Associations March 2014

MARCH 2014

OTEN - Changes to funding structures Into the abyss: Challenges and benefits of delving deep into the ear canal Government announcements

The Official Journal of the Australian College of Audiology (AcAud)

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Contents

2014

OTEN

09

Changes to funding structures.

ACAud National Congress 2015

11 14

Save the date!

Into the Abyss: Challenges and Benefits of Delving Deep into the Ear Canal A seminar presented by Brian Fligor and Mark Sanford.

Government Announcements

33 38

Updates from the Australian Government Hearing Services Program, Office of Hearing Services.

Hearing Nepal Program Passing it forward!

Regulars 04 Presidents Report 07 Matters & Natters

10 Industry News 43 Advertise with Accord

REPORT Sam Camilleri

What a busy few months it has been, hope you all enjoyed the Christmas break and we are off again racing through another year. Some of you may already be aware there has been a change of personnel at our ACAud office. The Executive have been discussing the future of ACAud since late 2012. This has included looking at the structure of the ACAud office and whether or not the current structure of the office suits our operational requirements. You may also be aware we reduced the work load of the office in August last year this has meant we no longer required a full time person and have now created a new part time position. The newly created part time clerical position was offered to and declined by Ellen-May. We would like to take this opportunity to thank Ellen-May for her service with the Company over the years and wish her all the best in future endeavours. To assist us temporarily, Kylie Dicieri has agreed to take on the role on a short-term basis to help us establish the new role at which time we will advertise for a new permanent part time person.

We received a lot of comments on the article titled, The future looks bright for Audiometrists, and I guess that’s exactly what we wanted. It may not have been what you wanted to hear but at least it made a lot of you sit up and have a little think. The article I refer to was about the future of Audiometrists if hearing assessments were to be funded by Medicare.

Our intention was not meant to frighten members, instead we wanted members to stop and think about their situation and what impact an event like this might have on them if it were to occur. ACAud have looked at the Medicare requirements and we understand there is a precedent for University graduates being granted Medicare numbers, but there is none for non-University graduates. If assessments were ever to be funded by Medicare, then an argument could be made for University graduates with relevant university qualifications to be included.

We must highlight again we are not aware of a current move from either OHS or government to move in this direction at this time, but it is simply a matter of each individual assessing their own risk looking into their future. Our letter to members clearly states the above and was sent with this intention only.

We have also recently made contact with HAASA in an effort for a joint Executive meeting to further discuss the future of Audiometrists and discuss issues that both Professional Bodies can take forward in the future. I will keep you posted of any outcomes.

A reminder for those of you considering a University degree, we also sent information about changes to the bachelor of Audiometry.

Currently the Diploma in Hearing aid Prescription and Evaluation contributes to 50% of the

Regular 5 Bachelor course, providing 72 of the 144 credit points required.

in our lobbying attempts with BUPA and we are considering strategies to tackle this issue.

In 2015 under the new AQF guidelines the Diploma course will only contribute 32 of the 144 credit points needed to complete the Degree.

Basically this means in 2015 you will be required to complete a higher number of core and elective units to finish your Degree. UNE have suggested if you prefer a reduced workload you should enrol before September 2014.

We also sent out information from OTEN who have some good news for members who have not yet completed the Diploma of Hearing Device Prescription & Evaluation. OTEN advise they may be able to assist members with previous training and experience by providing a full RPL (Recognition of Prior Learning) Diploma program at a reduced cost of $998.00. I would suggest you contact them directly to see if you are eligible.

Contact details are Janette Brazel, Pia Doss or Monica Summers (02) 9715 8366.

UNE also advises there is no longer a compulsory on campus component which means the complete course can be done online.

On another front, ACAud along with HAASA and HCIA have been lobbying BUPA over its decision to reject claims where an Audiometrist fits a hearing device. At this time we have been unsuccessful

Sam Camilleri, President

Email: samuel.camilleri@connecthearing.com.au

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Regular 7 Membership

& NATTERS Contact the AC Aud Secretariat Phone (07) 3839 1622 Fax (07) 3839 1822 Email acaud@acaud.org Kylie Dicieri

AC Aud National Congress 2015 Save the date!

6 – 8 August 2015 ACAud National Congress 2015 Novotel Twin Waters Sunshine Coast, Queensland Watch this space, more information coming soon.

to our New Ordinary Members!

• • •

Aswin Kumar Saiful Quddus Shwetha Mysore

• • •

Pooja Dayal Melinda Brown Orlando Zilich

MAY BHA EXAMINATIONS Attention Associate Members We have recently completed our February 2014 BHA Examinations and are in preparations for our May 2014 BHA Examinations.

May BHA Examinations will be held in Brisbane around the middle of May (date to be confirmed).

