INTRODUÇÃO: O desenvolvimento e a organização das vias auditivas centrais em crianças estão intimamente relacionados a uma experiência auditiva efetiva. Em crianças usuárias de Implante Coclear (IC), a utilização dos Potenciais Evocados Auditivos de Longa Latência (PEALL), em conjunto com a avaliação das medidas comportamentais de audição e linguagem, constitui-se como um instrumento capaz de avaliar a integridade e a funcionalidade das vias auditivas centrais, além de monitorar as mudanças neurofisiológicas ocorridas após estimulação por meio do IC. OBJETIVO: Acompanhar a maturação cortical de crianças usuárias de IC, por meio de medidas comportamentais de audição e linguagem, e medidas eletrofisiológicas. METODOLOGIA: Estudo longitudinal composto por 22 sujeitos, sendo 11 (6 meninas e 5 meninos) com perda auditiva neurossensorial de grau severo e/ou profundo bilateral congênita, os quais aguardavam a ativação dos eletrodos do IC, com média de idade na ativação de 35 meses (mínimo de 17 e máximo de 66 meses), e 11 crianças ouvintes pareadas por gênero e idade cronológica. As crianças do grupo estudo foram avaliadas quanto às medidas comportamentais de audição e linguagem, de acordo com a percepção dos pais, por meio dos protocolos Infant-Toddler: Meaningful Auditory Integration Scale (IT-MAIS/MAIS) e Meaningful Use of Speech Scales (MUSS), e por meio de avaliação realizada com a própria criança através da aplicação do Glendonald Auditory Screening Procedure (GASP). Ambos os grupos realizaram uma avaliação eletrofisiológica da audição por meio dos PEALL em sistema de campo sonoro, com a sílaba /ba/, com intervalos inter-estímulos de 416 ms na intensidade de 70 dBnNA. Cada criança foi avaliada em três diferentes momentos: anterior à ativação do IC e após três e nove meses de ativação, seguindo o mesmo intervalo de tempo para as crianças do grupo controle. RESULTADOS: Houve melhora nos comportamentos de audição e linguagem, mensurados por meio dos protocolos IT-MAIS/MAIS e MUSS ao longo do tempo de uso do IC. Da mesma forma, na avaliação por meio dos PEALL, observou-se surgimento do componente P1 após ativação, que diminuiu em latência com o decorrer do tempo; no entanto, a mesma manteve-se estatisticamente maior quando comparada ao grupo controle, mesmo após nove meses de uso do IC. Observou-se correlação negativa entre a avaliação dos PEALL e a pontuação do IT-MAIS/MAIS (quanto menor a latência de P1, maior a pontuação deste protocolo). No que tange às habilidades auditivas mensuradas por meio do GASP, observou-se que as crianças que alcançaram habilidade auditiva de discriminação, apresentaram melhores resultados nas demais avaliações, tanto comportamentais quanto eletrofisiológica, quando comparadas aquelas que alcançaram apenas a habilidade de detecção de fala. CONCLUSÕES: A estimulação auditiva por meio do IC possibilitou maturação das vias auditivas, proporcionando assim diminuição de latência do componente P1 e desenvolvimento das habilidades auditivas e de linguagem oral. A análise do componente P1 dos PEALL mostrou-se um importante biomarcador do comportamento auditivo, principalmente quando utilizado para monitoramento do processo de reabilitação / INTRODUCTION: The development and organization of central auditory pathways in children are closely related to an effective and appropriate auditory experience. The use of Long Latency Auditory Evoked Potentials (LLAEP) combined to behavioral evaluation of auditory and language measures in children with Cochlear Implant (CI) is considered as a procedure capable of determining the integrity and functionality of central auditory pathway. It is also capable of monitoring neurophysiological changes observed after the stimulation by CI. PURPOSE: To monitor central auditory pathways\' maturation in children with cochlear implant based on electrophysiological, auditory and language behavioral measures. METHODS: Longitudinal study of 22 subjects equally divided into study and control group. Study group was composed by 11 children (6 girls and 5 boys) with severe/profound bilateral congenital sensorineural hearing loss whose were awaiting the activation of CI electrodes. Their mean age at activation was 35 months (17 minimum and 66 maximum). Control group was composed by 11 normal hearing children paired by gender and chronological age. Study group\'s children evaluation involved auditory and language behavioral measures. The evaluation considered parents\' perception based on Infant-Toddler: Meaningful Auditory Integration Scale (IT-MAIS/MAIS) and Meaningful Use of Speech Scales (MUSS). Children were also assessed with the Glendonald Auditory Screening Procedure (GASP). Both groups were submitted