Graeme Clark Collection
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ItemSafety studies and preliminary patient trails with a new perimodiolar electrode array( 2000)A new perimodiolar electrode array, the curly-with stylet (CwS), has been developed and undergone safety trials in human cadaver temporal bones. The array was developed as a result of animal and modelling studies which indicated that there are potential advantages in situating the electrode array in closer proximity to the neural elements. Preliminary studies with four patients in Melbourne implanted with a developmental pre-curved array had supported the predictions of lower current requirements and possibly more focussed spread of excitation.
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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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ItemPeri-modiolar electrode arrays: a comparison of electrode position n the human temporal bone(Monduzzi Editore, 1997)This paper describes a radiologic evaluation of three types of peri-modiolar arrays, comparing their trajectory within the scala tympani with a standard Mini-22 electrode. All peri-modiolar arrays were found to lie closer to the modiolus for much of their insertion length compared with the standard array. While one design showed evidence for the potential of increased insertion trauma, two designs produced satisfactory results. Although further electrode development, temporal bone and histopathologic studies arE required, it would appear that the benefits of peri-modiolar electrode arrays will be realised clinically.
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ItemSteady-state evoked potentials (SSEPS): a new tool for the accurate assessment of hearing in cochlear implant candidates [Abstract]( 1992)Determining hearing thresholds is crucial in assessing cochlear implant candidates; never more so than in young children unable to undergo behavioural audiometry. In these children an objective measure of hearing is desirable. Steady-state evoked potentials (SSEPs) are potentials recorded from the scalp and simultaneously analysed. Stimuli ore amplitude and frequency modulated pure tones. A system has been developed which allows the presence of such a response to be automatically detected and the technique thus permits an objective, frequent specific assessment of hearing threshold to be mode in sleeping or awake subjects (1). This paper investigates the use of SSEPs in determining hearing thresholds in young profoundly deaf children who are candidates for cochlear implants. Responses in such patients are compared with those obtained in normal adults, neonates and experimental animals. Results indicate that the SSE? can provide a consistent and reliable measure of threshold and the technique appears to have a number of advantages over the auditory brainstem response: automated response detection removes the subjective element of threshold determination, higher levels of stimulus presentation are possible, low frequency threshold determination is more accurate and the testing procedure IS quicker.