The present invention relates to facial stimulation apparatus and particularly, but not exclusively, to wearable apparatus which uses the ear as an anatomical reference to ensure correct and repeatable placement of skin electrodes over the human facial nerves to facilitate Electrical Muscle Stimulation (EMS).

The facial muscles determine facial expression and facial shape and therefore exercise of the facial muscles is important in maintaining appearance. It is well known to employ EMS technology on different parts of the human body, for example the abdomen, to prevent muscle disuse atrophy, improve local blood circulation and to improve muscle strength and tone.

However, applying this technology to the face has been difficult for a number of reasons. Firstly, there is a complex network of interconnected muscles on the face and it is difficult to locate skin electrodes with sufficient accuracy to isolate a particular muscle. Furthermore, the ideal electrode location for stimulation of a given facial muscle will differ from person to person due to anatomical variability. There are several systems on the market today which require the user to stick electrodes to the face at various locations to achieve facial stimulation. However, inaccurate placement of skin electrodes can lead to unwanted stimulation of other tissues such as the dental nerves or the nerves controlling movement of the eye. A further problem is that it is difficult to maintain skin electrodes in reliable contact with the face. Facial skin produces natural oils which interfere with the function of adhesive hydrogel materials used on skin electrodes. Attempts have been made to solve one or more of the aforementioned problems. For example, WO 00/71075 (Maher & Johnson) discloses apparatus in the form of a headset, similar to an audio headset, which is fitted with a pair of adjustable booms each supporting an articulated paddle which in turn supports an electrode pair arranged to contact the face. The boom is adjustable in both its length and angle relative to its anchor point on the headset adjacent an earpiece such that the electrodes are individually positionable over a wide area of the face. Further positional adjustment is possible by virtue of the pivotal attachment of each paddle to the end of the boom through a ball and socket joint.

The disclosure of WO 00/71075 (Maher & Johnson) emphasises the positional adjustability of the electrodes and this aspect was clearly considered to be advantageous. However, this rather elaborate apparatus still suffers from a number of problems.

Firstly, the average end-user of facial stimulation apparatus generally lacks any expertise in the underlying anatomy of the facial muscles and nerves. This lack of anatomical knowledge on the part of the end-user increases the likelihood of incorrect placement of skin electrodes on the face. Whilst written instructions or illustrations for electrode placement may be provided to an end-user, in reality it is very difficult to translate two-dimensional illustrations to the actual three-dimensional reality particularly when inevitable interpersonal anatomical variations are taken into account. As discussed above, the consequences for the end-user of incorrect positioning of skin electrodes on the face can be significant discomfort due to stimulation of inappropriate tissues. Secondly, by providing a wide degree of adjustability in terms of electrode placement, this will inevitably contribute to a degree of confusion for the end-user when attempting to achieve correct electrode placement. Moreover, it is very difficult for the end-user to know how to combine the numerous adjustable features in a way which achieves a stable positioning of the electrodes such that they are continuously maintained in contact with the skin. Indeed, known mechanisms cannot readily accommodate natural movement of the face since the adjustments are mostly fixed. Electrode separation from the face is a frequent event, interrupting the treatment and causing discomfort and inconvenience.

There is therefore a need for an apparatus which locates appropriately arranged electrodes on the face in a reproducible way, and which requires no anatomical knowledge on the part of the end-user. Having found the correct electrode position, there is a further need that the electrode be maintained in contact with the skin with an appropriate pressure to ensure consistent and comfortable stimulation.

According to the present invention there is provided facial stimulation apparatus for applying an electrical current to the human facial nerves, the apparatus comprising:

(i) a transcutaneous stimulating electrode; and

(ii) a stimulation device connectable to the electrode for providing a stimulating current thereto, wherein, the apparatus is configured to be worn on an user's head such that, in use, the electrode engages a portion of the face to be stimulated; and characterised in that the apparatus is adapted to interact with the ear which is used as an anatomical reference to provide repeatable positioning of the electrode, with respect to the ear, in contact with a single predetermined localised region of the face. Preferably, the apparatus further comprises an electrode carrier for supporting the electrode in contact with the predetermined localised region of the face overlying the stylomastoid foramen.

