abstract: A multitude of individuals across the globe suffer from hearing loss and that number continues to grow. Cochlear implants, while having limitations, provide electrical input for users enabling them to "hear" and more fully interact socially with their environment. There has been a clinical shift to the bilateral placement of implants in both ears and to bimodal placement of a hearing aid in the contralateral ear if residual hearing is present. However, there is potentially more to subsequent speech perception for bilateral and bimodal cochlear implant users than the electric and acoustic input being received via these modalities. For normal listeners vision plays a role and Rosenblum (2005) points out it is a key feature of an integrated perceptual process. Logically, cochlear implant users should also benefit from integrated visual input. The question is how exactly does vision provide benefit to bilateral and bimodal users. Eight (8) bilateral and 5 bimodal participants received randomized experimental phrases previously generated by Liss et al. (1998) in auditory and audiovisual conditions. The participants recorded their perception of the input. Data were consequently analyzed for percent words correct, consonant errors, and lexical boundary error types. Overall, vision was found to improve speech perception for bilateral and bimodal cochlear implant participants. Each group experienced a significant increase in percent words correct when visual input was added. With vision bilateral participants reduced consonant place errors and demonstrated increased use of syllabic stress cues used in lexical segmentation. Therefore, results suggest vision might provide perceptual benefits for bilateral cochlear implant users by granting access to place information and by augmenting cues for syllabic stress in the absence of acoustic input. On the other hand vision did not provide the bimodal participants significantly increased access to place and stress cues. Therefore the exact mechanism by which bimodal implant users improved speech perception with the addition of vision is unknown. These results point to the complexities of audiovisual integration during speech perception and the need for continued research regarding the benefit vision provides to bilateral and bimodal cochlear implant users. / Dissertation/Thesis / Masters Thesis Speech and Hearing Science 2015

abstract: The present study describes audiovisual sentence recognition in normal hearing listeners, bimodal cochlear implant (CI) listeners and bilateral CI listeners. This study explores a new set of sentences (the AzAV sentences) that were created to have equal auditory intelligibility and equal gain from visual information. The aims of Experiment I were to (i) compare the lip reading difficulty of the AzAV sentences to that of other sentence materials, (ii) compare the speech-reading ability of CI listeners to that of normal-hearing listeners and (iii) assess the gain in speech understanding when listeners have both auditory and visual information from easy-to-lip-read and difficult-to-lip read sentences. In addition, the sentence lists were subjected to a multi-level text analysis to determine the factors that make sentences easy or difficult to speech read. The results of Experiment I showed that (i) the AzAV sentences were relatively difficult to lip read, (ii) that CI listeners and normal-hearing listeners did not differ in lip reading ability and (iii) that sentences with low lip-reading intelligibility (10-15 % correct) provide about a 30 percentage point improvement in speech understanding when added to the acoustic stimulus, while sentences with high lip-reading intelligibility (30-60 % correct) provide about a 50 percentage point improvement in the same comparison. The multi-level text analyses showed that the familiarity of phrases in the sentences was the primary driving factor that affects the lip reading difficulty. The aim of Experiment II was to investigate the value, when visual information is present, of bimodal hearing and bilateral cochlear implants. The results of Experiment II showed that when visual information is present, low-frequency acoustic hearing can be of value to speech understanding for patients fit with a single CI. However, when visual information was available no gain was seen from the provision of a second CI, i.e., bilateral CIs. As was the case in Experiment I, visual information provided about a 30 percentage point improvement in speech understanding. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2015

