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Biomedical subjects

J T Rubinstein

Publications and source records attributed to J T Rubinstein.

34 records · Page 2Linked to original sources

An empirically based model of the electrically evoked compound action potential.

The relationship between electrically evoked single-fiber action potentials and the electrically evoked compound action potential of the auditory nerve is of interest to those attempting to model such responses with computational techniques. It also relates to efforts to exploit the gross potentials that can now be recorded by some implantable cochlear prostheses. In this paper, we develop a computational model of the auditory nerve response to single, pulsatile, electrical stimuli based upon the response characteristics obtained from 230 single fibers of 13 cats. These fibers were stimulated by brief (39s) monophasic cathodic stimuli delivered by a monopolar intracochlear electrode. The data were pooled to obtain an estimate of the distribution of fiber thresholds. Post-stimulus time histograms were modeled using Poisson functions and adjusted to account for empirically determined latency and jitter characteristics. The probabilistic nature of single-fiber input-output functions (i.e. Verveen's (1961) 'relative spread') was also modelled. PST histograms from 5000 modelled fibers were then summed and convolved with an estimated 'unit potential' following the method of Goldstein and Kiang (1958). This convolution produced modelled compound action potentials, which were then compared with experimentally obtained data. Manipulations of model parameters affecting threshold, jitter, and relative spread suggest that the most important determinant of the shape of the EAP amplitude-level function is the threshold distribution. A model based solely on threshold distribution produces an EAP input-output function similar to one that accounts for probabilistic single-fiber input-output functions. Discrepancies between these two models do occur if the threshold distribution function is compressed significantly, as might be the case in pathological cochleae with altered distributions or numbers of nerve fibers.

Algorithms↗

How do cochlear prostheses work?

The past two decades have witnessed a revolution in the treatment of sensorineural hearing loss. Cochlear prostheses have evolved from laboratory experiment to a commercial technology that has benefited over 20,000 people. Paralleling this phenomenal development has been a substantial increase in our understanding of the biophysical, physiological and psychophysical mechanisms underlying the function of these devices.

Animals↗

Surgical management of Bell's palsy.

OBJECTIVES: Incomplete return of facial motor function and synkinesis continue to be long-term sequelae in some patients with Bell's palsy. The aim of this report is to describe a prospective study in which a well-defined surgical decompression of the facial nerve was performed in a population of patients with Bell's palsy who exhibit the electrophysiologic features associated with poor outcomes. In addition, management issues related to Bell's palsy including herpes simplex virus typel etiology, the natural history, electrodiagnostic testing, and efficacy of surgical strategies are reviewed. STUDY DESIGN AND METHODS: A multicenter prospective clinical trial was designed utilizing electroneurography (ENOG) and voluntary electromyography (EMG) to identify patients with Bell's palsy who would most likely develop poor return of facial function, as suggested by Fisch and Esslen. Patients who displayed electrodiagnostic features of poor outcome, >90% degeneration on ENOG testing and no voluntary motor unit EMG potentials within 14 days of onset of total paralysis, were offered a surgical decompression of the facial nerve through a middle cranial fossa surgical exposure, including the tympanic segment, geniculate ganglion, labyrinthine segment, and meatal foramen. Control subjects were those who displayed similar electrodiagnostic features and time course. RESULTS: Subjects who did not reach 90% degeneration on ENOG within 14 days of paralysis all returned to House-Brackmann grade I (n = 48) or II (n = 6) at 7 months after onset of the paralysis. Control subjects self-selecting not to undergo surgical decompression when >90% degeneration on ENOG and no motor unit potentials on EMG were identified had a 58% chance of developing a poor outcome at 7 months after onset of paralysis (House-Brackmann grade III or IV [n = 19]). A group with similar ENOG and EMG findings undergoing middle fossa facial nerve decompression exhibited House-Brackmann grade I (n = 14) or II (n = 17) in 91% of the cases. An exact permutation test confirmed that the surgical group had a significantly higher proportion of patients with a good outcome (House-Brackmann grade I or II) (P = .0002). CONCLUSION: Electroneurography in combination with voluntary EMG successfully identified patients who will most likely return to normal from those who had a greater chance of long-term sequelae from Bell's palsy. Surgical decompression medial to the geniculate ganglion significantly improves the chances of normal or near-normal return of facial function in the group that has a high probability of a poor result. Surgical decompression must be performed within 2 weeks of onset of total paralysis for it to be effective.