Preferably, the electrode carrier is provided with a supporting arm which, in use, is arranged to extend around or over the user's head and urge the electrode carrier and its associated electrode into contact with the predetermined localised region of the face.

Preferably, the supporting arm is a resilient, substantially C-shaped, band adapted to provide a degree of inward pressure at or near its opposing distal ends.

Preferably, the apparatus comprises a pair of electrode carriers adapted such that, in use, the apparatus interacts with both ears and maintains at least one electrode in contact with both predetermined localised regions of the face.

Preferably, the respective electrode carriers are connected by a supporting arm which, in use, is arranged to extend around or over the user's head and urge each electrode carrier and its associated electrode into contact with the predetermined localised regions of the face.

Preferably, the, or each, electrode carrier supports two spaced electrodes arranged to contact different parts of the face.

Preferably, a location feature of the apparatus is adapted to engage on and/or around and/or against or adjacent to one or more features of the ear(s) to achieve repeatable and non-adjustable positioning of the electrode(s) anteriorly of the ear(s) at a predetermined localised region which corresponds with the insertion of the branches of the facial nerve emerging from the stylomastoid foramen.

Preferably, the location feature of the apparatus is adapted to engage on and/or around and/or against or adjacent to one or more features of the ear selected from the group comprising the ear lobe, the tragus, the concha, and the top of the ear where the auricle joins the head.

Preferably, the location feature of the apparatus is defined by one or more tangible features of the electrode(s) and/or the electrode carrier and/or the supporting arm selected from the group comprising: (i) a shaped portion adapted to cooperate with one or more features of the ear; (ii) a specific dimension as measured from one or more features of the ear; (iii) a visually perceptible marker adapted to align with one or more features of the ear; and (iv) a textured portion adapted to align with one or more features of the ear.

In a first embodiment, the apparatus comprises two spaced apart electrodes arranged in a fixed relationship relative to one another within a notional minor sector of a circle.

Preferably, the dimensions of the notional minor sector of a circle are selected such that, in use, one electrode is located at the centre of the notional circle over an area proximate the insertion of the branches of the facial nerve anterior to the ear, the other electrode being located proximate the arc of its minor sector. Preferably, the electrode located at the centre of the notional circle has a smaller surface area than the electrode proximate the arc of its minor sector.

Preferably, the electrode located proximate the arc of its minor sector overlies all five branches of the facial nerve.

In an alternative embodiment, the apparatus comprises two spaced apart electrodes arranged in a fixed parallel relationship relative to one another

Embodiments of the present invention will now be described, by way of example only, with reference to the accompanying drawings, in which:

Figure 1 shows a schematic side view of the human head and illustrates the position of the underlying facial nerve and its constituent branches;

Figure 2a shows a view similar to that of Figure 1 indicating possible positioning of two transcutaneous stimulation electrodes proximate the insertion or trunk of the facial nerves;

Figure 2b shows a view similar to that of Figure 1 indicating possible positioning of two alternative transcutaneous stimulation electrodes proximate the insertion or trunk of the facial nerves;

Figure 3 shows apparatus according to an aspect of the present invention for providing repeatable and non-adjustable positioning of the electrodes of Figure 2 with respect to the ear using the ear lobe as the anatomical reference;

Figure 4 shows a schematic perspective view of the apparatus of Figure 3; Figure 5 shows a schematic front view of the apparatus of Figures 3 and 4;

Figure 6 is a view similar to that of Figure 4, but showing an alternative embodiment whereby the upper part of the ear (where the auricle joins the head) is used as the anatomical reference;

Figure 7 is a view similar to that of Figures 4 and 6, but showing a further alternative embodiment whereby the tragus is used as the anatomical reference;

Figure 8 is a view similar to that of Figures 4, 6 and 7, but showing a yet further alternative embodiment whereby the concha is used as the anatomical reference;

Figures 9a-c show front and cross-sectional views of one example of the apparatus of the present invention indicating the positioning of the electrodes within the apparatus.

