Jochen Tillein

Electric-Acoustic Stimulation of the Auditory System

Various devices have been developed to overcome the widespread phenomenon of different degrees of hearing deficits between mild and profound hearing loss. Basically, we differentiate between acoustic stimulation (hearing aids), restricted to cases with a partially functioning cochlear receptor, and electrical stimulation (cochlear implants), stimulating the auditory nerve directly in cases with profound or total hearing loss. For the first time, animal data have been collected that indicate the possibility of nearly interference-free use of both stimulation types simultaneously. In addition, we have gathered the first clinical patient experience, which confirms the encouraging results. Future implications for patients with severe high-frequency hearing loss are discussed.

Combined Electric and Acoustic Stimulation of the Auditory System: Results of a Clinical Study

Combined electric and acoustic stimulation (EAS) of the auditory system is a new therapy for patients with severe to profound high- and mid-frequency hearing loss but remaining low-frequency hearing. In a prospective study, 13 patients with low-frequency hearing of better than 60 dB below 1 kHz were implanted with a MED-EL COMBI 40+ cochlear implant. Pure tone thresholds as well as monosyllabic word scores and Hochmair-Schulz-Moser sentences in quiet and in noise were measured with hearing aids, cochlear implant alone and in the combined stimulation mode (EAS) in the same ear. Hearing could be partially preserved in 11 out of the 13 patients. All patients scored significantly higher with cochlear implant alone than with hearing aids. Seven patients scored higher in the EAS mode than with cochlear implant alone for sentences in noise, 4 remained unchanged, and 2 could not use EAS. Synergistic effects of EAS were most prominent for hearing in noise with increases of up to 72% as compared to cochlear implant alone.

Functional Organization of Auditory Cortex in the Mongolian Gerbil (Meriones unguiculatus). I. Electrophysiological Mapping of Frequency Representation and Distinction of Fields

The frequency representation within the auditory cortex of the anaesthetized Mongolian gerbil (Meriones unguiculatus) was studied using standard microelectrode (essentially multiunit) mapping techniques. A large tonotopically organized primary auditory field (AI) was identified. High best frequencies (BFs) were represented rostrally and low BFs caudally along roughly dorsoventrally oriented isofrequency contours. Additional tonotopic representations were found adjacent to AI. Rostral to AI was a smaller field with a complete tonotopic gradient reversed with respect to that in AI (mirror image representation) and was termed the anterior auditory field (AAF). BFs in the range from 0.1 to 43 kHz, apparently covering the hearing range of the Mongolian gerbil, were found in AI and AAF. Units in these two core fields responded to narrow frequency ranges with short latencies. Ventral to the common high‐frequency border to AAF and AI, a rapid transition to very low BFs suggested the presence of a ventral field (V). Caudal to AI two small tonotopically organized fields were identified, a dorsoposterior field (DP) and a ventroposterior field (VP). The VP showed a tonotopic organization mirror imaged to that of AI, i.e. low frequencies were represented rostrally near the caudal border of AI, and high frequencies caudally. The DP showed a concentric frequency organization with high BFs located in the centre. Units in DP and VP fired less strongly, with considerably longer latencies, and responded to a broader range of frequencies than units in AI and AAF. Dorsocaudal to AI a dorsal field (D) was identified, harbouring units that responded to very broad ranges of frequencies. A tonotopic organization of field D could not be discerned. In the border region of AI and D, low‐frequency responses were similar to those found in parts of AI and AAF, but without a clear‐cut tonotopic organization. This region was termed Aid. The two core fields AI and AAF appeared to be located within the koniocortex, while the remaining fields lay outside. Our data show that the organization of the gerbil auditory cortex is highly elaborate, with parcellation into fields as complex as in cat or primates.

Delayed Maturation and Sensitive Periods in the Auditory Cortex

Behavioral data indicate the existence of sensitive periods in the development of audition and language. Neurophysiological data demonstrate deficits in the cerebral cortex of auditory-deprived animals, mainly in reduced cochleotopy and deficits in corticocortical and corticothalamic loops. In addition to current spread in the cochlea, reduced cochleotopy leads to channel interactions after cochlear implantation. Deficits in corticocortical and corticothalamic loops interfere with normal processing of auditory activity in cortical areas. Thus, the deprived auditory cortex cannot mature normally in congenital deafness. This maturation can be achieved using auditory experience through cochlear implants. However, implantation is necessary within the sensitive period of the auditory system. The functional role of long-term potentiation and long-term depression, inhibition, cholinergic modulation and neurotrophins in auditory development and sensitive periods are discussed.

Electric-Acoustic Stimulation of the Auditory System: A Review of the First Decade

Electric-acoustic stimulation (EAS) was developed for individuals with a profound hearing loss in the high frequencies and a substantial residual low-frequency hearing (LFH). For this group of candidates, conventional hearing aids often neither provided sufficient amplification nor were they considered suitable for cochlear implantation due to the possible destruction of residual hearing capabilities. With EAS, combining electric stimulation with an ipsilateral acoustic stimulation, preservation of residual LFH and the development of a new speech processor uniting both strategies became essential. Over the last years, EAS has developed further and advanced in electrode design and surgery techniques. This paper summarizes the history of EAS and acknowledges the tremendous work of the many research groups who contributed to the success of EAS.

Application of a corticosteroid (Triamcinolon) protects inner ear function after surgical intervention.

