Objective: This present study aimed to evaluate whether cochlear implant (CI) surgery influences the patients’ postoperative work ability. Additionally, the influence of demographic, audiometric, and psychometric parameters on postoperative work ability was determined. This study also explored the contrasting relationship between the postoperative work ability of employed as well as pensioned patients and the above-mentioned influencing factors. Methods: In this prospective study, 79 patients were included. They responded to questionnaires and audiometric testing preoperatively and twelve months postoperatively. Work ability was evaluated with the Work Ability Index (WAI). Disease-specific health-related Quality of Life (HRQoL) was determined using the Nijmegen Cochlear Implant Questionnaire (NCIQ) and generic HRQoL was analyzed with the World Health Organization Quality of Life: Best Available Techniques Reference (WHO-QOL-BREF). Mental disorders (depression, somatoform disorder, stress) were assessed with the German Patient Health Questionnaire (PHQ-D). The patient’s personality was reviewed with the Big Five Personality Test (B5T). Speech comprehension was evaluated in noise with the Oldenburger sentence test. Results: The patients’ postoperative work ability was not significantly (p>0.05) affected by CI-treatment. However, employed patients displayed significantly (p<0.001) higher postoperative work ability than pensioners. The generic HRQoL, personality, and mental disorders were unaffected by CI-treatment (p>0.05). Instead, speech comprehension and disease-specific HRQoL displayed significant improvements (p<0.001) postoperatively. As shown through multiple regression analysis, age (ß = -0.275*, p<0.05) and the subdomain physical health of the patient’s generic HRQoL (ß = 0.471**, p<0.01) were significantly associated with postoperative WAI outcome scores. The influencing factors stress (ß = - 0.744**, p<0.01) and age (ß = -0.571*, p<0.05) displayed significant correlations with the postoperative work ability of employed patients. In contrast, the subdomain physical health of the patient’s generic HRQoL (ß = 0.805**, p<0.01) was significantly associated with the postoperative work ability of pensioned patients. Conclusions: Perceived stress, age, and physical health are strong predictive parameters for the patient’s postoperative work ability. The results indicate that preliminary multiprofessional and individualized counseling, the promotion of work accommodations, and physical activity during CI-(re)habilitation may contribute positively to the patient’s postoperative work ability. Additionally, a differentiated therapeutic approach between employed and pensioned CI- recipients is fundamental to bringing about better WAI outcome scores post-implant for each subgroup.

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

La musique et la parole possèdent toutes deux un degré d’organisation temporelle i.e. de régularité dans le temps. Les stimuli de nature rythmique ont la particularité de pouvoir être anticipés par le cerveau et des études en linguistique et neurosciences ont montré que plus le cerveau est capable d’anticiper les évènements auditifs, meilleure est la qualité du traitement des stimuli. Les enfants sourds, bien que bénéficiant d’un input auditif de plus en plus précis grâce aux implants cochléaires et d’une prise en charge précoce, n’atteignent pas des niveaux de langage homogènes et souffrent de difficultés de perception en milieux bruyants ou lors de conversations. La situation conversationnelle présente un contexte complexe, nécessitant l’activation de la voie audio-motrice pour anticiper et s’adapter aux variations de la parole de son interlocuteur notamment au niveau temporel. Dans ce travail de thèse, nous avons cherché à analyser, grâce à des mesures électrophysiologiques et comportementales, si un entrainement rythmique actif de 30 minutes, pouvait avoir un effet sur les capacités de perception et d’accommodation temporelles de l’enfant sourd dans une tâche de dénomination en alternance avec un partenaire virtuel. Nous avons également testé les capacités rythmiques de ces enfants à différents niveaux de complexités. Les résultats montrent que les enfants sourds souffrent de difficultés à structurer les événements acoustiques selon différent niveaux de hiérarchie mais qu’un entrainement rythmique de 30 minutes versus une stimulation auditive, permet d’améliorer leurs compétences de perception et de production temporelles de la parole dans une situation d’interaction. / Music and speech both possess a certain degree of temporal organization i.e. a certain degree of regularity across time. Studies in linguistics and neuroscience have shown that the brain can extract regularities and use them to anticipate the forthcoming stimuli. It is furthermore established that the better the brain is able to anticipate auditory events, the better the quality of stimulus processing. Deaf children benefit from more and more precise auditory inputs due to advances in cochlear implants development, together with early rehabilitation interventions. However, a great majority of them do not achieve consistent language levels and have strong difficulties in noisy environments or conversations. The conversational situation presents a complex context, requiring the activation of the audio-motor path to anticipate and adapt to the variations of the speech of its interlocutor notably at the temporal level. In this thesis work, we have investigated the temporal perception and accommodation capacities of deaf children in a naming task alternating with a virtual partner, at both behavioral and electrophysiological levels. We have also tested whether an active rhythmic training lasting 30 minutes, could enhance these conversational abilities. Then, we have investigated the rhythmic abilities of these children at different levels complexities. The results show that deaf children suffer from difficulties in structuring acoustic events according to different levels of hierarchy but that a rhythmic training of 30 minutes versus an auditory stimulation, makes it possible to improve their skills of temporal perception and production of speech in a situation of interaction.