Figure 1 illustrates the anatomy of the human facial nerves and, in particular, shows the nerve trunk (10) branching into five main components (12a-e) just anterior to the ear (14).

Transcutaneous stimulation involves the application of electrodes to the skin overlying the target nerve. The current density and the degree of penetration into the underlying tissue are dependent on both electrode surface area and the separation of an electrode pair. Electrodes which are close together produce minimal penetration into the skin and the underlying tissue since the electric field lines are relatively superficial. Conversely, electrodes which are spaced further apart create deeper field lines and therefore more penetrating currents. This is especially true when the electrodes are spaced over a curved surface. For the stimulation of facial nerves the creation of deep penetrating currents is undesirable since they can affect unintended nerves such as the dental nerves.

The present invention lies partly in the inventor's realisation that, to fulfil the objective of eliciting activity in the motor nerve of the facial muscle, the optimum location to influence the facial nerve is in the region where its constituent branches (12a-e) meet the nerve trunk (10) just anterior to the ear (14). At this location, the facial nerve is relatively superficial and therefore allows effective recruitment of the entire facial nerve without the need for creating deep penetrating currents along its branches (12a-e).

In two embodiments of the present invention, the arrangement of a pair of electrodes (16a, 16b) forming part of the facial stimulation apparatus is as shown in Figures 2a and 2b respectively. Each electrode is covered with a conductive and adhesive hydrogel which acts as an electrolyte and also prevents the electrode sliding on the skin. The respective electrodes (16a, 16b) are located against the skin surface at a predetermined localised region of the face which corresponds with the insertion of the branches (12a-e) of the facial nerve, just anterior to the ear (14). The shape, size and separation of the electrodes (16a, 16b) are each selected to optimise stimulation of the facial nerve at this localised region.

It has been found to be particularly advantageous to position one electrode (16a) proximate the centre of a notional minor sector of a circle (indicated by dashed lines (18) in Figure 2a) centred on the insertion of the branches (12a-e) of the facial nerve whilst the other electrode (16b) is located proximate the arc of the same minor sector. The first electrode (16a) is substantially circular in shape and the second electrode (16b) is substantially arcuate and follows the line of the aforementioned arc. Furthermore, the first electrode (16a) is smaller in surface area relative to the second electrode (16b). In a preferred arrangement, the first electrode (16a) has a surface area of approximately 4.8cm ² whilst the second electrode (16b) has an area of approximately 5.6cm ² . The separation the two electrodes (16a, 16b) should generally be at least 5mm to ensure penetration of the electric field lines into the skin. However, the separation should generally be no more than 12mm to prevent over-penetration of field lines into the skin.

This particular arrangement of electrodes in terms of their relative positioning, shape, size and separation causes the electrical field lines to diverge from the centre of the notional minor sector of the circle to its peripheral arc (i.e. from the first electrode (16a) to the second electrode (16b)). Accordingly, the arrangement illustrated in Figure 2a has been found to be particularly suitable for stimulation of the entire facial nerve tree albeit that the electrodes themselves overlie a relatively small localised region where the constituent branches (12a-e) of the facial nerve diverge from the nerve trunk (10).

In the alternative arrangement of Figure 2b, the electrodes (16a, 16b) are generally oval-shaped and are in a substantially parallel spaced arrangement. In a preferred arrangement, each electrode (16a, 16b) has a surface area of approximately 5cm ² and is separated by a distance of approximately 7mm. In the particular arrangement shown in Figure 2b, the second electrode (16b) overlies only three of the five nerve branches (12c, 12d, 12e). Instead of being circular, the first electrode (16a), which is the one closest to the ear in use in Figure 2a, can be any other suitable shape such as oval or lozenge shaped. The second electrode (16b), which is the one more distal to the ear, may partially envelope the first electrode (16a) whilst being spaced from it. For a circular first electrode (16a), the second electrode (16b) is preferably arcuate in shape. For other shapes of first electrode (16a), the second electrode (16b) may run substantially parallel to, and at a substantially constant distance from, the outer perimeter of the first electrode (16a).

