to the extent that artificial touch mimics its natural counterpart, these sensory signals will be more easily integrated into the motor plan for object manipulation.

APPROACH

We describe an approach to convey tactile feedback through electrical stimulation of the residual somatosensory nerves that mimics the aggregate activity of tactile fibers that would be produced in the nerve of a native hand during object interactions. Specifically, we build a parsimonious model that maps the stimulus-described as time-varying indentation depth, indentation rate, and acceleration-into continuous estimates of the time-varying population firing rate and of the size of the recruited afferent population.

MAIN RESULTS

The simple model can reconstruct aggregate afferent responses to a wide range of stimuli, including those experienced during activities of daily living.

SIGNIFICANCE

We discuss how the proposed model can be implemented with a peripheral nerve interface and anticipate it will lead to improved dexterity for prosthetic hands.

ECAP growth function to increasing pulse amplitude or pulse duration demonstrates large inter-animal variability that is reflected in auditory cortex of the guinea pig

Despite remarkable advances made to ameliorate how cochlear implants process the acoustic environment, many improvements can still be made. One of most fundamental questions concerns a strategy to simulate an increase in sound intensity. Psychoacoustic studies indicated that acting on either the current, or the duration of the stimulating pulses leads to perception of changes in how loud the sound is. The present study compared the growth function of electrically evoked Compound Action Potentials (eCAP) of the 8^th nerve using these two strategies to increase electrical charges (and potentially to increase the sound intensity). Both with chronically (experiment 1) or acutely (experiment 2) implanted guinea pigs, only a few differences were observed between the mean eCAP amplitude growth functions obtained with the two strategies. However, both in chronic and acute experiments, many animals showed larger increases of eCAP amplitude with current increase, whereas some animals showed larger of eCAP amplitude with duration increase, and other animals show no difference between either approaches. This indicates that the parameters allowing the largest increase in eCAP amplitude considerably differ between subjects. In addition, there was a significant correlation between the strength of neuronal firing rate in auditory cortex and the effect of these two strategies on the eCAP amplitude. This suggests that pre-selecting only one strategy for recruiting auditory nerve fibers in a given subject might not be appropriate for all human subjects.

Ouabain Does Not Induce Selective Spiral Ganglion Cell Degeneration in Guinea Pigs

Round window membrane (RWM) application of ouabain is known to selectively destroy type I spiral ganglion cells (SGCs) in cochleas of several rodent species, while leaving hair cells intact. This protocol has been used in rats and Mongolian gerbils, but observations in the guinea pig are conflicting. This is why we reinvestigated the effect of ouabain on the guinea pig cochlea. Ouabain solutions of different concentrations were placed, in a piece of gelfoam, upon the RWM of the right cochleas. Auditory function was assessed using acoustically evoked auditory brainstem responses (aABR). Finally, cochleas were fixed and processed for histological examination. Due to variability within treatment groups, histological data was pooled and three categories based upon general histological observations were defined: cochleas without outer hair cell (OHC) and SGC loss (Category 1), cochleas with OHC loss only (Category 2), and cochleas with OHC and SGC loss (Category 3). Animals treated with 1 mM or 10 mM ouabain showed shifts in hearing thresholds, corresponding with varying histological changes in their cochleas. Most cochleas exhibited complete outer hair cell loss in the basal and middle turns, while some had no changes, together with either moderate or near-complete loss of SGCs. Neither loss of inner hair cells nor histological changes of the stria vascularis were observed in any of the animals. Cochleas in Category 1 had normal aABRs and morphology. On average, in Category 2 OHC loss was 46.0±5.7%, SGC loss was below threshold, ABR threshold shift was 44.9±2.7 dB, and ABR wave II amplitude was decreased by 17.1±3.8 dB. In Category 3 OHC loss was 68.3±6.9%, SGC loss was 49.4±4.3%, ABR threshold shift was 39.0±2.4 dB, and ABR amplitude was decreased by 15.8±1.6 dB. Our results show that ouabain does not solely destroy type I SGCs in the guinea pig cochlea.