Cochlear implants (CIs) and auditory brainstem implants (ABIs) are prostheses for hearing used in patients with profound hearing impairment. A CI requires an operational cochlear nerve to function in contrast to an ABI. ABIs were initially designed for adult patients with neurofibromatosis type 2 (NF2), suffering from bilateral vestibular schwannomas. Now ABIs are also used for patients, both adults and children, with congenital cochlear malformations, cochlear nerve hypoplasia/aplasia, and cochlear ossification. The aims of this thesis are to evaluate hearing outcome in patients implanted with a CI after long-term deafness. An extended period of deafness has earlier been considered as a contraindication for CI surgery. Further, we analyzed if electrically evoked auditory brainstem responses (eABRs) can predict CI outcome and pinpoint the optimal selection of treatment such as CI or ABI. We also disclose our experiences from ABI surgery in Uppsala, such as implant use, hearing outcome, complications, and satisfaction among the patients. Finally, we evaluated the results and benefits of ABIs in non-NF2 pediatric patients. Results show that patients with an extended deafness period and durations over 20 years can achieve speech understanding and benefit from CIs. Patients with long-term deafness and limited years of hearing before deafness did not perform as well as those with shorter deafness duration and longer hearing experience did. eABR seems to have a definite role in the diagnostic armamentarium, to better consider alternative surgical strategies such as ABI. No eABR waveform predicted a poor CI outcome. There was no correlation between speech perception and eABR waveform latencies or eABR waveform quality. A majority of the ABI patients used their ABIs and benefited from them for at least some period. ABI assisted voice control in a majority of the full-time users and they reported improved understanding of speech with the implant switched on. No severe complications from ABI surgery or ABI stimulation were noted. The patients were generally satisfied, even if their hearing remained very limited. All pediatric patients but one used the implant continuously and benefited from it.

BACKGROUND: Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual's cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population. METHODS: Over 3800 articles related to cochlear implants, cognition, and older adults were reviewed. Inclusion criteria were as follows: (1) study population including adults > 65 years, (2) intervention with cochlear implantation, and (3) cognition as the primary outcome measure of implantation. RESULTS: Out of 3,886 studies selected, 3 met inclusion criteria for the review. CONCLUSIONS: While many publications have shown that cochlear implants improve speech perception, social functioning, and overall quality of life, we found no studies in the English literature that have prospectively evaluated changes in cognitive function after implantation with modern cochlear implants in older adults. The state of the current literature reveals a need for further clinical research on the impact of cochlear implantation on cognition in older adults.

