Effect of chronic electrical stimulation on cochlear nucleus neuron size in normal hearing kittens

Study on Recovery Strategy of Hearing Loss & SGN Regeneration Under Physical Regulation

The World Health Organization (WHO) reports that by 2050, nearly 2.5 billion people are expected to have some degree of hearing loss (HL) and at least 700 million will need hearing rehabilitation. Therefore, there is an urgent need to develop treatment strategies for HL. At present, the main treatment strategies for HL are hearing aids and cochlear implants (CIs), which cannot achieve a radical cure for HL. Relevant studies have shown that the most fundamental treatment strategy for sensorineural hearing loss (SNHL) is to regenerate hair cells and spiral ganglion neurons (SGNs) through stem cells to repair the structure and function of cochlea. In addition, physical stimulation strategies, such as electricity, light, and magnetism have also been used to promote SGN regeneration. This review systematically introduces the classification, principle and latest progress of the existing hearing treatment strategies and summarizes the advantages and disadvantages of each strategy. The research progress of physical regulation mechanism is discussed in detail. Finally, the problems in HL repair strategies are summarized and the future development direction is prospected, which could provide new ideas and technologies for the optimization of hearing treatment strategies and the research of SGN repair and regeneration through physical regulation.

Synaptic morphology and the influence of auditory experience

The auditory experience is crucial for the normal development and maturation of brain structure and the maintenance of the auditory pathways. The specific aims of this review are (i) to provide a brief background of the synaptic morphology of the endbulb of Held in hearing and deaf animals; (ii) to argue the importance of this large synaptic ending in linking neural activity along ascending pathways to environmental acoustic events; (iii) to describe how the re-introduction of electrical activity changes this synapse; and (iv) to examine how changes at the endbulb synapse initiate trans-synaptic changes in ascending auditory projections to the superior olivary complex, the inferior complex, and the auditory cortex.

Bilateral effects of unilateral cochlear implantation in congenitally deaf cats

Congenital deafness results in synaptic abnormalities in auditory nerve endings. These abnormalities are most prominent in terminals called endbulbs of Held, which are large, axosomatic synaptic endings whose size and evolutionary conservation emphasize their importance. Transmission jitter, delay, or failures, which would corrupt the processing of timing information, are possible consequences of the perturbations at this synaptic junction. We sought to determine whether electrical stimulation of the congenitally deaf auditory system via cochlear implants would restore the endbulb synapses to their normal morphology. Three and 6-month-old congenitally deaf cats received unilateral cochlear implants and were stimulated for a period of 10-19 weeks by using human speech processors. Implanted cats exhibited acoustic startle responses and were trained to approach their food dish in response to a specific acoustic stimulus. Endbulb synapses were examined by using serial section electron microscopy from cohorts of cats with normal hearing, congenital deafness, or congenital deafness with a cochlear implant. Synapse restoration was evident in endbulb synapses on the stimulated side of cats implanted at 3 months of age but not at 6 months. In the young implanted cats, postsynaptic densities exhibited normal size, shape, and distribution, and synaptic vesicles had density values typical of hearing cats. Synapses of the contralateral auditory nerve in early implanted cats also exhibited synapses with more normal structural features. These results demonstrate that electrical stimulation with a cochlear implant can help preserve central auditory synapses through direct and indirect pathways in an age-dependent fashion.

Auditory brainstem implants: past, present and future prospects

The purpose of the auditory brainstem implant (ABI) is to directly stimulate the cochlear nucleus complex and offer restoration of hearing in patients suffering from profound retrocochlear sensorineural hearing loss. Electrical stimulation of the auditory pathway via an ABI has been proven to be a safe and effective procedure. The function of current ABIs is similar to that of cochlear implants in terms of device hardware with the exception of the electrode array and the sound-signal processing mechanism. The main limitation of ABI is that electrical stimulation is performed on the surface of the cochlear nuclei, thereby making impractical the selective activation of deeper layers by corresponding optimal frequencies. In this article, we review the anatomical, and experimental basis of ABIs and the indications, and surgical technique for their implantation. To the best of our knowledge, we describe the first pathology images of the cochlear nucleus in a patient who had received an ABI.

