Graeme Clark Collection
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ItemFuture directions in the clinical application of multichannel cochlear prostheses [Abstract]( 1992)Three main areas of work at the University of Melbourne relating to the clinical application of multichannel cochlear prostheses will be discussed. Speech perception results for 40 children and adolescents implanted with the Nucleus multichannel device will be presented with an analysis of potentially predictive clinical factors. Overall results have shown that 60% of the children have developed useful open-set speech recognition ability without visual cues. Due to the improved speech perception for postlinguistically deafened adult cochlear implant patients, the multichannel implant has become a viable alternative for patients with some useful residual hearing. A "bimodal" speech processor which provides acoustic output for the residual hearing ear and electrical output for the cochlear implant will also be discussed. This device provides a flexible, programmable acoustic processor which can make use of feature coding aspects of the implant processing. The "bimodal" device has also addressed problems of incompatibility of the implant signal with the acoustic signal from conventional hearing aids. Results for the new "Spectral Maxima Speech Processor" (SMSP) will also be presented. The SMSP has shown improved speech perception performance in quiet and in noise when compared with the MSP (MULTIPEAK) system, currently in use with the Nucleus device. Results for four subjects with the SMSP showed mean scores of 57.4% for open-set monosyllabic words in quiet, and 78.7% for open-set sentences in a 10 dB signal-to-noise ratio
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ItemFuture developments in speech processing for multichannel cochlear implants in children [Abstract]( 1992)The average speech perception score for adult implant patients is now about 60% on an open-set sentence test without lipreading. This is higher than the scores obtained by many profound and severe-to-profoundly impaired hearing aid users. This suggests that some hearing aid users, particularly those who use a hearing aid in one ear only, could benefit from a cochlear implant. As neither the implant nor the hearing aid will provide perfect speech recognition it is to be expected that this group should obtain maximum benefit by using the hearing aid in one ear together with the implant in the other ear. However, experience with this group of patients has shown that many people find the use of two independent devices unacceptable. Furthermore, perceptual interaction of the acoustic and electrical signals makes it desirable to be able to control the two outputs in a more co-ordinated way than is possible with two independent devices. Consequently, a "bimodal" speech processor has been developed with both acoustic and electrical outputs controlled from the same speech processing unit. Feature coding aspects of the implant processing have been applied to the acoustic signal in such a way as to enhance speech perception with the hearing aid and improve compatibility with the implant. Initial testing with the bimodal aid shows promise to help severely-to-profoundly impaired individuals. The device has also been useful as a research tool to investigate the complex interactions of simultaneous acoustic and electrical stimulation. The Spectral Maxima Sound Processor (SMSP) has also been developed at the University of Melbourne for use with the Nucleus cochlear implant. Studies with adult subjects have shown improved perception of vowels, consonants, words and sentences in quiet and sentences in background noise with the SMSP as compared with the MSP(MULTIPEAK) which is currently supplied for use with this implant. Results for four subjects showed mean scores for open set sentences at a 10 dB signal-to-noise ratio of 78.7% for the SMSP and 50.0% for the MSP. Mean scores for the same group on open set monosyllabic words in quiet were 57.4% for SMSP and 39.9% for MSP. These results suggest that future improvements in speech perception will be possible for children using the Nucleus cochlear implant.
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ItemFactors affecting speech perceptual performance for children using the 22-electrode cochlear prosthesis [Abstract]( 1992)Speech perception results for all 40 children and adolescents implanted with the. Nucleus 22 electrode cochlear prosthesis in Melbourne (as of February 1, 1992) were used to categorize performance for each child into one of six hierarchical groups: 1: detection of speech including high frequencies 2: discrimination of suprasegmental features of speech in addition to 1,3: discrimination and recognition of .vowel sounds in addition to 1 and 2,.4: discrimination arid recognition of consonant sounds in addition to 1, 2 and 3,5: open set speech. recognition with scores less than 20% for unfamiliar material in addition to 1 to 4,6: open set speech recognition with scores greater than 20% for unfamiliar material in addition to 1 to 5, above.All children demonstrated discrimination of suprasegmentals (level 2) and 58% demonstrated some openset speech recognition (levels 5 and 6). The pattern of results suggested that children who can discriminate segmental features of speech tend to achieve open set speech perception after adequate experience with the prosthesis. The performance level, described above, was used as the dependent variable in a multiple regression analysis to assess the effect of various factors on speech perception performance. The duration of profound hearing impairment and the amount of experience with the prosthesis were shown to contribute significantly to the variance, in performance level. A weaker trend was evident (or recently implanted children which may suggest that those' in oral/aural educational settings progress more rapidly, in terms of speech perception, than those in total communication settings. Age at implantation, cause of deafness, hearing levels prior to implantation, and number of electrodes in use, did not contribute significantly. to the variance in speech perception performance for these children. The results showed that all children with less than seven years of profound hearing impairment and with over one year of experience with the prosthesis have achieved some open-set speech recognition. This is an encouraging result as the trend in clinical application of cochlear prostheses has been towards implanting younger children in recent years. If this sample of hearing-impaired children in Melbourne is representative of the general population, we may expect that most implanted young children will ,develop reasonable speech perception skills after adequate experience and training.