Adult↗

Residual speech recognition and cochlear implant performance: effects of implantation criteria.

OBJECTIVE: This study aimed to determine the effects of preoperative speech reception on postoperative speech recognition with a cochlear implant and to develop a statistical index allowing prediction of postoperative speech recognition before implantation. STUDY DESIGN: The study design was a retrospective case review with statistical modeling. SETTING: The study was conducted at a tertiary referral center with an associated Veteran's Administration hospital. PATIENTS: Postlingually deafened adults with and without residual speech reception participated. INTERVENTION: Cochlear implantation with Cochlear Corporation CI-22 and CI-24 devices was performed. MAIN OUTCOME MEASURES: Monosyllabic word recognition was measured. RESULTS: Duration of deafness and preoperative sentence recognition are both significant predictors of word recognition with a cochlear implant and can account for 80% of the variance in word recognition. CONCLUSIONS: Cochlear implant outcomes are variable but predictable within specific ranges.

Adult↗

Facial nerve grafts: from cerebellopontine angle and beyond.

OBJECTIVES: To review the outcomes from facial nerve cable grafting in a variety of pathologic conditions and to determine the possible causes of poor facial function after facial nerve grafting. STUDY DESIGN: A retrospective review of patients undergoing facial nerve grafts through a neurotologic procedure. SETTING: This study was performed at a university-based tertiary referral center. PATIENTS: All 27 patients undergoing a neurotologic procedure that required a facial nerve graft from 1982 to 1997 were reviewed. Fourteen patients had grafts from the facial nerve stump at the brainstem. INTERVENTIONS: All patients had facial nerve function determined by the senior neurotologist and through use of historical data and photographs. MAIN OUTCOME MEASURE: A facial nerve repair recovery score was developed for facial nerve transection and repair. The House-Brackmann scale was found to be inappropriate for transected and repaired nerves. RESULTS: Facial function was found in 23/25 (92%) patients with at least 8 months follow-up. Statistical analysis revealed no significant correlation between graft length and recovery score. Patients who had the nerve grafted to a site distal to the meatal foramen had a mean outcome that was nearly one grade level better than those with an anastomosis proximal to the meatal foramen (i.e., at the brainstem), but this did not reach statistical significance. CONCLUSIONS: Facial nerve grafting is an effective way of restoring facial motor function. A new facial recovery grading scale is proposed for repaired or grafted facial nerves.

Adolescent↗

Management of cochlear implant infections.

OBJECTIVE: The aim of this study was to illustrate and discuss management of cochlear implant infections. STUDY DESIGN: The study design was a retrospective case review. SETTING: This study was performed at a tertiary referral center with an associated Veterans Administration Hospital. PATIENTS: Postlingually deafened adults who had revision surgery for delayed cochlear implant infections were included in this study. INTERVENTION: Medical and surgical management of device infection without explantation. MAIN OUTCOME MEASURES: Eradication of infection without loss of speech reception. RESULTS: All four patients were successfully managed without explantation. CONCLUSIONS: Explantation of an infected but functioning multichannel implant is not mandatory in the absence of systemic sepsis.

Adult↗

Electrically evoked compound action potentials of guinea pig and cat: responses to monopolar, monophasic stimulation.

