Les enfants sourds congénitaux ne peuvent pas acquérir le langage oral. L'acquisition du langage après réhabilitation montre des différences individuelles qui peuvent être liées à la réorganisation corticale consécutive à la surdité. Le fonctionnement auditif cortical peut être exploré par les méthodes électrophysiologiques. Notre première étude a permis de montrer une relation entre les réponses auditives temporales (onde N1c) et les capacités langagières chez des enfants avec une réhabilitation audioprothétique. Dans une seconde étude, nous avons mis en évidence une réponse spécifique à la voix humaine chez les enfants implantés cochléaires ayant un bon niveau de langage. La distribution de cette réponse est cependant différente de celle obtenue chez les enfants normo-entendants. La réduction de l'artefact dû à l'implant cochléaire a été une étape préliminaire indispensable à l'analyse des potentiels évoqués auditifs corticaux. L’identification de tels marqueurs permettra de définir des facteurs pronostics et de mieux repérer les enfants nécessitant une adaptation précoce de la rééducation. / Congenitally deaf children cannot acquire spoken language. Language development following auditory rehabilitation varies widely from child to child; this variability could be explained by cortical reorganisation following congenital deafness. Electrophysiological techniques make it possible to investigate cortical auditory processing. Our first study identified a relationship between auditory temporal responses (N1c wave) and language performance in children fitted with hearing aids for moderate congenital deafness. Our second study investigated cortical voice processing in children with a cochlear implant (CI) and with good language performance. Minimisation of the CI artifact was a preliminary step to analyse cortical auditory evoked potentials. A specific response to voice was found in children with CI, broader and more frontally distributed than this recorded in normal hearing children. The identification of such markers shoult it make possible to identify prognostic factors and to better indentify children in need of early care management.

Submitted by Caroline Periotto (carol@ufscar.br) on 2016-10-03T12:55:03Z No. of bitstreams: 1 DissVCBB.pdf: 2619281 bytes, checksum: 2f5637e485c593fd995c61ac14eb2689 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T18:49:06Z (GMT) No. of bitstreams: 1 DissVCBB.pdf: 2619281 bytes, checksum: 2f5637e485c593fd995c61ac14eb2689 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-10T18:49:14Z (GMT) No. of bitstreams: 1 DissVCBB.pdf: 2619281 bytes, checksum: 2f5637e485c593fd995c61ac14eb2689 (MD5) / Made available in DSpace on 2016-10-10T18:49:25Z (GMT). No. of bitstreams: 1 DissVCBB.pdf: 2619281 bytes, checksum: 2f5637e485c593fd995c61ac14eb2689 (MD5) Previous issue date: 2016-03-08 / Não recebi financiamento / The objective of this study was to analyze the development of communicative actions in a child with congenital deafblindness after the Cochlear Implant (CI). The study took place in an inclusive public school with Service Center specializes in the area of Deafblind. Research it is a case study of a child with congenital deafblindness full, ie without hearing or visual residue and at eight was submitted to the IC. The child started the service in this center in 2011 and in 2013 passed the CI surgery, so in 2014 the device was activated, causing there was the possibility of communication using a sensory pathway. Data collection initially consisted of desk research in the records of the initial calls before the IC, then there was the interview with the mother, caregiver and teacher. still consisted with initial assessment through data collected in documentary research and final evaluation after the IC. To collect data after the IC, there were three weekly sessions lasting 3 hours, the comments were in attendance in activities such as reception, food, auditory stimulus and orientation and mobility. The data obtained were analyzed qualitatively according to the table of communicative competence levels, according to Rowland & Stremel-Campbell, adapted by Cambruzzi, considering them as a criterion for measuring the development of the child's communicative actions. The results showed progress in language acquisition, ie, the child presented intentional efficient communication using reference objects to express their desires and communicative actions to others. The family found itself without the support of a specialist that offers support to foster the process of communicative actions in their home environment. The results show a gradual development of communication levels after IC. However, it was noted that the presence of a qualified professional in the field of deafblindness paying attention not only the child is necessary, but family support for the success of communicative actions actually happen. / O objetivo do presente trabalho foi analisar o desenvolvimento das ações comunicativas em uma criança com surdocegueira congênita após o Implante Coclear (IC). O estudo aconteceu em uma escola pública inclusiva com Centro de Atendimento Especializado na área da Surdocegueira. A pesquisa trata-se de um estudo de caso de uma criança com surdocegueira congênita total, isto é, sem resíduo auditivo ou visual e que aos oito