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A New Auditory Prosthesis Using Deep Brain Stimulation: Development and Implementation

  • Hubert H. Lim
  • Minoo Lenarz
  • Thomas Lenarz
Chapter
First Online:
Part of the Biological and Medical Physics, Biomedical Engineering book series (BIOMEDICAL)

Abstract

The auditory midbrain implant (AMI) is a new auditory prosthesis designed for stimulation of the inferior colliculus, particularly its central nucleus (ICC), in deaf patients who cannot sufficiently benefit from current auditory implants (i.e., cochlear and brainstem implants). We have begun clinical trials in which three patients have been successfully implanted with the AMI. Although the intended target was the ICC, the AMI array was implanted into different regions across patients due to our learning experience with the surgical approach. The first patient was implanted into the dorsal cortex of the inferior colliculus, the second patient into the lateral lemniscus, and the third patient into the ICC. Nevertheless, all patients receive hearing benefits on a daily basis with their device, which has been encouraging for the potential of the AMI as a hearing alternative for deaf patients. The greatest improvements have been observed in the patient implanted into the target region of the ICC, indicating the importance of proper placement of the array into the midbrain. Furthermore, we have observed large differences in perceptual effects depending on location of stimulation. This chapter will provide an overview of the different steps that were taken to ensure safe and reliable translation and implementation of a new implant concept to clinical application. The first section of the chapter provides the rationale and issues that needed to be considered in the design of the AMI system. Section 2 covers the safety and feasibility studies performed in vitro and in animals to ensure the device would be safe and functional in humans. Section 3 describes our experience in determining how to implant and implement a new device into patients as well as the overall hearing performance achieved with the device. Finally, the last section provides some future directions for how to improve the AMI based on what we have learned from the human and animal findings. The underlying theme of this chapter is to provide the reader with a complete and realistic overview of the thought process, steps, and obstacles that were involved in translating an idealistic concept to a practical clinical device.

Keywords

Speech Perception Cochlear Implant Electrode Array Inferior Colliculus Acoustic Neuroma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Notes

Acknowledgments

We would like to thank Gert Joseph, Urte Rost, Joerg Pesch, and Rolf-Dieter Battmer for involvement with AMI patient testing and fitting; Madjid Samii, Amir Samii, and the International Neuroscience Institute (Hanover, Germany) for successful AMI surgery; and the engineers and scientists at Cochlear Ltd. (Lane Cove, Australia) for AMI development and technical assistance. We would also like to thank David J. Anderson for providing the scientific pathway for performing the initial AMI feasibility experiments at the University of Michigan; and Günter Reuter, Uta Reich, Gerrit Paasche, and Alexandru C. Stan for involvement with the animal safety studies at Hanover Medical University. We appreciate the contributions by Frank Risi and James F. Patrick from Cochlear Ltd. in the writing of Section 2.1. Funding was mostly provided by Cochlear Ltd. with contributions from the German Research Foundation (SFB 599) and NIH through P41 EB2030, P30 DC05188, T32 DC00011, and F31 DC007009.