The schedule for May BHA Examination is:By 31 MARCH 2014: Candidates must have submitted their request to sit BHA Examination and have paid their Examination fee.

By 15 APRIL 2014: Candidates must have lodged all documents as per Examination Checklist; apart from the final portion of their log books which is due approximately one week prior to sitting the Exam.

Please refer to website for required forms and documents www.acaud.org

CEP REMINDER Remember that the CEP system has recently changed. Please ensure that you are keeping your own records of CEP and ensure you fulfil the new requirements:

8 Feature

INIUM WIRELESS

Regular 9

Matters and natters continued

1) 2 Year CEP Collection Period

2) 2 Year Mandatory Conference Cycle

Starting from 1 July 2013 the CEP collection period will change from 1 to 2 years.

3) No Maximum Point for CEP Categories

The currently collection period will run from 1 July 2013 to 31 June 2015.

In each collection period, members will be required to collect: 50 points (for Full Members, Associate Members & Fellows), 25 points (Student Members).

Please refer to website for further information www.acaud.org

! s m a x e r u o y in k c Best of lu K ylie Dicieri

OTEN Funding Structure It has been an interesting start to 2014 for us here at OTEN with many changes to our funding structures. We have been working hard to find solutions for our non-NSW students and for those returning students who wish to upgrade to a Diploma to enable them to study the Bachelor of Audiometry degree.

We have some good news for those who wish to apply for full Recognition of Prior Learning (RPL) who have previous training and experience in Audiometry but do not have the Diploma qualification. We have been able to negotiate with our managers a full RPL Diploma program at a reduced cost of $998.00.

For students interested in this program of study they will need to follow this process: • C ontact one of the Audiometry teachers (Janette Brazel, Pia Doss or Monica Summers) to discuss their previous study and work experience • Send in all evidence for the recognition process • O nce the teachers have assessed the evidence they will direct the students to enrol in the course at https://www.tafensw.edu.au/

Industry News Unitron’s Moxi Kiss Wins iF Product Design Award 2014 Refined and intelligent design puts Unitron’s hearing instrument on the world stage Unitron is pleased to announce that its Moxi™ Kiss hearing instrument has won an internationally recognized iF product design award 2014. For 60 years, the iF product design award has been an internationally recognized label for awardwinning design, and the iF brand has become a symbol for outstanding achievements in design. Moxi Kiss was selected as one of this year’s winners out of more than 3,200 entries by a jury of experts and renowned designers from all over the world, who evaluated each submission against such criteria as design, quality, finish, choice of materials, degree of innovation and more.

Released to market in March 2013, Moxi Kiss is the first step in a design evolution for Unitron’s hearing instruments that will ultimately play out over many years. While the Moxi Kiss product was still on the drawing board, Unitron’s product design teams worked with industry-leading designers to study advanced industrial design trends and establish an all-encompassing framework that expresses Unitron’s brand essence, and the function and personality of its product families. This industrial design language was instrumental in forming Moxi Kiss’ organic, fluid form.

“Moxi Kiss is designed to be as intelligent as it is beautiful,” says Ara Talaslian, Vice President of Research & Development, Unitron. “The hearing instrument’s outer shell was meticulously designed, including precision of the tooling to the micron level and a G2 curvature to ensure a luxurious finish. Advances in mechanical

design ensure Moxi Kiss’ internal functionality upholds Unitron’s commitment to high fidelity natural sound, providing wearers a high degree of listening comfort even in the most difficult noise environments.”

In a recent survey, Unitron customers from several key countries gave Moxi Kiss high marks for satisfaction specifically for comfort on the ear; overall design and shape; and high quality look and feel.

“We are very proud to have Moxi Kiss recognized with an iF product design award. To be selected amongst a field of thousands is indeed an honour, and a clear recognition of our team’s focused commitment to creating both an aesthetically pleasing and highly functional hearing instrument,” says Jan Metzdorff, President, Unitron. “When we created Moxi Kiss, our goal was to design a hearing instrument that wearers would rate as stylish, discreet and comfortable, and hearing healthcare providers would be proud to represent. I believe we have succeeded in achieving those goals; Moxi Kiss is beautiful in form, powerful in performance, and now, award-winning on the world stage.”

Learn more about Moxi Kiss by visiting: unitron.com/au or call 1800 212 313

Regular 11

Interacoustics introduces another member of the True Hybrid Family – the AD226 portable diagnostic audiometer Denmark, November, 2013. Interacoustics is pleased to announce the release of the new AD226 diagnostic hybrid audiometer. With a weight of 1.3 kg and a compact footprint of 30x23x9 cm it is ideal for portable application as well as small office spaces.

The AD226 comes with multiple advanced features such as: • A high-resolution 4.3 inch colour display that presents crystal clear images for easy to read audiograms.

• A familiar keypad design that enables you to acclimate quickly without losing efficiency or speed.