anos foi submetida ao IC. A criança iniciou o atendimento neste Centro no ano de 2011 e no ano de 2013 passou pela cirurgia de IC, assim, no ano de 2014 o aparelho foi ativado, fazendo com que houvesse a possibilidade de comunicação utilizando uma via sensorial. A coleta de dados consistiu inicialmente em pesquisa documental nos registros dos atendimentos iniciais, antes do IC, em seguida, houve a entrevista com a mãe, a cuidadora e a professora. Constou ainda com avaliação inicial por meio dos dados coletados na pesquisa documental e avaliação final, após o IC. Para a coleta de dados após o IC, foram realizadas três sessões semanais com duração de 3horas, as observações foram nos atendimentos em atividades como recepção, alimentação, estímulo auditivo e orientação e mobilidade. Os dados adquiridos foram analisados qualitativamente de acordo com a tabela dos níveis de competência comunicativas, segundo Rowland & Stremel-Campbell, adaptada por Cambruzzi, considerando-os como critério para a aferição do desenvolvimento das ações comunicativas da criança. Os resultados apresentaram evolução na aquisição da linguagem, ou seja, a criança apresentou comunicação eficiente intencional, utilizando objetos de referência para expressar seus desejos e ações comunicativas a outros. A família encontrava-se sem apoio de um profissional especializado que oferecesse suporte para favorecer o processo das ações comunicativas em seu ambiente familiar. Os resultados demonstram desenvolvimento gradativo dos níveis de comunicação após o IC. No entanto, notou-se que é necessário a presença de um profissional qualificado na área da surdocegueira prestando atendimento não só a criança, mas apoio à família para que o sucesso das ações comunicativas realmente aconteça.

Submitted by ADRIANA MAURA BARBOZA MERLIN null (drimerlin@hotmail.com) on 2017-05-16T02:05:02Z No. of bitstreams: 1 Efeito do MEI (Multiple Exemplar Instruction) na integração entre repertórios de ouvinte e falante em crianças com Desordem do Espectro da Neuropatia Auditiva e implante coclear.pdf: 1899105 bytes, checksum: d8d54b35191a2f700898f07ef9b574b9 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-05-16T14:55:26Z (GMT) No. of bitstreams: 1 merlin_amb_me_bauru.pdf: 1899105 bytes, checksum: d8d54b35191a2f700898f07ef9b574b9 (MD5) / Made available in DSpace on 2017-05-16T14:55:26Z (GMT). No. of bitstreams: 1 merlin_amb_me_bauru.pdf: 1899105 bytes, checksum: d8d54b35191a2f700898f07ef9b574b9 (MD5) Previous issue date: 2017-03-28 / Estudos da parceria entre a Fonoaudiologia e Análise do Comportamento têm investigado sob quais condições de ensino implantados cocleares pré-linguais aprendem habilidades auditivas e as relações que estabelecem com a produção oral. Uma rota que permite a extensão do controle entre repertórios verbais é o Ensino por Múltiplos Exemplares (do inglês Multiple Exemplar Instruction, MEI), que tem sido pouco explorada em estudos com usuários de implante coclear. Este estudo objetivou investigar o efeito do ensino por MEI sobre a integração entre repertórios de ouvinte e falante em crianças com Desordem do Espectro da Neuropatia Auditiva (DENA) e usuárias de implante coclear (IC). Participaram três crianças com 6 anos de idade, uma do sexo feminino e duas do sexo masculino, com o diagnóstico de DENA e um quadro de perda auditiva severa-profunda, bilateral e pré-lingual. Todos os participantes usavam implante coclear uni ou bilateral, frequentavam o ensino regular e recebiam atendimento multidisciplinar no follow-up do serviço de implante coclear. Os participantes apresentavam maturidade intelectual típica e reconhecimento auditivo inferior à idade cronológica, aferidos pela Escala Colúmbia de Maturidade Intelectual e o Peabody Picture Vocabulary Test (PPVT-4R). Foram adotados estímulos auditivos e figuras que corresponderam às palavras (substantivos) e sentenças de dois termos (substantivos+adjetivos), que foram convencionais (para GABI e SOZA) e não convencionais (para DOZA). O estudo empregou um delineamento de sondas múltiplas e foi composto por sondas e ensino. As sondas foram intercaladas com o ensino e avaliaram as relações de discriminação condicional auditivo-visual, de tato e de ecoico para os estímulos de todas as unidades. O ensino foi organizado em duas unidades e cada unidade tinha dois passos; no passo 1, eram ensinadas relações verbais envolvendo apenas substantivos; no passo 2, substantivos+adjetivos. Os blocos de ensino foram estruturados por MEI e apresentavam de maneira rotativa as tarefas de ecoico, de ouvir baseado em seleção (discriminação condicional auditiva-visual) e de tato. Na primeira sonda (pré-teste), os participantes apresentaram desempenhos de ouvinte com variabilidade (100% de acertos para GABI, 60% para SOZA e nulo para DOZA) e os desempenhos de falante foram discrepantes, com porcentagem de acertos nos desempenhos de falante superior ou inferior ao de ouvinte. Os números de sessões variaram entre os participantes, até atingirem a maior porcentagem de acertos nas tarefas de ouvinte e de falante. Ainda que o repertório de ouvinte fosse mais preciso e aprendido primeiro, todos aumentaram a porcentagem de acertos nos desempenhos de falante que ficaram próximos aos de ouvinte após o ensino. Nas sondas que sucederam o ensino com substantivos, GABI e SOZA