Graeme Clark Collection
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ItemFactors affecting speech perception outcomes for older children using multichannel cochlear implants( 2002)Experience with cochlear implantation in early-deafened teenagers or young adults has been somewhat disappointing, however, in recent years a proportion of older children have demonstrated excellent speech perception performance. There appears to be a wide gap between the good and poor performers within this group. It is important to investigate the possible factors influencing performance so that adolescents and their families are able to make informed decisions regarding cochlear implant surgery. This study considered a number of factors in a group of 25 children implanted in Melbourne between the ages of 8 and 18 years. Each subject completed open set speech perception testing using BKB sentences before and after implantation and pre-operative language testing using the Peabody Picture Vocabulary Test. Data were collected regarding the type of hearing loss, age at implant, age at hearing aid fitting, audiometric details, and the pre-and postoperative communication mode. Multivariate analysis suggested that three factors have a significant predictive value for post-implant speech perception: pre-operative open-set sentence score, duration of profound hearing loss and equivalent language age. These three factors accounted for 66% of the variance in this group. The results of this study suggest that children who have useful pre-implant speech perception, and higher age-equivalent scores on language measures, would be expected to do well with a cochlear implant. A shorter duration of profound hearing loss is also advantageous. Mean speech perception scores for the older group were not significantly different from younger children.
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ItemInhibition underlies the encoding of short voice onset times in the ventral cochlear nucleus( 2001)Recent experiments in our laboratory have shown that voice onset time (VOT), the time between consonant release and the first glottal pulse of an ensuing vowel, is effectively encoded by neurons within the ventral cochlear nucleus (VCN). In this investigation we examined the possible neural mechanisms which may underlie this VOT encoding. In male rats anaesthetised with urethane (2.5g1kg i.p), microelectrodes containing 1M potassium acetate, were inserted into the VCN. Speech stimuli consisting of 3 syllables spoken naturally by a male and female were presented at double rate and 3 intensities (/bεt/, /dεt/, and /gεt/ at 45, 65 and 75 dB SPL). Intracellular recordings were made in 12 neurons, eight of which had a response to pure tones typical of spherical bushy neurons, responding in a primary-like (PL) fashion. The remaining cells were classified as either globular bushy (n=2) or stellate cells (n=2). In PL neurons, the VOT period was associated with hyperpolarisation. The duration and amplitude of this hyperpolarising influence was greater for female speech. These PL units showed better encoding of VOT than other cell types in which hyperpolarisation was less evident and action > potentials were often evoked during this period at the highest intensity level. We propose that this hyperpolarisation is due to stimulation of inhibitory sidebands by the high frequency frication noise within the VOT period. This inhibition reduces the probability of action potential generation during the VOT period and enhances the salience of the voice onset enabling more effective encoding of VOT than seen in the auditory nerve.
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ItemAuditory processing abilities in children using cochlear implants: their relevance to speech perception [Abstract]( 1999)This study aimed to investigate the relationships between some basic auditory processing skills, subject variables and speech perception ability in young children using cochlear implants. A modification of the play audiometry procedure was used to measure electrode discrimination and "rate-of-processing" ability in seventeen 4-10 year old children. In the electrode discrimination task, children responded with a game-like motor response when a repeating stimulation on a reference electrode "changed" to a different electrode. In the "rate-of processing" task, children had to respond to the "change" to a different electrode, when the duration of the stimuli and the time interval between the stimuli were decreased. Normally hearing children were assessed on this task with acoustic stimulation. Nonverbal intelligence, speech feature discrimination and closed-set word recognition were also measured in the children using implants.