• A fully self-contained standalone audiometer that can run independently from a computer.

ACAud National Congress 2015

• F ully PC-integrated audiometer (with the optional Diagnostic Suite software) offering all the benefits of a PC-based audiometer with full Noah, OtoAccessTM and EMR/HIS integration.

• Storage for 500 patients.

• The possibility to run on batteries.

Learn more here: www.interacoustics.com.au/AD226

Save the date!

6 – 8 August 2015 ACAud National Congress 2015 Novotel Twin Waters Sunshine Coast, Queensland Watch this space, more information coming soon.

12 Regular Industry News continued

Real value & exceptional performance with Bernafon’s carista At AudiologyNOW! 2014 from March 26 – 29 in Orlando, Bernafon presents Carista 5 | 3 and the newest wireless connectivity devices including SoundGate 2, Phone Adapter 2, and TV Adapter 2. With Carista, Audio Efficiency™ technology and wireless connectivity have become more affordable, enabling you to offer your customers an impressive combination of real value and exceptional performance.

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Carista – Get the Story in Detail Carista 5 | 3, with Audio Efficiency™ technology developed in Switzerland, is available in Bernafon’s two newest complete mid-range families. Audio Efficiency™ technology includes a number of high- end features such as Adaptive Noise Reduction Plus, for efficient and impressive noise suppression technology. Carista 5/3 portfolio also includes Wireless Connectivity.

SoundGate 2 connects to a multitude of devices.

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Improving the SNR Improves Audibility

Bernafon’s SoundGate 2, along with the new Phone Adapter 2 and TV Adapter 2, connects to devices such as mobile and landline telephones, TVs, computers, GPS systems, MP3 players, and more. Audio signals are transmitted wirelessly to your customers’ hearing aids, using SoundGate 2 as a wireless bridge. This offers the user a single interface to control many different audio sources and gives your customers added comfort and convenience at home, at work, and on-the-go.

There are clear benefits for customers in using the new SoundGate 2:

With a wireless connection and the hearing aid microphones switched off, there is no risk of unwanted feedback and the signal-to-noise ratio (SNR) is improved. This results in improved speech understanding and listening comfort for clients.

Contact: Brad McConville, Sales and Marketing Manager Bernafon Australia Phone: 07 3250 0368 Email: bmc@bernafon.com.au

Regular 13

Bernafon’s SoundGate 2 – Key to increasing client satisfaction Bern (December, 2013) – Research has shown that client satisfaction is correlated with the number of day-to-day environments where a hearing instrument proves useful.

Bernafon’s SoundGate 2, along with wireless accessories such as the Phone Adapter 2 and TV Adapter 2, connects to devices such as mobile and landline telephones, TVs, computers, GPS systems, MP3 players, and more. Audio signals are transmitted wirelessly to your clients’ hearing instruments, using SoundGate 2 as a wireless bridge. This offers the user a single interface to control many different audio sources and gives your clients added comfort and convenience at home, at work, and on-the-go.

significantly less battery expenditure than products which use 2.4 GHz technology.

Contact: Brad McConville, Sales and Marketing Manager Bernafon Australia Phone: 07 3250 0368 Email: bmc@bernafon.com.au

Improving the SNR Improves Audibility Not only does SoundGate 2 increase the options for being connected, it improves the quality of those connections. With a wireless connection and the hearing aid microphones switched off, there is no risk of unwanted feedback and the signal-to-noise ratio (SNR) is improved. This results in improved speech understanding and listening comfort for clients.

The Benefits of an Integrated Telecoil Additionally, SoundGate 2 features an integrated telecoil for audio streaming of induction looped theatres, classrooms, churches, etc. directly to the hearing instruments. Here again a better SNR is achieved which improves audibility.

Extended Rechargeable Battery Life Bernafon’s SoundGate 2 has a rechargeable battery and the battery life compared with similar products from competitors is impressive.

SoundGate 2 uses near field magnetic induction (NFMI) to detect incoming audio signals, using

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Into the abyss: Challenges and benefits of delving deep into the ear canal Editor’s Note: This text course is an edited transcript of a live seminar Brian Fligor: It is a pleasure to be talking with you today, and to co-present with Mark Sanford and Bob Hartenstein. Primarily what Mark, Bob and I wanted to talk about is what it takes to place a device down deep into the ear canal, as well as some reasons why deep fittings are not a big part of the current hearing aid market. We would like to think about ways in which we can leverage some of the benefits of placing devices deeply in the canal.