mantiveram os desempenhos em ouvir e falar e demonstraram a extensão de controle dos estímulos do Passo 1 (substantivo) para o Passo 2 (substantivo+adjetivo), mesmo que ainda não tivesse sido diretamente ensinado. Discute-se o potencial do uso clínico do MEI no estabelecimento, integração e extensão dos repertórios de ouvinte e falante em crianças com DENA e IC. / Studies of the partnership between Speech-Language Pathology and Behavioral Analysis have investigated under which teaching conditions that pre-lingual implanted cochlear learn listening skills and the relations that establish with oral production. A route that can be to promote the extension of control between verbal repertoires is designated Multiple Exemplary Instruction (MEI), which has been little explored in studies with cochlear implants users. This study aimed to investigate the effect of MEI’ teaching on the integration between listening and speaking repertoires in children with Auditory Neuropathy Spectrum Disorder (DENA) and cochlear implants users (CI). Participants were three 6-year-old children, one female and two males, with the diagnosis of DENA and a severe-profund, bilateral and pre-lingual hearing loss. All participants used a uni or bilateral cochlear implant, attended regular education and received multidisciplinary care in the follow-up of the cochlear implant service. Participants had typical intellectual maturity and auditory recognition lower the chronological age, measured by Columbia and PPVT-4R tests. Auditory stimuli and figures that corresponded to words (nouns) and sentences of two terms (nouns + adjectives) were used, which were conventional (GABI and SOZA) and nonconventional (DOZA). The study employed a multiple probe design and was composed of probes and teaching. The probes were intercalated with the teaching and evaluated the conditional auditory-visual relations, tact and echoic for the stimuli of all units. Teaching was organized into two units and each unit had two steps; in step 1, verbal relations involving only nouns were taught; in step 2, nouns + adjectives. The teaching blocks were structured by MEI and presented in a rotative way the tasks of echoic, listening based on selection (auditory-visual conditional discrimination) and tact. In the first probe (pre-test), the participants presented listener performances with variability (100% of GABI hits, 60% for SOZA and nil for DOZA) and the speaker performances were discrepant, with correct response percentage higher or lower than the listener. Participants required, an average, of eight sessions in the teaching until they achieved the highest percentage in the listening and speaking tasks. Although the listener's repertoire was more accurate and learned first, they all increased the correct response percentage in the performances of the speakers who were close to those of the listener after teaching. In the probes that succeeded teaching with nouns, GABI and SOZA maintained the listening and speaking performances and demonstrated the control extension of the stimuli from Step 1(noun) to Step 2 (noun + adjective), even though it had not yet been taught directly. The potential of the clinical use of MEI in the establishment, integration and extension of the listener and speaker repertoires in children with DENA and CI is discussed.

The thesis deals with a issue of significance of canistherapy for clients with hearing aid and cochlear implants. Canistherapy, as one of the forms of the zoo-therapy, represents a supporting rehabilitation method based on the contact of the man with the dog and their positive interaction. The theoretical part of the thesis contains the topical terminology of the zoo-rehabilitation and canistherapy, where the author makes the analysis of this topic and deals with influence of the canistherapy on the client with specific defects. Within the theoretical part also the issue of a hearing handicap is defined. The target of the thesis is describing canistherapy as supporting therapeutic method for children with hearing defects. The research is focused on applying the Animal Assisted Therapy method. Based on the qualitative research, four casuistic reports were created describing the importance of the canistherapy for children the hearing defects and their family. For the research, the method of participating observation was applied, method of the analysis of documents (method of the secondary data analysis) and a half-standardized talk. As supplementing method I selected questioning (technology of an questionnaire) with open questions and photo-documentation. The research was made on children of pre-school age after the cochlear implantation coming into the Special Pedagogical Centre for Hearing Handicapped in České Budějovice. The results of the research confirmed that canistherapy influences very positively the total development of the child personality, it contributes to the development of speech as well as communication abilities and psycho-social child development. The thesis may serve as information and study material for beginning and professional canistherapeutical teams, pedagogical, special pedagogical and further professional employees and also the lay public. The information may be disseminated in the form of lectures, by creating publications, leaflets etc..