to an auditory electrophysiological evaluation with the LLAEP in sound field system, recorded with the speech stimulus of the syllables /ba/, presented with inter-stimulus intervals of 416 ms, at the intensity of 70 dBnNA. Each child was evaluated three times: before CI activation, after three months and after none months of CI activation. Control group\'s children were evaluated considering the same intervals. RESULTS: Auditory and language behaviors improved during CI use according IT-MAIS/MAIS and MUSS measures. Similarly, the LLAEP evaluation indicated the appearance of P1 component after activation, and also the decrease of its latency over the course of time; however, the latency maintained statistically higher when compared to control group, even after nine months of CI use. A negative correlation between LLAEP and IT-MAIS/MAIS score was observed (the lower P1 latency, higher the protocol score). Regarding to hearing abilities measured by GASP, it was observed that the children who became able to discriminate sounds showed better performance on other behavioral and electrophysiological evaluations when compared to those who only became able to detect speech sounds. CONCLUSIONS: Auditory stimulation through CI enabled auditory pathways\' maturation, allowing decrease of latency of the P1 component and auditory and oral language abilities development. The analysis of the P1 component of LLAEP proved to be an important biomarker of auditory behavior, especially when used to monitor rehabilitation process

Esta pesquisa teve como objetivo conhecer o trabalho do Assistente Social nos Núcleos habilitados para desenvolver Programa de Implante Coclear do Brasil. De acordo com Cadastro Nacional de Estabelecimentos de Saúde (CNES) Brasil -07/2015 foi identificado um universo de 27 Núcleos habilitados para Programa de Implante Coclear pelo Ministério da Saúde objeto deste estudo. A abordagem foi quantiqualitativa e tipologia descritiva transversal. Para a fundamentação teórica foi realizada uma consulta às bases de dados Pubmed, Lilacs e Social Services mediante os descritores: políticas públicas de saúde, deficiência auditiva, surdez, implante coclear, auxiliares de audição, e serviço social. Para a coleta de dados junto aos 27 Núcleos foi elaborado um questionário on-line contendo perguntas abertas e fechadas que sustentaram ao objetivo da pesquisa. O mesmo foi aplicado com um Assistente Social de cada serviço. A análise dos dados quantitativos obedeceu ao método estatístico descritivo com base no objetivo do estudo e referenciais da literatura. Os dados qualitativos foram analisados pelos princípios da análise de conteúdo por método descritivo temático-categorial e teve como norte, o objetivo da pesquisa, as evidências da literatura e a experiência investigativa profissional. Este estudo ampliou o conhecimento acerca dos Programas de Implante Coclear do Brasil, uma vez que, na literatura nacional e internacional não foram identificados estudos anteriores sobre estes e suas equipes. Os resultados permitiram uma análise das atribuições e ações dos Assistentes Sociais nestes Programas que revelaram suas dimensões: investigativa e interventiva. / This research aimed to know the work of the social worker in enabled Services to develop Cochlear Implant Program of Brazil. According to National Health Facilities (CNES ) Brazil -07/2015 identified a universe of 27 enabled services Cochlear Implant Program by the Ministry of Health - the subject of this study. The approach was Quantiqualitative and cross descriptive type. For the theoretical foundation was held a query to the Pubmed, Lilacs and Social Services through the descriptors: public health policies, hearing impairment, deafness, cochlear implants, hearing aids, and social work. To collect data from the 27 services was prepared a questionnaire online with open and closed questions and that supported the purpose of the research. The same was applied to a social worker\'s for each service. The analysis of quantitative data followed the descriptive statistical method based on the purpose of the study and reference literature. Qualitative data were analyzed by the principles of content analysis by thematic-categorical and descriptive method was to the north, the research objective, the evidence from the literature and professional investigative experience. This study expanded the knowledge of the Cochlear Implant Program of Brazil, as in national and international literature were not identified earlier studies of these and their teams. The results allowed an analysis of the atributions and actions of social workers in these programs that showed its dimensions: investigative and interventional.