I would like to start with some background information. The auricle and the ear canal are formed from the ectoderm in the early gestational period of the fetus. The auricle is formed as early as 4 weeks’ gestation. It comes from the first and second branchial arches, although development completes by 12 weeks. We know that when something is disturbed during early development, you end up with something like microtia or atresia. The ear canal forms concurrently in parallel starting at week 8 from the first branchial cleft. Ossification of the inner two-thirds of the ear canal starts at 12 weeks gestation, and the whole canal opens up, or canalizes, by 28 weeks. Ear canal stenosis or ear canal atresia results if there is an interruption in the development here during the 28 weeks. We also know that ear canals change throughout one’s lifetime; they are as individual as fingerprints.

Figure 1 shows two 3D renderings of ear canals that have been reconstructed from CT scans. I think we would all agree that the canal on the left is outrageously curvy, whereas the canal on the right is fairly straight. The skin that lines the auricle and the ear canal is squamous epithelium, in that the basal layers grow up to the top, the skin flattens, dries, and the dead skin cells are sloughed off.

The outer one-third of the ear canal is surrounded primarily by cartilage, but also by soft tissue. It is rich in hair and sebaceous and ceruminous glands. The inner two-thirds is surrounded by bone, where there is minimal hair and sebaceous or ceruminous glands. The whole canal is innervated principally by the seventh cranial nerve. This is why some patients have that tickly throat with a cough when we place a block down in the ear canal. That is simply because we are stimulating that seventh nerve. It is normal, but to the patient, it might be unnerving. The rise of the canal from the tympanic membrane (TM) might be as much as 15 degrees, and the angle up to the TM might be 40 degrees.

Figure 1. 3D renderings of ear canals that have been reconstructed from CT scans.

Feature 15 The pinna is not just where you hang your eyeglasses or merely a convenience for hearing aids or an earmold. It participates in the function of us being able hear speech well. The difference in the acoustical property outside of the ear at position B (Figure 2), relative to down very close to the ear drum, could be looked at as an acoustical filter and described as the transfer function of the open ear (TFOE). If I play an 85dB sound in the sound field, what is that going to look like down at the ear drum? At 125 Hz to 250 Hz, it is nominally still at 85 dB, but as I continue sweeping up to higher frequencies, I get a strong amplification up to 15 dB at 3000Hz, even 20 dB in some ears, and then it slopes off again. We know this in audiological terms as the real-ear unaided gain (REUG). This is important when we think about fitting hearing aids. If I occlude the outer part of the ear, I will eliminate this transfer function, which means that I need to build it back in. I need my real-ear aided response (REAR) to make up for the insertion loss. I am going to turn the presentation over to Mark Sanford.

Figure 2. Transfer function of the open ear.

Deep insertion device history Mark Sanford: Thanks Brian. Let’s look at a timeline (Figure 3). Twenty-five years ago, in 1988, Resound developed the recontour procedure.

Those of us who have been around for a while remember when Rodney Perkins tried to almost

drill holes inside of people’s heads so they could put in the Resound technology from AT&T. He was trying to do a surgical procedure where ENTs enlarge the ear canal to then take an impression against the TM and fit a device very deep inside.

This happened about 125 times. If you ever see one of those cases, it is not a pretty sight.

Figure 3. Deep insertion device history timeline.

A few years went by, and the Philips Peritympanic was introduced. We saw benefits from that, which was wonderful, but it did not have staying power.

Then completely-in-the-canal hearing aids (CICs) were introduced in the 1990s, which were not truly recessed or deep in-the-ear devices. It really was not until the Lyric came along in 2007 that we had a device that consistently rested in the bony part of each canal, as well as being physically recessed by 3, 4, or 5 mm, depending on the length of the ear canal, from the meatal opening. Those benefits are significant.

Then in 2010, Starkey and the SoundLens introduced a custom-fit device that can be recessed in the ear canal. In my somewhatbiased opinion, a lot of manufacturers are recessing the device into the ear canal 2, 3 or 4 mm, and sometimes longer than that, but unfortunately they are not always getting the depth that accesses the benefit of being closer to the TM.

The benefits of going deep Some people think the people who go deep are out of their minds. There are some significant benefits that have been proven back as early as 1994 by well-respected researchers (Staab,

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Feature 17 1994; Agnew, 1994; Arbogast & Whichard, 2009; Preves, Fortune, Woodruff, & Newton, 1991).

As a result, we have seen benefits of reduced occlusion effect, increased gain, reduced feedback, improved head room, and improved directionality. When you are placing the receiver 3 to 6 mm from the ear drum compared to maybe 10 to 14 like we do with traditional hearing aids, that is significant for increased gain. Staab (1994) found that 5 dB for low frequencies and 9 to 12 dB for high frequencies is significant in the world of hearing aids. Then Tanya Arbogast and Susan Whichard (2009) found that deep microphone placement as well as deep receiver placement can add up to 15 to 17 dB additional gain, compared to a traditional in-the-canal (ITC) device.

Both of these studies found significant benefits for improved head room, such as less saturation induced with distortion, and better sound quality.