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.

Orientadores: Edi Lúcia Sartorato, Arthur Menino Castilho / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-20T16:24:36Z (GMT). No. of bitstreams: 1 Ramos_PriscilaZonzini_M.pdf: 3611007 bytes, checksum: 2be9b03e75155e4bfaecc2357fec2c70 (MD5) Previous issue date: 2012 / Resumo: A surdez é considerada a doença sensorial mais prevalente em humanos, causada por uma variedade de fatores ambientais e genéticos. No Brasil, não há dados oficiais referentes à prevalência e à etiologia das deficiências auditivas, mas sabe-se que os fatores ambientais ainda superam os de origem genética. No diagnóstico etiológico da surdez, a realização concomitante de exames laboratoriais, de imagem e genéticos, embora amplie a chance diagnóstica, onera o Sistema de Saúde, devido ao alto custo. Deste modo, o objetivo do presente estudo foi avaliar a eficácia dos exames de imagem e genéticos e seu impacto em Saúde Pública, bem como estabelecer um protocolo diagnóstico, visando maior eficiência e redução de custos na determinação da etiologia das perdas auditivas. Foi realizada a análise de 100 indivíduos com perda auditiva neurossensorial, atendidos no Ambulatório de Otorrinolaringologia do Hospital das Clínicas da UNICAMP, no período de 2002 a 2010, e que foram submetidos ao implante coclear. Uma investigação detalhada foi realizada nos pacientes, incluindo exames de imagem, genéticos e laboratoriais (em casos específicos). Após a realização dos exames específicos, o número de casos com a etiologia não esclarecida foi reduzido de 72 para 42, representando redução de 42%. Alterações radiológicas foram identificadas em 29 pacientes, enquanto alterações moleculares foram encontradas em 31 indivíduos, incluindo a c.35delG, p.V27I, p.M34T, p.V37I, p.E47X, p.L90P, p.V95M, p.K168R, p.W172X no gene GJB2, a del(GJB6-D13S1830) no gene GJB6 e a m.1555A>G no gene mitocondrial MTRNR1. Os exames de imagem e genéticos contribuíram, respectivamente, para o diagnóstico etiológico de 20% e 19% dos casos analisados. A etiologia não foi esclarecida em 42% dos pacientes, em 25% foi de origem ambiental, 19% genética, e em 14% dos casos decorrente de malformações ou outros problemas na orelha interna. Pôde-se concluir que tanto os exames de imagem quanto os genéticos foram importantes para a identificação da etiologia das perdas auditivas, no entanto, os testes moleculares contribuíram principalmente para o diagnóstico dos pacientes com surdez congênita, enquanto os exames radiológicos tiveram maior contribuição para os casos com perda progressiva ou abrupta. A alta prevalência de mutações no gene GJB2 foi confirmada, especialmente da mutação c.35delG, nos casos de perda auditiva neurossensorial severa a profunda bilateral. A pesquisa molecular teve importante contribuição no diagnóstico etiológico da surdez, além de possibilitar o aconselhamento genético e sugerir melhor prognóstico para o implante coclear, como observado em estudos prévios. O TaqMan® OpenArray® Genotyping é uma técnica promissora para o diagnóstico molecular da perda auditiva, pois permite a análise de diversas mutações em vários pacientes de uma só vez, o que implica em um diagnóstico mais rápido a um custo mais baixo. O protocolo sequencial permite a otimização do diagnóstico etiológico e redução dos custos, ao contrário da realização concomitante de exames de imagem, laboratoriais e genéticos. Por fim, mesmo com uma investigação detalhada, a etiologia desconhecida continuou prevalecendo, o que aponta para a necessidade de estudos moleculares mais aprofundados, para que a real causa possa ser esclarecida / Abstract: Deafness is considered the most prevalent sensory disorder in humans, caused by a variety of environmental and genetics factors. In Brazil, there are no official data regarding the prevalence and etiology of hearing impairment, but it is known that environmental factors are among the major causes. Although a simultaneous testing approach, including clinical exams, audiological, laboratorial, imaging and genetic expands the etiological diagnosis, overloads the healthcare system due to high costs. Thus, the goal of the present study is to evaluate the effectiveness of imaging and genetics tests and their impact on public health, aiming to increase efficiency and reduce costs of the etiological diagnosis of hearing loss. It was conducted an analysis of 100 patients with sensorineural hearing loss, from Department of Otorhinolaryngology of the State University of Campinas (UNICAMP), submitted to cochlear implantation between 2002 and 2010. A detailed investigation was performed in patients, including imaging and genetics analysis. After specific tests, the number of individuals with unknown cause was reduced from 72 to 42 (42% of reduction). Radiologic abnormalities were identified in 29 of the patients, while