Auditory system development: primary auditory neurons and their targets

The neurons of the cochlear ganglion transmit acoustic information between the inner ear and the brain. These placodally derived neurons must produce a topographically precise pattern of connections in both the inner ear and the brain. In this review, we consider the current state of knowledge concerning the development of these neurons, their peripheral and central connections, and their influences on peripheral and central target cells. Relatively little is known about the cellular and molecular regulation of migration or the establishment of precise topographic connection to the hair cells or cochlear nucleus (CN) neurons. Studies of mice with neurotrophin deletions are beginning to yield increasing understanding of variations in ganglion cell survival and resulting innervation patterns, however. Finally, existing evidence suggests that while ganglion cells have little influence on the differentiation of their hair cell targets, quite the opposite is true in the brain. Ganglion cell innervation and synaptic activity are essential for normal development of neurons in the cochlear nucleus.

Plastic changes in the central auditory system after hearing loss, restoration of function, and during learning

Traditionally the auditory system was considered a hard-wired sensory system; this view has been challenged in recent years in light of the plasticity of other sensory systems, particularly the visual and somatosensory systems. Practical experience in clinical audiology together with the use of prosthetic devices, such as cochlear implants, contributed significantly to the present view on the plasticity of the central auditory system, which was originally based on data obtained in animal experiments. The loss of auditory receptors, the hair cells, results in profound changes in the structure and function of the central auditory system, typically demonstrated by a reorganization of the projection maps in the auditory cortex. These plastic changes occur not only as a consequence of mechanical lesions of the cochlea or biochemical lesions of the hair cells by ototoxic drugs, but also as a consequence of the loss of hair cells in connection with aging or noise exposure. In light of the aging world population and the increasing amount of noise in the modern world, understanding the plasticity of the central auditory system has its practical consequences and urgency. In most of these situations, a common denominator of central plastic changes is a deterioration of inhibition in the subcortical auditory nuclei and the auditory cortex. In addition to the processes that are elicited by decreased or lost receptor function, the function of nerve cells in the adult central auditory system may dynamically change in the process of learning. A better understanding of the plastic changes in the central auditory system after sensory deafferentation, sensory stimulation, and learning may contribute significantly to improvement in the rehabilitation of damaged or lost auditory function and consequently to improved speech processing and production.

Expression of NMDA, AMPA and GABA(A) receptor subunit mRNAs in the rat auditory brainstem. II. Influence of intracochlear electrical stimulation

We investigated the effects of intracochlear electrical stimulation (ICES) on auditory pathways of neonatal rat deafened by daily amikacin injections. Expression of mRNAs encoding ionotropic glutamate receptor subunits such as alpha-amino-3-hydroxy-5-methyl-4-isoxazole (AMPA) and N-methyl-D-aspartate (NMDA), and gamma-aminobutyric acid type A (GABA(A)) receptor subunits was assessed by in situ hybridization in the dorsal (DCN) and the ventral cochlear nucleus (VCN) and in the central nucleus of the inferior colliculus (CNIC). After 15 days of daily unilateral ICES, the expressions of NR1, NR2b and NR2c subunits of NMDA receptor, that of GluRA, B, C, D flop isoforms of AMPA receptor and that of some GABA(A) subunits (alpha1, beta1, gamma1, gamma2) were increased bilaterally in the DCN, VCN and the CNIC. These changes last over a week after stimulation for only NR1 and NR2c. These modifications might be related to long lasting synaptic plasticity of brainstem auditory pathways. As far as analogy to deaf children can be made, early electrical stimulation might be of interest to maintain neuronal networks.