The branches of the facial nerve diverge and continue anteriorly after they emerge through the orifice in the skull, just anterior to the ear. The ideal arrangement of the two electrodes is therefore when the angle subtended by the upper and lower limits of the second electrode (16b), relative to the centre of the first electrode (16a), overlaps all the branches of the facial nerve. Such an electrode arrangement ensures that electric field lines exist beneath the skin to interact with and stimulate each branch of the facial nerve. The optimum angle is 180 degrees since this ensures that all possible pathways of the nerve are covered. However, an angle of 120 degrees also works well and may be more practical for construction.

It is important to realise that while diverging electric field lines are ideal, effective stimulation of the facial nerves can also occur with non-diverging field line patterns. The first and second electrodes (16a, 16b) can be the same size and shape (as in Figure 2b), or indeed the second electrode (16b) could be smaller in surface area than the first electrode (16a). The essential element is that electrical activity is created in the region of the facial nerve at the point where it branches so provided the first electrode (16a) is located just anterior to the tragus and the second electrode (16b) is located anterior of the first electrode (16a), then effective stimulation will occur.

Therefore, in its broadest sense, the apparatus of the present invention comprises at least one transcutaneous stimulating electrode (16a, 16b) and a stimulation device (not shown) connectable thereto for providing a stimulating current whereby at least part of the apparatus is shaped and/or dimensioned and/or otherwise adapted to interact with the ear (14). In all cases the ear is used as an anatomical reference to provide repeatable and non-adjustable positioning of the electrode(s) (16a, 16b), with respect to the ear (14), and in contact with a predetermined localised region of the face. Accordingly, one possibility is that the electrode(s) (16a, 16b), or a part thereof, may themselves be shaped and/or dimensioned to interact with one or more features of the ear (14), for example, with the tragus.

However, the apparatus may further comprise an electrode carrier (20) functioning, in use, to support the electrode(s) (16a, 16b) in contact with the predetermined localised region of the face. If present in the apparatus, the electrode carrier (20), or apart thereof, may be shaped and/or dimensioned to interact with one or more features of the ear (14) in addition to, or instead of, any adaptation made to the electrode(s) (16a, 16b) for this purpose.

A further possibility, an example which is illustrated in the embodiment of Figure 3 is that the apparatus also comprises a supporting arm (22) which, in use, is arranged to extend around or over the user's head and urge the electrode carriers (20) connected to its opposing distal ends, and its associated electrodes (16a, 16b), into contact with the desired localised regions of the face anterior to the ear (14). If present in the apparatus, the supporting arm (22), or a part thereof, may be shaped and/or dimensioned and/or otherwise adapted to interact with one or more features of the ear (14) in addition to, or instead of, any adaptation made to the electrode(s) (16a, 16b) and/or the electrode carrier (20) for this purpose.

As shown in Figures 3-5, the supporting arm (22) is provided with a non- adjustable elbow bend (24) near its point of attachment to the electrode carrier (20). The supporting arm (22) takes the form of a resilient C- shaped band which, in use, locates around the back of the head in a generally horizontal orientation along a line coincident with the ear lobes where they join the head. In use, the internal angle of the elbow bend (24) locates immediately beneath or against a peripheral region of the ear (14) proximate the ear lobe which functions as an anatomical reference to provide repeatable and non-adjustable positioning of the electrodes (16a, 16b), with respect to the ear (14), to thus ensure electrical contact is made with the desired localised regions of the face anterior to the ear (14).

Relative to the bottom of the ear lobe, the ideal position of the centre of the first electrode (16a) is found by moving 30mm ± 5mm anteriorly and then up 15mm ± 5mm. The elbow bend (24) can be a sharp angle or a curved piece which ensures this relative displacement from the anatomical reference provided by the ear lobe.