Η παρούσα εργασία μελετά την επίδραση του κοχλιακού εμφυτεύματος στην κοινωνική και ακαδημαϊκή πρόοδο των κωφών μαθητών με κοχλιακό εμφύτευμα πρωτοβάθμιας εκπαίδευσης σύμφωνα με τις απόψεις των εκπαιδευτικών τους. Στην έρευνα συμμετείχαν 24 παιδιά ηλικίας 2 έως 14 ετών με κοχλιακό εμφύτευμα τα οποία φοιτούσαν σε ειδικά σχολεία και αξιολογήθηκαν από τους εκπαιδευτικούς τους στον τομέα της επικοινωνίας, της ακαδημαϊκής και κοινωνικής προόδου συμπληρώνοντας ένα ερωτηματολόγιο για το κάθε παιδί. Τα αποτελέσματα έδειξαν ότι οι μαθητές αυτοί είχαν αναπτύξει ορισμένες επικοινωνιακές δεξιότητες, η κοινωνική τους πρόοδος ήταν κατάλληλη για την ηλικία τους και είχαν διαμορφώσει ταυτότητα κωφού ατόμου, αλλά σε ακαδημαϊκό επίπεδο υπολείπονταν σε σχέση με τους ακούοντες συνομηλίκους τους. Σημαντική επίδραση στους παραπάνω τομείς φάνηκε να έχει η ύπαρξη επιπρόσθετων αναπηριών, η ηλικία εμφύτευσης, ο χρόνος χρήσης του εμφυτεύματος και η μέθοδος επικοινωνίας του σχολείου. Τέλος, γίνεται μια προσπάθεια να αξιοποιηθούν τα αποτελέσματα αυτά και να ληφθούν υπόψη από τους εκπαιδευτικούς για να βελτιωθεί η εκπαίδευση των κωφών μαθητών με κοχλιακό εμφύτευμα. / This paper examines the social and academic outcomes of deaf students with cochlear implants from the perspectives of their teachers. The participants were 24 children aged from 2 to 14 years old who attended special primary schools. Their teachers completed a survey for each child with a cochlear implant about their communication, academic and social outcomes. The results revealed that the students with cochlear implants seemed to show improvements in the area of communication, they also had age-appropriate social skills, while they developed an identity as a deaf person, but they lagged behind their hearing peers in academic achievement. Significant factors influencing the social, and academic progress of these students seemed to be the additional disabilities, the age of implantation, the usage of cochlear implant and the communication approach used in special schools. Finally, implications for teachers working with deaf students with cochlear implants are discussed in order to improve the education of the deaf.

The diploma thesis deals with the problem of phonemic differentiation in preschool children. The introductory part is focused on the specifics of preschool age, ontogenesis of speech and characterization of phonemic hearing. The aim of this thesis is to determine the level of phonemic differentiation in children with cochlear implant and children without hearing impairment. The results were obtained using a standardized test battery Evaluation of Phonemic Hearing in Preschool Children by authors Škodová, Mischek and Moravcová from 1995, which is created for this issue. Subsequently, the results of both groups were compared and individual differences in performance between children with cochlear implant and children without hearing impairment were examined. Research has shown that better results in phonemic distinction amounted children without hearing impairment, although the difference in success rate between the two groups was not significant. The main benefit of this work is the fact that the ability of phonemic differentiation is important in children with cochlear implant and its development should be part of rehabilitation care. KEYWORDS phonemic hearing, preschool age, cochlear implant, hearing impairment

INTRODUÇÃO: A surdez profunda é uma deficiência que afeta a personalidade, o relacionamento e todo o estilo de vida do paciente e quando se trata de adolescentes com surdez profunda pré-lingual, esses conflitos biopsicossociais são exacerbados, necessitando de cautela na avaliação e escolha destes candidatos ao implante coclear. OBJETIVO: Avaliar a percepção de fala em adolescentes portadores de surdez pré-lingual do tipo neurossensorial severa a profunda bilateral com implante coclear. FORMA DE ESTUDO: Prospectivo. CASUÍSTICA E MÉTODO: O estudo foi desenvolvido no Ambulatório de Implante Coclear do grupo de Otologia do Hospital das Clinicas da Faculdade de Medicina da USP. 25 indivíduos com surdez pré-lingual, sensório-neural, de grau severo ou profundo, que foram submetidos ao implante coclear na adolescência, definida entre 10 a 17 anos e 11 meses, passaram por testes de percepção de fala pré-implante coclear e 2 anos após a ativação do dispositivo. Para a comparação e análise utilizamos os resultados dos testes de four choice, reconhecimento de vogais e reconhecimento de sentenças em conjunto fechado e aberto. RESULTADOS: Devido a assimetria na distribuição dos dados, os mesmos estão sumarizados como mediana e intervalo interquartis (percentil 25 percentil 75). Houve variação estatisticamente significante entre as avaliações pré e pós- implante para todos os testes analisados. CONCLUSÃO: Todos os pacientes, embora com resultados heterogêneos, obtiveram melhora estatística em todos os testes de fala que foram aplicados / INTRODUCTION: The profound deafness is a disability that affects personality, relationships and lifestyle of the patient and when it comes to teenagers with profound hearing loss before language, these conflicts are exacerbated biopsychosocial, requiring careful evaluation and choice of candidates implant. OBJECTIVE: To evaluate speech perception in Cochlear Implants for adolescents with severe to profound prelinguistic deafness. STUDY DESIGN: Prospective. MATERIAL AND MÉTHOD: The study was conducted at the Ambulatório de Implante Coclear do grupo de Otologia do Hospital das Clinicas da Faculdade de Medicina da USP. 25 individuals with severe or profound prelinguistic deafness who underwent cochlear implantation in adolescence, set between 10 to 17 years and 11 months, passed tests of speech perception pre-implant and 2 years after activation of the device. For comparison and analysis were used the results of tests of four choice, recognition of vowels and recognition of sentences in closed set and open set. RESULTS: Because of asymmetry in the distribution of data, they are summarized as median and interquartile range (25th percentile - 75th percentile). The results have very significant differences between pre-and post-implant for all tests analyzed. CONCLUSION: All patients, although with mixed results, achieved statistical improvement in all speech tests that were applied