Psychophysical Tuning Curves as a Correlate of Electrode Position in Cochlear Implant Listeners

Speech understanding abilities vary widely among cochlear implant (CI) listeners. A potential source of this variability is the electrode-neuron interface (ENI), which includes peripheral factors such as electrode position and integrity of remaining spiral ganglion neurons. Suboptimal positioning of the electrode array has been associated with poorer speech outcomes; however, postoperative computerized tomography (CT) scans are often not available to clinicians. CT-estimated electrode-to-modiolus distance (distance from the inner wall of the cochlea) has been shown to account for some variability in behavioral thresholds. However, psychophysical tuning curves (PTCs) may provide additional insight into site-specific variation in channel interaction. Thirteen unilaterally implanted adults with the Advanced Bionics HiRes90K device participated. Behavioral thresholds and PTCs were collected for all available electrodes with steered quadrupolar (sQP) configuration, using a modified threshold sweep procedure, used in Bierer et al. (Trends Hear 19:1-12, 2015). PTC bandwidths were quantified to characterize channel interaction across the electrode array, and tip shifts were assessed to identify possible contributions of neural dead regions. Broader PTC bandwidths were correlated with electrodes farther from the modiolus, but not correlated with sQP threshold, though a trend was observed. Both measures were affected by scalar location, and PTC tip shifts were observed for electrodes farther from the modiolus. sQP threshold was the only variable correlated with word recognition. These results suggest PTCs may be used as a site-specific measure of channel interaction that correlates with electrode position in some CI listeners.

Computational Evaluation of Cochlear Implant Surgery Outcomes Accounting for Uncertainty and Parameter Variability

Cochlear implantation (CI) is a complex surgical procedure that restores hearing in patients with severe deafness. The successful outcome of the implanted device relies on a group of factors, some of them unpredictable or difficult to control. Uncertainties on the electrode array position and the electrical properties of the bone make it difficult to accurately compute the current propagation delivered by the implant and the resulting neural activation. In this context, we use uncertainty quantification methods to explore how these uncertainties propagate through all the stages of CI computational simulations. To this end, we employ an automatic framework, encompassing from the finite element generation of CI models to the assessment of the neural response induced by the implant stimulation. To estimate the confidence intervals of the simulated neural response, we propose two approaches. First, we encode the variability of the cochlear morphology among the population through a statistical shape model. This allows us to generate a population of virtual patients using Monte Carlo sampling and to assign to each of them a set of parameter values according to a statistical distribution. The framework is implemented and parallelized in a High Throughput Computing environment that enables to maximize the available computing resources. Secondly, we perform a patient-specific study to evaluate the computed neural response to seek the optimal post-implantation stimulus levels. Considering a single cochlear morphology, the uncertainty in tissue electrical resistivity and surgical insertion parameters is propagated using the Probabilistic Collocation method, which reduces the number of samples to evaluate. Results show that bone resistivity has the highest influence on CI outcomes. In conjunction with the variability of the cochlear length, worst outcomes are obtained for small cochleae with high resistivity values. However, the effect of the surgical insertion length on the CI outcomes could not be clearly observed, since its impact may be concealed by the other considered parameters. Whereas the Monte Carlo approach implies a high computational cost, Probabilistic Collocation presents a suitable trade-off between precision and computational time. Results suggest that the proposed framework has a great potential to help in both surgical planning decisions and in the audiological setting process.

Optimization of cochlear implant stimulation resolution using an intracochlear electric potential model

Designing an electrode array with a high stimulation resolution (SR) is the main challenge in cochlear implant development. In this work, a thin-film electrode array (TFEA) and partial tripolar (pTP) mode were combined in the design stage to optimize the SR. A finite-element model of the intracochlear electric potential V_e incorporating a TFEA and pTP mode was built and validated using previous experimental measurements. Based on this model, the SR was analyzed by using a defined stimulation factor V_s, which takes both the amplitude and bandwidth of V_e into account. A co-simulation method integrating the model and genetic algorithm was employed to maximize V_s with an optimized parameter set including the electrode diameter d, electrode interval g, and compensation coefficient σ. The results indicated that a TFEA combined with pTP mode outperforms their individual utilization to improve the SR and that d has an independent negative correlation with the SR, but it is more effective and feasible to consider all three parameters in the design stage with the proposed model and co-simulation optimization method. In our design, the optimized parameters were d = 150 μm, g = 200.5 μm, and σ = 0.746.

Simulated auditory nerve axon demyelination alters sensitivity and response timing to extracellular stimulation