That is one thing you hear over and over from patients who wear deep insertion devices. They always say how natural it sounds and how good the sound quality is. I will turn it over to Bob. Bob Hartenstein: As far as the anatomy of the ear, as Brian was saying, it does get tricky as we get down deeper in the canal. If we move deeper in the canal, we certainly get away from the occlusion effect. That is very beneficial for so many people. But if we get too deep, it can get uncomfortable. All the Lyric studies were done 4 mm from the TM. There are many contraindications with which we have to be concerned, such as osteomas.

People who work with Lyric know that when you pull the Lyric out, you have to check the health of the skin. Sometimes you have patients who are diabetic or are on blood thinners, and we have to take extra precautions. It does not mean that we cannot fit instruments down that deep, but we have to be careful. Certainly, radiation to the head can also create risks, and we have to be cautious of that. We have to be careful when

there is a perforation of the TM and ensure that we are not butting right up to it or touching any type of active infection.

When the invisible-in-the-canal (IIC) is placed deep in the canal, you get the benefits of lack of occlusion from being that close to the TM, which is certainly much more than 2 mm in entrance, - typical in CICs. I think too we often see that people are not taking a deep enough impression for IICs, so some IICs are not going in any further than the typical CIC. It is essentially a smaller instrument with a recessed faceplate, but without all the benefits of a true IIC. Mark, you can take over.

Mark Sanford: I think that is an important point, Bob. If you ask most manufacturers what their number-one return reason is for the IIC, I would bet it is for occlusion effect. That is one of the big problems I see right now with a lot of IICs in my practice. That is why I am doing some other things.

The Lyric was commercially available in 2007.

The company was formed in 1999 by Robert Schindler and Adnan Shennib who drew up the idea on a cocktail napkin. It was originally not going to be in there 24 hours a day. That came later, and the question was asked, “What if we could have it stay in there for 24 hours a day?”

They then created seals to for a patient to wear it up to 120 days in a row. The first version, or Lyric I, was 16 mm long. We were able to fit 54% of ears successfully with the device. In April of 2012, they came out with Lyric 2, which was 12 mm long and a different design. It is now able to fit 87% of ears.

Obviously, some people cannot wear it because of their ear anatomy or severity of their hearing loss, but it does cover a fairly broad fitting range.

Lyric fits within the 4 mm sweet spot of the TM. It is amazing how many people you can fit and how excited they are, as well as patients who have dexterity problems like Parkinson’s disease

or arthritis, or certain mental incapacities. It is an easy device for lots of people to use, and they do not lose them all the time. It is a lot like extended wear contact lenses.

The Starkey SoundLens then came out in June of 2010, after being introduced to the American Academy of Audiology (AAA) that year in Charlotte. It was recessed into the ear canal, and they have stayed with a very deep insertion device for the most part. You are taking impressions using a cotton block that is literally placed against the TM. Now, since the end of 2012, all the manufacturers have said that they have “IICs.” Our definition defines that as being recessed at least 2 mm inside the opening of the canal, as well as being within 5 or 6 mm of the ear drum to get the benefits that we have been discussing.

Starkey has shared some data with us. About half the devices can be made at the second bend, which is fairly significant. It does also mean that there are a lot of people who cannot wear that.

Returns are higher with an IIC, but 30% of the people who return it then choose to get a CIC or other product. They still end up with something, instead of nothing. The determining factor of success is with the diameter of the ear canal and the depth of the impression. Depending on the manufacturer and how good that impression is, a successful make can be as low as 55%, but as high as 95% if good impressions are taken.

We asked several manufacturers what they feel the future of IIC may be. As technology improves, some are hopeful that Bluetooth will get smaller and have potentially less battery drain, so as to fit a Bluetooth device into an IIC. I think that will be very challenging for both power and size, but hopefully we will see some advancements there as time goes along.

Hearing protection devices Brian Fligor: I want to shift gears ever so slightly and talk about maintaining the hearing people do have left, as well as understanding some of the benefits of custom hearing protection devices versus non-custom hearing protection.

There are different purposes with hearing protection devices. We need to provide as much sound isolation as possible. Maximum attenuation devices might include industrial hearing protection, and sometimes even that is not the best kind of protection when you do need to hear things like a forklift backup alarm.

However, in other cases, like on an aircraft carrier where the flight deck has 150 dB of ambient noise, they are necessary. With in-ear monitors, we want to isolate the musician’s ear from the crowd, which is about 100 dB, the drum kit that averages between 110 and 115 dB, and everyone else’s amplifiers that are pushing the same intensities.

In other instances, we want more uniform attenuation, and in fact, we want modest attenuation. More is not always good. Less is more. This is where we start thinking about how we would provide maximum ability to manipulate the acoustics of the external ear, such as by using a custom product. The benefits of a deeper earmold impression are greater attenuation and the ability to take advantage of and better represent ear canal acoustics. Non-custom protection has its acoustic downsides.