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ItemPreliminary speech perception results for children with the 22-electrode Melbourne / cochlear hearing prosthesis( 1992)The Cochlear 22-electrode cochlear prosthesis was first implanted in a child at the Cochlear Implant Clinic at the University of. Melbourne and Royal Victorian Eye & Ear Hospital in 1985. Since that time 42 children have received the device in Melbourne. Analysis of patient details shows that the majority of these children have a congenital as opposed to on acquired aetiology of hearing loss. In all but 3 cases, the children use 15 or more electrodes. In order to assist with evaluation of, benefits to speech perception across the very heterogeneous group of children, a six level hierarchical classification scheme for speech perception performance levels was created. All of the children achieved a minimum of Category 2 (discrimination of suprasegmental information). In total, 59 % of the children achieved Category 5 or 6 (open set recognition for unfamiliar materials). Analysis showed that the majority of these children had more than one year of experience. In contrast, the majority of children in Category 2 are those with less than one year of experience with the device.
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ItemImprovements in speech processing for the nucleus cochlear implant [Abstract]( 1992)The Nucleus Cochlear implant allows ~ variety of multiple channel speech processing strategies to be developed and trialled. The initial strategy first developed by the University of Melbourne presented the second formant frequency as place and voicing as rate of stimulation. The strategy was subsequently improved by presenting the first format on a place basis as well. Since that time the addition of more spectral information coded as place of stimulation and temporal information presented as variations in amplitude have resulted in better open-set CNC word and sentence scores for electrical stimulation alone. One of the improved strategies selects four pairs of electrodes from the 22 electrode array each glottal pulse to present the first and second formants as well as the output from two high Frequency band pass filters. The other strategy stimulates six of the 22 electrodes representing the six maximal outputs from 16 bandpass filters. The clinical results have shown that both the above strategies results in better open-set speech perception for electrical stimulation in quiet and in noise. 80 % scores have been obtained for open-sets of CNC words and 90 % for open-sets of words in sentences for some of the patients using the latter strategy.
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ItemPsychophysical studies with children using cochlear implants [Abstract]( 1992)Psychophysical studies were conducted on a heterogeneous group of 12 patients using, the Cochlear Nucleus cochlear implant. These patients became profoundly deaf early in life, prior to the full development of auditory and speech skills. The aim of the studies was to determine whether the basic hearing skills of these patients differ from those of patients who becamedeaf later in life. The mean age of, the patients at confirmation of the profound hearing loss was 22.3 months (range 6 to 45 months). The mean age of at the time of implantation as 14.8 years (range 5 to 24 years). The cause of deafness was meningitis for 7 patients, congenital Usher's syndrome for 3 patients and congenital unknown for 2 patients.
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ItemMultichannel cochlear implants in children: an overview of experimental and clinical results [Abstract]( 1991)During the last decade there has been great progress in the clinical management of profound, postlinguistically deafened adults through the use of multichannel cochlear implants. The device developed by Cochlear Pty. Ltd. in association with the University of Melbourne, electrically stimulates selective regions of the residual auditory nerve using an array of 22 Pt electrodes located within the scala tympani. A speech processing strategy has been developed to provide patients with both voice pitch, and first and second formant information. Following experimental safety studies and successful clinical trials, this device was approved for use in adults by the United States FDA in 1985. In 1990, following further miniaturization of the implant, the FDA approved the device for use in profoundly deafened children above the age of two years. The present paper presents an overview of our recent biological safety studies and clinical experience with cochlear implants in children, and discusses the likely future development of these devices. Our biological safety studies were designed to evaluate the safety and design requirements of cochlear implantation in children, and more recently has focussed on issues for implantation in very young children (< 2 years old). These studies included the measurement of growth in the human temporal bone and the development of lead wires that can accommodate such growth, the development of an electrode fixation technique close to the cochlea, the effect of cochlear implantation on skull growth, the effect of long-term electrical stimulation on the maturing auditory system and the stimulating electrodes, and the effect of middle ear infection on cochlear implantation. Our clinical experience is based on twenty-five children that have now been implanted in our clinic. They include (i) postlinguistically deafened children; (ii) congenitally or early-deafened young children; and (iii) congenitally or early deafened adolescents. Clinical testing has shown improvements in speech perception, speech production and language in all three groups. Postlinguistically deafened children show similar speech perception results to postlinguistically deafened adults. For the congenitally deaf, younger children tend to show better results than the adolescents. Significantly, these clinical results are consistent with results from 142 children obtained from clinics throughout the world. These experimental and clinical results support the use of cochlear implants in young children. Further clinical improvements can be expected in the future with advances in both hardware and speech processing strategies.
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ItemClinical results for children using the 22-channel cochlear prosthesis [Abstract]( 1991)Twenty five profoundly/totally hearing-impaired children aged between 2 and 18 years have been implanted with the 22-channel cochlear prosthesis (Cochlear Pty. Ltd.) at The University of Melbourne over the last five years. Speech perception, speech production and language development have been monitored for these children both pre- and postoperatively. Results have shown improvements for all children in speech perception, postoperatively. The younger children (< 12 years) and those with an acquired (postlinguistic) profound hearing loss, have demonstrated some open-set speech recognition without visual clues. In general, older children with a prelinguistic profound hearing loss have not attained this level of performance. Improvements in speech production and language have also been demonstrated and tend to occur faster in younger children. Importantly, a number of congenitally deaf young children have shown significant improvements in speech perception, production and language. Important factors in the success of cochlear implants in children appear to be: educational environment - it is vital to have a strong auditory component (i.e. non-signing); careful attention to correct programming and maintenance of the prosthesis; support of family and other professionals.