Since cochlear implant function involves direct depolarization of spiral ganglion neurons (SGNs) by applied current, SGN physiological health must be an important factor in cochlear implant (CI) outcomes. This expected relationship has, however, been difficult to confirm in implant recipients. Suggestively, animal studies have demonstrated both acute and progressive SGN ultrastructural changes (notably axon demyelination), even in the absence of soma death, and corresponding altered physiology following sensorineural deafening. Whether such demyelination occurs in humans and how such changes might impact CI function remains unknown. To approach this problem, we incorporated SGN demyelination into a biophysical model of extracellular stimulation of SGN fibers. Our approach enabled exploration of the entire parameter space corresponding to simulated myelin diameter and extent of fiber affected. All simulated fibers were stimulated distally with anodic monophasic, cathodic monophasic, anode-phase-first (AF) biphasic, and cathode-phase-first (CF) biphasic pulses from an extracellular disc electrode and monitored for spikes centrally. Not surprisingly, axon sensitivity generally decreased with demyelination, resulting in elevated thresholds, however, this effect was strongly non-uniform. Fibers with severe demyelination affecting only the most peripheral nodes responded nearly identically to normally myelinated fibers. Additionally, partial demyelination (<50%) yielded only minimal increases in threshold even when the entire fiber was impacted. The temporal effects of demyelination were more unexpected. Both latency and jitter of responses demonstrated resilience to modest changes but exhibited strongly non-monotonic and stimulus-dependent relationships to more profound demyelination. Normal, and modestly demyelinated fibers, were more sensitive to cathodic than anodic monophasic pulses and to CF than AF biphasic pulses, however, when demyelination was more severe these relative sensitivities were reversed. Comparison of threshold crossing between nodal segments demonstrated stimulus-dependent shifts in action potential initiation with different fiber demyelination states. For some demyelination scenarios, both phases of biphasic pulses could initiate action potentials at threshold resulting in bimodal latency and initiation site distributions and dramatically increased jitter. In summary, simulated demyelination leads to complex changes in fiber sensitivity and spike timing, mediated by alterations in action potential initiation site and slowed action potential conduction due to non-uniformities in the electrical properties of axons. Such demyelination-induced changes, if present in implantees, would have profound implications for the detection of fine temporal cues but not disrupt cues on the time scale of speech envelopes. These simulation results highlight the importance of exploring the SGN ultrastructural changes caused by a given etiology of hearing loss to more accurately predict cochlear implantation outcomes.

Current Focusing to Reduce Channel Interaction for Distant Electrodes in Cochlear Implant Programs

Speech understanding abilities are highly variable among cochlear implant (CI) listeners. Poor electrode-neuron interfaces (ENIs) caused by sparse neural survival or distant electrode placement may lead to increased channel interaction and reduced speech perception. Currently, it is not possible to directly measure neural survival in CI listeners; therefore, obtaining information about electrode position is an alternative approach to assessing ENIs. This information can be estimated with computerized tomography (CT) imaging; however, postoperative CT imaging is not often available. A reliable method to assess channel interaction, such as the psychophysical tuning curve (PTC), offers an alternative way to identify poor ENIs. This study aimed to determine (a) the within-subject relationship between CT-estimated electrode distance and PTC bandwidths, and (b) whether using focused stimulation on channels with suspected poor ENI improves vowel identification and sentence recognition. In 13 CI listeners, CT estimates of electrode-to-modiolus distance and PTCs bandwidths were measured for all available electrodes. Two test programs were created, wherein a subset of electrodes used focused stimulation based on (a) broad PTC bandwidth (Tuning) and (b) far electrode-to-modiolus distance (Distance). Two control programs were also created: (a) Those channels not focused in the Distance program (Inverse-Control), and (b) an all-channel monopolar program (Monopolar-Control). Across subjects, scores on the Distance and Tuning programs were significantly higher than the Inverse-Control program, and similar to the Monopolar-Control program. Subjective ratings were similar for all programs. These findings suggest that focusing channels suspected to have a high degree of channel interaction result in quite different outcomes, acutely.

Analysis of a purely conductance-based stochastic nerve fibre model as applied to compound models of populations of human auditory nerve fibres used in cochlear implant simulations

The study presents the application of a purely conductance-based stochastic nerve fibre model to human auditory nerve fibres within finite element volume conduction models of a semi-generic head and user-specific cochleae. The stochastic, threshold and temporal characteristics of the human model are compared and successfully validated against physiological feline results with the application of a mono-polar, bi-phasic, cathodic first stimulus. Stochastic characteristics validated include: (i) the log(Relative Spread) versus log(fibre diameter) distribution for the discharge probability versus stimulus intensity plots and (ii) the required exponential membrane noise versus transmembrane voltage distribution. Intra-user, and to a lesser degree inter-user, comparisons are made with respect to threshold and dynamic range at short and long pulse widths for full versus degenerate single fibres as well as for populations of degenerate fibres of a single user having distributed and aligned somas with varying and equal diameters. Temporal characteristics validated through application of different stimulus pulse rates and different stimulus intensities include: (i) discharge rate, latency and latency standard deviation versus stimulus intensity, (ii) period histograms and (iii) interspike interval histograms. Although the stochastic population model does not reduce the modelled single deterministic fibre threshold, the simulated stochastic and temporal characteristics show that it could be used in future studies to model user-specific temporally encoded information, which influences the speech perception of CI users.

