Graeme Clark Collection
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ItemThe biologic safety of the Cochlear Corporation multiple-electrode intracochlear implant( 1988)Studies have been undertaken to confirm the biologic safety of the Cochlear Corporation multi-electrode intracochlear implant. The materials used are biocompatible. The electrode array is flexible: it can be inserted with minimal or no trauma, providing the insertion is stopped when resistance is first felt. An atraumatic insertion is facilitated if a good view is obtained along the scala tympani of the basal turn of the cochlea by drilling through the crista fenestrae. The passage of the electrode around the cochlea can be facilitated if the electrode is rotated during insertion (clockwise for the left and anticlockwise for the right cochlea). The electrode can be explanted and another one reinserted with minimal or no trauma. A seal established around the electrode after an implantation period of 2 weeks can prevent infection extending from the middle to the inner ear. The electrical stimulus parameters produced by the Nucleus receiver-stimulator cause no loss of spiral ganglion cells or corrosion of the platinum band electrodes. Long-term stimulation has been carried out for up to 8 years in patients without affecting their clinical performance.
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ItemSynthetic vowel studies on cochlear implant patients( 1988)Abstract not available due to copyright.
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ItemPerceptual studies on cochlear implant patients with early onset of profound hearing impairment prior to normal development of auditory, speech, and language skills( 1988)Abstract not available due to copyright.
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ItemThe surgical anatomy for multiple-electrode extracochlear implant operations(Cambridge University Press, 1988)Direct access to the whole length of the cochlear turns via endaural middle ear approach for the placement of extracochlear electrodes is severely restricted. Approximately 10 mm. of the cochlear turns are accessible, being less than a third of their length. The middle cranial fossa, the facial nerve, the internal carotid artery and the temporomandibular joint restrict the access. A further restriction is caused by the position of the cochlea and the direction of its axis. The anterior part of the cochlea lies anterior to the tympanic membrane and medial to the temporomandibular joint, thus limiting an endaural approach to a posterolateral direction. Despite this limitation small sections of the basal, middle and apical turns of the cochlea can be reached.
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ItemPreliminary evaluation of a multichannel electrotactile speech processor( 1988)Abstract not available due to copyright.
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ItemThe histopathology of the human temporal bone and auditory central nervous system following cochlear implantation in a patient: correlation with psychophysics and speech perception results( 1988)Cochlear implantation has become a recognised surgical procedure for the management of a profound-total hearing loss, especially in patients who have previously had hearing before going deaf (postlingual deafness). Nevertheless, it is important for progress in the field that patients who have had a cochlear implant, bequeath their temporal bones for research. This will then make it possible to further assess the safety of the procedure, and the factors that are important for its effectiveness. Biological safety has been assessed in a number of studies on animals, in particular, the biocompatibility of the materials used (1,2), the histopathological effects of long-term implantation on the cochlea (3, 4, 5, 6, 7, 8), and the effects of chronic electrical stimulation on the viability of spiral ganglion cells (9, 10, 11, 12). In studying the temporal bones of deceased cochlear implant patients it is possible to help establish that the animal experimental results are applicable to Man. Surgical trauma has been most frequently evaluated by inserting electrodes into cadaver temporal bones. It is important, however, to examine bones that have been previously implanted surgically to ensure that the cadaver findings are applicable to operations on patients. The effectiveness of cochlear implantation can be studied by correlating the histopathological findings, the dendrite and spiral ganglion cell densities, in particular, with the psychophysical and speech perception results. Other benefits also accrue, for example, establishing the accuracy of preoperative X-rays and electrical stimulation of the promontory in predicting cochlear pathology and spiral ganglion cell numbers. For the above reasons it has been especially interesting to examine both the temporal bones and central nervous system from one of our patients (patient 13) who participated in the initial clinical trial of the Cochlear Proprietary Limited (a member of the Nucleus group) multiple-electrode cochlear prosthesis, and who died due to a myocardial infarction following coronary bypass surgery.