INTRODUÇÃO: A literatura é discordante com relação à interferência do IC sobre o equilíbrio corporal. Sendo assim, resolvemos avaliar o equilíbrio corporal de pacientes surdos pós-linguais, submetidos a implante coclear unilateral. OBJETIVO: Observar o equilíbrio corporal pré e pós-implante coclear (IC) ao longo de 1 ano. CASUÍSTICA E METODOLOGIA: Estudo prospectivo observacional realizado com 24 pacientes adultos, surdos pós-linguais submetidos à avaliação vestibular antes e depois da cirurgia de implante coclear unilateral. A avaliação vestibular contou com um questionário sobre vertigem, prova calórica (PC), cadeira rotatória (CR) e posturografia dinâmica computadorizada (PDC) aplicados no pré-operatório, 60, 120, 180 dias e 1 ano após a cirurgia de IC. RESULTADOS: A tontura foi referida por 13 (54,2%) pacientes pré-IC, enquanto 11 (45.8%) não apresentaram a queixa. Ao final do estudo 11 sujeitos (84,6%) referiram melhora da tontura, em 1 (7,7%) permaneceu inalterada e em 1 (7,7%) piorou. Dos 24 pacientes apenas 5 indivíduos (20,8%) desenvolveram tontura no pós-operatório imediato com resolução completa após um mês. A prova calórica identificou 7 (29,2%) sujeitos normorreflexos, 8 (33,3%) com hiporreflexia ou arreflexia unilateral , 3 (12,5%) com hiporreflexia bilateral e 6 (25%) com arreflexia vestibular bilateral (AVB).Houve interferência do estímulo elétrico em ambas as orelhas e na evolução da recuperação postural após ativação do IC, que promoveu a melhora significativa dos índices da PDC ao longo de um ano de acompanhamento. Ao final do estudo, as médias numéricas das condições avaliadas pela PDC mostraram-se superiores nos indivíduos que apresentaram resposta à prova calórica em relação àqueles que possuíam AVB. CONCLUSÃO: Foi decisiva a presença ou não de resposta pós-calórica na evolução do equilíbrio corporal ao longo de 1 ano. A ausência de resposta pós-calórica na avaliação pré-operatória implicou em pior prognóstico na evolução do equilíbrio corporal. No entanto, o melhor desempenho postural dos sujeitos com AVB pode ser explicado pelo melhor aproveitamento da informação visual. É fundamental documentar a presença de função vestibular antes da cirurgia de IC, pois dela depende o prognóstico do individuo em relação às habilidades de aprendizado e recuperação postural ao longo do tempo / INTRODUCTION: There is no consensus in the literature with regard to the effects of cochlear implantation (CI) on vestibular function and balance in patients with deafness. Because of this fact we decided to assess vestibular function before and after unilateral cochlear implantation (CI) in patients with postlingual deafness. OBJECTIVE: To assess balance before and after cochlear implantation (CI) over the course of 1 year. PATIENTS AND METHODS: prospective, observational study sought to assess balance in 24 postlingually deaf adults undergoing vestibular evaluation before and after cochlear implantation (CI). Vestibular assessment consisting of a vertigo questionnaire, caloric tests (CT), rotary chair testing (RC), and computerized dynamic posturography (CDP) was performed preoperatively and at 60, 120, 180 days and 1 year after CI. RESULTS: Overall, 13 patients (54.2%) reported preoperative dizziness and 11 (45.8%) did not have the symptom pre-CI. At the end of the study dizziness ameliorated in 11 (84.6%), remained unchanged in 1 (7.7%) and worsened in 1 (7.7%). Only 5 of the 24 patients (20.8%) developed immediate postoperative dizziness, which resolved within a month. The caloric tests identified 7 (29.2%) patients with normal reflexes, 8 (33.3%) with unilateral areflexia or hyporeflexia, 3 (12.5%) with bilateral hyporeflexia, and 6 (25%) with bilateral vestibular loss (BVL). Electrical stimulation affected both ears and interfered with the progression of postural recovery after CI activation, which led to a significant improvement in CDP values over the course of 1 year of follow-up. At the end of the study, the mean values of the conditions assessed by CDP were higher in individuals who had responded to caloric tests than in individuals with BVL. The better postural performance of subjects with BVL may be due to better use of visual information. CONCLUSION: The presence or absence of CT response was a decisive determinant of balance outcomes over the year after surgery. The absence of post-caloric response in preoperative assessment resulted in a worse prognosis in the evolution of body balance. However, patients with BVL were able to use the visual information for postural stabilization with improvement in the Composite Score. It is essential that vestibular assessment findings be documented before CI surgery because a patient\'s prognosis in terms of learning skills and postural recovery over time depends on this information