Figure 4 shows two Verifit tracings – the left is with a foam earplug and the right is with an ER 15 musician’s earplug. I swept an 85 dB tone with a probe microphone down near my eardrum.

The TFO, or real ear unaided response (REUR), shows a nice ear canal resonance (green line).

If I put in a foam plug, you will notice I have only a decibel of two of sound isolation in the low frequencies, but quite a bit more attenuation in the higher frequencies. There is a good 35

Feature 19 dB difference there between the lows and highs. With a musician’s earplug, however, I still have a good representation of the ear canal resonance. It is being maintained and not obliterated. This is not even a very well-fitting musician’s earplug in that it is over-attenuating in the low frequencies due to a slit leak, so we have the same issue there as with the foam plug. That plug is not fully conforming to the ear canal, and therefore it is allowing sound to pass right on through. Lower frequencies pass through little leaks much better. Overall, however, the attenuated response with the custom plug more closely follows the natural acoustic characteristics of the open ear canal.

Figure 4. Non-custom (left, foam earplug) versus custom (right, ER 15 musician’s earplugs) hearing protection as evidences by real-ear attenuation measures.

As with any earplug, comfort is a concern because there are discreet areas where pressure is applied, and that discreet area results in discomfort. The individual components of a musician’s earplug include acoustic resistance, acoustic compliance and acoustic inductance. The sound bore of the musician’s earplug acts as an acoustic inductance. This channel replicates the resonance of your natural open ear. When you have a deep earmold impression and a deep sleeve, you get flat attenuation of about 15 dB (Killion, DeVilbiss, & Stewart, 1988). If you have an undersized sound channel that it is not very deep, you end up with a slight over-attenuation in the high frequencies, and a loss of the ear canal resonance. That resonant peak is shifted slightly lower in frequency, which results in a distortion of the sound. Moreover, when your seal is poor, you get no sound isolation. You need a deep earmold impression that is going to show all of the anatomy of the ear and a sleeve that conforms well.

Figure 5 shows some Verifit measures when you have a sleeve that conforms well, compared to the open ear. You can see the ear canal resonance in the open-ear conditions (green). Again, I used an 85 dB swept tone with a probe mic down near the eardrum. The musician’s earplug runs are represented in purple. Averaging the values across frequencies shows an even amount of attenuation with low standard deviations across the spectrum.

20 Feature

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Feature 21

Figure 5. Verification of flat attenuation (green = open ear; purple = musician earplug inserted).

Figure 6 is an example of earplugs that were not well fitting. These were musician’s earplugs, but there was an absolute lack of attenuation in the low frequencies and some over-attenuation in the high frequencies. I am suspicious that this is the result of earmold impressions that were not deep enough. Additionally, some earmold labs may not be superior in conforming to all of the areas of high curvature, which results

in loss of low frequency sound isolation. The under-protection for the low frequencies will sound distorted. This musician will complain that you told them they were flat, but clearly they are not, and as a result, they may not use their earplugs. Therefore, you have caused them to lose confidence in musician’s earplugs, rather than to embrace them and protect their hearing.

Figure 6. Poorly fitting musician’s earplugs (green = open ear; purple = musician earplug inserted) with loss of attenuation in the low frequencies and over-attenuation in the high frequencies.

The maximum sound attenuation that is required is about 100 dB. Remember that the drum kit is 110 to 115 dB. The drummer personally experiences peak levels well above 120 to 125 dB. Sometimes when they hit the crash cymbal, the sound peaks over 130 dB. Additionally, these musicians are surrounded by amplifiers on stage. Some groups run all their instrumentals and vocals through a mixing board. In this case, each member of the band can hear more of what they want. The singer may prefer to hear more of himself and less of the drums. It all comes through their in-ear monitors, which are essentially full-shell silicone hearing aids with a direct audio connect that goes into a belt pack which transmits wirelessly from the in-ear monitor engineer. The idea is to monitor at the lowest tolerable level for the musician so they do not exceed the allowable

sound exposure. They should be protected from the other instruments on stage, as well as from the audience. They need something that is going to provide maximum attenuation. That maximum attenuation is provided by a tight seal at the aperture of the ear canal, as well as down through the canal, extending deeper than the second bend.

I would like to turn it over to Mark and Bob to start our discussion of deep insertion techniques.

Bob Hartenstein: Before we get into that, I wanted to mention that a number of years ago I did a research project with bagpipers. With an individual bagpiper, we saw levels well above 115 or 120 dB. Excess exposure does not only occur on a full sound stage with lots of musicians.

It can be just one person practicing at home.