We recorded electrically evoked compound action potentials (EAPs) from guinea pigs and cats using monophasic current pulses delivered by a monopolar intracochlear electrode. By using simple stimuli, we sought results that could shed light on basic excitation properties of the auditory nerve. In these acute experiments, the recording electrode was placed directly on the auditory nerve. Responses to anodic and cathodic stimulus pulses were recorded separately to evaluate stimulus polarity effects. Several polarity-dependent properties were observed. Both EAP morphology and latency were polarity-dependent, with greater latencies for cathodic stimulation. Threshold stimulus level was also polarity-dependent, but in different directions in the two species: cats had lower cathodic thresholds while guinea pigs had lower anodic thresholds. We also observed that the slopes of the EAP amplitude-level functions depended upon stimulus polarity. In most cases where EAP saturation amplitude could be measured, that amplitude was similar for anodic and cathodic stimuli, suggesting that either stimulus polarity can recruit all fibers, or at least a comparable numbers of fibers. The common findings (e.g., EAP morphology and polarity-dependent latency) observed in these two species suggest results that can be extrapolated to responses obtained in humans, while the species-specific findings (e.g., dependence of threshold on polarity) may point to underlying anatomical differences that caution against overgeneralization across species. Some of our observations also bear upon hypotheses of how electrical stimuli may excite different sites on auditory nerve fibers.

Action Potentials↗

Single-channel to multichannel conversions in adult cochlear implant subjects.

OBJECTIVE: This study aimed to compare open-set speech perception of single-channel with multichannel cochlear implants in the same ear of postlingually deafened adults. STUDY DESIGN: The study design was a retrospective case and literature review. SETTING: The study was conducted at a tertiary referral center with an associated veterans administration hospital. PATIENTS: Postlingually deafened adults with at least 6 months of experience with a single-channel cochlear implant were studied. INTERVENTION: Replacement of a single-channel with a multichannel cochlear implant in the same ear was performed. MAIN OUTCOME MEASURES: Open-set word and sentence perception scores at least 6 months after single-channel implantation and multichannel reimplantation were measured. RESULTS: Six of six patients had substantial improvement in open-set speech recognition after reimplantation of the same ear. CONCLUSIONS: Removal of a functioning single-channel implant and replacement with a multichannel device are appropriate in postlingually deafened adults who desire better speech recognition.

Adult↗

Invisible culprit: intralabyrinthine schwannomas that do not appear on enhanced magnetic resonance imaging.

Intralabyrinthine schwannoma (ILS) is an infrequent tumor that arises in isolation within the periphery of the temporal bone. Only 32 cases have been reported to date in the literature, of which 12 were discovered at autopsy. Prior to the advent of gadolinium-enhanced magnetic resonance imaging (Gd-MRI), only 1 ILS had been diagnosed preoperatively. However, after Gd-MRI became a common modality, 5 ILSs were imaged. Two additional cases are reported that were discovered during labyrinth-destructive surgery despite normal Gd-MRI findings. Possible explanations for and potential ramifications of nonenhancing ILS are discussed.

Adult↗

Threshold fluctuations in an N sodium channel model of the node of Ranvier.

Computer simulations of stochastic single-channel open-close kinetics are applied to an N sodium channel model of a node of Ranvier. Up to 32,000 voltage-gated sodium channels have been simulated with modified amphibian sodium channel kinetics. Poststimulus time histograms are obtained with 1000 monophasic pulse stimuli, and measurements are made of changes in the relative spread of threshold (RS) with changes in the model parameters. RS is found to be invariant with pulse durations from 100 microseconds to 3 ms. RS is approximately of inverse proportion to square-root of N. It decreases with increasing temperature and is dependent on passive electrical properties of the membrane as well as the single-channel conductance. The simulated RS and its independence of pulse duration is consistent with experimental results from the literature. Thus, the microscopic fluctuations of single, voltage-sensitive sodium channels in the amphibian peripheral node of Ranvier are sufficient to account for the macroscopic fluctuation if threshold to electrical stimulation.

Action Potentials↗

Axon termination conditions for electrical stimulation.