Made available in DSpace on 2014-06-11T19:22:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-25Bitstream added on 2014-06-13T19:48:38Z : No. of bitstreams: 1 battaglini_mp_me_bauru.pdf: 4950134 bytes, checksum: 026f2d3f745835396852953d61bb0e0e (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Crianças com surdez adquirida antes da linguagem (surdez pré-lingual) podem ter a detecção auditiva estabelecida pela primeira vez a partir da ativação do implante coclear (IC), contudo, os repertórios de ouvir e de falar requerem aprendizagem. Uma questão de pesquisa e intervenção diz respeito às condições sob as quais estes repertórios se estabelecem e se expandem a partir do uso do IC. Este estudo teve como objetivo verificar se implantados cocleares pré-linguais aprenderiam relações condicionais entre palavra ditada e figura (AB) e entre figura e palavra impressa (BC) via exclusão; e se a aprendizagem destas relações seria condição para a emergência de relações transitivas (AC) e simétricas (CB), para a nomeação de figuras (BD) e de palavras impressas (CD) e para o responder generalizado diante das mesmas palavras ditadas no ensino (voz feminina de adulto), mas com outra intensidade e freqüência de voz (voz masculina de adulto e de criança). Foram realizados dois estudos com objetivos semelhantes, porém, com uma diferença procedimental. No Estudo 1, três crianças entre seis e sete anos de idade, com surdez pré-lingual e usuárias de IC modelo Nucleus 24k foram expostas a tarefas de emparelhamento de acordo com o modelo, pelo software MTS®. As sessões foram realizadas individualmente e gravadas em fitas VHS para registro e análise das vocalizações. O procedimento iniciava com o Pré-treino e, posteriormente, o repertório inicial era avaliado no Pré-teste, a partir do qual eram escolhidos os estímulos que participariam do ensino e testes subseqüentes. O procedimento de ensino da linha de base (AB e BC) foi o ensino por exclusão. Após a aquisição da linha de base, eram conduzidos testes de formação de classes (AC e CB), seguidos pelos testes de generalização, de nomeação de figuras (BD) e de palavras... / Prelingual acquired deafness (prelingual deafness) may present hearing detection achieved for the first time stemming from the activation of the cochlear implant (CI), although the hearing and speaking repertories require learning. A case of research and intervention describes the conditions in which these repertories are established and expand from the use of CI. The present study aimed to verify if prelingual cochlear implanted subjects, would learn conditional discriminations between the dictated word and the picture (AB) and between the picture and the printed word (BC) by exclusion; and if learning these discriminations would be a condition for the emergence of transitive relations (AC) and symmetric (CB), for the nomination of pictures (BD) and printed words (CD) and for answering in a general way, facing the same words dictated when teaching (adult female voice), with different intensity and voice frequency (male voice of adult and child). Two studies, with similar objectives were realized, employing a different procedure. In study n° 1, three children whose ages ranged from six to seven years of age, with prelingual deafness and users of CI, model Nucleus 24k were exposed to matching-to-sample, according to the model, using software MTS®. The sessions were realized individually and recorded in VHS for registering and analysis of the vocalizations. The procedure started with the Pre-training and afterwards, the initial repertory was evaluated on the Pre-test and then the stimuli were selected in order to take part of the teaching and subsequent tests. The baseline teaching procedure (AB and BC) was by exclusion. After the acquisition of the baseline, classes of equivalent stimuli tests were conducted (AC and CB), followed by the generalization tests, nomination of pictures (BD) and words (CD). Two of the three... (Complete abstract click electronic access below)