molecular alterations were found in 31 individuals, including c.35delG, p.V27I, p.M34T, p.V37I, p.E47X, p.L90P, p.V95M, p.K168R, p.W172X in the GJB2 gene, del(GJB6-D13S1830) in the GJB6 gene and m.1555A>G in the MTRNR1 mitochondrial gene. Genetic and imaging results contributed to the etiological diagnosis of 19% and 20% of the cases, respectively. The etiology remained unknown in 42% of the patients, was due to environmental factors in 25%, genetics in 19% and inner ear malformations or other defects in 14% of the cases. It was concluded that both imaging and genetic analysis were important to identify the etiology of hearing loss, however, molecular tests contributed mainly for diagnosis of patients with congenital deafness, while radiologic exams had greater contribution for diagnosis of cases with progressive or sudden hearing loss. The high prevalence of mutations in the GJB2 gene was confirmed, especially the c.35delG mutation, in cases of sensorineural severe to profound bilateral hearing loss. The molecular research had an important contribution to the etiology of deafness, besides providing genetic counseling and a better prognosis for cochlear implantation, as suggested by previous studies. The TaqMan® OpenArray® Genotyping is a promising technique for molecular diagnostic of hearing loss, because it allows the analisys of many mutations in several patients at once, which implies in a faster diagnosis at a lower cost. The sequential protocol enables an optimization of the etiological diagnosis and cost reduction, as opposed to simultaneously holding imaging, laboratory and genetic tests. Finally, even with a careful investigation, the unknown etiology prevailed as main cause which points to the need of carrying out detailed genetic studies in those cases with idiopathic hearing loss in order to elucidate the diagnosis / Mestrado / Genetica Animal e Evolução / Mestre em Genética e Biologia Molecular

Les implants cochléaires sont des appareils destinés à la réhabilitationdes surdités profondes et totales. Ils assurent la stimulation du nerf auditif en plaçant des électrodes dans la cochlée. Différentes études ont été établis afin d’améliorer l’intelligibilité de la parole dans le bruit chez le patientporteur de cet appareil. Les techniques bilatérales et binaurales permettent dereproduire une audition binaurale, car les deux oreilles sont simulées (commepour les personnes normo-entendantes). Ainsi la localisation et la perceptiondes sons environnants sont améliorées par rapport à une implantationmonaurale. Toutefois, les capacit´es de reconnaissances des mots sont trèsvite limitées en pr´esence de bruits. Nous avons d´evelopp´es des techniquesde r´eduction de bruit afin d’augmenter les performances de reconnaissance.Des améliorations de 10% à 15% suivant les conditions ont été observées. Néanmoins, si la perception est améliorée par les algorithmes, ils focalisent sur une direction, et ainsi, la localisation est alors réduite à l’angle delocalisation. Une seconde étude a alors été effectuée pour mesurer l’effetdes algorithmes sur la localisation. Ainsi, le beamformer donne les meilleurs résultats de compréhension mais la moins bonne localisation. La ré-injectiond’un pourcentage du signal d’entrée sur la sortie a permis de compenser laperte de la localisation sans détériorer l’intelligibilité. Le résultat de ces deux expériences montre qu’il faut un compromis entre laperception et la localisation des sons pour obtenir les meilleures performances. / Cochlear implants are to sail for the rehabilitation of deep and totaldeafness. They provide stimulation of the auditory nerve by placing electrodesin the cochlea. Various studies have been established to improve thespeech intelligibility in noise in the patient of this device. Bilateral andbinaural techniques allow reproducing a binaural hearing, since both earsare simulated (as for normal hearing people). Thus localization and theperception of the surrounding sounds are improved from a monauralimplantation. However, the recognition of the words capabilities are limitedvery quickly in the presence of noise.We developed noise reduction techniquesto increase the performance of recognition. Improvements of 10% to 15%depending on the conditions were observed. Nevertheless, if the perception isenhanced by algorithms, they focus on a direction, and thus the location isthen reduced at the corner of localization. Then, a second study was madeto measure the effect of localization algorithms. Thus, the beamformer givesthe best results of understanding but the less good location. The re-injectionof a percentage of the input to the output signal helped offset the loss of thelocation without damaging the intelligibility.The result of these two experiments shows that it takes a compromisebetween perception and sound localization for best performance.

