Implications of Deep Electrode Insertion on Cochlear Implant Fitting

Using long Med-El Combi40+ electrode arrays, it is now possible to cover the whole range of the cochlea, up to about two turns. Such insertion depths have received little attention. To evaluate the contribution of deeply inserted electrodes, five Med-El cochlear implant users were tested on vowel and consonant identification tests with fittings with first one, two, and up to five apical electrodes being deactivated. In addition, subjects performed pitch-ranking experiments, using loudness-balanced stimuli, to identify electrodes creating pitch confusions. Radiographs were taken to measure each electrode insertion depth. All subjects used each modified fitting for two periods of about 3weeks. During the experiment, the same stimulation rate and frequency range were maintained across all the fittings used for each individual subject. After each trial period the subject had to perform three consonant and three vowel identification tests. All subjects showed deep electrode insertions ranging from 605° to 720°. The two subjects with the deepest electrode insertions showed significantly increased vowel- and consonant-identification performances with fittings with the two or three most apical electrodes deactivated compared to their standard fitting with all available electrodes activated. The other three subjects did not show significant improvements in performance when one or two of their most apical electrodes were deactivated. Four out of five subjects preferred to continue use of a fitting with one or more apical electrodes deactivated. The two subjects with the deepest insertions also showed pitch confusions between their most apical electrodes. Two possible reasons for these results are discussed. One is to reduce neural interactions related to electrodes producing pitch confusions. Another is to improve the alignment of the frequency components of sounds coded by the electrical signals delivered to each electrode to the overall pitch of the auditory perception produced by the electrical stimulation of auditory nerve fiber

fMRI Evidence for Activation of Multiple Cortical Regions in the Primary Auditory Cortex of Deaf Subjects Users of Multichannel Cochlear Implants

To investigate the activation of the auditory cortex by fMRI, three deaf subjects users of the Ineraid cochlear implant participated in our study. Possible interference between fMRI acquisition and the implanted electrodes was controlled and safe experimental conditions were obtained. For each subject, electrical stimuli were applied on different intracochlear electrodes, in monopolar mode. Stimulation of each electrode was actually producing auditory sensations of different pitches, as demonstrated by psychophysical pitch-ranking measurements in the same subjects. Because deaf subjects did not hear scanner noise, the data were collected in ‘silent background' conditions, i.e. as a result of pure auditory sensations. Functional maps showed activation of the primary auditory cortex, predominantly in the left hemisphere. Stimulation of each different intracochlear electrode revealed different clusters of activation. After cluster grouping, at least three regions have been identified in the auditory cortex of each subject, and comparisons with previous architectonic and functional studies are proposed. However, a tonotopic organization could not be clearly identified within each region. These arguments, obtained without interference with unwanted scanner noise, plead in favor of a functional subdivision of the primary auditory cortex into multiple cortical regions in cochlear implant user

Acoustic to Electric Pitch Comparisons in Cochlear Implant Subjects with Residual Hearing

The aim of this study was to assess the frequency-position function resulting from electric stimulation of electrodes in cochlear implant subjects with significant residual hearing in their nonimplanted ear. Six cochlear implant users compared the pitch of the auditory sensation produced by stimulation of an intracochlear electrode to the pitch of acoustic pure tones presented to their contralateral nonimplanted ear. Subjects were implanted with different Clarion® electrode arrays, designed to lie close to the inner wall of the cochlea. High-resolution radiographs were used to determine the electrode positions in the cochlea. Four out of six subjects presented electrode insertions deeper than 450°. We used a two-interval (one acoustic, one electric), two-alternative forced choice protocol (2I-2AFC), asking the subject to indicate which stimulus sounded the highest in pitch. Pure tones were used as acoustic stimuli. Electric stimuli consisted of trains of biphasic pulses presented at relatively high rates [higher than 700 pulses per second (pps)]. First, all electric stimuli were balanced in loudness across electrodes. Second, acoustic pure tones, chosen to approximate roughly the pitch sensation produced by each electrode, were balanced in loudness to electric stimuli. When electrode insertion lengths were used to describe electrode positions, the pitch sensations produced by electric stimulation were found to be more than two octaves lower than predicted by Greenwood's frequency-position function. When insertion angles were used to describe electrode positions, the pitch sensations were found about one octave lower than the frequency-position function of a normal ear. The difference found between both descriptions is because of the fact that these electrode arrays were designed to lie close to the modiolus. As a consequence, the site of excitation produced at the level of the organ of Corti corresponds to a longer length than the electrode insertion length, which is used in Greenwood's function. Although exact measurements of the round window position as well as the length of the cochlea could explain the remaining one octave difference found when insertion angles were used, physiological phenomena (e.g., stimulation of the spiral ganglion cells) could also create this difference. From these data, analysis filters could be determined in sound coding strategies to match the pitch percepts elicited by electrode stimulation. This step might be of main importance for music perception and for the fitting of bilateral cochlear implant

