Thesis (MEdPsych)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Cochlear implantation is a surgical procedure, where an electronic device is implanted into the inner ear to give people, with severe to profound hearing loss, access to sound and the spoken word. In spite of a wealth of international research, local studies on cochlear implants, and more specifically research concerning the experience of adolescents with the device, are limited. Adolescence, as a development stage, is also a very difficult phase, which is marked as a crisis period in the developement process towards maturity, as well as a continued selfconsciousness and worry about how others perceive them. It may therefore be deduced that the use of the cochlear implants could cause this to be an intense experience during this developmental phase and that served as motivation to conduct my research specifically on adolescents. This generic qualitative study had a dual purpose: Firstly it endeavoured, through explorative and descriptive research, to determine the experience of adolescents with cochlear implants in school and also in other social circumstances. That sparked off a better understanding and insight, concerning the experience of adolescents with these devices. Secondly, the purpose of this study was to enquire into and describe the experience of adolescents with their support systems. This in turn lead to the identification of support systems, but also the lack of such systems in the personal-, social- and learning environment. An interpretative qualitative study was designed to explain the experience of adolescents with cochlear implants. The Bronfenbrenner Bioecological Model of human development was used as framework to discuss the complex experience of adolescents with cochlear implants. The Asset based approach, as well as Outcomes of well-being founded on the principles of Positive Psychology, was also used as theoretical and conceptual framework to explain existing assets, support systems and management strategies. Four adolescents with cochlear implants and their parents took part in the the study. In-depth data was generated through alternative methods of interviewing, which were adjusted according to the unique requirements of each participant as well as the level of their loss of hearing. Interactive activities, that targeted the interest of participants, were adapted to their language ability and visually interactive were also used. Interviews were constantly supported by thorough field notes. Raw data was then transcribed and processed by using the constant comparative method. The themes, that were constructed from these, seem to indicate that the experieces of these adolescents are unique and are influenced by several intrapersonal and external factors. The exploration of these factors revealed the following: • Adolescents with cochlear implants sometimes experience social exclusion at school as well as amongst their friends. • Various obstacles lead up to social exclusion: Firstly, adolescents with cochlear implants are not able to follow group conversations and background interference further hampers their limited hearing. Secondly, they experience a lack of effort from their peers and teachers to include them in conversations, because the latter have a wrong perception that cochlear implants restore deaf people's hearing 100%. • Participants often experience powerlessness concerning their deafness and are selfconscious due to the visibility of the cochlear implant. • Scholastic advancement is further hampered by the ignorence of teachers, concerning the needs of learners with cochlear implants, and also due to language impairments caused by their deafness. • Personal strengths, like a positive outlook, assertiveness and perseverance, along with coping strategies, like extreme effort and mediation by parents at school, for their adolescents with cochlear implants, improve the resilience of this group to handle the above mentioned obstacles. • Other children with cochlear implants, the families of participants and school are considered to be the primary support systems. Suggestions, concerning the development and improvement of the support systems of adolescents with cochlear implants, were made on the basis of the data results. Due to the limited range of this study, further research suggestions have been made, that are supported by the knowledge gained in this study about the experience of adolescents with cochlear implants. / AFRIKAANSE OPSOMMING: Kogleêre