Orientador: Cristina Broglia de Feitosa Lacerda / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:45:28Z (GMT). No. of bitstreams: 1 Pinto_ElaineSoaresMonteiro_D.pdf: 1533807 bytes, checksum: e9fa442c2cdc808029d958967a73fcf9 (MD5) Previous issue date: 2007 / Resumo: O implante coclear é um dispositivo eletrônico de alta tecnologia, que estimula eletricamente as fibras nervosas remanescentes, permitindo a transmissão do sinal elétrico ao nervo auditivo, para que seja codificado pelo córtex cerebral. Ele difere das próteses auditivas convencionais por não amplificar o som, mas, sim, fornecer impulsos elétricos e, portanto, é considerado uma boa alternativa àqueles pacientes que não apresentam benefícios com a amplificação. Esta tecnologia vem sendo utilizada em crianças cada vez menores, e cabe aos profissionais da área eleger os melhores candidatos a este dispositivo. O objetivo principal desta pesquisa foi analisar aspectos do atendimento oferecido às crianças pela equipe de Implante Coclear do HC-UNICAMP, focalizando os protocolos utilizados para elegibilidade de casos, no que diz respeito à capacidade comunicativa dos sujeitos que receberam o implante e sua audibilidade, apontando diretrizes para um procedimento de seleção de casos mais adequados. Foram considerados sujeitos da amostra 7 crianças com deficiência auditiva severa a profunda, que obedecessem os critérios de inclusão do programa de Implante Coclear do HC-UNICAMP. Foram analisados os limiares audiométricos em campo livre, os índices obtidos para o questionário de avaliação da percepção auditiva IT-MAIS (Escala de Integração Auditiva Significativa para Crianças Pequenas (Castiquini, 1998), os dados dos questionários MUSS (Questionário de Avaliação da Linguagem Oral) (Nascimento, 1997), a vídeo-gravação das crianças em situação lúdica e a análise das anotações do prontuário referentes ao desempenho comunicativo. As análises foram feitas no período pré e pós cirúrgico. O processo de seleção de crianças candidatas ao implante coclear precisa valorizar a observação do comportamento dessas crianças em situações lúdicas, com o objetivo de investigar os aspectos comunicativos. A vídeo-gravação demonstrou ser um importante instrumento para esse fim, ao registrar que as crianças com melhor desempenho comunicativo também apresentaram um melhor desempenho com o implante coclear. As crianças portadoras de perda auditiva de grau severo devem ser consideradas como candidatos em potenciais, pois apresentam melhor estímulo com o aparelho auditivo (apesar de muitas vezes não serem capazes de desenvolver fala), o que parece favorecer a resposta com o implante coclear. Os limiares auditivos melhoram com o aprimoramento do mapeamento e também são melhores quando os limiares elétricos são obtidos por meio de resposta comportamental. A percepção auditiva melhora na mesma proporção. No momento pós-cirúrgico, o aparecimento ou a melhora dos comportamentos comunicativos são os primeiros indícios de benefícios do implante coclear / Abstract: Cochlear implants are high- technology electronic devices that electrically stimulate remaining nervous fibers, allowing the transmission of electric signals to the auditory nerve for codification by the cerebral cortex. They differ from conventional auditory prosthesis because they do not amplify sound but supply electric impulses, and are therefore considered a good alternative for patients who are not benefited by sound amplification. This technology is being increasingly used for very young children and professionals of the field are responsible for choosing the best candidates for using the devices. The main goal of this research was to analyze aspects of assistance given to children by the team of Cochlear Implantation of the Hospital of Clinics (HC)-UNICAMP, and focused on protocols used for eligibility to implantation regarding communicative capacity and audibility, suggesting guidelines to a more adequate procedure for selection. The subjects were 7 children with auditory inabilities ranging from severe to profound that met the criteria for inclusion of HC-UNICAMP¿s Cochlear Implantation Program. Free-field audiometric thresholds, rates from IT-MAIS (Infant-Toddler: Meaningful Auditory Integration Scale - Castiquini, 1998), an auditory perception evaluation questionnaire, data from MUSS (Meaningful Use of Speech Scale - Nascimento, 1997), video-recordings of children in a playful situation and notes of clinical histories regarding communicative performance were analyzed both before and after surgery. The process of selection of children for cochlear implantation needs to recognize the value of observing children¿s behavior in playful situations, aiming to investigate the communicative actions they present, and video-recordings turned out to be an important tool. Better-performing children in communicative behaviors presented better results after cochlear implantation. Children with a severe auditory loss must be considered as potential candidates because they present a better stimulation with the auditory device¿s help (although many times they are not able to develop speech), what seems to favor their response to cochlear implantation. Auditory thresholds improve with the improvement of mapping and are better when electric thresholds are elicited through behavioral response. Auditory perception improvement follows the same ratio. Post-surgically, the emergence or improvement of the communicative behaviors is the first indication of benefits of cochlear implantation / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