Towards a Complete In Silico Assessment of the Outcome of Cochlear Implantation Surgery

Cochlear implantation (CI) surgery is a very successful technique, performed on more than 300,000 people worldwide. However, since the challenge resides in obtaining an accurate surgical planning, computational models are considered to provide such accurate tools. They allow us to plan and simulate beforehand surgical procedures in order to maximally optimize surgery outcomes, and consequently provide valuable information to guide pre-operative decisions. The aim of this work is to develop and validate computational tools to completely assess the patient-specific functional outcome of the CI surgery. A complete automatic framework was developed to create and assess computationally CI models, focusing on the neural response of the auditory nerve fibers (ANF) induced by the electrical stimulation of the implant. The framework was applied to evaluate the effects of ANF degeneration and electrode intra-cochlear position on nerve activation. Results indicate that the intra-cochlear positioning of the electrode has a strong effect on the global performance of the CI. Lateral insertion provides better neural responses in case of peripheral process degeneration, and it is recommended, together with optimized intensity levels, in order to preserve the internal structures. Overall, the developed automatic framework provides an insight into the global performance of the implant in a patient-specific way. This enables to further optimize the functional performance and helps to select the best CI configuration and treatment strategy for a given patient.

Ups and Downs in 75 Years of Electrocochleography

Before 1964, electrocochleography (ECochG) was a surgical procedure carried out in the operating theatre. Currently, the newest application is also an intra-operative one, often carried out in conjunction with cochlear implant surgery. Starting in 1967, the recording methods became either minimal- or not-invasive, i.e., trans-tympanic (TT) or extra tympanic (ET), and included extensive studies of the arguments pro and con. I will review several valuable applications of ECochG, from a historical point of view, but covering all 75 years if applicable. The main topics will be: (1) comparing human and animal cochlear electrophysiology; (2) the use in objective audiometry involving tone pip stimulation-currently mostly pre cochlear implantation but otherwise replaced by auditory brainstem response (ABR) recordings; (3) attempts to diagnose Ménière's disease and the role of the summating potential (SP); (4) early use in diagnosing vestibular schwannomas-now taken over by ABR screening and MRI confirmation; (5) relating human electrophysiology to the effects of genes as in auditory neuropathy; and (6) intracochlear recording using the cochlear implant electrodes. The last two applications are the most recently added ones. The "historical aspects" of this review article will highlight the founding years prior to 1980 when relevant. A survey of articles on Pubmed shows several ups and downs in the clinical interest as reflected in the publication counts over the last 75 years.

Stimulation strategies and electrode design in computational models of the electrically stimulated cochlea: An overview of existing literature

Since the 1970s, computational modeling has been used to investigate the fundamental mechanisms of cochlear implant stimulation. Lumped parameter models and analytical models have been used to simulate cochlear potentials, as well as three-dimensional volume conduction models based on the Finite Difference, Finite Element, and Boundary Element methods. Additionally, in order to simulate neural responses, several of these cochlear models have been combined with nerve models, which were either simple activation functions or active nerve fiber models of the cochlear auditory neurons. This review paper will present an overview of the ways in which these computational models have been employed to study different stimulation strategies and electrode designs. Research into stimulation strategies has concentrated mainly on multipolar stimulation as a means of achieving current focussing and current steering, while modeling work on electrode design has been chiefly concerned with finding the optimal position and insertion depth of the electrode array. Finally, the present and future of computational modeling of the electrically stimulated cochlea is discussed.

Exploring the Source of Neural Responses of Different Latencies Obtained from Different Recording Electrodes in Cochlear Implant Users

In this study we measured the electrically evoked compound action potential (ECAP) from different recording electrodes in the cochlea. Under the assumption that different response latencies may be the result of differences in the neural population contributing to the response, we assessed the relationship between neural response latency and spread of excitation. First, we evaluated changes in N1 latency when the recording electrode site was varied. Second, we recorded channel interaction functions using a forward masking technique but with recording electrodes at different intracochlear locations. For most individuals, N1 latency was similar across recording electrodes. However, reduced N1 latencies were observed in 21% of cochlear implant users when ECAPs were recorded using a remote recording electrode. We hypothesized that if recordings from different electrodes represented contributions from different populations of neurons, then one might expect that channel interaction functions would be different. However, we did not observe consistent differences in channel interaction functions (neither peak location nor breadth of the functions), and further, any variation in channel interaction functions was not correlated with ECAP latency. These results suggest that ECAPs from different recording electrodes with different latencies originate from similar neural populations.