References

  1. 1.
    Zeng FG. Trends in cochlear implants. Trends Amplif  8: 1–34, 2004.CrossRefGoogle Scholar
  2. 2.
    Adams JS, Hasenstab MS, Pippin GW, and Sismanis A. Telephone use and understanding in patients with cochlear implants. Ear Nose Throat J 83: 96, 99–100, 102–103, 2004.Google Scholar
  3. 3.
    McCreery DB. Cochlear nucleus auditory prostheses. Hear Res 242: 64–73, 2008.CrossRefGoogle Scholar
  4. 4.
    Colletti V, and Shannon RV. Open set speech perception with auditory brainstem implant? Laryngoscope 115: 1974–1978, 2005.CrossRefGoogle Scholar
  5. 5.
    Evans DG, Huson SM, Donnai D, Neary W, Blair V, Teare D, Newton V, Strachan T, Ramsden R, and Harris R. A genetic study of type 2 neurofibromatosis in the United Kingdom. I. Prevalence, mutation rate, fitness, and confirmation of maternal transmission effect on severity. J Med Genet 29: 841–846, 1992.CrossRefGoogle Scholar
  6. 6.
    Yost WA. Fundamentals of Hearing: An Introduction. New York: Academic Press, 2000.Google Scholar
  7. 7.
    Casseday JH, Fremouw T, and Covey E. The inferior colliculus: A hub for the central auditory system. In: Springer Handbook of Auditory Research: Integrative Functions in the Mammalian Auditory Pathway (Vol 15), edited by Oertel D, Fay RR, and Popper AN. New York: Springer-Verlag, pp. 238–318, 2002.Google Scholar
  8. 8.
    Geniec P, and Morest DK. The neuronal architecture of the human posterior colliculus. A study with the Golgi method. Acta Otolaryngol Suppl 295: 1–33, 1971.Google Scholar
  9. 9.
    Oliver DL. Neuronal organization in the inferior colliculus. In: The Inferior Colliculus, edited by Winer JA, and Schreiner CE. New York: Springer Science+Business Media, Inc., pp. 69–114, 2005.CrossRefGoogle Scholar
  10. 10.
    Friesen LM, Shannon RV, Baskent D, and Wang X. Speech recognition in noise as a function of the number of spectral channels: comparison of acoustic hearing and cochlear implants. J Acoust Soc Am 110: 1150–1163, 2001.CrossRefGoogle Scholar
  11. 11.
    Shannon RV, Fu QJ, and Galvin J, 3rd. The number of spectral channels required for speech recognition depends on the difficulty of the listening situation. Acta Otolaryngol Suppl 50–54, 2004.Google Scholar
  12. 12.
    Green AL, Wang S, Owen SL, Xie K, Bittar RG, Stein JF, Paterson DJ, and Aziz TZ. Stimulating the human midbrain to reveal the link between pain and blood pressure. Pain 124: 349–359, 2006.CrossRefGoogle Scholar
  13. 13.
    Wichmann T, and Delong MR. Deep brain stimulation for neurologic and neuropsychiatric disorders. Neuron 52: 197–204, 2006.CrossRefGoogle Scholar
  14. 14.
    Dahmen JC, and King AJ. Learning to hear: plasticity of auditory cortical processing. Curr Opin Neurobiol 2007.Google Scholar
  15. 15.
    Keuroghlian AS, and Knudsen EI. Adaptive auditory plasticity in developing and adult animals. Prog Neurobiol 82: 109–121, 2007.CrossRefGoogle Scholar
  16. 16.
    Ehret G, and Romand R. The Central Auditory System. New York: Oxford University Press, Inc., 1997.Google Scholar
  17. 17.
    Owen SL, Green AL, Nandi DD, Bittar RG, Wang S, and Aziz TZ. Deep brain stimulation for neuropathic pain. Acta Neurochir Suppl 97: 111–116, 2007.CrossRefGoogle Scholar
  18. 18.
    Ehret G. The auditory midbrain, a “shunting yard” of acoustical information processing. In: The Central Auditory System, edited by Ehret G, and Romand R. New York: Oxford University Press, Inc., pp. 259–316, 1997.Google Scholar
  19. 19.
    Winer JA. Three systems of descending projections to the inferior colliculus. In: The Inferior Colliculus, edited by Winer JA, and Schreiner CE. New York: Springer Science+Business Media, Inc., pp. 231–247, 2005.CrossRefGoogle Scholar