Feature 23 Deep insertion techniques Mark Sanford: Bob and I both have been doing deep fitting earmolds and devices for a long time, so we are very comfortable with it. There are things that we have learned along the way.

Anyone can do deep fittings and impressions with good training.

The most important thing is having clear visualization of the ear canal. I started using a microscope back in 2007, and I cannot believe I practiced for 20 years without it. The benefit of it, even with traditional devices and removing wax, is amazing. That magnification power is worth every cent. There is a learning curve with it, but once you use it, you will never want to go back.

High powered loupes can be the same way. They both have pros and cons. Loupes can be moved from office to office easily, where a microscope is set where it is. Some people say they feel seasick when they use loupes. There are certain tricks that you need to learn with whatever you use, but the result is worth it. When I first got the microscope in my office, people acted like I upgraded the place. The professionalism it gives you puts you in a different league than others who do not use a microscope or loupes on a regular basis. So number one is that you have to see where the device is going to sit in the ear canal.

Other critical techniques include using vented otoblocks, which are fairly standard now and easy to purchase, as well as lubricating the canal using a material that is non-abrasive to the skin.

Bob Hartenstein: Once you get used to working with the microscope and working deep in the canal, I feel that the other professionals that we work with such as ear, nose, and throat (ENT) physicians, realize that and are glad to let you do things that they normally would feel they need to do. I routinely work with some ENTs for wax deep in the canal. They are more than comfortable for me to take that out now.

I gave a talk a few years ago about taking very deep impressions, and not one person in the audience said that they would be comfortable going that deep in the canal. As Mark said, the key is having good visualization. My preference is a microscope over loupes; I feel that the ability to visualize the canal and TM is better.

Brian Fligor: Figure 7 is a photo of me using a microscope to put a Lyric in a patient’s ear. The learning curve is getting used to the distance and how close (or far) you are to the patient. You can also get a camera and have a screen mounted in your room. Patients and family members love that. You can charge for wax removal. We do that once we are trained. People appreciate being able to do that in your office instead of having to go over to the ENT. Bob is right. The ENTs think that it is a wonderful thing and they have no problem allowing us to do it.

Figure 7. Example of fitting a deep device using a microscope.

The next picture (Figure 8) shows using a video otoscope or loupes. I might use loupes for removing wax that was not too deep. With deep things, I am more comfortable with a microscope.

I know people who only use loupes and they are comfortable with that. You have to find what your sweet spot is. Microscopes are usually more expensive, but you can find used ones that work just fine. They both have pros and cons, but you need to choose one or have both. Bob and I use both.

loupes or an operating microscope when I am at work on a band’s tour bus. I do this with a regular handheld otoscope and place the cotton block as deep in the canal as I can by my best guess. I lubricate the block heavily with some Otoslick and find I have a better tolerance with that, but each patient is different.

One thing that Alison thought would be interesting was to get a sense for what happens down in the ear canals when you are doing an earmold impression. She developed a pressure cavity using a pressure sensor. We had different audiologists inject impression material into this simulated ear canal as though they were taking a regular earmold impression. We had them do this over and over again. We found that at the time the audiologist would start to depress the plunger of a syringe and inject the material, there was an immediate spike of pressure with another quick drop back down. I would ask them to aim for 0.4 psi. One individual averaged just less than 2.0 psi pressure, and another one averaged over 5.0 psi, which were well over the target mark.

Figure 8. Practitioner using a video otoscope (top) or loupes (bottom).

User comfort Alison Forsyth, who is a Ph.D. biomedical engineer, made a presentation at AAA last year.

I had the pleasure of doing some work with her.

It was eye opening to me thinking how we each learn and use different techniques when we are injecting impression material into a patient’s ear. Most of us learned first at our university, and then we learned other techniques in our community placements. I do not often have

When different audiologists used the Lantos scanner, rather than the impression syringe, they each averaged about 0.5 psi. There is pressure applied to that canal wall, but it is considerably more even without that initial spike in pressure.

This might relate to how much discomfort a patient might experience and why some people tolerate earmold impressions better than others.

As we know, ear canal is much more pliable in the outer one-third, and much less so down in the inner two-thirds. When we are take an earmold impression down deep and we apply this amount of pressure there, a person will likely find that to be highly uncomfortable. We did look at different materials while taking the impressions, such as low viscosity versus high viscosity, as well.

There is a lot of variability in the process of obtaining earmold impressions. It may not be necessary to do earmold impressions for

Feature 25 all of the risks reasons that we just described, particularly down deep in the ear canal, but one approach to capturing that data in a different way is through a 3D scanner. Lantos is gearing up to launch their Aura 3D scanner and video otoscope (Figure 9).

Figure 10. Visualization and placement with AURA in the ear canal.

Figure 9. Lantos AURA 3D scanner and video otoscope.