A melhora na percepção da fala dos usuários de implante coclear (IC) ao longo do tempo está relacionada, entre outros fatores, ao avanço tecnológico das estratégias de processamento do sinal. Deste modo, o objetivo deste trabalho foi avaliar o desempenho de percepção da fala em crianças usuárias de IC, utilizando duas diferentes estratégias de processamento do sinal do sistema HiResolution da Advanced Bionics. Para tanto, participaram deste estudo 11 crianças com deficiência auditiva pré-lingual, usuárias do componente interno HiRes 90K e processador de fala modelo platinum, e que apresentavam habilidade auditiva de reconhecimento em conjunto aberto. Foi realizada a avaliação intra-sujeito em três momentos, de acordo com a estratégia de fala utilizada. O desempenho da linha de base foi avaliado com a estratégia HiResolution 120 (HiRes 120) e posteriormente, foi realizada a conversão da estratégia para a HiResolution (HiRes). Após três meses de uso da estratégia HiRes, os participantes foram avaliados e realizada a conversão da estratégia para a HiRes 120. Após três meses de uso da HiRes 120, os participantes foram reavaliados. Em todas as avaliações, os participantes foram submetidos à pesquisa dos limiares audiométricos em campo livre, avaliação da percepção da fala por meio do teste Hearing in Noise (HINT), no silêncio e na presença de ruído competitivo e, avaliação dos benefícios proporcionados pelo uso do IC em situações cotidianas, por meio do questionário Parents\' Evaluation of Aural/oral Performance of Children (PEACH). Os resultados demonstraram que não houve diferença dos limiares audiométricos em campo livre, do desempenho auditivo no silêncio e do benefício do IC em situações de vida diária, em função da estratégia de processamento de sinal utilizada. Houve tendência de melhor desempenho auditivo na situação de ruído com o uso da estratégia de processamento de sinal HiRes 120, embora, tal resultado não tenha sido estatisticamente significante. Essa tendência indica que a representação espectral do sinal acústico de forma mais detalhada proporcionada pela HiRes 120 pode auxiliar no desempenho auditivo de crianças usuárias de IC em situações de ruído, contudo, essa característica da estratégia de processamento de sinal não influenciou o desempenho auditivo nas situações de silêncio. Reforça-se a importância da observação clínica e avaliação de percepção de fala com ruído na seleção da estratégia de processamento de sinal, a fim de otimizar o desempenho auditivo dos usuários de IC. / Improvements in speech perception with cochlear implant (CI) over the years is related, among others factors, to the technological advance of the sound processing strategy. The purpose of the present study was to investigate speech perception performance in CI children, with two different Advanced Bionics sound processing strategy. Subjects were 11 prelingually deafened children implanted with the HiRes 90K cochlear implant and used a bodyworn platinum sound processor. All subjects showed evidence of open-set speech recognition. A within-subjects design was used to compare performance with standard HiRes and HiRes 120. Baseline performance was assessed with HiResolution 120 (HiRes 120). Subjects then were fitted with HiResolution (HiRes) and returned for re-evaluation after three months of use. After three months of HiRes experience, subjects were refitted with HiRes 120 and returned three months later for reassessment. During test sessions, subject\'s performance was evaluated by warble-tone sound-field thresholds, the Brazilian Hearing in Noise test (HINT) in quiet and in noise and Parents\' Evaluation of Aural/oral Performance of Children questionnaire (PEACH). The detection thresholds, the speech perception in quiet and the CI benefit in daily life were similar for both sound processing strategy. There was a trend toward better hearing performance in noise with HiRes 120, although this result was not statistically significant. This trend indicates that more precise spectral representation of the acoustic signal provided by the HiRes 120 can result in an improvement in the speech perception in noise by CI children. However, this characteristic did not influence the auditory performance in quiet. It reinforces the importance of clinical observation and speech perception in noise assessment in the sound processing strategy selection, in order to optimize the auditory performance of CI users.