inplantering is 'n chirurgiese metode, waar 'n elektroniese toestel in die binneoor inplanteer word om mense met erge tot uitermatige gehoorverlies, toegang tot klanke en gesproke taal te gee. Ten spyte van 'n rykdom internasionale navorsing, is nasionale studies oor kogleêre inplantings, en meer spesifiek rakende adolessente se ervaring daarmee, beperk. Adolessensie, as ontwikkelingstadium, is ook 'n moeilike fase wat gekenmerk word as 'n krisistydperk in die ontwikkelingsproses tot volwassenheid, asook volgehoue selfbewussyn en kommer oor hoe ander hul ervaar. Die afleiding is dus dat die gebruik van kogleêre inplantings tydens hierdie ontwikkelingsfase, aanleiding kan gee tot 'n intense belewing daarvan en het dit daarom ook as motivering gedien om my ondersoek spesifiek op adolessente te rig. Die doel van hierdie generies kwalitatiewe studie was tweeledig: Eerstens het dit gepoog om, deur verkennende en beskrywende navorsing, die ervaring van vier adolessente met kogleêre inplantings in die skool, en ander sosiale hoedanighede, te bepaal. Dít het aanleiding gegee tot 'n ruimer begrip en insig aangaande adolessente se belewing met hierdie apparate. Tweedens het die studie ten doel gehad om die adolessente se belewing van hul ondersteuningsisteme te ondersoek en te beskryf. Dit het voorts gelei tot die identifisering van ondersteuningsisteme, maar ook die leemtes daarvan in hul persoonlike-, sosiale- en leeromgewing. 'n Interpretivistiese, kwalitatiewe studie is ontwerp om die ervarings van adolessente met kogleêre inplantings te verduidelik. Bronfenbrenner se Bioekologiese Model van menslike ontwikkeling is as raamwerk gebruik om die kompleksiteit van adolessente met kogleêre inplantings se ervaring te bespreek. Die Bategebaseerde benadering, sowel as Uitkomste van welwees ("well-being") wat berus op die beginsels van die Positiewe Sielkunde, is verder as teoretiese en konseptuele raamwerk gebruik om bestaande bates, ondersteuningsisteme en hanteringstrategieë te verduidelik. Vier adolessente met kogleêre inplantings en hul ouers het aan die studie deelgeneem. Data is genereer deur alternatiewe metodes van onderhoudsvoering, wat aangepas is volgens elke deelnemer se unieke behoeftes en verskillende grade van gehoorverlies. Daar is ook gebruik gemaak van interaktiewe aktiwiteite, wat op deelnemers se belangstellings gerig was, volgens hul taalbekwaamheid aangepas is en ook visueel ondersteunend was. Onderhoude is deurlopend met deeglike veldnotas ondersteun. Rou data is getranskribeer en deur middel van die konstante vergelykende metode verwerk. Die temas, wat hieruit gekonstrueer is, dui daarop dat hierdie adolessente se ervarings uniek blyk te wees en deur verskeie intrapersoonlike en eksterne faktore beïnvloed word. Die verkenning van hierdie faktore het die volgende aan die lig gebring: • Adolessente met kogleêre inplantings beleef soms sosiale uitsluiting in die skool, asook tussen hul vriende. • Verskeie hindernisse gee aanleiding tot sosiale uitsluiting: Eerstens kan adolessente met kogleêre inplantings nie gesprekke in groepe volg nie en word hul gehoor verder deur agtergrondgeraas belemmer. Tweedens is hul belewing dat hul vriende en onderwysers nie aanpassings maak om hul by gesprekke te betrek nie, omdat hulle oor 'n wanpersepsie beskik dat kogleêre inplantings mense wat doof is se gehoor 100% herstel. • Deelnemers beleef dikwels magteloosheid oor hul doofheid en is selfbewus oor die sigbaarheid van die kogleêre inplanting. • Skolastiese vordering word belemmer deur onderwysers se onkunde aangaande die behoeftes van leerders met kogleêre inplantings, maar ook as gevolg van taalagterstande, wat deur hul doofheid veroorsaak word. • Persoonlike sterktes, soos 'n positiewe lewensingesteldheid, beslistheid en deursettingsvermoë, asook hanteringstrategieë, soos uiterse harde werk en voorspraak, wat ouers vir hul adolessente met kogleêre inplantings by die skool maak, bevorder veerkragtigheid ("resilience") by hierdie groep adolessente om bogenoemde hindernisse te hanteer. • Ander kinders met kogleêre inplantings, adolessente deelnemers se gesinne en ook die skool word as primêre ondersteuningsisteme beskou. Aanbevelings rakende die verbetering van adolessente met kogleêre inplantings se ondersteuningsisteme is op grond van die bevindinge uit die data gemaak. Vanweë die beperkte omvang van hierdie studie is daar ook, na aanleiding van verworwe kennis aangaande die ervarings van adolessente met kogleêre inplantings, verdere navorsingsvoorstelle gemaak.