Esta pesquisa teve como objetivo conhecer o trabalho do Assistente Social nos Núcleos habilitados para desenvolver Programa de Implante Coclear do Brasil. De acordo com Cadastro Nacional de Estabelecimentos de Saúde (CNES) Brasil -07/2015 foi identificado um universo de 27 Núcleos habilitados para Programa de Implante Coclear pelo Ministério da Saúde objeto deste estudo. A abordagem foi quantiqualitativa e tipologia descritiva transversal. Para a fundamentação teórica foi realizada uma consulta às bases de dados Pubmed, Lilacs e Social Services mediante os descritores: políticas públicas de saúde, deficiência auditiva, surdez, implante coclear, auxiliares de audição, e serviço social. Para a coleta de dados junto aos 27 Núcleos foi elaborado um questionário on-line contendo perguntas abertas e fechadas que sustentaram ao objetivo da pesquisa. O mesmo foi aplicado com um Assistente Social de cada serviço. A análise dos dados quantitativos obedeceu ao método estatístico descritivo com base no objetivo do estudo e referenciais da literatura. Os dados qualitativos foram analisados pelos princípios da análise de conteúdo por método descritivo temático-categorial e teve como norte, o objetivo da pesquisa, as evidências da literatura e a experiência investigativa profissional. Este estudo ampliou o conhecimento acerca dos Programas de Implante Coclear do Brasil, uma vez que, na literatura nacional e internacional não foram identificados estudos anteriores sobre estes e suas equipes. Os resultados permitiram uma análise das atribuições e ações dos Assistentes Sociais nestes Programas que revelaram suas dimensões: investigativa e interventiva. / This research aimed to know the work of the social worker in enabled Services to develop Cochlear Implant Program of Brazil. According to National Health Facilities (CNES ) Brazil -07/2015 identified a universe of 27 enabled services Cochlear Implant Program by the Ministry of Health - the subject of this study. The approach was Quantiqualitative and cross descriptive type. For the theoretical foundation was held a query to the Pubmed, Lilacs and Social Services through the descriptors: public health policies, hearing impairment, deafness, cochlear implants, hearing aids, and social work. To collect data from the 27 services was prepared a questionnaire online with open and closed questions and that supported the purpose of the research. The same was applied to a social worker\'s for each service. The analysis of quantitative data followed the descriptive statistical method based on the purpose of the study and reference literature. Qualitative data were analyzed by the principles of content analysis by thematic-categorical and descriptive method was to the north, the research objective, the evidence from the literature and professional investigative experience. This study expanded the knowledge of the Cochlear Implant Program of Brazil, as in national and international literature were not identified earlier studies of these and their teams. The results allowed an analysis of the atributions and actions of social workers in these programs that showed its dimensions: investigative and interventional.

A preocupação com a inclusão social da pessoa com deficiência é crescente. Especificamente quanto ao deficiente auditivo, o rol normativo está em desenvolvimento, porém ainda não supre todas as necessidades da sociedade. No contexto do serviço de implante coclear o Centro de Pesquisas Audiológicas (CPA) do Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) da Universidade de São Paulo (USP), popularmente conhecido como Centrinho, que já realizou mais de 1.500 cirurgias de implante coclear (IC), constatou-se um grupo de pacientes implantados que não realizam a (re)habilitação auditiva por meio da terapia fonoaudiológica após a cirurgia do IC, ou ainda, não respeitam a periodicidade desse processo, comprometendo o desenvolvimento do deficiente auditivo. A falta ou negligência com o processo de terapia fonoaudiológica da (re)habilitação auditiva enseja na consequente violação de direitos fundamentais do deficiente. Toda equipe interdisciplinar de profissionais responsáveis pela indicação e adaptação do IC assumem papel fundamental no processo de (re)habilitação do deficiente auditivo, devendo acima de tudo zelar pela ética e humanização com o paciente e seus familiares. Como o IC é de elevado custo (tecnologias duras) incluso no procedimento de alta complexidade contemplado pelo Sistema Único de Saúde quem paga é a própria sociedade (através dos recursos públicos), por esse motivo é fundamental que o beneficiário dessa intervenção não apenas reivindique seus direitos, mas também cumpra com seus deveres. Apesar dos recentes avanços normativos do IC, a regulamentação existente é vulnerável frente à complexidade do processo de habilitação e reabilitação auditiva por meio do IC, deixando margem para violações, omissões e abusos. Diante desse cenário todos acabam sendo prejudicados, o Estado, a sociedade e o próprio beneficiário da prótese auditiva. O escopo do presente estudo é analisar criticamente o panorama jurídico em nível nacional das regulamentações voltadas ao implante coclear no processo de (re)habilitação auditiva. Os materiais e métodos utilizados serão os de levantamento bibliográfico, jurídico-doutrinário e revisão jurídica. / Concern about the