The cable model for electrical stimulation near the terminal of a passive fiber is derived for excitation by an arbitrary, time-varying, applied extracellular field. Unless the termination impedance is comparable to that of mammalian node of Ranvier, the end-conditions require the longitudinal intracellular current at the fiber terminal to be negligibly small. This requirement substantially alters the membrane potential profile from that obtained with a fiber of infinite length. Stimulation near the end of a fiber may result in lower thresholds and may reverse the anodal/cathodal threshold ratio obtained with stimulation in the mid-portion of the fiber. Chronaxie for stimulation near the terminal may be much smaller than at a distance from the terminal and the strength-duration curve may be nonmonotonic. These differences may have significant implications for any application of electrical stimulation where fiber terminations may play a role in the excitatory process.

Electric Stimulation↗

Analytical theory for extracellular electrical stimulation of nerve with focal electrodes. II. Passive myelinated axon.

The cable model of a passive, myelinated fiber is derived using the theory of electromagnetic propagation in periodic structures. The cable may be excited by an intracellular source or by an arbitrary, time-varying, applied extracellular field. When the cable is stimulated by a distant source, its properties are qualitatively similar to an unmyelinated fiber. Under these conditions relative threshold is proportional to the cube of the source distance and inversely proportional to the square of the fiber diameter. Electrical parameters of the model are chosen where possible, from mammalian peripheral nerve and anatomic parameters from cat auditory nerve. Several anatomic representations of the paranodal region are analyzed for their effects on the length and time constants of the fibers. Sensitivity of the model to parameter changes is studied. The linear model reliably predicts the effects of fiber size and electrode-fiber separation on threshold of cat dorsal column fibers to extracellular electrical stimulation.

Animals↗

In vitro measurement and characterization of current density profiles produced by non-recessed, simple recessed, and radially varying recessed stimulating electrodes.

Potential fields induced by nonrecessed, simple recessed, and radially varying recessed electrode designs were measured in vitro. Comparison of experimental results with theoretical analyses substantiated the experimental measurement technique and emphasized the importance of considering both nonuniform charge injection and surface electrochemistry when designing implantable stimulating electrodes. Radially varying recesses produced uniform charge injection at the electrode surface and at the aperture-tissue interface. In general, the radially varying recessed electrodes provided a combination of uniform charge injection and flexibility in design and fabrication that warrants their incorporation into all appropriate planar stimulating electrode designs.

Electric Conductivity↗

Analytical theory for extracellular electrical stimulation of nerve with focal electrodes. I. Passive unmyelinated axon.

The cable model of a passive, unmyelinated fiber in an applied extracellular field is derived. The solution is valid for an arbitrary, time-varying, applied field, which may be determined analytically or numerically. Simple analytical computations are presented. They explain a variety of known phenomena and predict some previously undescribed properties of extracellular electrical stimulation. The polarization of a fiber in an applied field behaves like the output of a spatial high-pass and temporal low-pass filter of the stimulus. High-frequency stimulation results in a more spatially restricted region of fiber excitation, effectively reducing current spread relative to that produced by low-frequency stimulation. Chronaxie measured extracellularly is a function of electrode position relative to the stimulated fiber, and its value may differ substantially from that obtained intracellularly. Frequency dependence of psychophysical threshold obtained by electrical stimulation of the macaque cochlea closely follows the frequency dependence of single-fiber passive response.

Animals↗

Development of a biophysical model for vestibular prosthesis research.

Physiologic properties of primary vestibular neurons are compared and contrasted with properties of primary auditory neurons. The differences and similarities suggest possible coding strategies for a vestibular implant. The degree of spike rate variability, or coefficient of variation (CV), is a prominent physiological property of vestibular neurons with undetermined functional significance. At the very least, CV is highly correlated with threshold to electrical stimulation in the intact vestibular labyrinth. If CV is also important for vestibular coding, then electrical stimulation strategies should be designed to restore relatively physiologic patterns of CV. Simulations using a stochastic model of primary afferent vestibular neurons reveal that this should be possible using combinations of low and high-rate pulsatile stimulation. They also demonstrate that differences in the number and independence of synaptic inputs can significantly affect CV.

Action Potentials↗