The impact of the diagnosis and the reality of being hearing impaired could trigger uncomfortable feelings at different times in the client's life. With the cochlear implant, these feelings will still be a reality, as the implant does not heal the hearing impairment. Psychological interventions could assist the client during this healing process. The process of cochlear implants could also bring other challenges into the client's life. Expectations of quick healing play a major role and should be addressed throughout the process of implantation and rehabilitation. This is another opportunity for the psychologist to intervene. This research shows that the role of the psychologist could be expanded not only to evaluate but also to bring about change. The treatment model gives a logical and workable explanation of how and where the psychologist may intervene in the process of cochlear implantation. This model was tested and adapted by the cochlear implant team at the University of Pretoria over a period of ten years. The model may be used as a template for new teams. Intervening as described in the model presents the opportunity to address various different needs as they occur. The qualitative research design proved to be a fitting method to explore the experiences of the participants from their own viewpoints. The qualitative research is also congruent with a systemic perspective and emphasises social context, multiple perspectives, complexity, recursion and holism. This study aims to develop a complementary psychological treatment programme and create awareness within professionals working with hearing impairment of the complexity of systems. The study shows that one can only understand the behaviour of any given system by tracking changes that occur within that system and its subsystems and by tracking changes between that system and the larger whole. In this study three different therapeutic interventions are used on three different case studies, two children from different age groups and an adult, to accommodate the multiple realities of the different systems. The aim of the study with cochlear implantees and their families is to stimulate new leads and avenues of enquiry that may be used as a basis for further research. / Psychology / Thesis (D.Litt. et Phil. (Psychology))

Thesis (MSL and HT (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--Stellenbosch University, 2008. / This study aims to describe the speech processing skills of three children ages 6;0, 6;10 and 8; 10, with cochlear implants. A psycholinguistic framework was used to profile each child’s strengths and weaknesses, using a single case study approach. Each child’s speech processing skills are described based on detailed psycholinguistically-orientated assessments. In addition, retrospective data from 1-2 years post-implantation were examined in the light of the psycholinguistic framework in order to describe each child’s development over time and in relation to time of implantation. Results showed each child to have a unique profile of strengths and weaknesses, and widely varying outcomes in terms of speech processing even though all three children had the same initial difficulty (congenital bilateral hearing loss). Links between speech processing and other aspects of development as well as contextual factors are discussed in relation to outcomes for each child. The case studies contribute to knowledge of speech processing skills in children with cochlear implants, and have clinical implications for those who work with children with cochlear implants and their families.

<p>Hearing loss afflicts as many as 10\% of our population.Fortunately, technologies designed to alleviate the effects ofhearing loss are improving rapidly, including cochlear implantsand the increasing computing power of digital hearing aids. Thisthesis focuses on theoretically sound methods for improvinghearing aid technology. The main contributions are documented inthree research articles, which treat two separate topics:modelling of human speech recognition (Papers A and B) andoptimization of diagnostic methods for hearing loss (Paper C).Papers A and B present a hidden Markov model-based framework forsimulating speech recognition in noisy conditions using auditorymodels and signal detection theory. In Paper A, a model of normaland impaired hearing is employed, in which a subject's pure-tonehearing thresholds are used to adapt the model to the individual.In Paper B, the framework is modified to simulate hearing with acochlear implant (CI). Two models of hearing with CI arepresented: a simple, functional model and a biologically inspiredmodel. The models are adapted to the individual CI user bysimulating a spectral discrimination test. The framework canestimate speech recognition ability for a given hearing impairmentor cochlear implant user. This estimate could potentially be usedto optimize hearing aid settings.Paper C presents a novel method for sequentially choosing thesound level and frequency for pure-tone audiometry. A Gaussianmixture model (GMM) is used to represent the probabilitydistribution of hearing thresholds at 8 frequencies. The GMM isfitted to over 100,000 hearing thresholds from a clinicaldatabase. After each response, the GMM is updated using Bayesianinference. The sound level and frequency are chosen so as tomaximize a predefined objective function, such as the entropy ofthe probability distribution. It is found through simulation thatan average of 48 tone presentations are needed to achieve the sameaccuracy as the standard method, which requires an average of 135presentations.</p>

No description available.