Orientador: Edi Lucia Sartorato / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-05T05:26:35Z (GMT). No. of bitstreams: 1 Christiani_ThalitaVitachi_M.pdf: 7416540 bytes, checksum: e3a8d9e21a7e00adc8a3661b08d564c3 (MD5) Previous issue date: 2005 / Resumo: A forma mais comum de surdez não-sindrômica com padrão de herança autossômico recessivo é causada por mutações no gene GJB2 (que codifica a proteína conexina 26). Recentemente duas deleções que interrompem o gene GJB6 (que codifica a proteína conexina 30), próximo ao gene GJB2, chamadas del(GJB6-D13S1830) e del(GJB6-D13S1854) foram descritas na presença de mutações in trans no outro alelo do gene GJB2. Dentre todas as mutações descritas até o momento, a mutação 35delG no gene GJB2 é a mais comum e é encontrada praticamente em todas as populações estudadas. Dados preliminares sugerem que as alterações causadas devido a mutações no gene GJB2 não afetam as células do gânglio espiral, as quais constituem o principal alvo de estimulação do implante coclear. Além disso, acredita-se que a sobrevida das células do gânglio espiral é fator determinante ao sucesso do implante. Desta forma, foram estudados 115 pacientes candidatos ou submetidos ao implante coclear com perda auditiva não-sindrômica de etiologia não esclarecida a fim de se determinar à prevalência de mutações nos genes GJB2 e GJB6, assim como mutações em genes mitocondriais 12S rRNA e tRNASer(UCN) em pacientes candidatos e submetidos ao implante coclear. Como resultado foram encontrados 42,85% de indivíduos com mutações, incluindo duas novas alterações no gene GJB2 ambas em heterozigose (W172X e K168R), um paciente homozigoto para a del(GJB6-D13S1830), e um paciente com a mutação mitocondrial A1555G. Concluindo, esses resultados estabelecem que o rastrearnento genético proporciona o diagnóstico etiológico, importante para o aconselhamento genético podendo fornecer um melhor prognóstico para o implante coclear, como sugerido em estudos prévios / Abstract: The most common form of non-syndromic autosomal recessive deafness is caused by mutations in the GJB2 gene which encodes connexin 26. Among all the mutations described to date in the GJB2 gene, is the most common and has been found in virtually of the populations studied. Preliminary data suggest that pathologic changes due to GJB2 mutations do not affect the spiral ganglion cells, which are the site of stimulation of the cochlear implant. Besides, the survival of the spiral ganglion cells is believed to be an important determinant of the outcome after surgery. Recently, two deletions truncating the GJB6 gene which encodes connexin 30, near GJB2, named deI (GJB6D13S1830) and del(GJB6-D13S1854) have also been frequently described accompanying in trans mutations in another allele ofthe GJB2 gene.Therefore, we have studied 115 nonsyndromic deaf patients with unlrnown etiologies in order to determine the prevalence of the GJB2 and GJB6 gene mutations as well as mutations in the mitochondrial genes 12S rRNA e tRNASer(UCN) in patients undergoing cochlear implantation surgery. As a result, we found 42,85% of the individuais with mutations including two new mutations in the gene GJB2 (W172X and KI68R), one patient homozygous for the ..1(GJB6-D13S1830) mutation, and one patient with the mitochondrial mutation A1555G. Concluding, these results establish that genetic screening can provi de an etiologic diagnosis, which highlights a counseling importance, and may provide a prognostic on performance after cochlear implantation, as has been hypothesized in previous studies / Mestrado / Biologia Celular / Mestre em Biologia Celular e Estrutural

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.

