MARIA VALERIA SCHMIDT GOFFI GOMEZ
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
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- Predicting emotion perception abilities for cochlear implant users(2023) PAQUETTE, S.; DEROCHE, M. L. D.; V, M. Goffi-Gomez; HOSHINO, A. C. H.; LEHMANN, A.Objective In daily life, failure to perceive emotional expressions can result in maladjusted behaviour. For cochlear implant users, perceiving emotional cues in sounds remains challenging, and the factors explaining the variability in patients' sensitivity to emotions are currently poorly understood. Understanding how these factors relate to auditory proficiency is a major challenge of cochlear implant research and is critical in addressing patients' limitations. Design To fill this gap, we evaluated different auditory perception aspects in implant users (pitch discrimination, music processing and speech intelligibility) and correlated them to their performance in an emotion recognition task. Study sample Eighty-four adults (18-76 years old) participated in our investigation; 42 cochlear implant users and 42 controls. Cochlear implant users performed worse than their controls on all tasks, and emotion perception abilities were correlated to their age and their clinical outcome as measured in the speech intelligibility task. Results As previously observed, emotion perception abilities declined with age (here by about 2-3% in a decade). Interestingly, even when emotional stimuli were musical, CI users' skills relied more on processes underlying speech intelligibility. Conclusions These results suggest that speech processing remains a clinical priority even when one is interested in affective skills.
- The Influence of Auditory Feedback and Vocal Rehabilitation on Prelingual Hearing-Impaired Individuals Post Cochlear Implant(2019) UBRIG, Maysa Tiberio; TSUJI, Robinson Koji; WEBER, Raimar; MENEZES, Marcia H. Moreira; BARRICHELO, Viviane M. O.; CUNHA, Maria Gabriela B. da; TSUJI, Domingos Hiroshi; GOFFI-GOMEZ, Maria Valeria S.Objective. To verify changes in the perceptual and acoustic vocal parameters in prelingual hearing-impaired adults with cochlear implants after vocal rehabilitation. Hypothesis. Auditory feedback restoration alone after cochlear implant is not enough for vocal adjustments. A targeted and specific voice therapy intervention is required. Study Design. Prospective and pre-post repeated measures design. Methods. Twenty literate adults with severe to profound prelingual bilateral sensorineural hearing loss participated in the study; individuals were implanted late and were fluent users of oral language. Ages ranged from 17 to 48 years. All individuals presented normal results in laryngoscopy, and hearing thresholds with the cochlear implant were over 40 dB HL. Individuals were randomly distributed into two groups: Group 1 (treatment group) and Group 2 (control group), both with ten patients each, five men and five women, matching mean age and hearing deprivation time before the cochlear implantation. Patients from Group 1 underwent a protocol of vocal therapy including 12 individual sessions with the same clinician. Group 2 only underwent vocal recordings. The vocal recordings occurred before and after the participation in the therapy protocol for Group 1 and after the same period, 3 months later, without any intervention, for Group 2. The recording sessions used the Consensus Auditory-Perceptual Evaluation of Voice protocol sentence reading and emission of sustained vowel /a/. Auditory-perceptual evaluation of voices was performed by three judges, and the acoustical analysis used the Praat program. Results. Statistically significant reductions in the overall vocal degree, vocal instability, and degree of resonance change were observed after vocal rehabilitation in Group 1. Statistically, individuals from Group 1 did not differ in regard to the modification of acoustic parameters. Group 2 did not present significant changes in any of the analyzed parameters. Conclusions. The cochlear implanted adults submitted to vocal rehabilitation presented changes in the auditory-perceptual parameters, with reduction of the overall voice severity, vocal instability, and degree of resonance after vocal intervention. There were no changes in the acoustic parameters in the implanted prelingual hearing-impaired adult subjects.