Hypothesis: Opening of the inner ear during stapes surgery or cochlear implantation may result in trauma to inner ear structures and possible hearing loss. The dual aim of the present study was to evaluate the effectiveness of locally applied Triamcinolon* to protect the inner ear against surgically induced trauma and to exclude possible ototoxic effects. Methods: In an animal model (guinea pig), a corticosteroid (Triamcinolon) was topically applied to the inner ear, either by extracochlear application and diffusion through the round window membrane or by direct intracochlear application via a cochleostomy. Physiological effects of the steroid were investigated by monitoring the hearing of steroid treated animals in comparison to control animals treated with Ringer solution instead of Triamcinolon. Thresholds as well as input/output functions (I/O function) of compound action potentials (CAPs) in response to auditory stimuli were determined before the cochleostomy and at specific intervals up to 4 weeks after application of Triamcinolon. Results: Extracochlear application of Triamcinolon induced only minor shifts of mean CAP thresholds but significantly increased mean maximal amplitudes of I/O function 14 d after application. No detrimental effects on cochlear function were noted; thus, indicating absence of ototoxicity for extracochlear application in the concentrations used. After the surgical trauma of cochleostomy, CAP thresholds increased by 12.5 dB directly after surgery and by 15.8 dB at day 3. Amplitudes of CAPs diminished. Intracochlear application of Triamcinolon resulted in significantly enhanced recovery of CAP thresholds and amplitudes of I/O function from initial loss over a period of 4 weeks. Conclusions: From these results, we conclude that extracochlear topical application of Triamcinolon has no ototoxic effect in the concentrations that were used and that intracochlear application supports an increased recovery of cochlear functions after surgical trauma. Furthermore, the results indicate a protective effect of corticosteroids, partially preventing progressive loss of hearing after cochleostomy over a period of 4 weeks. Intracochlear application of Triamcinolon may be useful to prevent hearing loss after surgical intervention on the inner ear; however, clinical safety and efficacy remain to be proven in clinical studies.

Spatiotemporal Patterns of Cortical Activity with Bilateral Cochlear Implants in Congenital Deafness

Congenital deafness affects developmental processes in the auditory cortex. In this study, local field potentials (LFPs) were mapped at the cortical surface with microelectrodes in response to cochlear implant stimulation. LFPs were compared between hearing controls and congenitally deaf cats (CDCs). Pulsatile electrical stimulation initially evoked cortical activity in the rostral parts of the primary auditory field (A1). This progressed both in the approximate dorsoventral direction (along the isofrequency stripe) and in the rostrocaudal direction. The dorsal branch of the wavefront split into a caudal branch (propagating in A1) and another smaller one propagating rostrally into the AAF (anterior auditory field). After the front reached the caudal border of A1, a “reflection wave” appeared, propagating back rostrally. In total, the waves took ∼13–15 ms to propagate along A1 and return back. In CDCs, the propagation pattern was significantly disturbed, with a more synchronous activation of distant cortical regions. The maps obtained from contralateral and ipsilateral stimulation overlapped in both groups of animals. Although controls showed differences in the latency–amplitude patterns, cortical waves evoked by contralateral and ipsilateral stimulation were more similar in CDCs. Additionally, in controls, LFPs with contralateral and ipsilateral stimulation were more similar in caudal A1 than in rostral A1. This dichotomy was lost in deaf animals. In conclusion, propagating cortical waves are specific for the contralateral ear, they are affected by auditory deprivation, and the specificity of the cortex for stimulation of the contralateral ear is reduced by deprivation.

Unilateral hearing during development: hemispheric specificity in plastic reorganizations.

The present study investigates the hemispheric contributions of neuronal reorganization following early single-sided hearing (unilateral deafness). The experiments were performed on ten cats from our colony of deaf white cats. Two were identified in early hearing screening as unilaterally congenitally deaf. The remaining eight were bilaterally congenitally deaf, unilaterally implanted at different ages with a cochlear implant. Implanted animals were chronically stimulated using a single-channel portable signal processor for two to five months. Microelectrode recordings were performed at the primary auditory cortex under stimulation at the hearing and deaf ear with bilateral cochlear implants. Local field potentials (LFPs) were compared at the cortex ipsilateral and contralateral to the hearing ear. The focus of the study was on the morphology and the onset latency of the LFPs. With respect to morphology of LFPs, pronounced hemisphere-specific effects were observed. Morphology of amplitude-normalized LFPs for stimulation of the deaf and the hearing ear was similar for responses recorded at the same hemisphere. However, when comparisons were performed between the hemispheres, the morphology was more dissimilar even though the same ear was stimulated. This demonstrates hemispheric specificity of some cortical adaptations irrespective of the ear stimulated. The results suggest a specific adaptation process at the hemisphere ipsilateral to the hearing ear, involving specific (down-regulated inhibitory) mechanisms not found in the contralateral hemisphere. Finally, onset latencies revealed that the sensitive period for the cortex ipsilateral to the hearing ear is shorter than that for the contralateral cortex. Unilateral hearing experience leads to a functionally-asymmetric brain with different neuronal reorganizations and different sensitive periods involved.

Impact of intrascalar blood on hearing

Objective/Hypothesis: The objective of this controlled animal study was to evaluate the effects of intrascalar blood on hearing.

Plastic Changes in the Auditory Cortex of Congenitally Deaf Cats following Cochlear Implantation

Congenitally deaf cats were used as a model for human inborn deafness and auditory deprivation. The deaf cats were supplied with a cochlear implant, chronically exposed to an acoustic environment and conditioned to acoustic stimuli. In case of early implantation the cats learned to make use of the newly gained auditory channel behaviourally. Neurophysiological and fMRI data showed that the central auditory system was recruited, if implantation took place within a sensitive period of <6 months.