Orientador: Zilda Maria Gesueli Oliveira da Paz / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T14:24:29Z (GMT). No. of bitstreams: 1 Souza_FabianaCristinade_M.pdf: 810485 bytes, checksum: b89bc001a541afe436ea3475d30b1285 (MD5) Previous issue date: 2013 / Resumo: O implante coclear é uma prótese auditiva colocada dentro da cóclea, por meio de cirurgia. O sistema do implante transforma a energia sonora em impulsos elétricos, dando ao indivíduo uma sensação auditiva. Dada a crescente demanda de crianças surdas encaminhadas para a cirurgia de implante coclear, vale saber como ocorre o desenvolvimento destas crianças no ensino regular. Como o dispositivo tem contribuído para o desempenho escolar destas crianças? Nesta discussão, cabe afirmar que a linguagem tem um papel fundamental no desenvolvimento infantil e, por isso, é concebida como enunciativa, mediadora das interações e da significação do mundo; consequentemente, a escrita também tem caráter dialógico e ultrapassa a aprendizagem da decodificação grafemas/fonemas, pois está relacionada às múltiplas formas de letramento nas sociedades contemporâneas e à produção de gêneros discursivos nestas sociedades. Portanto, pretendeu-se investigar qual a percepção dos pais e de profissionais da saúde e da educação sobre o desempenho escolar das crianças usuárias do implante coclear. Participaram do estudo quatro mães, três professores da rede de ensino e uma fonoaudióloga responsável pelo atendimento de quatro crianças usuárias do implante. As crianças tinham entre seis e dez anos, estavam matriculadas no ensino regular e frequentavam atendimento fonoaudiólogico em uma instituição educacional para surdos. Foram realizadas entrevistas semi-estruturadas com os participantes com o intuito de conhecer a opinião destes sobre a língua de sinais e sobre o desempenho escolar das crianças. Trata-se de uma pesquisa de cunho qualitativo utilizando-se a Análise de Conteúdo na interpretação dos dados coletados. A pesquisa mostrou que pais e profissionais, afetados pela área da saúde, concebem a criança usuária do implante coclear com base na visão clínica, considerando-a como sujeitos ouvintes, na tentativa de apagamento da surdez. Assim, dificuldades escolares que poderiam ser minimizadas por um olhar de sujeito constituído na diferença são consideradas inerentes à surdez. Dessa forma, concluímos que a mudança de olhar sobre a surdez e a língua de sinais se faz importante para a superação de preconceitos em relação a esta língua e à comunidade surda e para possibilitar um melhor desempenho escolar de crianças surdas usuárias do implante coclear / Abstract: The cochlear implant is an auditive prothesis placed inside the cochlea, by means of surgery. The implant's system turns the sound energy into electric impulses, allowing the individual to have auditive sensation. Given the growing demand of deaf children which are lead to cochlear implant surgery, it is worthy to know how the development of these children at regular schooling occurs. How has the prosthesis contributed to the learning performance of these children? In this discussion, it is possible to affirm that language has a fundamental role at a child's development, and therefore it is conceived as enunciative, mediator of interactions and significations of the world; consequently, writing also has a dialogical character and surmounts the learning of deciphering graphemes and phonemes, since it is related to the multiple forms of literacy and to the production of speech genres in the contemporary societies. Thus, the aim is to investigate the perception of parents and health and education professionals on the schooling performance of children who use the cochlear implant. Four mothers, three teachers from public schools and a speech therapist, which was responsible for taking care of the children with the implants, took part in the present study. The children's ages ranged from 6 to 10, they were enrolled at regular schools and attended a doctor at an educational institution for deaf people. Semi-structured interviews with the participants were taken in order to obtain their opinions on sign language and the children's performance. It is a qualitative research that uses Content Analysis for the interpretation of collected data. The research has shown that parents and professionals, influenced by health ground, conceive the child user of the prothesis based on a clinic view, considering him/her as listener subjects, at an attempt of deafness extinguishing. Thus, school difficulties that could be minimized by a glance of a subject constituted by difference are considered inherent to deafness. This way we conclude that the change of view on deafness and sign language becomes important for the overcoming of prejudice related to this language and to the deaf community, as well as it allows users of the prothesis a better development at school / Mestrado / Interdisciplinaridade e Reabilitação / Mestra em Saúde, Interdisciplinaridade e Reabilitação

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.

Cochlear implants are a recognised treatment for severe and profound hearing losses, and can greatly improve speech discrimination in a quiet listening environment. However, poor specificity of neural excitation resulting from wide current spread within the cochlea leads to inadequate complex pitch perception, affecting speech discrimination in noisy environments and music perception. Tripolar is a stimulation mode with a greater degree of current focusing than the monopolar mode currently used in the clinic. The overall aim of the experiments in this thesis was to evaluate the potential of tripolar stimulation mode to improve complex pitch perception compared to monopolar stimulation mode in a group of Advanced Bionics cochlear implant listeners. First, the place specificity of tripolar and monopolar stimulation was compared using a psychophysical forward masking task with a dual-electrode masking stimulus to limit off-site listening. An overall improvement in the place specificity of tripolar compared to monopolar stimulation indicated that current focusing may provide more independent transmission of temporal information from different electrode places. This conclusion was unaffected by the degree of residual masking which, although measurable, was similar in both modes. Second, the effect of current focusing on delivery of independent temporal patterns was evaluated, specifically whether transmission of fine temporal information about interpulse intervals was improved using tripolar over monopolar stimulation. No advantage was found for current focusing in the delivery of temporal patterns on either a single electrode site, or across-electrodes. Third, the effect of mode on complex pitch perception was investigated by comparing a tripolar with a monopolar listening program. Results showed no improvement in pitch ranking ability from current focusing using sung vowel stimuli, and further suggested that a cue related to the centroid of excitation was providing a stronger cue to pitch than the temporal modulations available in both modes in this group. In conclusion, tripolar stimulation, on average, improved place specificity using forward masking, but not temporal cues to pitch using the methods chosen to evaluate this. Furthermore, current focusing did not improve the ability to rank sung vowels based on pitch over monopolar mode. Current focusing, therefore, was not found to enhance perception of complex harmonic pitch in this group. However, a degree of inter-participant variability in amount of benefit from current focusing observed in this series of experiments suggests that it may be useful for some cochlear implant listeners if a predictive measure of benefit were developed.

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.