Graeme Clark Collection
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ItemWhat factors contribute to successful outcomes for children using cochlear implants( 2000)Long term speech perception data has been collected for 100 children using the Nucleus multichannel cochlear prosthesis in Melbourne. Scores on a number of different assessments are available at approximately six month intervals following implantation for these children. The group represents an unselected sample of cochlear implant users, as all children were included if they had sufficient developmental skills to perform formal speech perception tests. Information was also collected on each child regarding type of hearing loss, age of onset of profound hearing loss, duration of profound hearing loss, age at implantation, pre and post-implant communication mode, developmental delay, speech processing strategy and length of experience with implant use.
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ItemHearing levels and speech perception prior to cochlear implantation - are they predictive of outcomes for adult implant users?( 2000)As the speech perception results obtained for adults using multichannel cochlear implants have improved, people with a wider range of hearing losses are now considering implantation. In the mid-1980s, most adults undergoing cochlear implantation had little or no residual hearing. This made selection and counselling relatively straightforward as any level of hearing obtained through use of the cochlear implant could be considered as a benefit in such cases. Most patients evaluated for implantation today have some degree of useful residual hearing, and may be reliant on this hearing to varying degrees in their everyday life. In essence, they have something to lose if their postoperative performance is poor. In counselling these patients, it would be most helpful to have reliable predictors of postoperative performance. A number of factors such as duration of profound hearing loss, congenital profound hearing loss, and certain aetiologies (eg, head injury) have shown significant links with outcomes in previous studies.
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ItemHow much residual hearing is too much?( 2000)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 (U.S. National Institutes of Health Consensus Statement 1995). As a direct consequence of the level of benefits shown for cochlear implant users on measures of speech perception, research has focused on investigating whether severely hearing impaired adults and children would be suitable candidates for cochlear implantation. I n considering the candidature of any individual, both medical and audiological suitability are investigated. The primary concern is to establish to what degree the patient would benefit from use of the cochlear implant.
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ItemSpeech perception & indirect benefits for severely hearing impaired children using cochlear implants [Abstract]( 1998)The benefits to speech perception, speech production, communication, and quality of life were investigated for severely hearing impaired children using cochlear implants and hearing aids. For the youngest children, assessments of psychological status, and use of a battery of cognitive and language tests were important factors in determining performance benefits prior to the child developing speech. For older children, the effects of increased one-to-one oral habilitation, and systematic encouragement of parental involvement were also investigated. Results suggested that parental support for consistent device use was an important factor in producing outcomes. Children with residual hearing were more likely to achieve open-set perception. Each child was also assessed for changes in quality of life, through use of a standardized health utility instrument. Results from the group were collated, and teamed with a costing assessment for the procedure, which allowed a complete cost-utility analysis to be completed. Results suggested that indirect benefits, such as the effects on speech production, usual activities, lower concentration, and less distress were ranked as more important than changes to hearing in a number of the children. Costs per QALY were consistent with those reported in the literature, and suggested that the cochlear implant is highly cost-effective as a medical technology.
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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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ItemEvaluation of direct and indirect benefits in the selection of cochlear implant candidates [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 clearly established the benefits available (U.S. National Institutes of Health Consensus Statement 1995). Benefit has traditionally been considered as the impact of the cochlear implant procedure on hearing, and in the case of children, on the use of that hearing to develop speech and language. However, as a result of continuing research, improvements have been realised both in hardware and speech processing. As a direct consequence of these improvements, the mean open-set implant-alone speech perception scores for implanted adults have continued to increase. In response to the increased mean scores shown by adult cochlear implant users in quiet, perception tests in background noise are now being used as a direct measure of the potential benefits of cochlear implants available to severely-to-profoundly hearing-impaired candidates. In addition, consideration in candidature 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 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 a costing study, enabling evaluation of the implant procedure from a cost-utility standpoint, and comparison of outcomes using other technologies such as hearing aids. The use of new approaches to candidature, including new measures of direct and indirect benefit is reported using data from the Melbourne cochlear implant program.
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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 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 results for the nucleus multiple channel cochlear implant in children and adults with residual hearing [Abstract]( 1996)Speech perception results for profoundly deaf children and adults using advanced speech processing strategies for the Nucleus multiple-channel cochlear implant have continued to improve, and are now better than those reported in research with severely-to-profoundly hearing-impaired people using aided residual hearing.
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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.