Figure 6 shows an alternative embodiment which is similar in many respects to that described above. However, the resilient C-shaped band locates around the back of the head in a generally horizontal orientation along a line coincident with the top of the ear (14), and the internal angle of the elbow bend (24) locates immediately above or against a peripheral region of the ear (14) proximate the point where the auricle meets the head. This part of the ear (14) also acts as an effective anatomical reference to provide repeatable and non-adjustable positioning of the electrodes, with respect to the ear (14), to ensure contact with the desired localised regions of the face anterior to the ear (14).

A further alternative embodiment is shown in Figure 7 whereby the resilient supporting arm (22) locates around the top of the head in a generally vertical orientation along a line just anterior to the ear (14). The absence of an elbow bend in this embodiment means that the supporting arm (22) itself does not interact with the ear (14). Instead, the electrode carrier (20) locates immediately beside or against a peripheral region of the ear (14) proximate the tragus. Whilst the tragus also acts as an equally effective anatomical reference to ensure correct lateral positioning of the electrodes, the advantage of the aforementioned embodiments is that the internal angle of the elbow bend (24) ensures correct lateral and longitudinal positioning of the electrodes. In the embodiment of Figure 7, it is necessary to provide adjustability in the resilient supporting arm (22) to allow for the greater degree of interpersonal variation in the over-the-head path length, and to ensure that the first electrode (16a) lies at the correct longitudinal position approximately 15mm ± 5mm from the bottom of the ear lobe.

A yet further alternative embodiment is shown in Figure 8 whereby the resilient supporting arm (22) locates around the top of the head in a generally vertical orientation along a line coincident with the ear canal. The resilient supporting arm (22) is provided with conventional earphones (26) which, in use, are urged against the concha. The resilient supporting arm (22) is provided with a non-adjustable generally right-angled elbow bend (24) on each earphone near its point of attachment to the electrode carrier (20). Alternatively, a separate supporting arm may depend from the earphone in a generally horizontal orientation along a line coincident with the middle of the ear, for example, over the tragus. In either case, the concha also acts as an effective anatomical reference to provide repeatable and non-adjustable positioning of the electrodes, with respect to the ear (14), to ensure electrical contact with the desired localised regions of the face anterior to the ear (14).

With regard to the embodiments of Figures 3-5, in use, an end-user opens the C-shaped band (22) to a degree sufficient for it to pass forward from the back of the head below the ears. The C-shaped band is then gently released and the electrode carriers (20) locate over the facial nerve on either side of the face. To ensure accurate placement of the electrodes

(16a, 16b) over the desired localised region of the face the end-user's sole task is to locate the internal angles of each elbow bend (24) immediately below or against the underside of the ear lobes.

With regard to the embodiment of Figure 6, in use, an end-user opens the C-shaped band (22) to a degree sufficient for it to pass forward from the back of the head above the ears. This may require a greater opening force in view of the increased width of the head at this position. The C- shaped band is then gently released and the electrode carriers (20) locate over the facial nerve on either side of the face. To ensure accurate placement of the electrodes (16a, 16b) over the desired localised region of the face the end-user's sole task is to locate the internal angles of each elbow bend (24) immediately above or against the uppermost portion of the ear where the auricle meets the head.

With regard to the embodiment of Figure 7, in use, an end-user opens the C-shaped band (22) to a degree sufficient for it to pass down from the top of the head just anterior to the ears. The C-shaped band is then gently released and the electrode carriers (20) locate over the facial nerve on either side of the face. To ensure accurate placement of the electrodes (16a, 16b) over the desired localised region of the face the end-user's sole task is to locate the electrode carriers (20) immediately beside or against the tragus of the ear. The electrode carriers (20) may be shaped (or otherwise adapted) to match the outline of the tragus to assist correct placement.

