Orientadores: Roberto Benedito de Paiva e Silva, Maria de Lurdes Zanolli / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-11T14:55:34Z (GMT). No. of bitstreams: 1 Yamanaka_DanielaAparecidaRissi_M.pdf: 1042600 bytes, checksum: b1950b6046515e322ec782b8cc522e60 (MD5) Previous issue date: 2008 / Resumo: O Implante Coclear é utilizado atualmente em adultos e crianças com perda auditiva neurossensorial profunda e bilateral, de natureza congênita ou adquirida, que não se beneficiam da prótese auditiva. É um recurso que visa criar um campo elétrico no interior da cóclea, com a finalidade de estimular as fibras acústicas, por meio de impulsos sonoros transformados em sinais elétricos proporcionando uma audição útil, auxiliando na comunicação da pessoa surda. Encontra-se na literatura inúmeros trabalhos com enfoque na técnica cirúrgica do Implante Coclear. No entanto, poucos são os trabalhos que buscam identificar a percepção que as famílias das crianças surdas têm sobre o Implante Coclear. Nesse sentido, o objetivo desse estudo foi analisar os aspectos emocionais dos pais de crianças surdas envolvidas no processo de triagem para o Implante Coclear, isto é, conhecer as expectativas, dúvidas e dificuldades de pais de crianças surdas frente à possibilidade do filho se submeter ao Implante Coclear e entender os significados que pais de crianças surdas, que procuram o Implante Coclear, têm de surdez e qual a visão que eles têm de tratamento. Para isso, foram realizadas entrevistas semi-estruturadas com dez pais de crianças surdas candidatas ao Implante Coclear no Hospital de Clínicas da Unicamp. O estudo caracterizou-se como uma pesquisa qualitativa, utilizando-se para a análise dos dados a técnica de análise de conteúdo, na qual se estabeleceram três categorias temáticas: vivência da surdez, tratamento da surdez e implante coclear. Na discussão dos dados constatou-se que a maioria dos pais busca a cura da surdez por meio do Implante Coclear e, conseqüentemente a aquisição da fala. Para essas famílias, o Implante Coclear é visto como uma solução para a surdez de seus filhos e como uma possibilidade desses terem um futuro melhor, isto é, melhores oportunidades de estudo, trabalho e relacionamentos. Verificou-se que no processo de conhecimento do implante, os pais vivenciaram a ansiedade, angústia frente às informações sobre os riscos e benefícios do procedimento e a necessidade de optarem em realizar ou não o Implante Coclear. Considera-se a importância dos pais receberem informações sobre a surdez e as possibilidades de atendimento para os filhos, dentre elas o Implante Coclear, de forma clara e objetiva para que possam ter expectativas condizentes com a realidade / Abstract: Cochlear implants are currently used in adults and children with acquired or congenital deep and bilateral neurosensory hearing loss, whose hearing was not improved by prosthesis. This is a resource that aims to create an 'electrical field¿ inside the cochlea in order to stimulate the acoustic fibers by sonorous impulses transformed into electrical signs, providing an useful hearing, aiding communication with deaf people. There are countless works in the literature focusing on the surgical technique for cochlear implants; however, little works seek to identify the perception of deaf children¿s families about cochlear implants. Therefore, the objective of this study was to analyze the emotional aspects of parents of deaf children involved in the triage process for cochlear implant, i.e. to know their expectations, doubts and difficulties regarding the possibility of their children undergo cochlear implant, as well as to understand their view about deafness and its treatment. In addition, semi-structured interviews were performed with ten parents of deaf children, candidates to cochlear implant at the University of Campinas Teaching Hospital. The study characterized as qualitative, using for data analysis the content analysis technique, in which three thematic categories were established: deaf experience, deafness treatment and cochlear implant. The data discussion showed that most parents seek deafness cure by cochlear implant and, in consequence, the speech acquisition. These families see the cochlear implant as a solution for their deaf children and as a possibility for a better future for their children, i.e. better opportunities for study, work and relationships. It was verified that during the process of knowing the implant, the parents experienced anxiety and anguish in the face of information on risks and benefits of the procedure and the need to opt for the cochlear implant or not. It was evidenced that the parents should be aware in a clear and objective way about the importance of receiving information about deafness and the possibilities of assistance for their children, including the cochlear implant, in order that they may have real expectations / Mestrado / Saude da Criança e do Adolescente / Mestre em Saude da Criança e do Adolescente

