Graeme Clark Collection

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    Chronic middle ear disease and cochlear implantation
    Donnelly, M. J. ; Pyman, B. C. ; Clark, Graeme M. ( 1995)
    Profound or total hearing loss can occur in the setting of chronic suppurative otitis media (CSOM), either coincidentally or secondary to the disease process. Obviously, inserting a foreign body through a potentially infected field into a space that communicates intracranially presents a challenging management problem. This paper presents the experience from the Melbourne Cochlear Implant Clinic (CIC) in implanting patients with bilateral CSOM. This is certainly not a common problem, as there have been only 3 cases from 121 implanted adults. However, we feel that it is an important issue with potentially devastating consequences. In addition, there are many countries in which bilateral CSOM is a more common problem and cause of profound or total hearing loss.
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    Initial investigation of the efficacy and biosafety of sodium hyaluronate (healon) as an aid to electrode array insertion
    Donnelly, M. J. ; Cohen, L. T. ; Clark, Graeme M. ( 1995)
    Stimulation of residual neural elements by electrodes inserted into the cochlea to produce the perception of speech and environmental sounds in profoundly deaf people is a fundamental aim of cochlear implantation. The multiple-channel cochlear implant utilizes the tonotopic arrangement of the organ of Corti to also achieve place pitch perception by stimulating different electrode bands. It may be possible to improve the range of pitches perceived by present cochlear implant patients by inserting the electrode array more deeply. To help achieve this, investigators have used sodium hyaluronate as a lubricant for electrode insertions. 1 It was felt deeper insertions were produced with sodium hyaluronate. Before introducing this substance as part of the surgical protocol for the Melbourne Cochlear Implant Clinic, it was decided to investigate its efficacy in aiding deeper insertions of the electrode. In addition, it was also necessary to determine if sodium hyaluronate, in conjunction with cochlear implantation, had adverse effects on the inner ear. This study was undertaken to address these issues.
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    Vowel imitation task: results over time for 28 cochlear implant children under the age of eight years
    Dettman, S. J. ; Barker, E. J. ; Dowell, R. C. ; Dawson, P. W. ; Blamey, P. J. ; Clark, Graeme M. ( 1995)
    With increasing numbers of implanted children under the age of 4 years, numerous researchers have reminded us of the need for valid, sensitive, and reliable tests of developing speech perception.1,2 In addition to studies of the efficacy of implanted prostheses, there is a need to investigate the many variables that influence children's communicative performance, such as changes in speech-coding strategy, updated speech-processing systems, the effects of various training regimens, and the selection of educational and communication modes.
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    Speech perception in children using the advanced Speak speech-processing strategy
    Cowan, R. S. C. ; Brown, C. ; Whitford, L. A. ; Galvin, K. L. ; Sarant, J. Z. ; Barker, E. J. ; Shaw, S. ; King, A. ; Skok, M. ; Seligman, P. M. ; Dowell, R. C. ; Everingham, C. ; Gibson, W. P. R. ; Clark, Graeme M. ( 1995)
    The Speak speech-processing strategy, developed by the University of Melbourne and commercialized by Cochlear Pty Limited for use in the new Spectra 22 speech processor, has been shown to provide improved speech perception for adults in both quiet and noisy situations. The present study evaluated the ability of children experienced in the use of the Multipeak (Mpeak) speech-processing strategy (implemented in the Nucleus Minisystem-22 cochlear implant) to adapt to and benefit from the advanced Speak speech-processing strategy (implemented in the Nucleus Spectra 22 speech processor). Twelve children were assessed using Mpeak and Speak over a period of 8 months. All of the children had over 1 year's previous experience with Mpeak, and all were able to score significantly on open-set word and sentence tests using the cochlear implant alone. Children were assessed with both live-voice and recorded speech materials, including Consonant-Nucleus-Consonant monosyllabic words and Speech Intelligibility Test sentences. Assessments were made in both quiet and in noise. Assessments were made at 3-week intervals to investigate the ability of the children to adapt to the new speech-processing strategy. For most of the children, a significant advantage was evident when using the Speak strategy as compared with Mpeak. For 4 of the children, there was no decrement in speech perception scores immediately following fitting with Speak. Eight of the children showed a small (10% to 20%) decrement in speech perception scores for between 3 and 6 weeks following the changeover to Speak. After 24 weeks' experience with Speak, 11 of the children had shown a steady increase in speech perception scores, with final Speak scores higher than for Mpeak. Only 1 child showed a significant decrement in speech perception with Speak, which did not recover to original Mpeak levels.