Results of cochlear implantation in patients with severe to profound hearing loss--implications for patient selection

In patients with some residual hearing and minor benefit from conventional hearing aids, the benefits of cochlear implantation have to be weighed carefully against eventual adverse effects. In this study, pre- and post-operative thresholds as well as functional results after cochlear implantation are reported; 17 of 44 implanted adults had residual hearing pre-operatively (mean threshold(250 to 4000 Hz): 106 dB HL) in the implanted ear. Residual hearing in the implanted ear could not, in general, be preserved post-operatively. Seventeen of 44 implanted children had some amount of residual hearing in the implanted ear pre-operatively (implanted ear: 114 dB HL; contralateral ear: 109.9 dB HL; mean thresholds(250 to 4000 Hz))). Contrary to the results in adults, residual hearing in the implanted ear remained statistically unchanged. Hearing in the contralateral ear increased significantly from 109.9 to 101.9 dB HL post-operatively. This increase was mainly attributed to maturation of the central auditory pathway. In adults with residual hearing, the monosyllable word recognition scores increased significantly from 9 per cent pre-operatively to 42 per cent post-operatively. Children with residual hearing tended to perform better on speech-related test material compared to children without prior auditory experience. Cochlear implantation is indicated in adults and children with residual hearing and minor benefit from conventional amplification. The contralateral ear in children should be considered for additional acoustical stimulation.

Acute study on the efficacy and safety of an auditory brainstem prosthesis

Patients with profound binaural sensorineural hearing loss can be treated with cochlear implantation. In recent years, patients who have lost the integrity of the auditory nerve between the spiral ganglion and the cochlear nucleus in the brainstem, and cannot benefit from a cochlear implant, have reported auditory sensations following direct stimulation of the cochlear nucleus with an auditory brainstem prosthesis. To examine the safety and efficacy of such a prosthesis, the cochlear nuclei of guinea-pigs were acutely implanted and stimulated unilaterally with bipolar surface electrodes using the parameters of human implants. The activation of the central auditory pathway by the prosthesis was demonstrated using the 2-deoxyglucose technique. There was broad 2-deoxyglucose labelling in the ipsilateral cochlear nucleus and bilaterally in the inferior colliculi, indicating unusual stimulation of the ipsilateral ascending pathway. Histological examination was performed on all cochlear nuclei. The volumes of cochlear nuclei and the neuron sizes and density in the cochlear nuclei were analysed with three-dimensional reconstruction techniques, and comparisons were made between the stimulated and unstimulated sides. No histological difference, either by direct visual observation or by statistical comparisons, was observed between the stimulated cochlear nuclei and the control sides. These results suggest that in the acute case the auditory brainstem prostheses can safely and effectively activate the auditory pathway in guinea-pigs.

Histological and physiological effects of the central auditory prosthesis: surface versus penetrating electrodes

To rehabilitate profoundly deaf patients who are not suitable for cochlear implants, central auditory prostheses have been implanted. To compare two possible electrode configurations - penetrating and surface ones - electrical stimulation of the cochlear nucleus with both types of arrays was tested on guinea pigs and cats. Electrophysiological, autoradiographic and histological measures were used to study effects of the central auditory prostheses on the auditory pathway. The results showed that a successful electrically evoked auditory brainstem response could be recorded with both surface and penetrating electrodes in cats and guinea pigs. In guinea pigs the penetrating electrodes had advantages over surface arrays in the sense of lower thresholds and wider dynamic ranges. In cats penetrating electrodes showed lower thresholds than surface ones. In cats and guinea pigs stimulated with either surface or penetrating electrodes, evoked 2-deoxyglucose (2-DG) label was found in the auditory pathway from the cochlear nucleus to the inferior colliculus. No non-auditory tissues were found with evoked 2-DG label. Histological results showed that in subdivisions of the guinea pig cochlear nucleus stimulated with penetrating electrodes the neurone density was decreased, and the mean soma area was increased compared with the control side. In the cat, penetrating electrodes were associated only with increased mean soma area in parts of the stimulated cochlear nucleus. These results suggest that the physiological advantages of penetrating electrodes over surface ones were achieved with some trade-off in safety, especially in the guinea pig.

Afferent projection patterns in the auditory brainstem in normal and congenitally deaf white cats

Cochlear implantation in congenitally deaf children is developing to a successful medical tool. Little is known, however, on morphology and pathophysiology of the central auditory system in these auditory deprived children. One form of congenital hearing loss, that seen in the deaf white cat, was investigated to see if there are differences in the afferent pathways from the cochlear nuclei to the inferior colliculus. The retrogradely transported fluorescent tracer diamidino yellow (DY) was injected into different parts of the central nucleus of the inferior colliculus (ICC) of normal cats and deaf white cats. It was found that the main afferent projection patterns in deaf white cats were unchanged in spite of congenital auditory deprivation; minor differences were seen.