social inclusion of people with disabilities is growing. Specifically regarding the hearing impaired, the normative roll is in development, but it still does not supply all the needs of society. In the context of the cochlear implant service, the Center for Audiological Research (CAR) of the Hospital of Rehabilitation of Craniofacial Anomalies (HRCA) of the University of São Paulo (USP), popularly known as Centrinho, which has already performed more than 1,500 cochlear implant surgeries, a group of implanted patients who did not perform auditory (re)habilitation by means of phonaudiologic therapy after cochlear implant surgery were found, or did not respect the periodicity of this process, compromising the development of the hearing impaired. Failure or negligence with the audiological (re)habilitation process leads to a consequent violation of the fundamental rights of the handicapped. Every interdisciplinary team of professionals responsible for the indication and adaptation of the cochlear implant assume a fundamental role in the process of (re) habilitation of the hearing impaired, and above all must care for the ethics and humanization with the patient and their relatives. Since the cochlear implant is of high cost hard technologies included in the procedure of high complexity contemplated by the Unified Health System who pays is the company itself (through public resources), for this reason it is fundamental that the beneficiary of this intervention not only claim their rights, but also fulfill your duties. Despite the recent normative advances in the cochlear implant, the existing regulations are vulnerable to the complexity of the process of habilitation and auditory rehabilitation through the cochlear implant, leaving room for violations, omissions and abuse. Faced with this scenario, all of them end up being harmed, the State, society and the beneficiary of the hearing aid itself. The scope of the present study is to critically analyze the legal framework at the national level of the regulations aimed at the cochlear implant in the (re)habilitation process. The materials and methods used will be those of bibliographical, legal-doctrinal and legal review.

The ability to perceive speech is related to the listener's ability to differentiate among frequencies (i.e. spectral resolution). Cochlear implant users exhibit variable speech perception and spectral resolution abilities, which can be attributed at least in part to electrode interactions at the periphery (i.e. spatial resolution). However, electrophysiological measures of peripheral spatial resolution have not been found to correlate with speech perception. The purpose of this study was to systematically evaluate auditory processing from the periphery to the cortex using both simple and spectrally complex stimuli in order to better understanding the underlying processes affecting spatial and spectral resolution and speech perception. Eleven adult cochlear implant users participated in this study. Peripheral spatial resolution was assessed using the electrically evoked compound action potential (ECAP) to measure channel interaction functions for thirteen probe electrodes. We evaluated central processing using the auditory change complex (ACC), a cortical response, elicited with both spatial (electrode pairs) and spectral (rippled noise) stimulus changes. Speech perception included a vowel-discrimination task and the BKB-SIN test of keyword recognition in noise. We varied the likelihood of electrode interactions within each participant by creating three experimental programs, or MAPs, using a subset of seven electrodes and varying the spacing between activated electrodes. Linear mixed model analysis was used to account for repeated measures within an individual, allowing for a within-subject interpretation. We also performed regression analysis to evaluate the relationships across participants. Both peripheral and central processing abilities contributed to the variability in performance observed across CI users. The spectral ACC was the strongest predictor of speech perception abilities across participants. When spatial resolution was varied within a person, all electrophysiological measures were significantly correlated with each other and with speech perception. However, the ECAP measures were the best single predictor of speech perception for the within-subject analysis, followed by the spectral ACC. Our results indicate that electrophysiological measures of spatial and spectral resolution can provide valuable information about perception. All three of the electrophysiological measures used in this study, including the ECAP channel interaction functions, demonstrated potential for clinical utility.