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ItemSpeech perception & indirect benefits for severely hearing impaired children using cochlear implants [Abstract]( 1998)The benefits to speech perception, speech production, communication, and quality of life were investigated for severely hearing impaired children using cochlear implants and hearing aids. For the youngest children, assessments of psychological status, and use of a battery of cognitive and language tests were important factors in determining performance benefits prior to the child developing speech. For older children, the effects of increased one-to-one oral habilitation, and systematic encouragement of parental involvement were also investigated. Results suggested that parental support for consistent device use was an important factor in producing outcomes. Children with residual hearing were more likely to achieve open-set perception. Each child was also assessed for changes in quality of life, through use of a standardized health utility instrument. Results from the group were collated, and teamed with a costing assessment for the procedure, which allowed a complete cost-utility analysis to be completed. Results suggested that indirect benefits, such as the effects on speech production, usual activities, lower concentration, and less distress were ranked as more important than changes to hearing in a number of the children. Costs per QALY were consistent with those reported in the literature, and suggested that the cochlear implant is highly cost-effective as a medical technology.
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ItemEvaluation of direct and indirect benefits in the selection of cochlear implant candidates [Abstract]( 1998)The value of cochlear implants as an established clinical option for profoundly hearing-impaired adults and children has been supported by significant research results over a number of years which clearly established the benefits available (U.S. National Institutes of Health Consensus Statement 1995). Benefit has traditionally been considered as the impact of the cochlear implant procedure on hearing, and in the case of children, on the use of that hearing to develop speech and language. However, as a result of continuing research, improvements have been realised both in hardware and speech processing. As a direct consequence of these improvements, the mean open-set implant-alone speech perception scores for implanted adults have continued to increase. In response to the increased mean scores shown by adult cochlear implant users in quiet, perception tests in background noise are now being used as a direct measure of the potential benefits of cochlear implants available to severely-to-profoundly hearing-impaired candidates. In addition, consideration in candidature should also be given to indirect benefits, such as reduction in the stress. of listening and lipreading, improved performance at work, enhanced opportunity to maintain or in children to develop speech which is understandable to the general community, and the social effects of reducing the isolating effects of profound deafness. Measurement of indirect benefit can be combined with a costing study, enabling evaluation of the implant procedure from a cost-utility standpoint, and comparison of outcomes using other technologies such as hearing aids. The use of new approaches to candidature, including new measures of direct and indirect benefit is reported using data from the Melbourne cochlear implant program.
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ItemAn analysis of high rate speech processing strategies using the Nucleus 24 cochlear implant [Abstract]( 1998)The effects of varying the stimulation rate on speech perception was evaluated in five postlinguistically deaf adult users of the Nucleus 24 Cochlear Implant System. Three different rates of electrical stimulation, 250, 807, and 1615 pulses per second per channel were employed. For the high stimulus rate the analysis frequency was the same as for the medium rate condition. The study investigated the effect of varying rate of stimulation when using the electrode selection technique of the SPEAK strategy. The study used a repeated ABC experimental design, in order to account for learning effects and to minimize ordering effects. Speech perception was evaluated using both monosyllabic words (open-sets of CNC words in quiet) and sentence materials (open-sets of CUNY sentences at signal-to-noise ratios from +20 to 0dB). In addition, the subjects' perception of closed-sets of 19 vowels and 24 consonants, presented in the H/VID and A/C/A context, were also investigated. The recognition and perception of distinctive features were assessed across strategies and patients. Preliminary speech perception results have shown no statistically significant difference in performance between the low and medium stimulation rates. However, significantly poorer results were observed for the high rate condition for some tests with some individuals. Individual differences may be explained by the effects of rate of stimulation on speech features.
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ItemFactors influencing gap detection in children using cochlear implants [Abstract]( 1998)Two studies on gap detection were conducted with children implanted with the Cochlear Limited multiple-electrode prosthesis. In the first study, gap thresholds were measured at three pulse rates (200, 500, and 1000 pulses/s) and two stimulus durations (500 and 1000 ms) in 15 subjects. Average gap thresholds ranged from 1.8 to 32.1 ms. There was, essentially, no effect of pulse rate and in all but two subjects, no effect of stimulus duration. For these two subjects, thresholds were higher for the 1000 ms stimulus duration. In the second study, the relationships between gap thresholds and subject characteristics, and between gap thresholds and speech perception scores were examined using data from 27 subjects. A significant negative correlation between age at onset of deafness and gap thresholds was found, indicating that subjects with an earlier onset of deafness had larger gap thresholds, and most of the variability in gap thresholds was found for the congenitally deaf subjects. Gap thresholds did not correlate with other subject variables, such as duration of deafness and duration of implant use. Significant negative correlations were found between gap thresholds and word scores for open-set BKB sentences in the auditory-visual condition and the lipreading enhancement scores for the same test, indicating that subjects with poorer gap thresholds had lower speech scores. Gap thresholds did not correlate with word scores for BKB sentences in the audition alone condition, and scores for closed-set monosyllabic word tests.
