Graeme Clark Collection

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    Research directions for future generations of cochlear implants.
    Clark, G (Maney Publishing, 2004-09)
    Physiological and psychophysical research indicates that improved hearing in noise and music appreciation are likely with cochlear implants, with better reproduction of the fine temporospatial patterns of neural response in the auditory pathways due to phase differences in neuron firing patterns as the result of the basilar membrane travelling wave. An initial speech-processing strategy, to in part reproduce this information, is showing better frequency discrimination and musical perception. However, more exact reproduction is likely with a new generation electrode array which could involve the use of neurotrophins and inherently conducting polymers. The siting and design of this, as well as safety, needs further investigation before it is implemented.
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    Optimizing dynamic range in children using the nucleus cochlear implant
    Dawson, PW ; Decker, JA ; Psarros, CE (LIPPINCOTT WILLIAMS & WILKINS, 2004-06)
    OBJECTIVE: The aim of this study was to investigate the benefits of the preprocessing scheme "Adaptive Dynamic Range Optimization" (ADRO) in children using Nucleus cochlear implants. Previous research with adults indicates improved speech perception in quiet and improved sound quality in everyday listening environments with the ADRO scheme. DESIGN: Children were given 4 wk of take-home experience with ADRO, with a minimum of 2 wk in which ADRO was "locked-in." After 1 wk of ADRO use and again after 4 wk of ADRO use, Bench-Kowal-Bamford (BKB) sentence perception in quiet at a low input level of 50 dB SPL (unweighted root mean square) and sentence perception in noise were compared with the child's everyday (Standard) program and the ADRO program. Children also rated the loudness of a variety of environmental sounds and indicated which program provided the best hearing in a variety of everyday listening situations. RESULTS: On average, BKB sentence perception in quiet at 50 dB SPL was significantly better with the ADRO program compared with the Standard program. The group mean improvement was 8.60%. Similarly, group mean scores for BKB sentences presented at 65 dB SPL in multitalker babble were significantly higher with the ADRO program (an improvement of 6.87%). The ADRO program was the preferred program in 46% of the listening situations, whereas the Standard program was preferred in 26% of situations. Everyday sounds were not unacceptably loud with ADRO. CONCLUSIONS: There was an ADRO benefit for this group of children in quiet and in noise. These findings suggest that young children would benefit from the ADRO programming option being locked in along with other processor settings in the SPrint processor once their MAP levels have stabilized. Some older children and teenagers may choose to use ADRO selectively for specific listening situations.
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    Pneumococcal meningitis post-cochlear implantation: preventative measures.
    Wei, BPC ; Shepherd, RK ; Robins-Browne, RM ; Clark, GM ; O'Leary, SJ (Wiley, 2010-11)
    OBJECTIVE: Both clinical data and laboratory studies demonstrated the risk of pneumococcal meningitis post-cochlear implantation. This review examines strategies to prevent post-implant meningitis. DATA SOURCES: Medline/PubMed database; English articles after 1980. Search terms: cochlear implants, pneumococcus meningitis, streptococcus pneumonia, immunization, prevention. REVIEW METHODS: Narrative review. All articles relating to post-implant meningitis without any restriction in study designs were assessed and information extracted. RESULTS: The presence of inner ear trauma as a result of surgical technique or cochlear implant electrode array design was associated with a higher risk of post-implant meningitis. Laboratory data demonstrated the effectiveness of pneumococcal vaccination in preventing meningitis induced via the hematogenous route of infection. Fibrous sealing around the electrode array at the cochleostomy site, and the use of antibiotic-coated electrode array reduced the risk of meningitis induced via an otogenic route. CONCLUSION: The recent scientific data support the U.S. Food and Drug Administration recommendation of pneumococcal vaccination for the prevention of meningitis in implant recipients. Nontraumatic cochlear implant design, surgical technique, and an adequate fibrous seal around the cochleostomy site further reduce the risk of meningitis.
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    Pneumococcal meningitis post-cochlear implantation: potential routes of infection and pathophysiology.
    Wei, BPC ; Shepherd, RK ; Robins-Browne, RM ; Clark, GM ; O'Leary, SJ (Wiley, 2010-11)
    OBJECTIVE: This review describes the current concept of pneumococcal meningitis in cochlear implant recipients based on recent laboratory studies. It examines possible routes of Streptococcus pneumoniae infection to the meninges in cochlear implant recipients. It also provides insights into fundamental questions concerning the pathophysiology of pneumococcal meningitis in implant recipients. DATA SOURCES: Medline/PubMed database; English articles after 1960. Search terms: cochlear implants, meningitis, pneumococcus, streptococcus pneumonia. REVIEW METHODS: Narrative review. All articles relating to post-implant meningitis without any restriction in study designs were assessed and information extracted. RESULTS: The incidence of pneumococcal meningitis in cochlear implant recipients is greater than that of an age-matched cohort in the general population. Based on the current clinical literature, it is difficult to determine whether cochlear implantation per se increases the risk of meningitis in subjects with no existing risk factors for acquiring the disease. As this question cannot be answered in humans, the study of implant-related infection must involve the use of laboratory animals in order for the research findings to be applicable to a clinical situation. The laboratory research demonstrated the routes of infection and the effects of the cochlear implant in lowering the threshold for pneumococcal meningitis. CONCLUSION: The laboratory data complement the existing clinical data on the risk of pneumococcal meningitis post-cochlear implantation.
