Graeme Clark Collection
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ItemIs deep insertion of the cochlea implant electrode array necessary and possible?( 1995)Hyaluronate (Healon TM) appears to be useful in achieving deeper electrode insertions than are generally achieved at present. However, biosafety studies are still being conducted. If found to be a safe technique, further work to explore different electrical stimulation strategies and speech processing schemes will also need to be undertaken. This work is ongoing.
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ItemSteady state evoked potentials: a new tool for the accurate assessment of hearing in cochlear implant candidates( 1993)Precise determination of residual hearing in prospective cochlear implant candidates is essential. As the minimum age of implantation for young children has reduced, the use of objective measures of hearing has become more important. At the University of Melbourne Cochlear Implant Clinic, steady state evoked potential (SSEP) assessments are routinely carried out on all candidates under the age of 5 years using a microcomputer and custom-designed hardware in the manner described by Cohen et al. [1].
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ItemA comparison of steady-state evoked potentials to modulated tones in awake and sleeping humans( 1991)Abstract not available due to copyright.
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ItemDevelopment of safe and effective electrodes: a risk management approach [Abstract]( 1999)Results from studies on experimental animals, computer modelling and preliminary psychophysical studies with three patients, have confirmed the potential for subjective improvement with electrode arrays which lie closer to the modiolus than does the Nucleus straight array. Results of psychophysical studies with three cochlear implant patients, using developmental pre-curved arrays, confirm the feasibility of improving patients' performance through improvements in electrode design. In particular, it was found in psychophysical tests, with patients using a developmental pre-curved electrode array, that both maximum comfortable level and threshold reduced with decreasing distance of a stimulated electrode from the modiolus, and that the dynamic range increased. More intense neural excitation patterns were obtained with the closer electrodes. From this it is inferred that the development of more sophisticated electrode arrays, positioned closer to the modiolus than is currently the case with the Nucleus standard array, will enable the development of improved speech processing strategies. There are technical constraints in the design of a peri-modiolar array, and currently a number of approaches to this problem have been investigated. Whilst the goal of the design is that it be effective for sophisticated and variable manners of stimulus delivery, a primary constraint is safety.
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ItemInsertion study using new peri-modiolar electrode array designs [Abstract]( 1999)Intracochlear multi-channel cochlear implants have been shown to successfully provide auditory information for profoundly deaf patients by electrically stimulating discrete populations of auditory nerve fibers via a scala tympani (ST) electrode array. Histological and radiological examination of implanted human temporal bones showed that the current straight Nucleus® array is usually positioned against the outer wall of the ST. An electrode array close to the modiolus could be expected to reduce stimulation thresholds and result in a more localized neural excitation pattern.
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ItemPsychophysics of a peri-modiolar electrode array( 1999)Psychophysical findings in three adult patients implanted with a CI22 cochlear prosthesis (Cochlear Limited) fitted with a developmental peri-modiolar electrode array have been reported. This array was moulded with a curvature approximating that of the inner wall of scala tympani but, after straightening and insertion into the cochlea, it adopted a position on average approximately half way between the inner and outer walls. However, the considerable variations in electrode trajectories across subjects allowed an analysis which could separate the effects due to longitudinal distance into the cochlea and lateral distance from the modiolus. Radiographic analysis enabled the positions of the individual electrodes to be measured, both longitudinally and laterally. This paper presents additional results and an in-depth analysis of the data, supported by psychophysical findings in subjects with straight arrays. It also introduces a model which describes the effect of distance from the modiolus on the loudness growth function.
