Adaptação ao uso da prótese auditiva, impacto e percepção do paciente em relação a um grupo psicoeducativo

Abstract

Auditory deficit can impair quality of life, socialization and independence, due to its impact on speech, language, learning and communication. The negative consequences of hearing impairment on overall functioning can also increase vulnerability to mental disorders such as anxiety and depression resulting academic and professional problems. Objectives: To characterize patients with AD and evaluate symptoms of anxiety and depression, pre and post psychoeducative group and placement of Individual Sound Amplification Apparatus (ISAA); to evaluate adaptation, satisfaction, impact on lifestyle, adhesion and difficulties associated to the use of the hearing aid. Materials and Methods: Adult patients of both sexes with AD (losses between mild and deep) attended at the Hearing Impairment Service of a teaching hospital in the interior of São Paulo state during a 12-month period participated in the study. All patients were evaluated before and after the psychoeducational group and placement of the ISAA by means of an interview, Hospital Anxiety and Depression Scale (HAD) and SADL Questionnaire (Satisfaction with Amplification in Daily Life). Results: A total of 103 patients, 54 (52.4%) of t male gender, a mean age of 68.06 (SD = 1.07) participated. A sensorineural loss was observed in 94 patients (91.3%), bilateral mild loss in 49 (47.6%) and 92 (89.3%) had a bilateral prosthesis indication. Most evaluated the family relationship as optimal (n = 40, 38.8%) and good (n = 42, 40.8%); avoidance of social situations (n = 56. 54.4%) and isolation (n = 3. 2.9%) were reported by more than half of the participants. Expectations regarding ISAA included better listening (n = 79), communication facilities (n = 58) and better speech understanding (n = 54). There was a statistically significant reduction of anxiety (p <0.0001) and depression symptoms (p <0.0001) in post-psychoeducational assessment and ISAA placement. No statistically significant correlation between anxiety symptoms and degree of hearing loss (r = 0.07027 and p = 0.4806) was observed according to the post evaluation. However, there was a trend showing that increasing the degree of loss can worsen anxiety symptoms. There was a negative correlation between symptoms of depression and hearing loss in the post evaluation (r = 0.209 and p = 0.0341), pointing out that the higher the degree of loss, the less depressive symptoms after the placement of the hearing aids. The use of ISAA throughout the day was reported by 43 (41.7%) patients, 28 (27.2%) used up to 8 hours a day and 46.6% (n = 48) reported total adaptation to the hearing aid. There was a negative correlation between AASI adaptation and symptoms of anxiety and depression, that is, the greater the adaptation to the prosthesis, the less anxiety and depression symptoms (P <0.0001). The main difficulties associated with the use of hearing aids were taking care of the prosthesis (n = 31), talking on the telephone (n = 30) and noisy environments (n = 19). The majority (n = 74) reported satisfaction with the use of ISAA The following benefits of prosthesis use were reported: improvement of family relationship (n = 62), social relationship (n = 49), improvement on quality of life (n = 42) and better listening and understanding of other speech (n = 41). The majority (n = 97, 94.2%) highlighted satisfaction with the psychoeducational group and its positive impact on the management of the demands of the daily use of hearing aids: 69 pointed out that the group was important for information acquirement 51 reported the guidelines received for adaptation to the hearing aid, 17 reported the help to deal with the family, 15 that the group assisted on the acquisition of psychological repertoire and 13 pointed out that the intervention helped on the emotional preparation for the process of adaptation to the prosthesis. The patients' answers to the SADL Questionnaire showed maximum satisfaction according to 69.9% of the participants. The maximum satisfaction was also showed in the subscales: Positive Effects (62.2%), Services and Costs (90.3%), Negative Factors (56.3%) and Personal Image (79.6%). Conclusion: Patients with AD were mainly males, elderlies, with neurosensorial loss and indication of bilateral prosthesis, good family relationship and difficulties in social interaction. There was a reduction of anxiety and depression symptoms after the psychoeducational group and the placement of the ISAA. Most of the participants used ISAA adequately, reported adaptation and satisfaction with the prosthesis. There was a negative correlation between adaptation to hearing loss and symptoms of anxiety and depression. There was also a significant negative correlation between satisfaction with ISAA and symptoms of anxiety and depression. The psychoeducational group as well as the placement of hearing aids were evaluated as positive.