Algumas crianças usuárias de implante coclear (IC) não desenvolvem a habilidade de reconhecimento auditivo em conjunto aberto, mesmo após um longo período de uso do dispositivo e mesmo sem apresentar fatores na etapa pré-operatória que sugiram esse prognóstico. Os fatores que influenciam o desempenho dessas crianças atuam de maneira complexa também nas etapas intra e pós-operatórias e o conhecimento profundo dos mesmos é fundamental para direcionar condutas em busca de uma habilitação auditiva de sucesso. Sobre a atuação fonoaudiológica na etapa pós-operatória, o uso de marcadores clínicos de desempenho permite a identificação de atrasos no desenvolvimento de percepção da fala e linguagem. Alguns fatores já são descritos como negativamente influentes, mas, estudos que realizem análises profundas das causas dos mesmos são necessários. Objetivos: a) descrever o desenvolvimento das habilidades auditivas de crianças que não apresentaram a habilidade de reconhecimento auditivo em conjunto aberto ao final de cinco anos de uso do IC; b) analisar os fatores que influenciam o desenvolvimento da percepção auditiva da fala, considerando este grupo de crianças, e a atuação fonoaudiológica na etapa pós-operatória. Metodologia: estudo exploratório, retrospectivo longitudinal por meio de análise de prontuário realizado no Centro de Pesquisas Audiológicas/Setor de IC do HRAC-USP. Foram analisadas 21 crianças. O desenvolvimento das habilidades auditivas foi descrito por meio das Categorias de Audição (GEERS, 1994). Os fatores analisados foram: fatores relacionados aos eletrodos e problemas relacionados ao mapeamento; interrupção do uso do implante coclear; uso assistemático do dispositivo; faltas no acompanhamento pós-operatório; fatores relacionados à terapia fonoaudiológica e fatores relacionados ao neurodesenvolvimento. Foi realizada análise qualitativa dos resultados por meio da metodologia de análise temática e a análise quantitativa, por meio da estatística descritiva e inferencial. Resultados e Discussão: desenvolvimento auditivo houve uma tendência discreta de curva crescente ao longo dos anos de uso, com oscilações; o desempenho ao final do período estudado, pôde ser representado pela Categoria de Audição 2 detecção de padrões de percepção. Para crianças implantadas unilateralmente, até os 36 meses e sem fatores influentes na etapa pré-operatória pode-se esperar que atinjam a categoria 3 a partir de 5 meses de uso do IC, sendo um alerta se não a alcançarem até os 12 meses de uso. Os fatores interrupção do uso/uso assistemático foram os mais frequentemente observados e as causas foram relacionadas ao funcionamento do IC, comportamento da família e recusa da criança; o tempo de interrupção foi significativamente maior quando problemas do componente externo aconteceram após o término de sua garantia (p=0,001). Houve tendência de indivíduos que moravam mais longe do hospital faltarem mais aos retornos, entretanto, a associação não foi significativa. Conclusão: foi possível obter um padrão de desenvolvimento auditivo do grupo estudado e os resultados podem ser utilizados como marcadores clínicos de desempenho. A análise dos fatores pôde nortear discussões referentes às possíveis condutas fonoaudiológicas no acompanhamento pós-operatório da criança usuária de implante coclear e pode servir como base para investigações de fatores na prática clínica, bem como futuras investigações científicas. / There are some pediatric cochlear implant (CI) patients who do not develop open set speech recognition even after a long period of device use, and even without presenting factors in the preoperative stage suggestive of this prognosis. The factors that influence the outcomes of these children act in a complex way also in the intra and postoperative stages and the deep knowledge of them is fundamental to conduct intervetion to achieve a successful auditory habilitation. Regarding audiological postoperative follow up, the use of benchmarkers allows the identification of delayed speech perception and language development. Some factors are already described as negatively influential, but an in-depth analysis studies of their causes are needed. Objectives: a) to describe the auditory skills development of children who did not achieve open set speech recognition at the end of five years of CI use; b) to analyze the factors that influence the auditory speech perception development during the five years of CI use, considering audiological postoperative follow up. Methods: exploratory, retrospective longitudinal study by chart analysis, performed at the CPA/Seção de IC of HRAC-USP. Twenty-one children were analyzed. The development of hearing abilities was described through the Hearing Categories (GEERS, 1994). The factors analyzed were: factors related to the electrodes and problems related to the mapping; use interruption of the device; unsystematical use of the device; missed postoperative follow-up; factors related to the auditory therapy and factors related to neurodevelopment. A qualitative analysis of the results was performed using thematic analysis methodology and quantitative analysis, using descriptive and inferential statistics. Results and Discussion: auditory development there was a discrete trend of increasing curve over the years of use, with oscillations; the performance at the end of the studied period could be represented by the Hearing Category \"2\" detection of perception patterns. For unilaterally implanted children, who do the activation until 36 months of age and without influential factors in the preoperative stage, it can be expected that they reach category 3 after 5 months of CI use, and it can be considered a red flag if they are not reached it until the 12 months of use .The interruption/unsystematic use were the most frequently observed factors and the causes were related to the functioning of the CI, family behavior and refusal of the child; the interruption time was significantly higher when problems of the external component occurred after the end of its warranty (p=0.001). There was a tendency for individuals living farther from the hospital to miss more returns, however, the association was not significant. Conclusion: it was possible to obtain an auditory developmental pattern of the studied group and the results can be used as benchmarks of performance. The analysis of the factors could guide discussions regarding possible audiological intervention in the postoperative follow-up of the cochlear implanted child and can serve as guide for investigations of factors in clinical practice, as well as future investigations.