Introdução: Apesar do usuário de implante coclear (IC) apresentar limiares tonais audiométricos compatíveis com os critérios exigidos para pilotos à obtenção do certificado médico aeronáutico (CMA), a inteligibilidade da fala via rádio no ambiente de ruído da aeronave pode não ser suficiente para uma boa comunicação. As regras de aptidão para o CMA de pilotos de 1ª classe constam no manual da Organização Internacional da Aviação Civil (ICAO): devem escutar em cada um dos ouvidos separadamente, até 35 dB NA nas frequências de 500, 1 000 e 2 000 Hz, e até 50 dB NA em 3 000 Hz. Pilotos também podem ser aprovados em teste de inteligibilidade no ruído com exigência mínima de acerto de 80% das palavras foneticamente equilibradas. Objetivos: (1) avaliar se implantados, que atingem limiares tonais exigidos pela ICAO, tem inteligibilidade da fala suficiente para comunicação via rádio, na situação de ruído da cabine do helicóptero; (2) avaliar se recursos de atenuação de ruído otimizam a inteligibilidade da fala de usuários de IC; (3) avaliar se a comunicação pelo rádio prejudica a inteligibilidade de usuários de IC. Métodos: Foi avaliada a performance em testes de inteligibilidade de 12 usuários de IC com surdez pós-lingual, que preencheram os critérios audiométricos da ICAO, e de 3 pilotos normo-ouvintes (controles). Realizamos testes com sentenças, números e dissílabos em diferentes situações: no silêncio da cabine audiométrica, no helicóptero desligado (testes via rádio), no helicóptero ligado sem e com ativação do sistema antirruído do fone e no helicóptero ligado através da conexão direta do processador de fala do IC ao sistema de rádio da aeronave. Resultados: Observamos diferenças significativas para todos os testes realizados quando comparamos as respostas no silêncio e na situação de ruído com o helicóptero ligado. Ao reduzirmos a exposição de ruído, ativando o sistema antirruído do fone, observamos melhora significativa apenas para as frases. Já quando reduzimos ao máximo a exposição ao ruído pela conexão direta via cabo entre o implante e o sistema de rádio da aeronave, houve melhora significativa nos resultados para números e dissílabos. Houve piora significativa nos testes com dissílabos na situação do helicóptero desligado (rádio) em relação à cabine audiométrica. Conclusões: Os usuários de IC não alcançaram níveis de inteligibilidade de fala compatíveis com os requisitos auditivos para pilotos da aviação civil nos testes realizados no helicóptero. Os recursos de atenuação de ruído propostos auxiliaram na inteligibilidade de fala dos usuários de IC. A comunicação pelo rádio interferiu de forma significativa na inteligibilidade dos usuários de IC / Introduction: Although the cochlear implant (CI) user meets audiometric thresholds for the criteria required for pilots, the speech recognition through the radio in the aircraft noise condition may not be sufficient for good communication. Rules for 1st class pilots are given in the International Civil Aviation Organization (ICAO) manual: they must hear in each ear separately, up to 35 dB NA at 500, 1 000 and 2 000 Hz, and up to 50 dB NA at 3 000 Hz. Pilots can also be fit if they understand at least 80% of the phonetically balanced words against a background noise. Objectives: (1) to assess if CI users, who reach thresholds required by the ICAO also achieve speech recognition levels good for radio communication in the noise situation of the helicopter cockpit; (2) to evaluate if noise attenuation features optimize the speech recognition of CI users; (3) evaluate whether radio communication affects the speech recognition of CI users. Methods: We evaluated the performance of 12 CI users with post-lingual deafness, who met ICAO audiometric criteria, and three normal hearing (control) pilots in intelligibility tests. We performed tests with sentences, numbers and disyllables in different situations: in the quiet (sound proof booth), in the helicopter with the engine off (radio tests), in the helicopter with the engine running, without and with activation of the anti-noise system of the headphones and in the helicopter (engine turned on) through the direct connection of the speech processor of the CI to the aircraft\'s radio system. Results: We observed significant differences for all tests performed when we compared scores in quiet and in the noisy environment of the helicopter with engine turned on. When the noise exposure was reduced by activating the headphones anti-noise system, we observed significant improvement only for the sentences. We found a significant improvement in the results for numbers and disyllables when we reduced the exposure to noise by the direct cable connection between the CI and the aircraft radio system. We also observed a significant worsening in the disyllabic speech perception in the helicopter even with the engine off (quiet).Conclusions: In the helicopter environment, CI subjects did not achieve levels of speech recognition requirements for civil aviation pilots. The proposed noise attenuation features offered improvement for speech recognition of CI users. Radio communication significantly interfered with speech recognition in CI users