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ItemThe University of Melbourne/Nucleus cochlear prosthesis( 1988)This is a review of research to develop the University of Melbourne/Nucleus cochlear prosthesis for patients with a profound-total hearing loss. A more complete review can be obtained in Clark et al. A prototype receiver-stimulator and multiple-electrode array developed at the University of Melbourne was first implanted in a postlingually deaf adult patient with a profound-total hearing loss on 1 August 1978. A speech processing strategy which could help this patient understand running speech, especially when combined with lipreading was developed in 1978 following initial psychophysical studies. A prototype wearable speech processor was fabricated in 1979, that could provide significant help for the first two patients in understanding running speech when used in combination with lipreading compared with lipreading alone, and it also enabled them to understand some running speech when using electrical stimulation alone. An implantable receiver-stimulator and wearable speech processor embodying the principles of the prototype devices were then produced for clinical trial by the Australian biomedical firm, Nucleus Ltd, and its subsidiaries, Cochlear Pty Ltd and Cochlear Corporation. This cochlear implant was initially clinically trialled on six patients at The Royal Victorian Eye & Ear Hospital in 1982, and shown to give similar results to those obtained with the prototype device. In view of these findings a clinical trial was carried out for a Premarket Approval Application to the US Food and Drug Administration (FDA), and extended to a number of centres in the US, Canada, and West Germany. This clinical trial confirmed that patients could understand running speech when electrical stimulation was combined with lipreading, and that some patients could also understand running speech when using electrical stimulation alone. Today, more than 600 patients world-wide are using cochlear implants developed from the research described in this paper.
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ItemUnderlying structure of auditory-visual consonant perception by hearing-impaired children and the influences of syllabic compression( 1988)The identification of consonants in /a/-C-/a/ nonsense syllables, using a fourteen-alternative forced-choice procedure, was examined in 4 profoundly hearing-impaired children under five conditions: audition alone using hearing aids in free-field (A), vision alone (V), auditory-visual using hearing aids in free-field (AV1), auditory-visual with linear amplification (AV2), and auditory-visual with syllabic compression (AV3). In the AV2 and AV3 conditions, acoustic signals were binaurally presented by magnetic or acoustic coupling to the subjects' hearing aids. The syllabic compressor had a compression ratio of 10:1, and attack and release times were 1.2 ms and 60 ms. The confusion matrices were subjected to two analysis methods: hierarchical clustering and information transmission analysis using articulatory features. The same general conclusions were drawn on the basis of results obtained from either analysis method. The results indicated better performance in the V condition than in the A condition. In the three AV conditions, the subjects predominately combined the acoustic parameter of voicing with the visual signal. No consistent differences were recorded across the three AV conditions. Syllabic compression did not, therefore, appear to have a significant influence on AV perception for these children. A high degree of subject variability was recorded for the A and three AV conditions, but not for the V condition.
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ItemPhonemic information transmitted by a multichannel electrotactile speech processor( 1988)A wearable electrotactile speech processor was evaluated in a study with seven normally hearing and four hearing-impaired subjects. The processor estimated the fundamental frequency, the second-formant frequency, and amplitude of the acoustic speech signal. These parameters were presented as a pattern of electrical pulses applied to eight electrodes positioned over the digital nerve bundles on one hand. The device was shown to provide useful information for the recognition of phonemes in closed sets of words using tactile information alone. The device also supplemented lipreading to improve the recognition of open-set words. The recognition of duration and first-and second-formant frequencies of vowels and the recognition of voicing and manner of consonants were improved over recognition with lipreading alone. Recognition of final consonants was improved more than recognition of initial consonants. These results indicate that the device may be useful to both severely and profoundly hearing-impaired people.
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ItemResults for Chinese and English in a multichannel cochlear implant patient( 1987)A multichannel cochlear prosthesis was implanted in a Chinese patient who suffered from profound sensory hearing loss. The preoperative Minimal Auditory Capabilities (MAC) battery tests in English, as well as an open set bisyllable word test, an open set sentence test, and speech tracking in Chinese indicated significant improvement of speech perception for both English and Chinese after the operation. Substantial understanding of running speech was possible in both languages without the help of lipreading.