The development of biophysical models of the electrically stimulated auditory nerve: Single-node and cable models

In the last few decades, biophysical models have emerged as a prominent tool in the study and improvement of cochlear implants, a neural prosthetic that restores a degree of sound perception to the profoundly deaf. Owing to the spatial phenomena associated with extracellular stimulation, these models have evolved to a relatively high degree of morphological and physiological detail: single-node models in the tradition of Hodgkin-Huxley are paired with cable descriptions of the auditory nerve fiber. No singular model has emerged as a frontrunner to the field; rather, parameter sets deriving from the channel kinetics and morphologies of numerous organisms (mammalian and otherwise) are combined and tuned to foster strong agreement with response properties observed in vivo, such as refractoriness, summation, and strength-duration relationships. Recently, biophysical models of the electrically stimulated auditory nerve have begun to incorporate adaptation and stochastic mechanisms, in order to better realize the goal of predicting realistic neural responses to a wide array of stimuli.

Three-dimensional models of cochlear implants: A review of their development and how they could support management and maintenance of cochlear implant performance

Three-dimensional (3D) computational modeling of the auditory periphery forms an integral part of modern-day research in cochlear implants (CIs). These models consist of a volume conduction description of implanted stimulation electrodes and the current distribution around these, coupled with auditory nerve fiber models. Cochlear neural activation patterns can then be predicted for a given input stimulus. The objective of this article is to present the context of 3D modeling within the field of CIs, the different models, and approaches to models that have been developed over the years, as well as the applications and potential applications of these models. The process of development of 3D models is discussed, and the article places specific emphasis on the complementary roles of generic models and user-specific models, as the latter is important for translation of these models into clinical application.

Computational Models for Predicting Outcomes of Neuroprosthesis Implantation: the Case of Cochlear Implants

Electrical stimulation of the brain has resulted in the most successful neuroprosthetic techniques to date: deep brain stimulation (DBS) and cochlear implants (CI). In both cases, there is a lack of pre-operative measures to predict the outcomes after implantation. We argue that highly detailed computational models that are specifically tailored for a patient can provide useful information to improve the precision of the nervous system electrode interface. We apply our framework to the case of CI, showing how we can predict nerve response for patients with both intact and degenerated nerve fibers. Then, using the predicted response, we calculate a metric for the usefulness of the stimulation protocol and use this information to rerun the simulations with better parameters.

Effect of cochlear implant electrode array design on auditory nerve and behavioral response in children

AIM

To study the effect of change in the array design of cochlear implant electrode on electrophysiological, and behavioral functional measures of cochlear implant users.

METHOD

A total of 33 children using cochlear implants were included in this study. Subjects were implanted with different electrode types including Slim Straight (CI422) and Freedom Contour Advance (CI24RE) electrode arrays. The electrically evoked compound action potential (ECAP) thresholds were evoked by stimulation of basal, mid, and apical electrodes. The behavioral aided responses using the implant were obtained about 6-12 months post fitting of implant.

RESULTS

ECAP thresholds decreased significantly postoperatively in both electrode arrays. Slim straight electrode (CI422) had higher thresholds than Freedom Contour Advance (CI24RE) electrode at most recording sites, but the differences were only significant at basal site. This is a direct consequence of a perimodiolar electrode versus a lateral wall electrode, i.e., the neurons are further away requiring more current (higher threshold) to record the NRT.

CONCLUSION

Although the curved electrode array appeared to evoke responses at lower thresholds, effect on patient performance was not obvious.

Current focussing in cochlear implants: an analysis of neural recruitment in a computational model

Several multipolar current focussing strategies are examined in a computational model of the implanted human cochlea. The model includes a realistic spatial distribution of cell bodies of the auditory neurons throughout Rosenthal's canal. Simulations are performed of monopolar, (partial) tripolar and phased array stimulation. Excitation patterns, estimated thresholds, electrical dynamic range, excitation density and neural recruitment curves are determined and compared. The main findings are: (I) Current focussing requires electrical field interaction to induce spatially restricted excitation patterns. For perimodiolar electrodes the distance to the neurons is too small to have sufficient electrical field interaction, which results in neural excitation near non-centre contacts. (II) Current focussing only produces spatially restricted excitation patterns when there is little or no excitation occurring in the peripheral processes, either because of geometrical factors or due to neural degeneration. (III) The model predicts that neural recruitment with electrical stimulation is a three-dimensional process; regions of excitation not only expand in apical and basal directions, but also by penetrating deeper into the spiral ganglion. (IV) At equal loudness certain differences between the spatial excitation patterns of various multipoles cannot be simulated in a model containing linearly aligned neurons of identical morphology. Introducing a form of variability in the neurons, such as the spatial distribution of cell bodies in the spiral ganglion used in this study, is therefore essential in the modelling of spread of excitation. This article is part of a Special Issue entitled <Lasker Award>.