Improved cochlear implant (CI) designs and surgical techniques have allowed CI patients to retain acoustic hearing in the implanted ear post-operatively. These EAS (electric-acoustic stimulation) CI users listen with a combination of acoustic and electric hearing in the same ear. While electric hearing alone improves speech recognition in quiet, preserved acoustic hearing allows EAS CI users to outperform traditional CI users in speech recognition in noise and demonstrate “speech masking release,” an improvement in speech recognition in temporally fluctuating noise relative to steady noise. Masking release is arguably an ecologically valid metric, as listeners often attend to target speech embedded in fluctuating competing speech. Improved speech recognition outcomes have been attributed to the spectral and temporal resolution provided by acoustic hearing. However, the relationship between spectral and temporal resolution and outcomes in EAS CI users is not clear. This study evaluated speech masking release, spectral ripple density discrimination thresholds, and fundamental frequency difference limens (f0DLs) in EAS CI users. Both the ripple and f0DL tasks are thought to measure underlying spectral resolution and temporal fine structure. EAS CI subjects underwent testing in three listening modes: acoustic-only, electric-only, and acoustic+electric. Comparisons across listening modes allowed the benefit provided by acoustic hearing to be quantified. It was hypothesized that speech masking release, spectral ripple density discrimination thresholds, and f0DLs would be poorest with electric-only hearing and would improve in the acoustic-only and acoustic+electric listening modes. This would reflect the benefit of preserved acoustic hearing. It was also hypothesized that speech masking release would correlate with spectral ripple density discrimination thresholds and f0DLs, reflecting the roles of spectral and temporal fine structure cues. Lastly, it was hypothesized that EAS CI users with more residual hearing (lower audiometric thresholds) would perform better on all three tasks. Speech masking release was evaluated using a 12-alternative-forced-choice (AFC) spondee recognition in noise task. The noise was a two-talker and a ten-talker babble presented at -5 dB SNR, and masking release was quantified as the difference in spondee recognition in two-talker babble relative to ten-talker babble. Spectral ripple density discrimination thresholds were assessed in a 3-AFC task using a broadband stimulus that contained spectral peaks and valleys logarithmically spaced on the frequency axis. The spacing between spectral peaks (ripple density) was varied to determine the threshold at which listeners could no longer resolve the individual spectral peaks. F0DLs were assessed via a 3-AFC task using a broadband harmonic complex with a baseline f0 = 110 Hz. The f0 of the test intervals was varied to determine the smallest change in f0 that the listener could detect. Results showed that performance in all three measures was poorest when EAS CI users were tested using electric-hearing only, with significant improvements when tested in the acoustic-only and acoustic+electric listening modes. F0DLs, but not spectral ripple density discrimination thresholds or audiometric thresholds, significantly correlated with speech masking release. Speech masking release also significantly correlated with open-set AzBio sentence recognition in noise scores obtained from clinical records. Results indicated that preservation of residual acoustic hearing allows for speech masking release, likely due to access to temporal fine structure cues provided by residual hearing. The significant correlation between speech masking release and sentence recognition in noise indicates that the ability to extract target speech embedded in temporally fluctuating competing speech is important for speech recognition in noise. Funded by National Institutes of Health/National Institutes on Deafness and Other Communication Disorders (NIH/NIDCD) P50 DC000242, American Speech-Language-Hearing Foundation Student Research Grant, and American Academy of Audiology Student Investigator Research Grant.