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    Electrical stimulation of residual hearing in the implanted cochlea
    Clark, Graeme M. ; McAnally, K. I. ; Black, R. C. ; Shepherd, R. K. ( 1995)
    The average profoundly deaf person using a cochlear implant can now understand more speech than some severely to profoundly deaf people who use a hearing aid. For this reason there will be an increasing need to consider implanting people with residual hearing. In many of these people there could be significant hearing in the operated ear, as a majority of severely to profoundly deaf people are likely to have a symmetrical hearing loss. When three frequency average hearing thresholds were measured on 219 pensioners from the Australian National Acoustic Laboratories (H. Dillon, unpublished findings), 64% had less than a 10-dB difference between thresholds in each ear.
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    Cochlear implantation: osteoneogenesis, electrode-tissue impedance, and residual hearing
    Clark, Graeme M. ; Shute, S. A. ; Shepherd, R. K. ; Carter, T. D. ( 1995)
    This study was undertaken to find out how new bone is produced in the implanted cochlea, and the effects of fibrous tissue and new bone growth on electrode-tissue impedance. This knowledge is essential, as bone and fibrous tissue in the cochlea could account for variations in patients' speech perception performance. The study was also carried out to examine the effects of implantation on residual hearing. This information is also important, as cochlear implant speech perception results in profoundly deaf people are now better on average than severely or profoundly deaf people obtain with a hearing aid. Consequently, more people will need to be considered for cochlear implantation in ears with some residual hearing. In this case we need to know to what extent residual hearing is affected by implantation. (From Introduction)
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    Surgical considerations for the placement of the new Cochlear Pty Limited micro-multiple-channel cochlear implant for research studies
    Clark, Graeme M. ; Pyman, B. C. ; Webb, R. L. ( 1995)
    A new micro-receiver-stimulator for research studies on very young children as well as adults has been developed by Cochlear Pty Limited. The dimensions of the device are length 58 mm and width at front 18 mm. The width starts to increase 19 mm from the front, and the back section, which has the receiver coil and magnet, has a maximum diameter of 33 mm. The depth or thickness of the front portion of the electronic package is 5.7mm, and the remainder of the package 4.0 mm. The antenna section is 3.5 mm thick. The other dimensions of the front section of the electronic package are length 9.5 mm and width 13.7 mm. There is an angle of 160° between the titanium electronic package and the receiver coil. The dimensions of the receiver-stimulator were arrived at after anatomic studies on the temporal bones of children ranging in age from 2 to 11 months.
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    Temporal coding of frequency: neuron firing probabilities for acoustic and electric stimulation of the auditory nerve
    Clark, Graeme M. ; Carter, T. D. ; Maffi, C. L. ; Shepherd, R. K. ( 1995)
    A better understanding of the temporal coding of frequency, and its application to electrical stimulation of auditory nerve fibers, should lead to advances in cochlear implant speech processing. Past research studies have suggested that the intervals between nerve action potentials are important in the temporal coding of frequency. For sound frequencies up to approximately 500 Hz, the shortest or predominant intervals between the nerve action potentials are usually the same as the periods of the sound waves. The intervals between each nerve action potential can be plotted as an interval histogram. Although there is evidence that the intervals between spikes are important in the temporal coding of frequency, it is not known up to what frequency this applies. It is also not known whether the information transmitted along individual fibers or an ensemble of fibers is important, to what extent the coding of frequency is interrelated with the coding of intensity, the relative importance of temporal and place coding for different frequencies, and finally, how well electrical stimulation can simulate the temporal coding of sound.
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    A physiological investigation of chronic electrical stimulation with scala tympani electrodes in kittens
    Ni, Daofeng ; Shepherd, Robert K. ; Clark, Graeme M. ( 1992)
    A physiological investigation of cochlear electrical stimulation was undertaken in six two-month-old kittens. The scala tympani electrodes were implanted and electrically stimulated using biphasic balanced electrical pulses' for periods of 1000-1500h in four ears. Four ears received implants for same period but without electrical stimulation. The other two ears served as normal control. The results indicated: 1) Chronic electrical stimulation of the cochlea within electrochemically safe limits did not influence the hearing of kittens and the normal delivery of impulses evoked by acoustic and electrical signals on the auditory brainstem pathway. 2) The wave shapes of EABRs were similar to those of ABRs. The aptitudes of EABRs showed a significant increase following chronic electrical stimulation, resulting in a leftward shift in the input/ output function. The absolute latencies and interwave latencies of waves II-III , III -IV and II -IV were significantly shorter than those of ABRs. These results imply that there was no adverse effect of chronic electrical stimulation on the maturing auditory systems of kittens using these electrical parameters and the mechanism of electrical hearing should be further studied.
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    The excitability of units in the central nucleus of the inferior colliculus to monaural electrical stimulation
    Lithgow, Brian J. ; Clark, Graeme M. ; Tong, Yit C. ( 1992)
    Single unit responses to electric stimuli can be markedly different to those obtained with comparable acoustic stimuli. For the development of future cochlear implant coding strategies a detailed understanding of the effects of electrical stimulation is required. This study investigated the comparative number of single units exhibiting excitatory responses in the central nucleus of the inferior colliculus to monaural electric versus acoustic stimuli.