Place pitch versus electrode location in a realistic computational model of the implanted human cochlea

Place pitch was investigated in a computational model of the implanted human cochlea containing nerve fibres with realistic trajectories that take the variable distance between the organ of Corti and spiral ganglion into account. The model was further updated from previous studies by including fluid compartments in the modiolus and updating the electrical conductivity values of (temporal) bone and the modiolus, based on clinical data. Four different cochlear geometries are used, modelled with both lateral and perimodiolar implants, and their neural excitation patterns were examined for nerve fibres modelled with and without peripheral processes. Additionally, equations were derived from the model geometries that describe Greenwood's frequency map as a function of cochlear angle at the basilar membrane as well as at the spiral ganglion. The main findings are: (I) in the first (basal) turn of the cochlea, cochlear implant induced pitch can be predicted fairly well using the Greenwood function. (II) Beyond the first turn this pitch becomes increasingly unpredictable, greatly dependent on stimulus level, state of the cochlear neurons and the electrode's distance from the modiolus. (III) After the first turn cochlear implant induced pitch decreases as stimulus level increases, but the pitch does not reach values expected from direct spiral ganglion stimulation unless the peripheral processes are missing. (IV) Electrode contacts near the end of the spiral ganglion or deeper elicit very unpredictable pitch, with broad frequency ranges that strongly overlap with those of neighbouring contacts. (V) The characteristic place pitch for stimulation at either the organ of Corti or the spiral ganglion can be described as a function of cochlear angle by the equations presented in this paper.

A novel perfusion-based method for cochlear implant electrode insertion

A cochlear implant (CI) restores partial hearing to profoundly deaf individuals. CI electrodes are inserted manually in the cochlea and surgeons rely on tactile feedback from the implant to determine when to stop the insertion. This manual insertion method results in a large degree of variability in surgical outcomes and intra-cochlear trauma. Additionally, implants often span only the basal turn. In the present study we report on the development of a new method to assist CI electrode insertion. The design objectives are (1) an automated and standardized insertion technique across patients with (2) more apical insertion than is possible by the contemporary methods, while (3) minimizing insertion trauma. The method relies on a viscous fluid flow through the cochlea to carry the electrode array with it. A small cochleostomy (∼100-150 um in diameter) is made in scala vestibuli (SV) and the round window (RW) membrane is opened. A flow of diluted Sodium Hyaluronate (also known as Hyaluronic Acid, (HA)) is set up from the RW to the SV opening using a perfusion pump that sets up a unidirectional flow. Once the flow is established an implant is dropped into the ongoing flow. Here we present a proof-of-concept study where we used this technique to insert silicone implants all the way to the cochlear apex in rats and gerbils. In light-microscopic histology, the implantation occurred without cochlear trauma. To further assess the ototoxicity of the HA perfusion, we measured compound action potential (CAP) thresholds following the perfusion of HA, and found that the CAP thresholds were substantially elevated. Thus, at this point the method is promising, and requires further development to become clinically viable.

Threshold levels of dual electrode stimulation in cochlear implants

Simultaneous stimulation on two contacts (current steering) creates intermediate pitches between the physical contacts in cochlear implants. All recent studies on current steering have focused on Most Comfortable Loudness levels and not at low stimulation levels. This study investigates the efficacy of dual electrode stimulation at lower levels, thereby focusing on the requirements to correct for threshold variations. With a current steered signal, threshold levels were determined on 4 different electrode pairs for 7 different current steering coefficients (α). This was done psychophysically in twelve postlingually deafened cochlear implant (HiRes90K, HiFocus1J) users and, in a computer model, which made use of three different neural morphologies. The analysis on the psychophysical data taking all subjects into account showed that in all conditions there was no significant difference between the threshold level of the physical contacts and the intermediate created percepts, eliminating the need for current corrections at these very low levels. The model data showed unexpected drops in threshold in the middle of the two physical contacts (both contacts equal current). Results consistent with this prediction were obtained for a subset of 5 subjects for the apical pair with wider spacing (2.2 mm). Further analysis showed that this decrease was only observed in subjects with a long duration of deafness. For current steering on adjacent contacts, the results from the psychophysical experiments were in line with the results from computational modelling. However, the dip in the threshold profile could only be replicated in the computational model with surviving peripheral processes without an unmyelinated terminal. On the basis of this result, we put forward that the majority of the surviving spiral ganglion cells in the cochlea in humans with a long duration of deafness still retain peripheral processes, but have lost their unmyelinated terminals.

Information theoretic inference of the optimal number of electrodes for future cochlear implants using a spiral cochlea model

Contemporary cochlear implants stimulate the auditory nerve with an array of up to 22 electrodes. More electrodes do not typically provide improved hearing performance. Given that this limitation is primarily due to current spread, and that newly developing kinds of electrodes may enable more focused stimulation, we recently proposed an information theoretic modeling framework for estimating how many electrodes might achieve optimal hearing performance under a range of assumptions about electrodes and their placement relative to the nerve. Here, we extend this approach by introducing more realistic three-dimensional spiral geometries for the cochlea and array, and comparing the optimal number of electrodes predicted by our model for this case with that in our original model, which used a linear geometry.