Pinealectomy affects bone mineral density and structure - an experimental study in sheep

<p>Abstract</p> <p>Background</p> <p>Osteoporosis and associated fractures are a major public health burden and there is great need for a large animal model. Melatonin, the hormone of the pineal gland, has been shown to influence bone metabolism. This study aims to evaluate whether absence of melatonin due to pinealectomy affects the bone mass, structure and remodeling in an ovine animal model.</p> <p>Methods</p> <p>Female sheep were arranged into four groups: Control, surgically ovariectomized (Ovx), surgically pinealectomized (Px) and Ovx+Px. Before and 6 months after surgery, iliac crest biopsies were harvested and structural parameters were measured using μCT. Markers of bone formation and resorption were determined. To evaluate long term changes after pinealectomy, bone mineral density (BMD) was analyzed at the distal radius at 0, 3, 9, 18 and 30 months.</p> <p>Results</p> <p>Cancellous bone volume (BV/TV) declined after 6 months by -13.3% Px and -21.5% OvxPx. The bone loss was due to increased trabecular separation as well as decreased thickness. The histomorphometric quantification and determination of collagen degradation products showed increased bone resorption following pinealectomy. Ovariectomy alone results in a transient bone loss at the distal radius followed by continuous increase to baseline levels. The bone resorption activity after pinealectomy causes a bone loss which was not transient, since a continuous decrease in BMD was observed until 30 months.</p> <p>Conclusions</p> <p>The changes after pinealectomy in sheep are indicative of bone loss. Overall, these findings suggest that the pineal gland may influence bone metabolism and that pinealectomy can be used to induce bone loss in sheep.</p

The SIB Swiss Institute of Bioinformatics' resources: focus on curated databases

The SIB Swiss Institute of Bioinformatics (www.isb-sib.ch) provides world-class bioinformatics databases, software tools, services and training to the international life science community in academia and industry. These solutions allow life scientists to turn the exponentially growing amount of data into knowledge. Here, we provide an overview of SIB's resources and competence areas, with a strong focus on curated databases and SIB's most popular and widely used resources. In particular, SIB's Bioinformatics resource portal ExPASy features over 150 resources, including UniProtKB/Swiss-Prot, ENZYME, PROSITE, neXtProt, STRING, UniCarbKB, SugarBindDB, SwissRegulon, EPD, arrayMap, Bgee, SWISS-MODEL Repository, OMA, OrthoDB and other databases, which are briefly described in this article

Measurement of dynamic visual acuity in patients with vestibular areflexia

CONCLUSION: The test is simple and sensitive enough to separate normal subjects from patients suffering from a vestibular loss. There was also a good correlation between the objective results and the subjective complaint of oscillopsia. OBJECTIVES: Oscillopsia (i.e. blurred vision while walking) is often reported by patients suffering from vestibular loss. We developed a test to quantify oscillopsia. METHODS: Visual acuity was determined in 16 normal subjects and in 8 patients suffering from a bilateral vestibular loss, at rest and while walking at increasing speed on a treadmill. Snellen optotypes were randomly projected on a screen and the visual acuity was determined with an adaptative staircase algorithm. RESULTS: In normal subjects, the visual acuity did not decrease markedly during walking, but decreased significantly in patients with a vestibular loss

Measurements of electrode position inside the cochlea for different cochlear implant systems

Conclusions: This study demonstrates that the exact location of an electrode inside the cochlea needs to be assessed using two complementary measures, namely the length and angle of insertion, both of which are mandatory if one wants to prevent erroneous outcomes. Knowledge of the contact position may become very useful when tuning a cochlear implant processor in a patient with contralateral residual hearing, or in cases of binaural implants. Objective: Multichannel cochlear implants restore useful hearing to deaf patients. However, several types of intracochlear electrodes are presently available, each featuring a specific technology or design. The aim of this study was to determine precisely the intracochlear position of the contacts for different electrode arrays. Material and methods: Electrode array insertions were estimated using special radiographs. A total of 26 cochlear implantations were included in the study: 6 Ineraid; 5 Clarion HiFocus I; 11 Clarion HiFocus II; and 4 Med-El Combi40+. In each case, a measurable reference or marker ring placed close to the round window (within 2 mm) could be identified. Insertion lengths and angles were measured and then plotted on a graphl based on 3D reconstructions. Results: Both Clarion HiFocus I and II electrode arrays were found to be placed close to the inner wall of the cochlea. Ineraid and Med-El Combi40+ electrode arrays were both placed close to the organ of Corti, the Med-El Combi40+ arrays demonstrating the deepest insertions overall. In spite of marked differences in the positions of the contacts, we did not find any correlation with speech perception performance for the different types of implants studied