With regard to the embodiment of Figure 8, in use, an end-user opens the C-shaped band (22) to a degree sufficient for it to pass down from the top of the head anterior to the ears. The C-shaped band is then gently released and the electrode carriers (20) locate over the facial nerve on either side of the face. To ensure accurate placement of the electrodes (16a, 16b) over the desired localised region of the face the end-user's sole task is to locate the earphones (26) centrally on the concha.

The surface profile of the human head anterior to the ear is highly variable from person to person and therefore the electrode carriers (20) must be able to accommodate any undulations whilst maintaining a uniform pressure over the surface of the electrode. To allow the electrode carrier to adapt to the shape of an end-user's face the preferred solution, as shown schematically in Figures 9a-c, is to use an electrode carrier (20) which comprises a paddle of flexible rubber material (21 ) which is attached to the remainder of the apparatus by a flexible neck (23). Moreover, the paddle of flexible rubber material (21 ) is sufficiently flexible so as to readily accommodate deviations from a true planar surface.

The electrode carrier (20) comprises a conductive means (25) corresponding to each electrode (16a, 16b). In a preferred arrangement, the conductive means (25) is provided integrally within the electrode carrier (20) as regions of conductive flexible polymer. It is well established in the field of medical electrodes to add a conductive material such as carbon black to a polymer compound. The conductive sections (25) are moulded into the electrode carrier (20, 21 ) at the time of manufacture. Alternatively, the conductive means comprises metallic contacts moulded into the paddle of flexible rubber material (21 ) with flexible wires (25) travelling through the flexible neck (23) into the adjoining electrode carrier (20). Figure 4 shows one example of a lead extending from the C-shaped band (22) for connection to an external stimulation device (not shown).

It will be appreciated that the various embodiments of the present invention each provide several important distinctions and advantages over prior art facial stimulation apparatus. Firstly, known prior art devices fail to disclose apparatus which:

(i) is shaped and dimensioned to interact with the ear; and (ii) whereby the ear is used as an anatomical reference to provide repeatable and, importantly, non-adjustable positioning of the electrode with respect to the ear; and (iii) ensures the stimulating electrodes are maintained in contact with a predetermined localised region of the face just anterior to the ear.

The inventor of the present invention has realised that there is relatively little interpersonal variation in the positioning of the insertion of the facial nerve relative to several features of the ear. This is because the orifices which accommodate the facial nerve and the auditory canal, called the stylomastoid foramen and the auditory meatus respectively, are both located on the temporal bone, which is one of the constituent bones of the skull. These orifices are relatively close together and the ear is attached to the head at the overlying auditory meatus. The ear therefore provides the ideal and unambiguous location for the stylomastoid foramen through which the facial nerve enters the face. The stylomastoid foramen is located on the underside of the zygomatic process, which is the part of the temporal bone which partly forms the cheek bone. The facial nerve diverges after emerging from the stylomastoid foramen. The electrodes in the apparatus of the present invention are therefore designed to interact with the facial nerve in the region where it diverges. The optimal position for the, or the first, electrode is where its centre is located over the stylomastoid foramen. Even if the electrode is not ideally placed, provided some of it overlaps the stylomastoid foramen, then effective stimulation of the facial nerve can be achieved.

As a consequence, it was further realised that by providing a tangible and readily identifiable "location feature" on a facial stimulation apparatus to assist its location relative to a particular feature of the ear (i.e. whereby the ear acts as an anatomical reference), the problem of inconsistent electrode placement by end-user's lacking sufficient anatomical knowledge could be overcome. In particular, it was found that by adapting the apparatus to provide a tangible "location feature" to assist with correct electrode placement for one end-user, this would also reliably position electrodes over the same predetermined localised regions of the face for all other end-users.

Hence, contrary to the accepted wisdom in the art, there is in fact a surprising advantage in providing no adjustability in the apparatus in terms of the relative distance between the anatomical reference point on the ear and the predetermined localised region of the face. Many prior art examples fail to recognise this fundamental point and have provided unnecessary and unreliable adjustability. In some cases, such as in the apparatus disclosed in the aforementioned WO 00/71075 (Maher & Johnson), the very adjustability of the apparatus actually precludes the location of the electrodes over the insertion of the facial nerve since the booms to which the electrodes are attached cannot be shortened to the extent that their distal ends lie sufficiently close to relevant area of the face just anterior to the ears.