Introdução: Apesar do usuário de implante coclear (IC) apresentar limiares tonais audiométricos compatíveis com os critérios exigidos para pilotos à obtenção do certificado médico aeronáutico (CMA), a inteligibilidade da fala via rádio no ambiente de ruído da aeronave pode não ser suficiente para uma boa comunicação. As regras de aptidão para o CMA de pilotos de 1ª classe constam no manual da Organização Internacional da Aviação Civil (ICAO): devem escutar em cada um dos ouvidos separadamente, até 35 dB NA nas frequências de 500, 1 000 e 2 000 Hz, e até 50 dB NA em 3 000 Hz. Pilotos também podem ser aprovados em teste de inteligibilidade no ruído com exigência mínima de acerto de 80% das palavras foneticamente equilibradas. Objetivos: (1) avaliar se implantados, que atingem limiares tonais exigidos pela ICAO, tem inteligibilidade da fala suficiente para comunicação via rádio, na situação de ruído da cabine do helicóptero; (2) avaliar se recursos de atenuação de ruído otimizam a inteligibilidade da fala de usuários de IC; (3) avaliar se a comunicação pelo rádio prejudica a inteligibilidade de usuários de IC. Métodos: Foi avaliada a performance em testes de inteligibilidade de 12 usuários de IC com surdez pós-lingual, que preencheram os critérios audiométricos da ICAO, e de 3 pilotos normo-ouvintes (controles). Realizamos testes com sentenças, números e dissílabos em diferentes situações: no silêncio da cabine audiométrica, no helicóptero desligado (testes via rádio), no helicóptero ligado sem e com ativação do sistema antirruído do fone e no helicóptero ligado através da conexão direta do processador de fala do IC ao sistema de rádio da aeronave. Resultados: Observamos diferenças significativas para todos os testes realizados quando comparamos as respostas no silêncio e na situação de ruído com o helicóptero ligado. Ao reduzirmos a exposição de ruído, ativando o sistema antirruído do fone, observamos melhora significativa apenas para as frases. Já quando reduzimos ao máximo a exposição ao ruído pela conexão direta via cabo entre o implante e o sistema de rádio da aeronave, houve melhora significativa nos resultados para números e dissílabos. Houve piora significativa nos testes com dissílabos na situação do helicóptero desligado (rádio) em relação à cabine audiométrica. Conclusões: Os usuários de IC não alcançaram níveis de inteligibilidade de fala compatíveis com os requisitos auditivos para pilotos da aviação civil nos testes realizados no helicóptero. Os recursos de atenuação de ruído propostos auxiliaram na inteligibilidade de fala dos usuários de IC. A comunicação pelo rádio interferiu de forma significativa na inteligibilidade dos usuários de IC / Introduction: Although the cochlear implant (CI) user meets audiometric thresholds for the criteria required for pilots, the speech recognition through the radio in the aircraft noise condition may not be sufficient for good communication. Rules for 1st class pilots are given in the International Civil Aviation Organization (ICAO) manual: they must hear in each ear separately, up to 35 dB NA at 500, 1 000 and 2 000 Hz, and up to 50 dB NA at 3 000 Hz. Pilots can also be fit if they understand at least 80% of the phonetically balanced words against a background noise. Objectives: (1) to assess if CI users, who reach thresholds required by the ICAO also achieve speech recognition levels good for radio communication in the noise situation of the helicopter cockpit; (2) to evaluate if noise attenuation features optimize the speech recognition of CI users; (3) evaluate whether radio communication affects the speech recognition of CI users. Methods: We evaluated the performance of 12 CI users with post-lingual deafness, who met ICAO audiometric criteria, and three normal hearing (control) pilots in intelligibility tests. We performed tests with sentences, numbers and disyllables in different situations: in the quiet (sound proof booth), in the helicopter with the engine off (radio tests), in the helicopter with the engine running, without and with activation of the anti-noise system of the headphones and in the helicopter (engine turned on) through