Graeme Clark Collection
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ItemPerformance benefits and costs for children using cochlear implants and hearing aids [Abstract]( 1998)The value of cochlear implants as an established clinical option for profoundly hearing impaired adults and children has been supported by significant research results over a number of years which has clearly established the benefits available (U.S. National Institutes of Health Consensus Statement 1995). Benefit has traditionally been considered as the direct impact of the cochlear implant procedure on speech perception, or in the case of children, on the use of that auditory information to develop understandable speech and to acquire a knowledge of language. As a consequence of continuing research to improve hardware and speech processing strategies, mean scores on open-set tests of monosyllables or sentence materials for implanted adults using the cochlear implant alone without lipreading have continued to show an upwards trend. In response to the increased mean scores in quiet, perception tests in background noise are now being used as a more accurate direct measure of the potential benefits of cochlear implants to severely-to-profoundly hearing-impaired candidates. Consideration should also be given to indirect benefits, such as reduction in the stress of listening and lipreading, improved performance at work, enhanced opportunity to maintain speech, or in children to develop speech which is understandable to the general community, and the social effects of reducing the isolating effects of profound deafness. Measurement of indirect benefit can be combined with an analysis of the costs of the procedure, enabling evaluation of the implant procedure from a cost-utility standpoint, and a comparison of outcomes using other technologies such as hearing aids. This study will present data on direct and indirect benefits for hearing-impaired children using Nucleus cochlear implant systems, and compare this data with benefits shown for similarly hearing impaired children using hearing aids. The significance of these results to cost-effective delivery of services will be discussed.
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ItemResults of multichannel cochlear implantation in very young children [Abstract]( 1995)Most researchers and clinicians working in the cochlear implant field have assumed that profoundly deaf children will have a better prognosis in terms of speech perception, speech production and language development, implanted at as young an age as possible. However, it has been difficult to gather direct evidence for this hypothesis due to the problems in assessing children under the age of five years with formal tests.
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ItemSpeech perception benefits for children using the Speak speech processing strategy in quiet and noise [Abstract]( 1995)The Speak speech processing strategy, based on the Spectral Maxima Speech Processor (SMSP) developed at the University of Melbourne, has now been implemented in the Spectra 22 speech processor developed by Cochlear Pty Limited, and clinical trials of both patients changing from the previous Multipeak strategy to Speak and patients starting up with Speak have been conducted. Results in adult patients changing to Speak have shown significant improvements in speech perception in quiet and particularly in background noise as compared with Multipeak.
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ItemSpeech perception results for children changing from multipeak to SPEAK speech processing strategy [Abstract]( 1996)In mid-1994, a new speech processing strategy termed SPEAK was introduced for the Nucleus Spectra-22 cochlear prostheses. To compare benefits in implanted children changing to the SPEAK strategy, speech perception in a group of twelve children from Melbourne and Sydney was evaluated. The children were assessed in quiet and in background noise.
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ItemFactors affecting speech perception in children cochlear 22-channel cochlear prosthesis [Abstract]( 1996)Since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne in 1985, there have been rapid expansion world-wide in the number of children using this implant system. Longer-term experience with implanted children has led to improvements in paediatric assessment and management. Speech processing strategies have also been improved, resulting in a series of increases in speech perception benefits.
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ItemSpeech perception results for implanted children with different levels of preoperative residual hearing [Abstract]( 1996)Many reports have established that hearing-impaired children using the Nucleus 22-channel cochlear implant may show both significant benefits to lipreading, and significant scores on open-set words and sentences using electrical stimulation only. These findings have raised suggestions that severely or severely-to-profoundly deaf children might benefit more from a cochlear implant than conventional amplification.
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ItemSpeech perception benefits for implanted children with preoperative residual hearing [Abstract]( 1995)Since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne in 1985, there has been rapid expansion in the number of implanted children world-wide. Improved surgical technique and experience in paediatric assessment and management have contributed to a trend to implant very young children. At the same time there has also been continuing development of improved speech processing strategies resulting in greater speech perception benefits.
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ItemSpeech perception benefits for implanted children with preoperative residual hearing [Abstract]( 1995)Since the implantation of the first children with the Nucleus 22-channel cochlear prosthesis in Melbourne in 1985, there has been rapid expansion in the number of implanted children world-wide. Improved surgical technique and experience in paediatric assessment and management have contributed to a trend to implant very young children. At the same time there has also been continuing development of improved speech processing strategies resulting in greater speech perception benefits. In the Melbourne program, over 60% of children obtain significant scores on open-set word and sentence tests using their cochlear implant alone without the aid of lipreading. As parents and professionals have become aware of these improved benefits to speech perception benefits in profoundly deaf children, there have been requests to consider implanting severely-to-profoundly deaf children. In these children with higher levels of residual hearing, only those children with poorer-than-expected performance on speech perception tests using hearing aids have been considered for surgery. A number of such cases have now been implanted in the Melbourne program. The speech perception benefits for this group are reported and are being compared with benefits for the profoundly deaf group of children.
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ItemSpeech perception benefits for children using the Speak speech processing strategy in quiet and noise [Abstract]( 1995)The Speak speech processing strategy, based on the Spectral Maxima Speech Processor (SMSP) developed at the University of Melbourne, has now been implemented in the Spectra 22 speech processor developed by Cochlear Pty Limited, and clinical trials of both patients changing from the previous Multipeak strategy to Speak and patients starting up with. Speak have been conducted. Results in adult patients changing to Speak have shown significant improvements in speech perception in quiet and particularly in background noise as compared with Multipeak. Preliminary studies with children changing from Multipeak to Speak strategy, measured over a 10 month period, have also shown significant benefits from use of the Speak scheme in both quiet and noisy test situations. Results of follow up studies of these children after more than one year experience with the Speak processing strategy are presented. Statistical analysis of performance over time suggests that an increase in benefit is observed in children after additional experience with the Speak processing strategy. In addition, results for children who have used only the Speak processing strategy from the time of implantation are also presented. The results confirm that the Speak processing strategy provides significant benefits in quiet, and particularly in the presence of background noise for both groups of patients.
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ItemResults of multichannel cochlear implantation in very young children [Abstract]( 1995)Most researchers and clinicians working in the cochlear implant field have assumed that profoundly deaf children will have a better prognosis in terms of speech perception, speech production and language development. if implanted at as young an age as possible. However, it has been difficult to gather direct evidence for this hypothesis due to the problems in assessing children under the age of five years with formal tests. Recent results with older children have supported the view that early implantation may provide the optimal outcome in most cases. The implantation of very young children raises two areas of concern that do not apply in adults and older children: accurate assessment of degree of hearing loss and auditory potential; and postoperative assessment of outcomes. This paper will describe research results from the University of Melbourne which address these issues and present results for children implanted as young as eighteen months of age.