Advantageously, the apparatus of the present invention requires no anatomical knowledge on the part of the end-user. The sole responsibility of the end-user is to position the relevant "location feature", adjacent to or in direct contact with an unambiguous anatomical reference point on the ear. In doing so, the electrodes will inevitably be correctly positioned on the face over the insertion of the facial nerves anterior to each ear.

A further advantage of the present invention is that a consistent inward pressure is applied to each electrode carrier (20) thus ensuring a reliable electrical contact with the skin. Advantageously, this is achieved without complicated arrangements of pivots or springs commonly found in prior art devices thus reducing manufacturing costs. The C-shaped band (22) of the present invention is arranged such that when its opposing distal ends are separated to an extent corresponding to the width of the head just anterior to the ear, its resilience ensures that adequate and equal inward pressure is applied to the respective electrode carriers (20) to maintain reliable electrical contact between each electrode (16a, 16b) and the skin.

A particular advantage of the under-ear arrangement of Figures 3-5 is that the head is at its narrowest at this point to allow unimpeded urging of the electrodes against the appropriate region on the face by the C-shaped band (22).

Modifications and improvements may be made to the foregoing embodiments without departing from the scope of the present invention as defined by the claims. For example, whilst the "location feature" described for each embodiment is defined by a shaped portion of the electrode carrier (20) (i.e. shaped to correspond with the tragus) and/or the supporting arm (22) (i.e. the internal angle of the elbow bend (24) shaped to correspond with the join of the ear lobe to the head), other means of providing the "location feature" are possible. For example, the "location feature" may alternatively, or additionally, take the form of a visible reference such as visually perceptible marker and/or a tactile reference such as change in surface texture of the relevant part of the apparatus intended to locate on, against or next to the anatomical reference point on the ear.

Whilst the supporting arm (22) has been described and illustrated as having an integral elbow bend (24) formed near its point of attachment to the electrode carrier (20), the bend (24) could instead be formed from two or more separate components connected together provided that the distance and angle of the distal ends are fixed and non-adjustable once assembled.

Whilst the four examples of C-shaped bands (22) are described and illustrated, any other type or orientation of band is possible provided they fulfil the function of maintaining the electrodes in contact with the desired region on the face with respect to an anatomical reference feature of the ear (14). For example, a band in the form of a stethoscope could fulfil this function.

Whilst four different anatomical features of the ear (14) have been described above as suitable anatomical references, any other feature of the ear (14) could be used provided that appropriately adapted apparatus is used to ensure correct placement of electrodes (16a, 16b). Also, the use of a combination of anatomical features of the ear (14) is not precluded.

The flexible paddle members (21 ) may connect to the electrode carriers (20) by means of a snap fit into a receptacle which carries conductive contacts which are crimped or soldered onto the wiring within each electrode carrier (20). The connection may take the form of a ball and socket joint which also provided an electrical connection between the two.

The apparatus of the present invention is connectable to an external stimulation device worn on another part of the body, for example by means of the electrical lead shown in Figure 4. However, it is also possible to integrate the stimulator electronics and a power source such as a battery within the apparatus worn on the head. The apparatus could be rechargeable and furthermore could be operated wirelessly for a remote control means.

The final connection between the electrodes (16a, 16b) and the end-user's skin may be by means of an electrolyte. This can be as simple as a water based gel or more preferably one or more conductive and adhesive hydrogel patch shaped to match that of the electrode carrier (20). Separate patches matching the shape of each individual electrode (16a, 16b) can be provided. Alternatively, it is possible to use a single patch which covers both electrodes (16a, 16b) provided the lateral conductivity of the patch is low. This is achieved by using a thin patch such that the shunting impedance between the electrodes (16a, 16b) is high compared to the impedance of the circuit through the subject's skin.