Graeme Clark Collection
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ItemA multiple-channel cochlear implant: an evaluation using open-set CID sentences( 1981)A multiple-channel cochlear implant and speech processor have been used in two postlingually deaf adult patients with a total hearing loss, to enable them to perceive varying degrees of running speech. The results have been confirmed with open-set CID everyday sentence tests. Using the implant alone, the patients obtained 8% and 14% scores with pre-recorded material, and 34% and 36% scores for "live" presentations. This was equivalent to the perception of 35% of connected discourse. When the implant was used in conjunction with lipreading, improvements of 188% and 386% were obtained over lipreading alone, and the scores were 68% and 98% which were equivalent to the perception of 60% and 95% of connected discourse.
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ItemA protocol for the prevention of infection in cochlear implant surgery(Cambridge University Press, 1980)The reduction of infection to an absolute minimum is a very desirable goal in any form of surgery. It is especially important with a cochlear implant operation as infection in the labyrinth can lead to degeneration of the auditory nerve fibres it is hoped to stimulate electrically (Clark et al, 1975). Furthermore, as the implantation of foreign materials increases the risk of infection, as the operation can last 6-7 hours (Altemeier et al., 1976), and as the operators are in very close proximity to the implant site, more stringent measures for the prevention of infection need to be adopted than with other forms of otological surgery. For these reasons a protocol has been developed for preventing infection in our cochlear implant surgery. This is an overall approach to the prevention of infection and involves pre-operative measures, an operating theatre routine, the use of horizontal laminar flow filter units, correct surgical technique and the use of systemic and local antibiotics.
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ItemSpeech processing for cochlear implant prostheses( 1984)The transformation of speech into electrical signals which can stimulate the auditory nerve in order to create hearing sensations that carry speech information depends on many factors. These include the limitations imposed by the current state-of-the-art in otological surgery, microelectronic and micromechanical technology, and knowledge of the functioning of the auditory system under both acoustic and electrical stimulation. Sufficient advances have been made in all these areas to enable several research centers to develop cochlear prostheses which give some hearing to certain totally deaf persons. The work of these centers towards the goal of full unaided speech perception via the prosthesis is examined and evaluated.
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ItemPermeability of the implanted round window membrane in the cat: an investigation using horseradish peroxidase( 1984)The round window membrane of seven cats was implanted with a Silastic® prosthesis 5 mm long. The membrane's permeability to horseradish peroxidase was investigated at different stages after implantation. All cats were treated with amoxycillin for a period of one week after the operation. Results showed an increased permeability over a period of approximately two weeks following implantation. Thereafter the round window barrier to horseradish peroxidase returned to normal. In all cases cochlear hair cells and auditory nerve fibres were preserved. In cases of spontaneous infection in the bulla the membrane responded with a proliferation of the subepithelial connective tissue, and the formation of protuberances. In these round windows although the permeability was increased the penetration of horseradish peroxidase into the scala tympani was limited. Horseradish peroxidase always passed through the gap between the membrane and the prosthesis. Particles were taken up, however, by the connective tissue envelope that formed around the prosthesis after one week.
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ItemTwo-component hearing sensations produced by two-electrode stimulation in the cochlear of a deaf patient( 1983)http://www.sciencemag.org/cgi/content/abstract/219/4587/993?ijkey=v6jEOhdpzPCxw&keytype=ref&siteid=sci
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ItemPsychophysical studies evaluating the feasibility of a speech processing strategy for a multiple-channel cochlear implant( 1983)Abstract not available due to copyright.
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ItemThe histopathological effects of chronic electrical stimulation of the cat cochlea(Cambridge University Press, 1983)The success of a cochlear implant depends on stimulating an adequate number of viable spiral ganglion cells. The effect of chronic electrical stimulation on ganglion cells is therefore an important consideration when assessing the effectiveness and safety of such a device. The histopathological assessment of chronic unstimulated intracochlear electrodes is now well documented (Simmons, 1967; Clark, 1973; Clark et al, 1975; Schindler and Merzenich, 1974; Schindler, 1976; Schindler et al, 1977; Sutton et al, 1980). These experimental studies have used a variety of electrode designs, materials and surgical techniques. However, all have shown that chronic implantation has little effect on the peripheral nerves and the spiral ganglion cells adjacent to an implant, provided the insertion procedure is free of trauma and infection.
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ItemChronic electrical stimulation of the auditory nerve in cats: physiological and histopathological results( 1983)The ability of spiral ganglion cells to survive long-term electrical stimulation is a precondition for the success of cochlear prostheses. In this study 10 cats were implanted bilaterally with bipolar scala tympani electrodes and stimulated for periods of up to 2029 hours using charge balanced biphasic current pulses. The status of the auditory nerve was monitored periodically by recording electrically evoked auditory brainstem responses. At the conclusion of the stimulation program, spiral ganglion cell survival was assessed for stimulated and control cochleas; comparison of the two groups showed no statistically significant difference. The results of this study indicate that long-term intracochlear electrical stimulation using carefully controlled biphasic pulses does not adversely affect the spiral ganglion cell population.
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ItemThe clinical trial of a multi-channel cochlear prosthesis( 1983)The results of a multiple-electrode cochlear implant carried out on 1st August, 1978 on a totally deaf patient (post-lingual hearing loss) showed that he could perceive sounds of different pitches depending on the electrode stimulated, and this finding was consistent with the place theory of frequency coding. Furthermore, stimulating individual electrodes produced percepts which the patient described as vowel-like in quality. The patient could also perceive different pitches which varied with the rate of stimulation up to 200 pulses/second, but at higher rates he had difficulties perceiving pitch changes (Clark et al. 1978; Tong et al, 1979). As a result of the psychophysical studies a speech processor was developed. The speech processor extracted: firstly, the voicing frequency to help the patient hear the rhythm of speech and know whether a speech sound was voiced or unvoiced (e.g., /b/ versus /p/); and, secondly, the second formant to enable the patient to recognize vowels and consonants and so hear words. In order to maximize speech intelligibility, the second formant stimulated an appropriate electrode, and the rate of stimulation on that electrode was related to the voicing frequency.
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ItemPreoperative hearing aid evaluations for cochlear implant patients: a preliminary report using a minimal auditory capabilities battery( 1983)Two profoundly deaf patients were evaluated using the Minimal Auditory Capabilities (MAC) battery of speech discrimination tests. One patient was a multiple-channel cochlear implant patient (MC1) using a wearable speech-processor, the other a prospective cochlear implant patient using a hearing aid (HA). Results from the MAC battery showed that MC1 received significantly more auditory information via the speech-processor than was provided by the hearing aid to HA. These results indicated that the cochlear implant could be a suitable alternative for HA. However, the results indicated that HA gained some minimal benefit from the hearing aid and these results should be taken into consideration when deciding which ear should be implanted.