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    Electrode discrimination by early-deafened subjects using the Cochlear Limited multiple electrode cochlear implant
    Busby, P. A. ; Clark, Graeme M. ( 2000)
    Objective: The aims of this study were to determine whether electrode discrimination by early-deafened subjects using the Cochlear Limited prosthesis varied at different locations on the electrode array, was influenced by the effects of auditory deprivation and experience with electric stimulation, and was related to speech perception. Design: Difference limens for electrode discrimination were measured in 16 early-deafened subjects at three positions on the array: electrodes 18 (apical), 14 (mid), and 8 (basal). Electrodes were stimulated using random variations in current level to minimize the influence of loudness cues. Assessed were correlations between the difference limens, subject variables related to auditory deprivation (age at onset of deafness, duration of deafness, and age at implantation) and auditory experience (duration of implant use and the total time period of auditory experience), and speech perception scores from two closed-set and two open-set tests. Results: The average difference limens across the three positions were less than two electrodes for 75%, of subjects, with average limens between 2 and 6.5 electrodes for the remaining 25% of subjects. Significant differences across the three positions were found for 69% of subjects. The average limens and those at the basal position positively correlated with variables related to auditory deprivation, with larger limens for subjects implanted at a later age and with a longer duration of deafness. The average limens and those at the apical position negatively correlated with closed-set speech perception scores, with lower scores for subjects with larger limens, but not with open-set scores. Speech scores also negatively correlated with variables related to auditory deprivation. Conclusions: These findings showed that early-deafened subjects were generally successful in electrode discrimination although performance varied across the array for over half the subjects. Discrimination performance was influenced by the effects of auditory deprivation, and both electrode discrimination and variables related to auditory deprivation influenced closed-set speech perception.
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    Pitch estimation by early-deafened subjects using a multiple-electrode cochlear implant
    Busby, P. A. ; Clark, Graeme M. ( 2000)
    Abstract not available due to copyright.
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    Meningitis after cochlear implantation: the risk is low, and preventive measures can reduce this further
    Wei, Benjamin P. C. ; Clark, Graeme M. ; O'Leary, Stephen J. ; Shepherd, Robert K. ; Robins-Browne, Roy M. ( 2007)
    Since the 1980s, more than 80 000 people have received cochlear implants worldwide. These implants are designed to enable people who are severely or profoundly deaf to experience sound and speech. Since 1990, implantation has become standard treatment for people who cannot communicate effectively despite well fitted hearing aids. Children who are deaf when they are born can perceive sound and learn to speak if they receive cochlear implants at a young age (ideally under 18 months). The use of cochlear implants has been thought to be safe. But since 2002 the number of patients with meningitis related to cochlear implantation has increased worldwide. Mortality and neurological complications after meningitis are high. We need to investigate the reasons for this and look at measures to reduce them.
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    Threshold shift: effects of cochlear implantation on the risk of pneumococcal meningitis
    Wei, Benjamin P. C. ; Shepherd, Robert K. ; Robins-Browne, Roy M. ; Clark, Graeme M. ; O'Leary, Stephen J. ( 2007)
    Unavailable due to copyright.
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    Effects of inner ear trauma on the risk of pneumococcal meningitis
    Wei, Benjamin P. C. ; Shepherd, Robert K. ; Robins-Browne, Roy M. ; Clark, Graeme M. ; O'LEARY, STEPHEN ( 2007)
    Objective: To examine the risk of pneumococcal meningitis in healthy rats that received a severe surgical trauma to the modiolus and osseous spiral lamina or the standard insertion technique for acute cochlear implantation. Design: Interventional animal studies. Subjects: Fifty-four otologically normal adult Hooded- Wistar rats. Interventions: Fifty-four rats (18 of which received a cochleostomy alone; 18, a cochleostomy and acute cochlear implantation using standard surgical techniques; and 18, a cochleostomy followed by severe inner ear trauma) were infected 4 weeks after surgery with Streptococcus pneumoniae via 3 different routes (hematogenous, middle ear, and inner ear) to represent all potential routes of bacterial infection from the upper respiratory tract to the meninges in cochlear implant recipients with meningitis. Results: Severe trauma to the osseous spiral lamina and modiolus increased the risk of pneumococcal meningitis when the bacteria were given via the middle or inner ear (Fisher exact test, P<.05). However, the risk of meningitis did not change when the bacteria were given via the hematogenous route. Acute electrode insertion did not alter the risk of subsequent pneumococcal meningitis for any route of infection. Conclusions: Severe inner ear surgical trauma to the osseous spiral lamina and modiolus can increase the risk of pneumococcal meningitis. Therefore, every effort should be made to ensure that cochlear implant design and insertion technique cause minimal trauma to the bony structures of the inner ear to reduce the risk of pneumococcalmeningitis.
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    Assessment of the protective effect of pneumococcal vaccination in preventing meningitis after cochlear implantation
    Wei, Benjamin P. C. ; Robins-Browne, Roy M. ; Shepherd, Robert K. ; AZZOPARDI, KRISTY ; Clark, Graeme M. ; O'Leary, Stephen J. ( 2007)
    Objectives: To examine if a 23-valent pneumococcal capsular polysaccharide vaccine (PPV23) reduces the risk of meningitis in healthy rats after cochlear implantation. Design: Interventional animal study. Interventions: Thirty-six rats (18 immunized and 18 unimmunized) received cochlear implantations and were then infected with Streptococcus pneumoniae via 3 different routes (hematogenous, middle ear, and inner ear) in numbers sufficient to induce meningitis. Results: The rats with implants that received PPV23 were protected from meningitis when the bacteria were delivered via the hematogenous and middle-ear routes (Fisher exact test P<.05). However, the protective effect of the vaccine in the rats with implants was only moderate when the bacteria were inoculated directly into the inner ear. Conclusions: Our animal model clearly demonstrates that immunization can protect healthy rats with a cochlear implant from meningitis caused by a vaccine-covered serotype. This finding supports the notion that all current and future implant recipients should be vaccinated against S pneumoniae.