Comerlatto Junior AA. Investigation of effectiveness of teleconsultation in cochlear implant programming [thesis]. São Carlos: Universidade de São Paulo, Programa de Pós Graduação Interunidades em Bioengenharia. 2016. 137f. The growing number of cochlear implant (CI) users and the uneven distribution of specialized professionals in the country makes necessary patients traveling over long distances to receive care, with consequent increase in direct and indirect costs of treatment. The telehealth can be viewed as an alternative for this population to access such services. This clinical randomized, controlled clinical trial evaluated the efficacy of synchronous teleconsultation in the programming of CI systems in a Cochlear Implant Program accredited by the National Health System in Brazil. Participate in this study 79 subjects aged between nine and 68 years (average 21.6), 41 males and 38 females, CI users for a period from 0.58 to 24.75 years. The participants were divided into two groups, according to the nature of consultation: control group (n = 40), who performed the CI programming face-to-face and experimental group (n = 39) who performed the CI programming through the synchronous teleconsultation. Thirteen audiologists without experience in CI programming acted as facilitators of teleconsultation. The CI programming procedures encompassed the impedance telemetry, setting of electrical stimulation levels, sweeping and balancing of the electrodes and programming evaluation in live speech mode. The outcome measures were the time spent in consultation, free field audiometry, the percentage of sentence recognition in quiet and in noise, the sentence recognition threshold in silence and noise (HINT-Brazil), satisfaction with the consultation (MISS-21 scale) and aspects related to teleconsultation. The facilitators responded open questions regarding their impressions of the teleconsultations. Data were analyzed using inferential statistics (Student t test, Wilcoxon, Mann-Whitney and Spearman correlation). The results showed that after CI programming, on average, the participants had audiometric thresholds below 30 dB HL. The speech perception for the experimental and control groups post CI programming were respectively, 81.3% and 83.8% (in silence) and 57.9% and 58.1% (in noise). In HINT-Brazil the results were, respectively, for the experimental and control groups 61.4 and 61.8 dB (silence) and S/N ratio of 9.5 dB and 10.4 dB (in noise). Participants were satisfied with the teleconsultation. There were no statistically significant difference between the groups in any of the outcome measures. All participants reported that teleconsultation could be a viable alternative to facilitate CI users follow up routine. Facilitators emphasized the importance of teleconsultation for learning and for continuing education. The teleconsultation was effective in programming the CI systems and accepted by users and professionals.

Inicialmente, agradeço ao meu orientador, Professor Calixto Salomão Filho, incondicional defensor da pesquisa acadêmica, que desde minha graduação e iniciação científica contribuiu imensamente para minha evolução acadêmica e pessoal. Sua orientação e provocação crítica foram fundamentais no desenvolvimento desta tese.Agradeço também aos Professores Carlos Ari Sundfeld e Carlos Portugal Gouvêa pelos comentários e sugestões durante o exame de qualificação. À Professora Barbara van Schewick, agradeço por ter me introduzido ao tema e ter me proporcionado a fascinante experiência de conhecer em detalhes e participar ativamente do processo regulatório americano. Agradeço também por sua paciência para longas discussões sobre os vários tópicos neste debate e por ter contribuído para a definição dos objetivos desta tese. Embora a versão final tenha sido escrita em português, a Professora Barbara gentilmente fez comentários sobre um sumário do projeto e diversos trechos inicialmente redigidos em inglês.Diversas pessoas contribuíram para minha compreensão do tema e reflexões sobre pontos diversos. Agradeço aos