Biomedical subjects

Donald K Eddington

Publications and source records attributed to Donald K Eddington.

9 recordsLinked to original sources

PubMed2006

Histopathology of the inner ear relevant to cochlear implantation.

The most common forms of severe hearing loss and deafness are related to morphological changes in the cochlea. Many individuals with such forms of hearing disorders have received cochlear implants. It has been assumed that preservation of spiral ganglion cells is important for success of cochlear implants. Preservation of ganglion cells is negatively correlated with the duration of the hearing loss. It has, however, not been possible to reveal a relationship between the degree of survival of spiral ganglion cells and performance of cochlear implants. It is important to understand the histopathological changes that follow cochlear implantation. Insertion of cochlear implants may cause trauma to the basilar membrane, the spiral lamina, and the spiral ligament. Rupture of the basilar membrane may occur. Over time, new bone forms at the cochleostomy and along the implant track. Further investigation is necessary to evaluate the causes of variability of behavioral measures of performance.

Adult↗

PubMed2005

Histopathology of human cochlear implants: correlation of psychophysical and anatomical measures.

The cadavaric temporal bones of five subjects who underwent cochlear implantation during life (2 Nucleus and 3 Ineraid) were analyzed using two-dimensional (2D) reconstruction of serial sections to determine the number of surviving spiral ganglion cells (SGCs) in the region of each electrode of the implanted arrays. The last psychophysical threshold and maximum-comfortable sensation level measured for each electrode were compared to their respective SGC count to determine the across-electrode psychophysical variance accounted for by the SGC counts. Significant correlations between psychophysical measures and SGC counts were found in only two of the five subjects: one Nucleus implantee (e.g., r=-0.71; p<0.001 for threshold vs. count) and one Ineraid implantee (e.g., r=-0.86; p<0.05 for threshold vs. count). A three-dimensional (3D) model of the implanted cochlea was formulated using the temporal-bone anatomy of the Nucleus subject for whom the 2D analysis did not result in significant correlations between counts and psychophysical measures. Predictions of the threshold vs. electrode profile were closer to the measured profile for the 3D model than for the 2D analysis. These results lead us to hypothesize that 3D techniques will be required to asses the impact of peripheral anatomy on the benefit patients derive from cochlear implantation.

Cadaver↗

PubMed2005

Is word recognition correlated with the number of surviving spiral ganglion cells and electrode insertion depth in human subjects with cochlear implants?

OBJECTIVES/HYPOTHESIS: Speech perception scores using cochlear implants have ranged widely in all published series. The underlying determinants of success in word recognition are incompletely defined. Although it has been assumed that residual spiral ganglion cell population in the deaf ear may play a critical role, published data from temporal bone specimens from patients have not supported this hypothesis. The depth of insertion of a multichannel cochlear implant has also been suggested as a clinical variable that may be correlated with word recognition. In the current study these correlations were evaluated in 15 human subjects. STUDY DESIGN: Retrospective review of temporal bone histopathology. METHODS: Temporal bones were fixed and prepared for histological study by standard techniques. Specimens were then serially sectioned and reconstructed by two-dimensional methods. The spiral ganglion cells were counted, and the depth of insertion of the cochlear implant as measured from the round window was determined. Correlation analyses were then performed between the NU6 word scores and spiral ganglion cell counts and the depth of insertion. RESULTS: The segmental and total spiral ganglion cell counts were not significantly correlated (P > .50) with NU6 word scores for the 15 subjects. Statistically significant correlations were not achieved by separate analysis of implant types. Similarly, no significant correlation between the depth of insertion of the electrode array and postoperative NU6 word score was identified for the group. CONCLUSION: Although it is unlikely that the number of residual spiral ganglion cell counts is irrelevant to the determination of word recognition following cochlear implantation, there are, clearly, other clinical variables not yet identified that play an important role in determining success with cochlear implantation.

Aged↗

PubMed2005

Effect of cochlear implantation on residual spiral ganglion cell count as determined by comparison with the contralateral nonimplanted inner ear in humans.

It is generally assumed that at least a minimal number of spiral ganglion cells is essential for successful speech perception with a cochlear implant. Although the insertion of a multichannel cochlear implant frequently results in loss of residual hearing in the implanted ear, this outcome does not imply that significant damage to residual populations of spiral ganglion cells has occurred. The purpose of the current study was to compare spiral ganglion cell counts in implanted and nonimplanted cochleas in 11 patients for whom both temporal bones were available and in whom a multichannel cochlear implant had been placed unilaterally. The temporal bones were processed for light microscopy by standard techniques. The cochleas were reconstructed by 2-dimensional methods. Spiral ganglion cell counts of the implanted and nonimplanted sides were compared by a paired t-test (2-tailed). The mean spiral ganglion cell counts for implanted and nonimplanted ears were not statistically different in the most basal three segments of the cochlea. However, the mean spiral ganglion cell count in segment 4 (apical segment) and the mean total spiral ganglion cell count were lower in the implanted cochleas than in the nonimplanted cochleas (p < .01). The results of this study suggest a modest decrease in the total spiral ganglion cell count in the implanted ears as compared to the nonimplanted ears, principally in the apical segment. Possible interpretations of this finding are discussed.

