Graeme Clark Collection
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ItemThe development of a tympanic membrane sensor for a totally implantable cochlear implant or hearing aid(Monduzzi Editore, 1997)We present the design and development of a tympanic membrane sensor for a totally implantable cochlear implant or hearing aid system. The sensor employs a fiber-optic lever which is hermetically sealed in a biocompatible cartridge and implanted in the middle ear cavity. The sensor prototype has been designed, constructed and tested in cats. In addition, the implantation procedure of the device has also been studied using human temporal bones.
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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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ItemSiting the receiver-stimulator of the CI-24M model of the Cochlear Limited multiple-channel cochlear implant and fixation of its electrode array(Monduzzi Editore, 1997)The correct siting of the cochlear implant receiver-stimulator package is important. The package should not obtrude significantly above the surface of bone, and should be so that blows to the head do not in damage to the package, skull or brain. The cochlear implant electrode array must be fixed at a site close to the cochlea, so that the electrode will not slide out, or be subject to differential movement with growth changes. Fixation, with Dacron® mesh, platinum-iridium ties, or clips, has been in the region of the posterior root of the zygoma and the floor of the antrum. Our research studies demonstrate that a specially-designed collar around the array can be placed through the cochleostomy and provide the necessary locking to prevent retraction of the array. It has a ceramic surround to encourage union with neighbouring bone, and stress relief to reduce wire fracture at the point where the array leaves the cochlea.
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ItemSpeech perception in implanted children: effects of speech processing strategy and residual hearing(Mendoza Editor, 1997)The ability of implanted children to adapt to different speech processing strategies has been demonstrated for the Nucleus implant system. Children previously experienced with the Multipeak speech processing strategy. were able to gain significant improvements in consonant, word and sentence perception using the Speak speech processing strategy. suggesting some degree of neural plasticity in neural-auditory coding. Of 192 implanted children with different degrees of preoperative residual hearing, 65% were found to obtain significant scores on open-set speech materials using electrical stimulation alone. Those children with more residual hearing had a greater probability of achieving open-set understanding and at a minimum level, perceived high frequency consonant information which would not have been available through conventional hearing aids.
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ItemImplantation of the new CI-24M Cochlear Limited receiver-stimulator and its electrode array(Monduzzi Editore, 1997)Cochlear Limited has released the new CI-24M model Nucleus 24 electrode cochlear implant system encompassing a series of new features. It offers the potential for improvements in hearing and cosmesis, as well as telemetry.
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ItemMulticenter evaluations of speech perception in adults and children with the nucleus (cochlear) 22-channel cochlear implant(Kugler, 1996)The Nucleus 22-channel cochlear implant has been implanted in over 10,500 patients in 79 countries. and used for more than 25 languages. It arose as a result of our early physiological, behavioral and biological research on experimental animals. The historical development of the Nucleus device has been outlined in detail by Clark. Our ongoing research has led to improvements in the way speech is processed with the 22-channel device that are now resulting in improved speech perception for profoundly totally deaf people that is, on average, better than the speech perception obtained by many deaf people with hearing aids. The multiple-channel cochlear implant was first approved by the US Food and Drug Administration (FDA) for use in postlinguistically deaf adults in 1985. It was subsequently approved for use in children in 1990. The proportion of children (18 years of age and under) to have now received it is approximately 439C (4,500 out of 10.500). In evaluating improvements in speech processing it is important to design well-controlled studies, and a number of important ones which have previously been published are summarized in this paper. In addition, speech perception results for all the Nucleus speech processing strategies have been obtained four to six months postoperatively from unselected patients presenting to the Cochlear Implant Clinic at the Royal Victorian Eye & Ear Hospital (RVEEH), Melbourne, and are presented in this paper. As results can vary greatly with different durations of experience it is essential to make comparisons at the same time postoperatively. These clinical data are the most complete to date for comparing the Nucleus speech processing strategies.
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ItemHabilitation issues in the management of children using the cochlear multiple-channel cochlear prosthesis( 1993)Since 1985, a significant proportion of patients seen In the Melbourne cochlear Implant clinic have been children. The children represent a diverse population, with both congenital and acquired hearing-impairment, a wide-range or hearing levels pre-Implant, and an age range from 2 years to 18 years. The habilitation programme developed for the overall group must be flexible enough to be tailored to the Individual needs of each child, and to adapt to the changing needs or children as they progress. Long-term data shows that children are continuing to show Improvements after 5-7 years of device use, particularly In their perception of open-set words and sentences. Habilitation programs must therefore be geared to the long-term needs of children and their families. Both speech perception and speech production need to be addressed In the specific content of the habilitation program for any Individual child. In addition, for young children, the benefits or Improved speech perception should have an Impact on development of speech and language, and the focus of the programme for this age child will reflect this difference In emphasis. Specific materials and approaches will vary for very young children, school-age and teenage children. In addition, educational selling will have a bearing on the Integration of listening and device use Into the classroom environment.
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Item3D reconstruction of the temporal bone in cochlear implant surgery( 1992)In the preoperative evaluation of prospective cochlear implant patients high resolution computed tomography (CT) is routinely performed. Sectional images of the temporal bones in the axial or coronal plane can give essential information about cochlear or mastoid pathology that will enable the surgeon to select a side for operation and alert him to surgical obstacles he might encounter. Even with the help of serial CTs it has always been very difficult to visualize the complicated anatomy of the normal temporal bone. In particular, in a patient with a malformation or a previous operation, even an experienced otologic surgeon cannot always avoid unwelcome surprises. In analyzing the CT films he must still try to form a 3-dimensional image in his mindby looking through a large number of different pictures s. Consequently, to make it easier to understand, a lot of effort has been put into the development of 3-dimensional (3D) imagingof the object. A variety of 3D graphics systems that provide multi-angled surface renderings from serial CT images have become available in recent years and proved to be useful in craniofacialreconstructive, orthopedic and neurosurgical planning. We applied our own image analysis technique to produce three-dimensional reconstructions of temporal bones in patients and in isolation on a personal computer9 We focused on the use of this method for the preoperative examination and surgical planning for cochlear implantation as well as for our research purposes. This system and the results are presented here.