  20. 20.
    Hage SR, and Ehret G. Mapping responses to frequency sweeps and tones in the inferior colliculus of house mice. Eur J Neurosci 18: 2301–2312, 2003.CrossRefGoogle Scholar
  21. 21.
    Stiebler I. Tone-threshold mapping in the inferior colliculus of the house mouse. Neurosci Lett 65: 336–340, 1986.CrossRefGoogle Scholar
  22. 22.
    Schreiner CE, and Langner G. Periodicity coding in the inferior colliculus of the cat. II. Topographical organization. J Neurophysiol 60: 1823–1840, 1988.Google Scholar
  23. 23.
    Langner G, Schreiner C, and Merzenich MM. Covariation of latency and temporal resolution in the inferior colliculus of the cat. Hear Res 31: 197–201, 1987.CrossRefGoogle Scholar
  24. 24.
    Krishna BS, and Semple MN. Auditory temporal processing: responses to sinusoidally amplitude-modulated tones in the inferior colliculus. J Neurophysiol 84: 255–273, 2000.Google Scholar
  25. 25.
    Seshagiri CV, and Delgutte B. Response properties of neighboring neurons in the auditory midbrain for pure-tone stimulation: a tetrode study. J Neurophysiol 98: 2058–2073, 2007.CrossRefGoogle Scholar
  26. 26.
    Anderson DJ. Penetrating multichannel stimulation and recording electrodes in auditory prosthesis research. Hear Res 242: 31–41, 2008.CrossRefGoogle Scholar
  27. 27.
    McCreery D, Lossinsky A, and Pikov V. Performance of multisite silicon microprobes implanted chronically in the ventral cochlear nucleus of the cat. IEEE Trans Biomed Eng 54: 1042–1052, 2007.CrossRefGoogle Scholar
  28. 28.
    Lenarz M, Lim HH, Lenarz T, Reich U, Marquardt N, Klingberg M, Paasche G, Reuter G, and Stan A. Auditory Midbrain Implant: Histomorphological effects of long-term implantation and electrical stimulation of a new DBS array. Otol Neurotol 28: 1045–1052, 2007.CrossRefGoogle Scholar
  29. 29.
    Lenarz M, Lim HH, Patrick JF, Anderson DJ, and Lenarz T. Electrophysiological validation of a human prototype auditory midbrain implant in a guinea pig model. JARO 7: 383–398, 2006a.Google Scholar
  30. 30.
    Lim HH, and Anderson DJ. Auditory cortical responses to electrical stimulation of the inferior colliculus: Implications for an auditory midbrain implant. J Neurophysiol 96: 975–988, 2006.CrossRefGoogle Scholar
  31. 31.
    Malmierca MS, Rees A, Le Beau FE, and Bjaalie JG. Laminar organization of frequency-defined local axons within and between the inferior colliculi of the guinea pig. J Comp Neurol 357: 124–144, 1995.Google Scholar
  32. 32.
    Wallace MN, Rutkowski RG, and Palmer AR. Identification and localisation of auditory areas in guinea pig cortex. Exp Brain Res 132: 445–456, 2000.CrossRefGoogle Scholar
  33. 33.
    Bierer JA, and Middlebrooks JC. Auditory cortical images of cochlear-implant stimuli: dependence on electrode configuration. J Neurophysiol 87: 478–492, 2002.Google Scholar
  34. 34.
    McCreery DB, Agnew WF, Yuen TG, and Bullara L. Charge density and charge per phase as cofactors in neural injury induced by electrical stimulation. IEEE Trans Biomed Eng 37: 996–1001, 1990.CrossRefGoogle Scholar
  35. 35.
    Merrill DR, Bikson M, and Jefferys JG. Electrical stimulation of excitable tissue: design of efficacious and safe protocols. J Neurosci Methods 141: 171–198, 2005.CrossRefGoogle Scholar
  36. 36.
    Shannon RV. A model of safe levels for electrical stimulation. IEEE Trans Biomed Eng 39: 424–426, 1992.CrossRefGoogle Scholar
  37. 37.
    Haberler C, Alesch F, Mazal PR, Pilz P, Jellinger K, Pinter MM, Hainfellner JA, and Budka H. No tissue damage by chronic deep brain stimulation in Parkinson’s disease. Ann Neurol 48: 372–376, 2000.CrossRefGoogle Scholar