the direct connection of the speech processor of the CI to the aircraft\'s radio system. Results: We observed significant differences for all tests performed when we compared scores in quiet and in the noisy environment of the helicopter with engine turned on. When the noise exposure was reduced by activating the headphones anti-noise system, we observed significant improvement only for the sentences. We found a significant improvement in the results for numbers and disyllables when we reduced the exposure to noise by the direct cable connection between the CI and the aircraft radio system. We also observed a significant worsening in the disyllabic speech perception in the helicopter even with the engine off (quiet).Conclusions: In the helicopter environment, CI subjects did not achieve levels of speech recognition requirements for civil aviation pilots. The proposed noise attenuation features offered improvement for speech recognition of CI users. Radio communication significantly interfered with speech recognition in CI users

INTRODUÇÃO: A introdução dos princípios da soft surgery desencadeou busca constante pela preservação auditiva, principalmente após a expansão dos critérios de inclusão para a cirurgia do implante coclear. Esses princípios cirúrgicos, associados a novos modelos de eletrodos e ao uso de fármacos no intraoperatório, têm sido utilizados a partir do melhor conhecimento da anatomia da orelha interna e da repercussão dos mecanismos inflamatórios desencadeados pelo trauma de inserção dos eletrodos. O objetivo deste estudo é avaliar o efeito de dexametasona tópica isolada e associada ao ácido hialurônico no intraoperatório de pacientes com audição residual submetidos ao implante coclear na preservação dos limiares tonais dos mesmos. MÉTODO: Foram avaliados 18 pacientes adultos com surdez severaprofunda submetidos à cirurgia de implante coclear divididos em 3 grupos: Implante coclear como grupo-controle, grupo 1; implante coclear com uso de dexametasona tópica no intraoperatório, grupo 2; e implante coclear com uso de dexametasona tópica associada ao ácido hialurônico no intraoperatório, grupo 3. Foram comparadas as médias dos limiares tonais nas frequências de 125, 250 e 500 Hz e nas frequências de 1000, 2000 e 4000 Hz no pré-operatório e no pós-operatório. RESULTADOS: A diferença entre as médias dos limiares tonais nas frequências baixas obtidas no 6º mês de pós-operatório e no pré-operatório foi de 28,03 dB + 6,77 dB no grupo 1, 30 dB + 14,53 dB no grupo 2 e 7,23 dB + 6,12 dB no grupo 3. Houve diferença estatisticamente significante dos valores do grupo 3 em relação ao grupo 1 e 2 (p = 0,002). A diferença entre as médias dos limiares tonais nas frequências altas obtidas no 6º mês de pós-operatório e no pré-operatório foi de 11,12 dB (DP + 9,71 dB) no grupo 1, 22,77 dB (DP + 12,79 dB) e 3,89 dB (DP + 3,1 dB). Houve diferença estatística entre os grupos 2 e 3 (p = 0,01). CONCLUSÕES: A associação do uso tópico de dexametasona e ácido hialurônico no intraoperatório de pacientes submetidos à cirurgia do implante coclear foi significantemente superior ao grupo controle e ao grupo no qual foi utilizado apenas a dexametasona tópica na preservação dos limiares auditivos. Por outro lado, o uso isolado de dexametasona tópica não demonstrou resultados superiores na preservação dos limiares acústicos quando comparado ao grupo controle / INTRODUCTION: The expansion of candidacy criteria for cochlear implantation led to a constant care for hearing preservation. The in-depth knowledge of the anatomy and function of the inner ear as well as the inflammatory repercussion caused by the insertion trauma led to the development of soft surgery principles, new electrode designs and pharmacotherapy. The purpose of this study was to compare the effects of topical dexamethasone isolated and associated with hyaluronic acid in hearing preservation in cochlear implantation. METHOD: Eighteen severely to profoundly hearing impaired adult patients were evaluated and divided into 3 groups: Cochlear implantation as a control group in group 1, cochlear implantation using topical dexamethasone intraoperatively in group 2 and cochlear implantation using topical dexamethasone associated with hyaluronic acid intraoperatively in group 3. Preimplant and postimplant low frequency and high frequency pure-tone average (PTA) from 125, 250, 500 Hz and 1000, 2000, 4000 Hz were calculated and compared from unaided audiograms. RESULTS: The mean changes in the low frequency PTA of preoperative and postoperative thresholds were 28.03 dB + 6.77 dB in group 1, 30 dB + 14.53 dB in group 2 and 7.23 dB + 6.12 dB in group 3. There was