Spread of excitation and channel interaction in single- and dual-electrode cochlear implant stimulation

OBJECTIVES

To determine how simultaneous dual-electrode stimulation (DES) can be optimized for the individual patient to deliver better sound quality and speech recognition. DES was compared with single-electrode stimulation (SES) with respect to the site of stimulation (X) in the cochlea, the spread of excitation (SOE), and channel interaction. Second, it was investigated whether the number of intermediate pitches created with DES can be predicted from SOE, channel interaction measures, current distribution in the cochlea, or distance of the electrode to the medial wall.

DESIGN

Twelve users of the HiRes90K cochlear implant with HiFocus1J electrode were randomly selected to participate in this study. Electrode contacts were selected based on their location in the cochlea as determined by multislice computed tomography, viz. 120 degrees (basal), 240 degrees (middle), and 360 degrees (apical) from the round window. The number of intermediate pitches with simultaneous DES was assessed with a three-alternative forced choice pitch discrimination experiment. The channel interactions between two single-electrode contacts and two DES pairs were determined with a threshold detection experiment (three-alternative forced choice). The eCAP-based SOE method with fixed probe and variable masker was used to determine the location of the neurons responding to a single-electrode contact or dual-electrode contact stimulus. Furthermore, the intracochlear electrical fields were determined with the Electrical Field Imaging tool kit.

RESULTS

DES was not different from SES in terms of channel interaction and SOE. The X of DES was 0.54 electrode contacts more basal compared with SES stimulation, which was not different from the predicted shift of 0.5. SOE and current distribution were significantly different for the three locations in the cochlea but showed no correlation with the number of perceivable pitches. A correlation was found between channel interaction and the number of intermediate pitches along the array within a patient, not between patients.

CONCLUSION

SES and DES are equivalent with regard to SOE and channel interaction. The excitation site of DES has the predicted displacement compared with the excitation region induced by the neighboring single-electrode contact. Unfortunately, no predictor for the number of intermediate pitches was found.

A point process framework for modeling electrical stimulation of the auditory nerve

Model-based studies of responses of auditory nerve fibers to electrical stimulation can provide insight into the functioning of cochlear implants. Ideally, these studies can identify limitations in sound processing strategies and lead to improved methods for providing sound information to cochlear implant users. To accomplish this, models must accurately describe spiking activity while avoiding excessive complexity that would preclude large-scale simulations of populations of auditory nerve fibers and obscure insight into the mechanisms that influence neural encoding of sound information. In this spirit, we develop a point process model of individual auditory nerve fibers that provides a compact and accurate description of neural responses to electric stimulation. Inspired by the framework of generalized linear models, the proposed model consists of a cascade of linear and nonlinear stages. We show how each of these stages can be associated with biophysical mechanisms and related to models of neuronal dynamics. Moreover, we derive a semianalytical procedure that uniquely determines each parameter in the model on the basis of fundamental statistics from recordings of single fiber responses to electric stimulation, including threshold, relative spread, jitter, and chronaxie. The model also accounts for refractory and summation effects that influence the responses of auditory nerve fibers to high pulse rate stimulation. Throughout, we compare model predictions to published physiological data of response to high and low pulse rate stimulation. We find that the model, although constructed to fit data from single and paired pulse experiments, can accurately predict responses to unmodulated and modulated pulse train stimuli. We close by performing an ideal observer analysis of simulated spike trains in response to sinusoidally amplitude modulated stimuli and find that carrier pulse rate does not affect modulation detection thresholds.

Nerve maintenance and regeneration in the damaged cochlea

Following the onset of sensorineural hearing loss, degeneration of mechanosensitive hair cells and spiral ganglion cells (SGCs) in humans and animals occurs to variable degrees, with a trend for greater neural degeneration with greater duration of deafness. Emergence of the cochlear implant prosthesis has provided much needed aid to many hearing impaired patients and has become a well-recognized therapy worldwide. However, ongoing peripheral nerve fiber regression and subsequent degeneration of SGC bodies can reduce the neural targets of cochlear implant stimulation and diminish its function. There is increasing interest in bio-engineering approaches that aim to enhance cochlear implant efficacy by preventing SGC body degeneration and/or regenerating peripheral nerve fibers into the deaf sensory epithelium. We review the advancements in maintaining and regenerating nerves in damaged animal cochleae, with an emphasis on the therapeutic capacity of neurotrophic factors delivered to the inner ear after an insult. Additionally, we summarize the histological process of neuronal degeneration in the inner ear and describe different animal models that have been employed to study this mechanism. Research on enhancing the biological infrastructure of the deafened cochlea in order to improve cochlear implant efficacy is of immediate clinical importance.