La communication parlée peut être vue comme un processus interactif impliquant un couplage fonctionnel entre les systèmes moteur et sensoriel. L’objectif de ce travail de thèse est de tester ces possibles liens perceptivo-moteurs, aussi bien lors de la perception que de la production de la parole, au travers de multiples paradigmes comportementaux et auprès de différentes populations de participants. Le protocole expérimental mis en place est composé de trois paradigmes expérimentaux classiques : un premier paradigme de close-shadowing,visant à explorer le format partiellement moteur de stimuli auditifs et audiovisuels de parole ; un second paradigme permettant de mettre en évidence des corrélations entre la production et la perception de voyelles ; et enfin, un dernier paradigme d’imitation consciente et inconsciente de fréquence fondamentale.Suite à la validation de notre protocole expérimental auprès d’une population contrôle de jeunes adultes normo-entendants, nous avons étudié une seconde population constituée d’adultes normo-entendants séniors, et ceci afin d’évaluer la conséquence d'un déclin des fonctions cognitives et langagières. Les résultats obtenus ont permis de suggérer une activation fonctionnelle des liens perceptivo-moteurs lors de la perception et de la production de parole chez l’ensemble des participants. La troisième population testée était constituée de patients sourds post-linguaux puis implantés, afin de déterminer l'impact d'une déprivation sensorielle ainsi que les éventuels réapprentissages liés à leur implantation sur ces liens perceptivo-moteurs. De manièresurprenante, les résultats ont mis en évidence des relations sensori-motrices actives chez ces participants, et ce même très peu de temps après l’implantation. Pris ensemble, les résultats observés avec ces trois paradigmes expérimentaux et auprès de ces trois groupes de participants attestent de la nature perceptivo-motrice de la parole. De manière importante, malgré des performances dégradées, ces interactions entre systèmes sensoriels et moteur lors de la perception et de la production de parole resteraient fonctionnelles auprès des deux populations, celle des adultes normo-entendants séniors etcelle des patients sourds post-linguaux porteurs d’un implant cochléaire. / Speech communication can be considered as an interactive process involving afunctional coupling between sensory and motor systems. The aim of this thesis was to test possible perceptuo-motor linkages during both speech perception and production, using distinct behavioral paradigms and populations. The experimental protocol was made of three classic experiments: a first paradigm of close-shadowing, aiming at exploring the partially motor format of audio and audiovisual stimuli; a second paradigm allowing to correlate production and perception of vowels; and a third paradigm of conscious and unconscious imitation of pitch. The experimental protocol was validated with a first group of young hearing adults. The second population studied was composed of elderly normal-hearing participants, in order to evaluate the consequences of both cognitive and linguistic declines. Results allowed us to suggest a functional activation of perceptuo-motor linkage during speech production and perception.The third population we tested comprised post-lingually deaf patients wearing acochlear implant. Our objective was to determine the impact of the sensorial deprivation and the re-learning processes, associated with their implantation, on perceptuo-motor linkages. Unexpectedly, results showed an active sensori-motor relationship in those participants, even shortly after the cochlear implantation. Altogether, our results confirmed the perceptuo-motor nature of speech. Importantly, in spite of degraded performances, these interactions between the sensory and the motor systems during speech production and perception remained functional in both the elderly normal-hearing population and the post-lingually deaf patients, wearing a cochlear implant.

The purpose of this study was to investigate how design changes in Cochlear Nucleus cochlear implants (CIs) (CI24M, CI24R, CI24RE and CI422) affected electrode impedance and ECAP measures, and to determine if these design changes affected post-lingually deafened adults and children with congenital hearing loss in a similar way. Results of this study showed that electrode impedance was inversely related to the area of the electrode contacts in the array: lowest for the full-banded CI24M CI and highest for adults who used the CI422 device which has the smallest electrode contacts of all four devices. The noise floor of the NRT system likely plays a significant role in the finding that CI users with older devices (the CI24M, and CI24R CIs) had higher ECAP thresholds than individuals with the CI24RE electrode array. The position of the electrode array in the cochlea was also found to have a significant effect on ECAP measures. CI users with modiolar hugging (the CI24R and CI24RE CIs) electrode arrays were found to have lower ECAP thresholds than CI users whose electrode arrays were seated more laterally in the cochlear duct (e.g. the CI24M and CI422 implants). The position of the electrode contacts relative to the modiolus of the cochlea was found to be related to slope of the ECAP growth functions. The lowest slopes were found in CI24RE users. It also had a significant impact on the width of the channel interaction function. Electrode arrays seated further from the modiolus have significantly more channel interaction than electrode arrays that hug the modiolus of the cochlea. Differences between results recorded from post-lingually deafened adults and children with congenital hearing loss were minimal. The difference only reflected on the ECAP slopes. Slopes in children with congenital hearing loss were significantly steeper than those recorded from adults. This may indicate that children with congenital hearing loss may have better neural survival than adults with acquired hearing loss. In conclusion, the results of the current study show evidence of the effects of variations in design and function of the implanted components of the Nucleus CI. Perhaps the most significant finding from the current data set is that electrode arrays located closer to the modiolus of the cochlea have lower thresholds and exhibit less channel interaction than electrode arrays that are positioned more laterally. An argument could be made that lower stimulation levels and less channel interaction may result in better outcomes and/or longer battery life. For CI candidates who do not have significant residual acoustic hearing, the CI24RE implant might be a better choice than the more recently introduced CI422 electrode array.