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ItemBenefits of pre-curved electrode arrays for the Nucleus multichannel cochlear implant [Abstract]( 1998)The purpose of the study was to evaluate whether placement of an electrode closer to the modiolus would provide a more efficient interface with the auditory nerve. A pre-curved, banded 22-electrode array has been developed. Following comprehensive safety studies, the array was inserted in three adult patients. Detailed x-ray analyses have been conducted to specify the positions of the electrode bands. Psychophysical studies have been conducted, within each subject, using electrodes which lie at differing distances from the modiolus. These studies have shown that as the distance from the modiolus decreased, electrode threshold currents decreased and dynamic ranges increased. Thresholds were lower than in a comparison group of standard array users. Forward masking studies showed current spread to be more focused at the electrodes lying closer to the modiolus. Electrode discrimination was also better at electrodes closer to the modiolus. JND for loudness, expressed as a function of dynamic range also decreased in this condition. Thus, a preliminary profile of the parameters of interest, for an improved implant design, suggest that an array which lies closer to the modiolus can result in lower current requirements and a more localised pattern of neural excitation.
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ItemSpatial spread of neural excitation in cochlear implants: comparison of measurements made using NRT and forward masking [Abstract]( 1998)Recently developed technology allows intracochlear potentials to be measured in cochlear implant recipients, using telemetry. Neural response telemetry (NRT) enables the measurement of compound action potentials evoked by stimulation of cochlear implant electrodes. These objective measures can now be compared with related psychophysical measures in humans. We will present data, from both NRT and forward masking, on spatial spread of neural excitation due to stimulation of cochlear implant electrodes. The response fields from more apical neurons will spread quite broadly to the sensing electrodes of an implanted array, resulting in misleadingly broad NRT estimates of the spatial spread of neural excitation. Forward masking, which might itself lay claims to some degree of "objectivity", will not suffer from this limitation. Comparison of data from the two measures will help to determine the limitations of NRT as a tool for measuring spatial spread of neural excitation.
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ItemA new pre-curved electrode array benefits as measured by initial psychophysics [Abstract]( 1998)Theory suggests that an electrode which lies close to the modiolus should provide a more efficient interface with the auditory nerve, although it is important to ensure that stimulating fields are not so intense as to risk neural damage. A pre-curved, banded 22-electrode array has been developed which, following evaluation for ease of insertion and comprehensive safety studies, has been inserted in three patients. Detailed X-ray analyses, in which the positions of the electrode bands are specified, have been carried out. This has enabled comparative detailed, psychophysical studies to be carried out, within each subject, between electrodes which lie at differing distances from the modiolus. These studies have shown that, as the as electrode distance from the modiolus decreased, threshold currents decreased and dynamic ranges increased. Thresholds are lower than in a comparison group of subjects fitted with straight arrays which had been similarly position specified. Extensive forward masking studies have shown that current spread was more focused at the electrodes closer to the modiolus. Electrode discrimination studies were carried out and in the loudness jittered condition, which is more representative of the dynamic speech signal, discrimination was better at the electrodes closer to the modiolus. Just Noticeable Differences for loudness, expressed as a function of dynamic range, also decreased in this condition. Thus, a preliminary psychophysical profile of the parameters of interest, for an improved implant design, indicate that an array which lies closer to the modiolus can result in lower current requirements and a more localised pattern of neural excitation.
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ItemThe development of a precurved cochlear implant electrode array and its preliminary psychophysical evaluation [Abstract]( 1998)A precurved banded electrode array may provide a better interface with the auditory neural pathways for cochlear implants, and provide better speech perception. A prototype arrray has been further evaluated for ease of insertion, siting within the cochlea and induction of any cochlear trauma. The arrays were inserted into the human cochlear under simulated surgery. The bones were embedded in Araldite, X-rayed and sectioned. X-ray reconstruction analyses of the position of the implanted array showed its insertion to be favourable. Cochlear implants with precurved arrays have been implanted in three patients. Psychophysical evaluation and X-ray analyses have shown that as electrode distance from the modiolus decreased: threshold current decreased; dynamic range increased; current spread as measured by forward masking studies, was more focused; electrode discrimination with loudness jitter (being abetter representation of the dynamic speech signal) improved; JNDs for loudness, expressed as a function of dynamic range, decreased.