Aged↗

PubMed2004

Histologic evaluation of the tissue seal and biologic response around cochlear implant electrodes in the human.

HYPOTHESIS: Histopathologic study of the tissue seal and biologic response around cochlear implant electrodes in patients who had received a cochlear implant during life could provide clues concerning the pathogenesis of meningitis after cochlear implantation. BACKGROUND: Bacterial meningitis has been reported as an infrequent complication of cochlear implantation using a variety of electrode designs. The cause of meningitis in cochlear implant recipients has not been firmly established. In an analogous surgical situation, namely stapedectomy, delayed meningitis could occur as a complication of ipsilateral acute suppurative otitis media in which there was open communication between the middle ear and perilymph. METHODS: Twenty-one temporal bones from 20 individuals who had undergone cochlear implantation during life were studied by light microscopy. All sections passing through the cochleostomy site and electrode track were examined to evaluate the tissue seal at the cochleostomy, the presence or absence of an extracochlear electrode sheath, and finally, to seek evidence of a cellular inflammatory response near the electrode. These data were compared with clinical data, including electrode system used, the number of years between implantation and death, type of tissue used at surgery, and the age and sex of the patients. RESULTS: The 21 specimens included cases implanted with the Symbion Ineraid, Cochlear Corporation Nucleus 22-channel, Cochlear Corporation Nucleus 24-channel, a Cochlear Corporation Nucleus single channel, and Advanced Bionics Clarion C1 devices. At the cochleostomy site, and just within the cochlea, there was a robust fibrous and bony tissue response in all 21 ears and in most cases, there was a fibrous sheath surrounding the electrode in the middle ear. No recognizable open communication or potential communication between the middle ear and the inner ear was seen in any of the 21 ears. An inflammatory cellular response, including mononuclear leukocytes, histiocytes, and foreign body giant cells, were present in 12 of the 21 temporal bones (57%) and was most intense at the cochleostomy site. No statistically significant relationship was found between the presence or absence of inflammatory cells and the type of tissue graft used at surgery. CONCLUSIONS: The histologic evidence presented in this study does not support open communication between the middle and the inner ear as part of the pathogenesis of bacterial meningitis as a late complication after cochlear implantation. Rather, the finding of a cellular inflammatory response in 12 of 21 temporal bones suggests that late hematogenous contamination and colonization of the implant is a much more likely pathogenic mechanism. This putative mechanism has implications for possible strategies to prevent meningitis after cochlear implantation.

Aged↗

PubMed2003

Binaural sensitivity as a function of interaural electrode position with a bilateral cochlear implant user.

Experiments were conducted with a single, bilateral cochlear implant user to examine interaural level and time-delay cues that putatively underlie the design and efficacy of bilateral implant systems. The subject's two implants were of different types but custom equipment allowed presentation of controlled bilateral stimuli, particularly those with specified interaural time difference (ITD) and interaural level difference (ILD) cues. A lateralization task was used to measure the effect of these cues on the perceived location of the sensations elicited. For trains of fixed-amplitude, biphasic current pulses at 100 pps, the subject demonstrated sensitivity to an ITD of 300 micros, providing evidence of access to binaural information. The choice of bilateral electrode pair greatly influenced ITD sensitivity, suggesting that electrode pairings are likely to be an important consideration in the effort to provide binaural advantages. The selection of bilateral electrode pairs showing sensitivity to ITD was partially aided by comparisons of the pitch elicited by individual electrodes in each ear (when stimulated alone with fixed-amplitude current pulses at 813 pps): specifically, interaural electrodes with similar pitches were more likely (but not certain) to show ITD sensitivity. Significant changes in lateral position occurred with specific electrode pairs. With five bilateral electrode pairs of 14 tested, ITDs of 300 and 600 micros moved an auditory image significantly from right to left. With these same pairs, ILD changes of approximately 11% of the dynamic range (in microApp) moved an auditory image from the far left to the far right-significantly farther than the nine pairs not showing significant ITD sensitivity. However, even these nine pairs did show response changes as a function of the interaural (or confounding monaural) level cue. Overall, insofar as the access to bilateral cues demonstrated herein generalizes to other subjects, it provides hope that the normal binaural advantages for speech recognition and sound localization can be made available to bilateral implant users.