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ItemAn analysis of high rate speech processing strategies using the Nucleus 24 cochlear implant [Abstract]( 1998)Speech comprehension for a group of five users of the Nucleus 24 Cochlear Implant system was explored at three rates of electrical stimulation, 250, 807, and 1615 pulses per second per channel. For the high stimulus rate the analysis frequency was the same as for the medium rate condition. The study investigated the effect of varying rate of stimulation when using the electrode selection technique of the SPEAK strategy. This has been undertaken using a repeated ABC experimental design to account for learning and minimize ordering effects. Speech perception was assessed using open-sets of CNC words in quiet and open-sets of CLTNY sentences at signal-to-noise ratios from +20 to 0dB. Closed-sets of 19 vowels and 24 consonants were also presented, in the H/V/D and A/C/A context. The recognition and perception of distinctive features were assessed across strategies and patients. Preliminary speech perception results have shown no statistically significant difference in performance between the low and medium stimulation rates. However, significantly poorer results were observed for the high rate condition for some tests. Individual differences may be explained by the effects of rate of stimulation on speech features.
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ItemElectrical stimulation of the auditory nerve: chronic monopolar stimulation using very high stimulus rates [Abstract]( 1998)Speech processing strategies based on high rate electrical stimulation have been associated with recent improvements of speech perception among cochlear implant users. In the present study we investigated the effects of chronic monopolar stimulation using very high rates (14493 pulses\s). Under general anaesthesia (ketamine (20 mg/kg) and xylazine (3.8 mg/kg) i.p.) six normal hearing cats were implanted bilaterally with a three channel platinum (Pt) scala tympani electrode array, while a return Pt-electrode was placed outside the bulla. Chronic electrical stimulation using charge-balanced biphasic current pulses was delivered unilaterally via a transcutaneous leadwire connected to a backpack-stimulator for up to 2000 h. The animals hearing status was periodically monitored using acoustically evoked compound action potentials (CAP's) and brainstem responses (ABR's). In addition the electrically evoked ABR (EABR) was also recorded to ensure that the chronic stimulus was above threshold. Stimulus current and electrode voltage waveforms were monitored twice daily and access resistance (Ra) and electrode impedance (Zc) calculated. ABR and CAP thresholds were elevated immediately following implantation, but generally showed evidence of partial recovery (0-40 dB). Further deterioration of thresholds on the stimulated side (10-30 dB) was subsequently observed, while control-thresholds remained more stable. Ra (1.3-1.8 kΩ) and Zc (2.2-3.8Ω) typically increased in the first few weeks of electrical stimulation up to Ra:5.6 kΩ and Zc:8.1 kΩ, before decreasing slightly to a constant plateau. These initial results indicate changes in the electrode-tissue interface and tissue growth within the cochlea. They also indicate that chronic stimulation at these high rates may decrease residual hearing.
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ItemCurrent speech perception benefits for adults using the speak strategy with the nucleus 22-channel cochlear implant( 1997)Present day recipients of the Nucleus 22-channel cochlear implant make use of the SPEAK speech processing strategy in the Spectra 22 speech processor. Introduced in 1994, the SPEAK strategy is based upon research conducted at the University of Melbourne and the Bionic Ear Institute. This paper compares the pre-and post-operative speech perception abilities of adults who have used the SPEAK speech processing strategy since the 'start-up' of their cochlear implant system. Data was analysed from open-set sentence and word tests administered pre-operatively and at regular intervals postoperatively. Patients showed significant improvement in their ability to recognise speech, when listening with the cochlear implant without lipreading, within the first two weeks. Mean scores for open-set sentences were 15% preoperatively and 64% two weeks after initial programming.