- Longitudinal Analysis of the Absence of Intraoperative Neural Response Telemetry in Children using Cochlear Implants(2014) MOURA, Amanda Christina Gomes de; GOFFI-GOMEZ, Maria Valéria Schmidt; COUTO, Maria Ines Vieira; BRITO, Rubens; TSUJI, Robinson Koji; BEFI-LOPES, Debora Maria; MATAS, Carla Gentile; BENTO, Ricardo FerreiraIntroduction Currently the cochlear implant allows access to sounds in individuals with profound hearing loss. The objective methods used to verify the integrity of the cochlear device and the electrophysiologic response of users have noted these improvements. Objective To establish whether the evoked compound action potential of the auditory nerve can appear after electrical stimulation when it is absent intraoperatively. Methods The clinical records of children implanted with the Nucleus Freedom (Cochlear Ltd., Australia) (CI24RE) cochlear implant between January 2009 and January 2010 with at least 6 months of use were evaluated. The neural response telemetry (NRT) thresholds of electrodes 1, 6, 11, 16, and 22 during surgery and after at least 3 months of implant use were analyzed and correlated with etiology, length of auditory deprivation, and chronological age. These data were compared between a group of children exhibiting responses in all of the tested electrodes and a group of children who had at least one absent response. Results The sample was composed of clinical records of 51 children. From these, 21% (11) showed no NRT in at least one of the tested electrodes. After an average of 4.9 months of stimulation, the number of individuals exhibiting absent responses decreased from 21 to 11% (n = 6). Conclusion It is feasible that absent responses present after a period of electrical stimulation. In our sample, 45% (n = 5) of the patients with intraoperative absence exhibited a positive response after an average of 4.9 months of continued electrical stimulation.
- Do the minimum and maximum comfortable stimulation levels influence the cortical potential latencies or the speech recognition in adult cochlear implant users?(2021) MARTINS, Kelly Vasconcelos Chaves; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; BENTO, Ricardo FerreiraIntroduction: Cochlear implants (CI) programming is based on both the measurement of the minimum levels required to stimulate the auditory nerve and the maximum levels to generate loud, yet comfortable loudness. Seeking for guidance in the adequacy of this programming, the cortical auditory evoked potentials (CAEP) have been gaining space as an important tool in the evaluation of CI users, providing information on the central auditory system. Objective: To evaluate the influence of mishandling of electrical stimulation levels on speech processor programming on hearing thresholds, speech recognition and cortical auditory evoked potential in adult CI users. Material and methods: This is a prospective cross-sectional study, with a sample of adult unilateral CI users of both sexes, aged at least 18 years, post-lingual deafness, with minimum experience of 12 months of device use. Selected subjects should have average free field hearing thresholds with cochlear implant equal to or better than 34 dBHL and monosyllable recognition different from 0%. Individuals who could not collaborate with the procedures or who had no CAEP recordings were excluded. Participants were routinely programmed, and the map was named MO (optimized original map). Then three experimentally wrong maps were made: optimized original map with 10 current units below the maximum comfort level (C), named MC-(map minus C); optimized original map with minus 10 current units at minimum threshold level (T), named MT-(map minus T) and optimized original map with 10 current units above minimum level (T), named MT + (map plus T). In all programs, participants underwent free-field auditory thresholds from 250Hz to 60 0 0Hz, recorded sentences and monosyllabic recognition tests presented at 65dB SPL in quiet and in noise, and free field CAEP evaluation. All tests were performed in an acoustically treated booth, in a randomized order of map presentation. Data were compared by Wilcoxon test. Results: Thirty individuals were selected and signed an informed consent form. The MC-map provided worsening of all free field thresholds, quiet and noise speech recognition, and P1 wave latency delay with significant difference from the results with the MO map. The MT-map worsened the hearing thresholds and statistically significantly reduced the P2 wave latency; MT + map improved free field thresholds except 60 0 0Hz, worsening speech recognition, without statistical significance. Conclusions: The results suggest that maximum levels below the optimal thresholds lead to worse cochlear implant performance in both hearing thresholds and speech recognition tests in quiet and noise, increasing CAEP component P1 latency. On the other hand, the manipulation of minimum threshold levels showed alteration in audibility without significant impact on speech recognition.