Nos últimos anos houve um grande avanço na tecnologia de processamento de sinal do Implante Coclear (IC), mas ainda há uma limitação a ser superada que é a percepção de fala no ruído. Este dispositivo passou a ser indicado para habilitação e reabilitação de um grupo com características audiológicas e eletrofisiológica específica, denominada de Desordem do Espectro da Neuropatia Auditiva (DENA). As características inerentes a este tipo de alteração auditiva podem determinar dificuldades adicionais para o desenvolvimento de habilidades auditivas mais complexas, tal como a percepção dos sons da fala na presença de ruído. Deste modo, este estudo tem como objetivo investigar a percepção de fala na presença de ruído em crianças portadoras de deficiência auditiva neurossensorial com DENA e usuárias de IC e comparar com um grupo de crianças portadoras de deficiência auditiva sensorial usuárias de IC. Trata-se de um estudo realizado no Centro de Pesquisas Audiológicas (CPA) do Hospital de Anomalias Craniofaciais da Universidade de São Paulo na cidade de Bauru (HRAC/ USP). Para a realização da avaliação da percepção de fala no ruído foi utilizado o Teste HINT / BRASIL (Hearing in Noise Test versão em português do Brasil), proposto por NILSSON et al. (1994) e adaptado para a língua portuguesa por BEVILACQUA et al. (2008). A amostra inicial foi formada por 48 crianças com DENA, após os critérios de inclusão 14 crianças com DENA fizeram para do grupo experimental e 12 crianças com deficiência auditiva neurossensorial do grupo controle. Não foram observados resultados estatisticamente significantes para os dois grupos com relação aos testes de percepção de fala no ruído, com relação às habilidades auditivas e de linguagem foi possível observar evolução das habilidades com o tempo de uso para os dois grupos. Pode-se concluir que o IC é indicado para o tratamento das crianças com DENA e estas se comportam de modo bem similar às crianças com deficiência auditiva neurossensorial. / In recent years, there has been a major breakthrough in signal processing technology of cochlear implant (CI), but there is a limitation to be overcome, which is the perception of speech in noise. This device is now indicated for habilitation and rehabilitation of a group with specific electrophysiological and audiological features, called Auditory Neuropathy Spectrum Disorder (ANSD). The characteristics inherent to this type of hearing impairment may determine additional difficulties for developing more complex listening skills, such as the perception of speech sounds in noise. Thus, this study aims to investigate the speech perception in noise in children with sensorineural hearing loss with ANSD and users of CI, and compare with a group of children with sensorineural hearing loss CI users. It is a study in Centro de Pesquisas Audiológicas (CPA), at the Hospital de Anomalias Craniofaciais da Universidade de São Paulo - Bauru (HRAC/ USP). To perform the evaluation of the speech perception in noise test was used HINT / BRAZIL (Hearing in Noise Test - Portuguese version of Brazil), proposed by Nilsson et al. (1994) and adapted into Portuguese by BEVILACQUA et al. (2008). The initial sample was formed consisting of 48 children with ANSD, after the inclusion criteria, 14 children with ANSD made for the experimental group and 12 children with sensorineural hearing loss in the control group. There was no statistically significant results for the two groups with respect to test speech perception in noise, compared with auditory and language skills was possible to observe the evolution of skills with time of use for both groups. It can be concluded that the CI is indicated for the treatment of children with ANSD, and they behave very similarly to children with sensorineural hearing loss.