The goal of this study was to investigate the methodology in designing a vowel intelligibility model that can objectively predict the outcome of a vowel confusion test performed with normal hearing individuals listening to a cochlear implant acoustic model. The model attempts to mimic vowel perception of a cochlear implantee mathematically. The output of the model is the calculated probability of correct identification of vowel tokens and the probability of specific vowel confusions in a subjective vowel confusion test. In such a manner, the model can be used to aid cochlear implant research by complementing subjective listening tests. The model may also be used to test hypotheses concerning the use and relationship of acoustic cues in vowel identification. The objective vowel intelligibility model consists of two parts: the speech processing component (used to extract the acoustic cues which allow vowels to be identified) and the decision component (simulation of the decision making that takes place in the brain). Acoustic cues were extracted from the vowel sounds and used to calculate probabilities of identifying or confusing specific vowels. The confusion matrices produces by the objective vowel perception model were compared with results from subjective tests performed with normal hearing listeners listening to an acoustic cochlear implant model. The most frequent confusions could be predicted using the first two formant frequencies and the vowel duration as acoustic cues. The model could predict the deterioration of vowel recognition when noise was added to the speech being evaluated. The model provided a first approximation of vowel intelligibility and requires further4 development to completely predict speech perception of cochlear implantees. / Dissertation (ME)--University of Pretoria, 2009. / Electrical, Electronic and Computer Engineering / unrestricted

Cette thèse porte sur la perception visuelle, auditive et audiovisuelle des voyelles nasales [ɑ̃] (« lent »),[ɔ̃] (« long ») et [ɛ̃] (« lin ») par des adultes devenus sourds, implantés cochléaires et implantés dutronc cérébral. L’étude sur la perception visuelle des voyelles, auprès de 22 adultes devenus sourds,redéfinit les sosies labiaux des voyelles nasales et propose une mise à jour de la classification desvisèmes. Trois études sur l’identification auditive des voyelles nasales auprès de 82, 15 et 10 adultesimplantés cochléaires mettent en évidence leur difficulté à reconnaitre les trois voyelles nasales, qu’ilsperçoivent comme des voyelles orales. Les analyses acoustiques et perceptives suggèrent que lesadultes implantés cochléaires s’appuient sur les informations fréquentielles des deux premiers picsspectraux mais négligent les informations d’intensité relative de ces pics. D’après l’étude menéeauprès de 13 adultes implantés du tronc cérébral, des informations acoustiques linguistiques sonttransmises par l’implant du tronc cérébral mais la fusion entre les informations auditives et visuellespourrait être optimisée pour l’identification des voyelles. Enfin, une enquête auprès de 179orthophonistes pointe le besoin d’une information sur la définition phonétique articulatoire actualiséedes voyelles [ɑ̃] et [ɛ̃]. / This thesis focuses on the visual, auditory and auditory-visual perception of french nasal vowels [ɑ̃](« lent »), [ɔ̃] (« long ») and [ɛ̃] (« lin ») by Cochlear Implant (CI) and Auditory Brainstem Implant(ABI) adults users. The study on visual perception of vowels, with 22 deafened adults, redefines thelip configuration of french nasal vowels and provides an update of the classification of vocalic visualphonemes. Three studies on auditory identification of nasal vowels with 82, 15 and 10 CI usershighlight their difficulty in recognizing the three nasal vowels, which they perceive as oral vowels.Acoustic and perceptual analyzes suggest that adults with CI rely on frequency informations of thefirst two spectral peaks but miss the informations of relative intensity of these peaks. The study with13 ABI users show that some linguistic acoustic cues are transmitted by the ABI but the fusion ofauditory and visual features could be optimized for the identification of vowels. Finally, a survey of179 Speech Language and Hearing Therapists show the need of an update on the phonetic articulationof french nasal vowels [ɑ̃] and [ɛ̃].

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