  38. 38.
    McCreery DB, Shannon RV, Otto S, and Waring MD. A cochlear nucleus auditory prosthesis based on microstimulation, Quarterly Report #3, Contract NO1-DC-4-0005, National Institute on Deafness and Other Communication Disorders: Neural Prosthesis Development Program. 2005.Google Scholar
  39. 39.
    Kretschmann HJ, and Weinrich W. Cranial Neuroimaging and Clinical Neuroanatomy: Magnetic Resonance Imaging and Computed Tomography. New York: Thieme Medical Publishers, Inc., p. 375, 1992.Google Scholar
  40. 40.
    Moore JK. The human auditory brain stem: a comparative view. Hear Res 29: 1–32, 1987.CrossRefGoogle Scholar
  41. 41.
    Trepel M. Neuroanatomie. Struktur und Funktion. Muenchen: Elsevier GmbH, p. 396, 2004.Google Scholar
  42. 42.
    Samii A, Lenarz M, Majdani O, Lim HH, Samii M, and Lenarz T. Auditory midbrain implant: a combined approach for vestibular schwannoma surgery and device implantation. Otol Neurotol 28: 31–38, 2007.CrossRefGoogle Scholar
  43. 43.
    Ammirati M, Bernardo A, Musumeci A, and Bricolo A. Comparison of different infratentorial-supracerebellar approaches to the posterior and middle incisural space: a cadaveric study. J Neurosurg 97: 922–928, 2002.CrossRefGoogle Scholar
  44. 44.
    Hitotsumatsu T, Matsushima T, and Inoue T. Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: technical note. Neurosurgery 53: 1436–1441; discussion 1442-1433, 2003.CrossRefGoogle Scholar
  45. 45.
    Ulm AJ, Tanriover N, Kawashima M, Campero A, Bova FJ, and Rhoton A, Jr. Microsurgical approaches to the perimesencephalic cisterns and related segments of the posterior cerebral artery: comparison using a novel application of image guidance. Neurosurgery 54: 1313–1327; discussion 1327-1318, 2004.CrossRefGoogle Scholar
  46. 46.
    Vougioukas VI, Omran H, Glasker S, and Van Velthoven V. Far lateral supracerebellar infratentorial approach for the treatment of upper brainstem gliomas: clinical experience with pediatric patients. Childs Nerv Syst 21: 1037–1041, 2005.CrossRefGoogle Scholar
  47. 47.
    Samii M, Gerganov V, and Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 105: 527–535, 2006.CrossRefGoogle Scholar
  48. 48.
    Stein BM. Supracerebellar-infratentorial approach to pineal tumors. Surg Neurol 11: 331–337, 1979.Google Scholar
  49. 49.
    Lim HH, Lenarz T, Joseph G, Battmer RD, Samii A, Samii M, Patrick JF, and Lenarz M. Electrical stimulation of the midbrain for hearing restoration: Insight into the functional organization of the human central auditory system. J Neurosci 27: 13541–13551, 2007.CrossRefGoogle Scholar
  50. 50.
    Lim HH, and Anderson DJ. Spatially distinct functional output regions within the central nucleus of the inferior colliculus: Implications for an auditory midbrain implant. J Neurosci 27: 8733–8743, 2007.CrossRefGoogle Scholar
  51. 51.
    Lim HH, Lenarz M, Joseph G, Battmer RD, Samii A, and Lenarz T. Hearing performance in the first auditory midbrain implant patients. Internat Conf Cochlear Implants and Other Implantable Auditory Technologies 10: 76, 2008a.Google Scholar
  52. 52.
    Loizou PC, Dorman M, and Fitzke J. The effect of reduced dynamic range on speech understanding: implications for patients with cochlear implants. Ear Hear 21: 25–31, 2000.CrossRefGoogle Scholar
  53. 53.
    Rance G, Cone-Wesson B, Wunderlich J, and Dowell R. Speech perception and cortical event related potentials in children with auditory neuropathy. Ear Hear 23: 239–253, 2002.CrossRefGoogle Scholar
  54. 54.
    Shannon RV, Zeng FG, Kamath V, Wygonski J, and Ekelid M. Speech recognition with primarily temporal cues. Science 270: 303–304, 1995.CrossRefGoogle Scholar