statistical difference comparing group 3 with group 1 and 2 (p = 0.002). The mean changes in the high frequency PTA of preoperative and postoperative thresholds were 11.12 dB + 9.71 dB in group 1, 22.77 dB + 12.79 dB e 3.89 dB + 3.1 dB. There was statistical difference between group 2 and 3 (p = 0.01). CONCLUSIONS: The use of topical dexamethasone associated with hyaluronic acid intraoperatively in cochlear implant surgery demonstrated a statistically significant difference in the preservation of low frequency thresholds when compared with the use of isolated topical dexamethasone and a control group. The use of isolated topical dexamethasone was not superior in hearing preservation when compared to a control group

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-11-14T13:39:22Z No. of bitstreams: 1 Lesle Maciel.pdf: 2105457 bytes, checksum: 569ddfc3d56e3def02f0761a9918655d (MD5) / Made available in DSpace on 2017-11-14T13:39:23Z (GMT). No. of bitstreams: 1 Lesle Maciel.pdf: 2105457 bytes, checksum: 569ddfc3d56e3def02f0761a9918655d (MD5) Previous issue date: 2017-10-06 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The deaf who has not developed any oral and / or signal language has not had access to assistance that introduces him to the sound world. The objective of this research is to develop a protocol of psychological assistance for the deep deaf subject who wishes to do the Cochlear Implantation procedure. Three records attended at a private hospital, from 2006 to 2009, were analyzed. A multiprofessional team (physicians, speech therapists and psychologist) was performed the medical services. Two patients were treated by the whole team and the third one was attended according to the standard protocol, being assisted by the physician and speech therapist. The criteria for selecting the medical records were: be diagnosed with severe or profound bilateral hearing loss neurosensory, prelingual with medical and phonoaudiological indication for Cochlear Implant procedures. The project was submitted and approved by the Research Ethics Committee, under number CAAE 68162017.0.0000.5482. The choice of data analysis was the Content Analysis. The results of psychological counseling in these profound pre-lingual deaf users did not meet the speech therapist criterion, but when listening to certain noises that were throughout the services symbolized and incorporated into the daily routine of their lives, dismissed of caregivers and / or companions. The recognition and symbolization of noise in sounds with meanings indicate the magnification of the subjectivity of these subjects. These results indicate guidelines for the creation of a psychological protocol that allows gains in the life quality of the subject who submits to the Cochlear Implant process, as well as autonomy and decrease in the dependence of third parties or caregivers / O surdo profundo, que não desenvolveu nenhuma linguagem oral e/ou de sinais, não tem tido acesso a assistência que o introduza no mundo sonoro. O objetivo dessa pesquisa é desenvolver um protocolo de assistência psicológica para o sujeito surdo pré lingual profundo que deseja fazer o procedimento do Implante Coclear. Foram analisados três prontuários de pessoas atendidas em hospital particular, no período de 2006 a 2009. Os atendimentos foram realizados por uma equipe multiprofissional (médicos, fonoaudiólogos e psicólogo). Em dois prontuários, os usuários foram atendidos pela equipe toda e o terceiro teve atendimento segundo o protocolo padrão sendo assistido pelo médico e fonoaudiólogo. Os critérios de seleção dos prontuários foram ser pessoa com diagnostico de perda neurossensorial severa e ou profunda bilateral, pré-linguais com indicação médica e fonoaudiológica para os procedimentos do Implante Coclear. O projeto foi submetido e aprovado pela Comissão de Ética em Pesquisa, sob número CAAE 68162017.0.0000.5482. A escolha de análise dos dados foi a Análise de Conteúdo. Os resultados da assistência psicológica nesses usuários surdos profundos pré-linguais não atenderam ao critério fonoaudiólogo, mas ao escutar certos ruídos que foram ao longo dos atendimentos simbolizados e incorporados no cotidiano de suas vidas, possibilitou a dispensa de cuidadores e ou acompanhantes. O reconhecimento e simbolização dos ruídos em sons com significados indicam a ampliação da subjetividade desses sujeitos. Estes resultados indicam diretrizes para a criação de protocolo psicológico que possibilita ganhos na qualidade de vida do sujeito que se submete ao processo de Implante Coclear, além de autonomia e diminuição da dependência de terceiros ou cuidadores

No description available.