Potential benefits from deeply inserted cochlear implant electrodes

OBJECTIVES

This review examines evidence for potential benefits of using cochlear implant electrodes that extend into the apical regions of the cochlea. Most cochlear implant systems use electrode arrays that extend 1 to 1.5 turns from the basal cochleostomy, but one manufacturer (MED-EL GmbH) uses an electrode array that is considerably longer. The fundamental rationale for using electrodes extending toward the apex of the cochlea is to provide additional low-pitched auditory percepts and thereby increase the spectral information available to the user. Several experimental long arrays have also been produced by other manufacturers to assess potential benefits of this approach.

DESIGN

In addition to assessing the effects of deeply inserted electrodes on performance, this review examines several underlying and associated issues, including cochlear anatomy, electrode design, surgical considerations (including insertion trauma), and pitch scaling trials. Where possible, the aim is to draw conclusions regarding the potential from apical electrodes in general, rather than relating to the performance of specific and current devices.

RESULTS

Imaging studies indicate that currently available electrode arrays rarely extend more than two turns into the cochlea, the mean insertion angle for full insertions of the MED-EL electrodes being about 630°. This is considerably shorter than the total length of the cochlea and more closely approximates the length of the spiral ganglion. Anatomical considerations, and some modelling studies, suggest that fabrication of even longer electrodes is unlikely to provide additional spectral information. The issue of potential benefit from the most apical electrodes, therefore, is whether they are able to selectively stimulate discrete and tonotopically ordered neural populations near the apex of the spiral ganglion, where the ganglion cells are closely grouped. Pitch scaling studies, using the MED-EL and experimental long arrays, suggest that this is achieved in many cases, but that a significant number of individuals show evidence of pitch confusions or reversals among the most apical electrodes, presumably reducing potential performance benefit and presenting challenges for processor programming.

CONCLUSIONS

Benefits in terms of speech recognition and other performance measures are less clear. Several studies have indicated that deactivation of apical electrodes results in poorer speech recognition performance, but these have been mostly acute studies where the subjects have been accustomed to the full complement of electrodes, thus making interpretation difficult. Some chronic studies have suggested that apical electrodes do provide additional performance benefit, but others have shown performance improvement after deactivating some of the apical electrodes. Whether or not deeply inserted electrodes can offer performance benefits, there is evidence that currently available designs tend to produce more intracochlear trauma than shorter arrays, in terms of loss of residual acoustic hearing and reduction of the neural substrate. This may have important long-term consequences for the user. Furthermore, as it is possible that subjects with better low-frequency residual hearing are more likely to benefit from the inclusion of apical electrodes, there may be a potential clinical dilemma as the same subjects are those most likely to benefit from bimodal electroacoustic stimulation, requiring a relatively shallow insertion.

Computer modelling of the cochlea and the cochlear implant: a review

In the last few decades, cochlear implants have experienced major developments with intensive studies carried out through experimental and computational analysis. With the rapid increase in computational resources available and the development of efficient computational techniques, computer models of the cochlea and the cochlear implant have become more sophisticated. It is now possible to analyze the micromechanics of the cochlea and the transient response of tissue to external stimulation. This study reviews the major developments in cochlear models, summarizes, and categorizes features of models used in different studies and makes recommendations for future development. The paper is classified into four sections detailing features of the cochlear models, electrodes, electrical stimulation, and software used in different studies. The paper highlights unexplored areas in the model design and suggests additions to develop a better computer model.

Neural excitation patterns induced by phased-array stimulation in the implanted human cochlea

CONCLUSIONS

Phased-array stimulation is a promising technique, which uses electrical interaction to focus the stimulation in cochlear implants, at the expense of limited threshold shifts. It has potential advantages over, for example, tripolar stimulation.

OBJECTIVES

Current spread imposes limitations in cochlear implants. Van Compernolle (1985) suggested using all electrode contacts simultaneously to reduce these effects. Van den Honert et al. (2007) validated this so-called phased array algorithm in patients with respect to the electrode potentials but the effect on neural excitation remained unclear. The present study used computational modeling to relate the effect of phased-array stimulation to the neural elements.

METHODS

A computational model of the implanted human cochlea was used to compare the neural excitation patterns induced by conventional monopolar stimulation and by phased-array stimulation. Neural thresholds and electrical dynamic ranges were visualized with excitation profiles, showing the auditory nerve's response to a range of stimulus levels.

RESULTS

Phased-array stimulation of a single region reduces the spread of excitation and increases the dynamic range. The phased array paradigm can be extended to stimulate multiple sites simultaneously, thereby eliminating the need for sequential stimulation, but with a more limited range of usable stimulus levels, especially with perimodiolar electrodes.