Acoustic Stimulation↗

PubMed2003

Desynchronization of electrically evoked auditory-nerve activity by high-frequency pulse trains of long duration.

Rubinstein et al. [Hear. Res. 127, 108-118 (1999)] suggested that the neural representation of the waveforms of electric stimuli might be improved by introducing an ongoing, high-rate, desynchronizing pulse train (DPT). A DPT may desynchronize neural responses to electric stimulation in a manner similar to spontaneous activity in a healthy ear. To test this hypothesis, responses of auditory-nerve fibers (ANFs) to 10-min-long electric pulse trains (5 kpps) were recorded from acutely deafened, anesthetized cats. Stimuli were delivered via an intracochlear electrode, and their amplitude was chosen to elicit a response in most ANFs. Responses to pulse trains showed pronounced adaptation during the first 1-2 min, followed by either a sustained response or cessation of spike discharges for the remainder of the stimulus. The adapted discharge rates showed a broad distribution across the ANF population like spontaneous activity. However, a higher proportion of fibers (46%) responded to the DPT at rates below 5 spikes/s than for spontaneous activity, and 12% of the fibers responded at higher rates than any spontaneously active fiber. Interspike interval histograms of sustained responses for some fibers had Poisson-like (exponential) shapes, resembling spontaneous activity, while others exhibited preferred intervals and, occasionally, bursting. Simultaneous recordings from pairs of fibers revealed no evidence of correlated activity, suggesting that the DPT does desynchronize the auditory nerve activity. Overall, these results suggest that responses to an ongoing DPT resemble spontaneous activity in a normal ear for a substantial fraction of the ANFs.

Acoustic Stimulation↗

PubMed2003

Improved temporal coding of sinusoids in electric stimulation of the auditory nerve using desynchronizing pulse trains.

Rubinstein et al. [Hearing Res. 127, 108-118 (1999)] suggested that the representation of electric stimulus waveforms in the temporal discharge patterns of auditory-nerve fiber (ANF) might be improved by introducing an ongoing, high-rate, desynchronizing pulse train (DPT). To test this hypothesis, activity of ANFs was studied in acutely deafened, anesthetized cats in response to 10-min-long, 5-kpps electric pulse trains that were sinusoidally modulated for 400 ms every second. Two classes of responses to sinusoidal modulations of the DPT were observed. Fibers that only responded transiently to the unmodulated DPT showed hyper synchronization and narrow dynamic ranges to sinusoidal modulators, much as responses to electric sinusoids presented without a DPT. In contrast, fibers that exhibited sustained responses to the DPT were sensitive to modulation depths as low as 0.25% for a modulation frequency of 417 Hz. Over a 20-dB range of modulation depths, responses of these fibers resembled responses to tones in a healthy ear in both discharge rate and synchronization index. This range is much wider than the dynamic range typically found with electrical stimulation without a DPT, and comparable to the dynamic range for acoustic stimulation. These results suggest that a stimulation strategy that uses small signals superimposed upon a large DPT to encode sounds may evoke temporal discharge patterns in some ANFs that resemble responses to sound in a healthy ear.

Animals↗

PubMed2002

Morphometric changes in the cochlear nucleus in patients who had undergone cochlear implantation for bilateral profound deafness.

We have investigated the morphometric changes in the cochlear nucleus of patients who had undergone cochlear implantation following profound deafness. The brain stems of 11 adult patients who had undergone implantation and four non-implanted control cases with varying degrees of hearing loss were studied. The volumes of the ventral cochlear nucleus (VCN) and dorsal cochlear nucleus (DCN), and the maximal cross-sectional area and densities of cell bodies in the anterior ventral cochlear nucleus (AVCN) were measured bilaterally by light microscopy assisted by the Neurolucida 2000 image analysis system. In addition, the density of synapses on cells of the AVCN were estimated using immunostaining for the synaptosome-associated protein (SNAP-25) by light microscopy. There was no significant difference in volumes of VCN and DCN, maximal cross-sectional area and density of cell bodies of the AVCN, and SNAP-25 immunostaining between the cochlear nucleus ipsilateral and contralateral to cochlear implantation. In addition, there was no significant correlation between these morphometric parameters and clinical performance. Peripheral deafness seems to reduce the size of neurons in the AVCN in that the maximum diameter of cell bodies was greater in the ear with better hearing preoperatively (chi-square test P<0.05). However, electrical stimulation provided by the cochlear implantation did not alter these morphometric changes in adult cochlear implant patients.

Aged↗