Children with cochlear implants show deficits in identifying emotional intent of utterances without facial or body language cues. A known limitation to cochlear implants is the inability to accurately portray the fundamental frequency contour of speech which carries the majority of information needed to identify emotional intent. Without reliable access to the fundamental frequency, other methods of identifying vocal emotion, if identifiable, could be used to guide therapies for training children with cochlear implants to better identify vocal emotion. The current study analyzed recordings of adults speaking neutral sentences with a set array of emotions in a child-directed and adult-directed manner. The goal was to identify acoustic cues that contribute to emotion identification that may be enhanced in child-directed speech, but are also present in adult-directed speech. Results of this study showed that there were significant differences in the variation of the fundamental frequency, the variation of intensity, and the rate of speech among emotions and between intended audiences.

The purpose of this dissertation was to investigate the influences of auditory information provided by the cochlear implant (CI) on the readings skills of children born with profound deafness. I investigated the relationship of access to the sound signal provided by the CI on a constellation of skills related to word-reading. In a preliminary study, I examined the relationship between the early speech production and perception skills of 72 CI users on later reading skills. Using regression analysis, I found I could explain 59% of the variance of later reading skills by early speech perception and production performance. Secondly, I examined the phonological processing skills of 29 children with prelingual, profound hearing loss with at least 4 years of CI experience. I compared this performance with 29 children with normal hearing, matched with regard to word-reading ability and Socio-Economic-Status. I also compared speech production and perception skills with phonological processing and reading skills. Results revealed that children with CIs were able to complete tasks measuring phonological processing, but there were performance differences between the two groups. Although the children with CIs had mean standard reading achievement standard scores that were about 12 points lower than the children with normal hearing, the mean standard scores for both groups was within the normal range. Finally, a regression analysis revealed that the Phonological Processing skills accounted for 50%, and 75% of the variance in word and paragraph reading scores for all the children. In conclusion early speech perception and production skills of children with profound hearing loss who receive CIs predict future reading achievement skills. Better early speech perception and production skills result in higher reading achievement. Furthermore, the early access to sound helps to build better phonological processing skills, which is one of the likely contributors to eventual reading success. Thus, it is reasonable, possible and important to assess the early speech production perception and subsequent phonological processing in children with profound hearing loss who receive CIs.

The objective of this thesis is to provide additional insight into the electrode array-nerve fibre interface that exists in the implanted cochlea and to facilitate investigation of new electrode arrays in interaction with the cochlea and auditory nerve fibres. The focus is on potential distributions and excitation profiles generated by different electrode array types and factors that could have an influence on these distributions and profiles. Research contributions made by the thesis are the creation of a detailed 3-D model of the implanted cochlea that accurately predicts measurable effects in cochlear implant wearers and facilitates effortless simulation of existing and new electrode array variations; the establishment of the important anatomical structures required in a 3-D representation of the implanted cochlea; establishment of evidence that array location is the primary parameter that controls spread of excitation; definition of the critical focussing intensity of intracochlear electrode pairs; confirmation thatmonopolar stimulation could deliver focussed stimulation to approximately the same degree than that delivered by widely spaced electrode configurations and that the use of monopolar configurations over bipolar configurations are therefore advantageous under certain conditions; explanation of the effect that encapsulation tissue around cochlear implant electrodes could have on neural excitation profiles; extension of the information available on the focussing ability of multipolar intracochlear electrode configurations; and establishment of evidence that a higher lateral electrode density could facilitate better focussing of excitation, continuous shaping of excitation profiles and postoperative customization of electrode arrays for individual implant wearers. / Dissertation (PhD(Electronic Engineering))--University of Pretoria, 2001. / Electrical, Electronic and Computer Engineering / Unrestricted