Morphological changes in the cochlear nucleus of congenitally deaf white cats

Investigations in animal models and humans have indicated that congenital deafness produces degenerative changes in the central auditory pathway. The cochlear nucleus is the first central structure that receives cochlear input, and may be considered the origin of ascending auditory pathways. In this context, we studied congenitally deaf white cats, who express early onset cochlear receptor loss, in order to assess the nature of structural changes in cells of the cochlear nucleus. It is conceivable that pathologic alterations in higher auditory structures are transneuronally distributed through this nucleus. The cochlear nuclei of nonwhite cats with normal hearing were compared to those of deaf white cats exhibiting hearing loss in excess of 70 dB SPL. The cochlear nuclei of the deaf white cats were smaller in volume by roughly 50%, with the ventral and dorsal divisions being equally affected. Cell body silhouette area was determined for spherical bushy cells of the anteroventral cochlear nucleus (AVCN), pyramidal cells of the dorsal cochlear nucleus (DCN), sensory neurons from the principal trigeminal nucleus, and motoneurons of the facial nucleus. We found no statistical difference in neuronal cell body size between nonauditory neurons of these two groups of cats, whereas auditory neurons of deaf white cats were 30.8-39.4% smaller than those of normal cats. These data imply that neuronal changes in congenitally deaf cats are specific to the auditory pathway. Although cochlear nucleus volume loss was uniform for both divisions, there was a differential effect on cell density: AVCN cell density increased by 40%, whereas DCN cell density was relatively unaffected (10% increase). Astrocyte density was also greater in the AVCN (52%) compared to that in the DCN (5%). These observations reveal a differential impact on cells in the cochlear nucleus to congenital deafness, suggesting selective processing impairment at this level. If similar patterns of degeneration occur in humans, such pathologies may underlie reduced processing of input from cochlear implants in congenitally deaf adults.

Does age at cochlear implantation affect the distribution of 2-deoxyglucose label in cat inferior colliculus?

Cochlear implants are one treatment for children who are born deaf or become deaf before acquiring language. The question of optimum age for implantation arises. Using an animal model, we have studied the response of the auditory brainstem to implantation at various ages. Neonatally, pharmacologically deafened cats were implanted with a 4-electrode array in the left cochlea at ages from 100 to over 180 days. Eleven were chronically stimulated (1000 h if possible) with charge-balanced, biphasic current pulses; eight were unstimulated controls. In a terminal experiment, each animal received [14C]2-deoxyglucose i.v. preceding a 45-min stimulation program. The fraction of the right inferior colliculus (IC) with a significant accumulation of label was calculated. If age at implantation were a significant factor in determining the size of the responding region, the fraction would depend on the age; this was not observed. However, there was considerable variation in the IC fraction sizes within both stimulated and unstimulated groups, leading to the conclusion that there are factors other than age which determine the size of the responding region. Thus, for deaf children of corresponding ages, age at implantation may not be of critical importance.

Multicentric field evaluation of a new speech coding strategy for cochlear implants

In a multicentric study involving 4 European cochlear implant centers, the speech perception abilities of 20 native German-speaking individuals implanted with the Nucleus 22 Channel Cochlear Implant System when using a new spectral peak (SPEAK) speech coding strategy were investigated. This strategy continuously analyzes the speech signal using 20 digital programmable bandpass filters and presents up to 10 spectral maxima to the 22 implanted electrodes. Each subject's performance on a variety of auditory perceptual tasks was evaluated with the experimental encoder (SPEAK), relative to his or her performance in a reference condition. An ABAB experimental design was used whereby each strategy was reversed and replicated. The reference levels of auditory performance were established using the multipeak (MPEAK) speech-processing strategy of the Nucleus speech processor. Only subjects who achieved open-set monosyllable word recognition in the reference condition were included in this study. Significant differences in group mean scores for most speech recognition subtests were obtained for the SPEAK versus the MPEAK strategy. The largest overall improvements were observed for the sentence tests under noisy conditions.