  55. 55.
    Zeng FG, and Galvin JJ, 3rd. Amplitude mapping and phoneme recognition in cochlear implant listeners. Ear Hear 20: 60–74, 1999.CrossRefGoogle Scholar
  56. 56.
    Dobelle WH, Stensaas SS, Mladejovsky MG, and Smith JB. A prosthesis for the deaf based on cortical stimulation. Ann Otol Rhinol Laryngol 82: 445–463, 1973.Google Scholar
  57. 57.
    Howard MA, Volkov IO, Mirsky R, Garell PC, Noh MD, Granner M, Damasio H, Steinschneider M, Reale RA, Hind JE, and Brugge JF. Auditory cortex on the human posterior superior temporal gyrus. J Comp Neurol 416: 79–92, 2000.CrossRefGoogle Scholar
  58. 58.
    Penfield W, and Perot P. The brain’s record of auditory and visual experience. A final summary and discussion. Brain 86: 595–696, 1963.CrossRefGoogle Scholar
  59. 59.
    Cariani PA, and Delgutte B. Neural correlates of the pitch of complex tones. I. Pitch and pitch salience. J Neurophysiol 76: 1698–1716, 1996.Google Scholar
  60. 60.
    Suta D, Kvasnak E, Popelar J, and Syka J. Representation of species-specific vocalizations in the inferior colliculus of the guinea pig. J Neurophysiol 90: 3794–3808, 2003.CrossRefGoogle Scholar
  61. 61.
    Syka J, Suta D, and Popelar J. Responses to species-specific vocalizations in the auditory cortex of awake and anesthetized guinea pigs. Hear Res 206: 177–184, 2005.CrossRefGoogle Scholar
  62. 62.
    Wang X, Merzenich MM, Beitel R, and Schreiner CE. Representation of a species-specific vocalization in the primary auditory cortex of the common marmoset: temporal and spectral characteristics. J Neurophysiol 74: 2685–2706, 1995.Google Scholar
  63. 63.
    Joris PX, Schreiner CE, and Rees A. Neural processing of amplitude-modulated sounds. Physiol Rev 84: 541–577, 2004.CrossRefGoogle Scholar
  64. 64.
    Lenarz T, Lim HH, Reuter G, Patrick JF, and Lenarz M. The auditory midbrain implant: a new auditory prosthesis for neural deafness-concept and device description. Otol Neurotol 27: 838–843, 2006b.Google Scholar
  65. 65.
    Lim HH, and Anderson DJ. Feasibility experiments for the development of a midbrain auditory prosthesis. In: Proc 1st Internat IEEE EMBS Conf Neural Eng. Capri Island, Italy, pp. 193–196, 2003.Google Scholar
  66. 66.
    Patrick JF, Busby PA, and Gibson PJ. The development of the Nucleus Freedom Cochlear implant system. Trends in amplification 10: 175–200, 2006.CrossRefGoogle Scholar
  67. 67.
    Lim HH, Lenarz T, Joseph G, Battmer RD, Patrick JF, and Lenarz M. Effects of phase duration and pulse rate on loudness and pitch percepts in the first auditory midbrain implant patients: Comparison to cochlear implant and auditory brainstem implant results. Neuroscience 154: 370–380, 2008c.Google Scholar
  68. 68.
    Perez-Gonzalez D, Malmierca MS, and Covey E. Novelty detector neurons in the mammalian auditory midbrain. Eur J Neurosci 22: 2879–2885, 2005.CrossRefGoogle Scholar
  69. 69.
    Strauss-Schier A, Battmer RD, Rost U, Allum-Mecklenburg DJ, and Lenarz T. Speech-tracking results for adults. Ann Otol Rhinol Laryngol Suppl 166: 88–91, 1995.Google Scholar
  70. 70.
    Winer JA, and Schreiner CE editors. The Inferior Colliculus. New York: Springer Science+Business Media, Inc., p. 736, 2005.Google Scholar
  71. 71.
    Lim HH, Lenarz T, Anderson DJ, and Lenarz M. The auditory midbrain implant: Effects of electrode location. Hear Res 242: 74–85, 2008b.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of Biomedical EngineeringUniversity of MinnesotaMinnesotaUSA
  2. 2.Otorhinolaryngology DepartmentHannover Medical UniversityHannoverGermany

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