- When May Cochlear Implant Not Work Even at a Very Young Age?(2023) GOMEZ, Maria Valeria Schmidt Goffi
- Central Auditory Nervous System Stimulation through the Cochlear Implant Use and Its Behavioral Impacts: A Longitudinal Study of Case Series(2021) CAVALCANTI, Marina Isabel; SILVA, Liliane Aparecida Fagundes; GOMEZ, Maria Valeria Schmidt Goffi; KOJI, Tsuji Robinson; BENTO, Ricardo Ferreira; CARVALHO, Ana Claudia Martinho de; GENTILE, Matas CarlaThe purpose of this study was to investigate, over a period of five years, the cortical maturation of the central auditory pathways and its impacts on the auditory and oral language development of children with effective use and without effective use of a Cochlear Implant (CI). A case series study was conducted with seven children who were CI users and seven children with normal hearing, with age- and gender-matched to CI users. The assessment was performed by long-latency auditory evoked potentials and auditory and oral language behavioral protocols. The results pronounced P1 latency decrease in all CI users in the first nine months. Over five years, five children with effective CI use presented decrease or stabilization of P1 latency and a gradual development of auditory and oral language skills, although, for most of the children, the electrophysiological and behavior results remained poor than their hearing peers' results. Two children who stopped the effective use of CI after the first year of activation had worsened auditory and oral language behavioral skills and presented increased P1 latency. A negative correlation was observed between behavioral measures and the P1 latency, the P1 component being considered an important clinical resource capable of measuring the cortical maturation and the behavioral evolution.
- Voice Analysis of Postlingually Deaf Adults Pre- and Postcochlear Implantation(2011) UBRIG, Maysa Tiberio; GOFFI-GOMEZ, Maria Valeria S.; WEBER, Raimar; MENEZES, Marcia H. Moreira; NEMR, Nair Katia; TSUJI, Domingos Hiroshi; TSUJI, Robinson KojiObjectives. To ascertain whether cochlear implantation (Cl), without specific vocal rehabilitation, is associated with changes in perceptual and acoustic vocal parameters in adults with severe to profound postlingual deafness. Hypothesis. Merely restoring auditory feedback could allow the individual to make necessary adjustments in vocal pattern. Study Design. Prospective and longitudinal. Methods. The experimental group composed of 40 postlingually deaf adults (20 males and 20 females) with no previous laryngeal or voice disorders. Participants' voices were recorded before CI and 6-9 months after Cl. To check for chance modifications between two evaluations, a control group of 12 postlingually deaf adults, six male and six female, without CI was also evaluated. All sessions composed of the recording of read sentences from Consensus Auditory-Perceptual Evaluation of Voice and sustained vowel /a/. Auditory and acoustic analyses were then conducted. Results. We found a statistically significant reduction in overall severity, strain, loudness, and instability in auditory analysis. In vocal acoustic analysis, we found statistically significant reduction fundamental frequency (F0) values (in male participants) and F0 variability (in both genders). The control group showed no statistically significant changes in most vocal parameters assessed, apart from pitch and F0 (in female participants only). On comparing the interval of variation of results between the experimental and control groups, we found no statistically significant difference in vocal parameters between Cl recipients and nonrecipients, with the exception of F0 variability in male participants. Conclusions. The patients in our sample showed changes in overall severity, strain, loudness, and instability values, and reductions in F0 and its variability. On comparing the variation of results between the groups, we were able to prove in our study that implant recipients postlingually deaf adults (experimental group), without specific vocal rehabilitation, differed from nonrecipients (control group) in loudness and F0 variability sustained vowel /a/ in male participants.
- Auditory brainstem implant in postmeningitis totally ossified cochleae(2018) MALERBI, Andrea Felice dos Santos; GOFFI-GOMEZ, Maria Valeria Schmidt; TSUJI, Robinson Koji; GOMES, Marcos de Queiroz Teles; NETO, Rubens de Brito; BENTO, Ricardo FerreiraIntroduction: An auditory brainstem implant (ABI) is an option for auditory rehabilitation in patients with totally ossified cochleae who cannot receive a conventional cochlear implant. Objective: To evaluate the outcomes in audiometry and speech perception tests after the implantation of an ABI via the extended retrolabyrinthine approach in patients with postmeningitis hearing loss. Materials and methods: Ten patients, including children and adults, with postmeningitis hearing loss and bilateral totally ossified cochleae received an ABI in a tertiary center from 2009 to 2015. The extended retrolabyrinthine approach was performed in all the patients by the same surgeons. A statistical analysis compared pure tonal averages and speech perception tests before and at least 12 months after the ABI activation. Results: Eight patients (80%) showed improvements in tonal audiometry and the word and vowel perception tests after an average follow-up of 3.3 years. Two patients recognized up to 40% of the closed-set sentences without lip-reading. Two patients had no auditory response. Conclusions: The ABI improved hearing performance in audiometry and speech perception tests in cases of postmeningitis hearing loss. The extended retrolabyrinthine approach is a safe surgical option for patients with postmeningitis hearing loss and bilateral totally ossified cochleae.