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Background: A review of literature shows that cochlear implant (CI) users face difficulties in terms of music interpretation when compared to regular hearing (RH) counterparts. The electrically pulsing nature of the CI acts differently than sound waves in a normally functioning ear, leading to different interpretations of musical concepts such as pitch or timbre. An exceptional case however has been observed in a university-level violinist with bimodal hearing (congenitally deaf in the right ear, and with very minimal residual hearing in the left; they use one CI and one hearing aid) at the University of Ottawa. Objective: This study will compare the pitch recognition, timbre preference and audiation (linked to pitch and rhythmic perception) abilities between an exceptional CI user and case-control RH violinists. Data has previously been collected on CI users not playing the violin due to CI technology's limitations in pitch processing. Since the violin is considered a pitch-heavy instrument to play, it is expected that the study participant has exceptional pitch recognition skills when compared to other CI users (and perhaps RH peers), while still demonstrating comparable timbre preference and rhythmic audiation abilities to an RH comparison group. Method: Three tests were administered relating to pitch recognition on a violin-like interface, timbre preference between two heard tones, and an Advanced Measures of Music Audiation (AMMA) test for general musical knowledge in pitch and rhythm-based melodic discrimination. Results were compared between the critical case-study with CIs and RH control participants to quantify a basis in pitch perception, timbre preference and melodic audiation (applied to pitch and rhythm) skills. Implications: The study participant demonstrated comparable timbre preference and rhythmic discrimination skills to an RH comparison group. The study participant demonstrated pitch perception skills higher than previously tested CI users, despite being lower than the RH comparison group. The CI-using study participant would have developed these higher-than- average pitch perception skills through rigorous early-age training, and passion and persistence of music training on a pitch-heavy instrument despite known recommendations. This sheds light on the CI's technology not necessarily limiting users' choice of instrument due to its pitch processing, despite previous recommendations.

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Orientador: José Walter Canôas / Resumo: A deficiência auditiva, em função da sua alta incidência, tem recebido da comunidade científica uma atenção especial na criação de dispositivos que viabilizem a (re)habilitação de seus portadores. Como uma alternativa para os portadores de deficiência auditiva neurossensorial profunda bilateral, surgiu o Implante Coclear - que envolve ato cirúrgico para a implantação de eletrodos na cóclea - que permite ao deficiente auditivo, uma audição útil, que viabilize ou melhore sua comunicação. Esta pesquisa refere-se aos usuários do Implante coclear, implantados no Centro de Pesquisas Audiológicas (CPA) do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) da Universidade de São Paulo (USP). Até junho de 2000, eram 163. O objetivo deste trabalho é traçar um perfil desse universo, chegando às repercussões do Implante Coclear (IC) na vida de seus usuários, por meio de uma amostra de 34 usuários. O que se constatou foi uma concentração de pacientes procedentes da região sudeste - mais especificamente Estado de São Paulo - pertencentes às classes menos favorecidas, que têm como expectativa inicial o Implante Coclear (IC). As demais categorias apresentam diferenças que, no entanto, não transparecem nas repercussões do IC na vida de seus usuários. As repercussões pesquisadas foram em nível de satisfação, mudanças na vida diária - no caso de crianças, mudança na vida dos pais também - e preocupações com relação ao IC. A maioria dos sujeitos da amostra (97.0%) esta satisfeita com o IC e concorda que, em virtude dele, ocorreram mudanças em suas vidas - a maioria positiva - sem, no entanto, descartar as preocupações decorrentes do uso do IC, que giram em torno dos dispositivos interno e externos (fragilidade e manutenção, em virtude dos custos). A realidade constatada é objeto de intervenção da Assistente Social, que...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The hearing loss, due to its high incidence has received special attention from the scientific community in the development and improvement of devices adressed to the hearing impaired people. The Cochlear Implant -surgery envolving electrode implantation inside the cochlea -an alternative to those who have bilateral profound sensorineural hearing loss. It provides to the hearing impaired people a useful hearing which improves their communication. This research is about Cochlear Implant (CI) users, who underwent surgery in the Centro de Pesquisas Audiológicas (CPA) from the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) of University of São Paulo. Until June/2000 totalized 163 cases. The aim of this study is to delineate the profile of those patients (the total) and to get to the CI repercussions in their lives, a sample of 34 cases was analysed. It was verified that there is a concentration of patients coming from the Southeast region - more specifically, from São Paulo state - belonging to the lowers classes and have the CI as a initial expectation. The others verified categories show differences that neverthless, do not appear in the CI repercussions in the users lives. The researched repercussions were related to satisfaction, changes in the daily life - with the children, changes in the parents lives too - and concerns about the CI. The majority of the subjects from the sample (97.0%) is satisfied with the CI and report positive changes in their lives without dismissing their concerns resulting from the CI use, that is about the external and internal devices (its fragility and maintenance, due the cost). The established reality is the object of the social worker intervention. This study, is an attempt to enlarge the knowledge about ...(Complete abstract, click electronic access below) / Mestre