Lantos AURA digital scanner Before the Lantos scanner is placed into the individual’s ear canal, a membrane is placed on the device tip, and there is a scope that is extended all the way down. You manually place this down the canal under direct visualization.

When the ear drum captures a little over 50% of the field of view, the tip is about 3 to 4 mm away the ear drum and you can stop. This is not in contact with the skin, and is comfortable for the patient. It is almost like holding an otoscope pen light down into the ear canal. The membrane is inflated with an optical dye that is housed inside the scanner, causing that membrane to expand out like a water balloon (Figure 10). The picture on the left of Figure 10 is the inside of that membrane. The optical scanner is able to see just where it is inside that conforming membrane to include all the nooks and crannies around the ear canal.

As that endoscope is retracted when it comes out, it stitches together all the points and data and creates a 3D rendering of the ear canal (Figure 11). When you finish stitching the information, the fluid that was filled into the conforming membrane is drawn back out into the handheld, and the membrane deflates. Then it is removed as a deflated water balloon.

Figure 11. Removal of membrane (top) and data points with 3D image (bottom) from Lantos AURA.

As one places this probe looking into this outer part of the ear canal, but still inside the ear canal,

26 Feature

Feature 27 you can capture images of how the ear canal is moving when the jar moves (Figure 12). I would suggest that that is not a very large excursion for the ear canals that the people at Lantos have looked at. They see that it does this over and over. Some change shape much more than that.

Figure 12. Inflation of the membrane during a closure of the jaw.

Summary There are significant benefits to fitting devices down to or past the second bend of the ear canal. One is that you can have improved gain via a smaller volume of air to act upon between the hearing aid receiver and the ear drum. The smaller volume of air boosts sound. Second, you have reduced occlusion effect because there is not as large of a chamber for sound, such as the patient’s voice, to resonate in the ear canal. Additionally, you can have less feedback in these instances. Lastly, you have more uniform attenuation with hearing protection devices, which results in better sound quality.

There are challenges and risks associated with the deep earmold impressions. As Bob and Mark mentioned, you need the ability to fully visualize the ear canal, and that requires loupes, an operating microscope or a video otoscope.

There is potential for patient discomfort. The ear drum can be highly vascularized when you take a deep earmold impression. I will admit in my experience taking very deep earmold impressions, no matter which otoscope I have used, I have found it difficult to tell whether or not I have passed that second bend especially if the ear canal flares out a little bit. If, in fact it

does, and I have placed my otoblock down inside that point, when I remove that impression, it will scrape along the wall of that area that is slightly more stenotic. That risks trauma. I would say that an ear canal bleeds in about 1 out of every 100 earmold impressions I do. I certainly do not want that; the patient certainly does not want that. Unless you are placing the block with a binocular microscope, you are going to have a challenge being able to judge distance.

There are new technologies that of fer opportunities for overcoming these challenges and managing those risks. This might facilitate fitting deeper devices, and it might make more individuals candidates for an IIC or a Lyric product. Perhaps it would answer on the spot whether or not a patient is a candidate for those devices by evaluating the canal and physical volume necessary to have one of those devices placed. This way, you can counsel a patient appropriately that which options are physically appropriate.

Bob Hartenstein: I have asked several hearing instrument manufacturers what the benefit would be for them to have deep impressions past the second bend. They are saying that the benefits would be tremendous, especially when they can see the dynamics of the ear, like jaw movement. This information when building hearing instruments is invaluable to them.

Mark Sanford: This shows why manufacturer want to come out with these products, why patients want them, and why we would want to fit these devices as audiologists. I can attest that patients love these devices because of how they sound. A former president of one of the manufacturers said to me, “Lyric is all cosmetic.” Well, if it was only cosmetic and it sounded awful, people would not wear it. But patients do like how it sounds. Please know they are not for everyone, but there are many people who would wear these devices successfully, and have for years.

I want people to realize that doing these fittings uses a different skill set, and that is what makes it fun. You are doing something different and setting yourself apart from other people in our industry fitting traditional devices. I love behind the ear hearing aids (BTEs), but it is always nice to do something different and new. I am excited to see where scanning technology takes us, because that is the way of the future in some shape or form. Deep placement is very critical.

Mark Sanford: Absolutely. Deep placement has been proven for years, and now the technology is available to make it a reality for many people.

It may or may not move our market penetration rate, but the benefits to the patients are real.

Manufacturers are able to make them more comfortable which makes the patients more successful, with less occlusion. I agree that manufacturers would be far happier with deep impressions, because they can make a more successful product that way. If we ask where we will be in five years, I would be willing to agree that deep insertion is the wave of the future.

Brian Fligor: Bob and Mark, do you have any reactions or thoughts to share about earmold impression techniques and challenges that you may have encountered in your years of experience?

Bob Hartenstein: I think you must take into account the comfort standpoint of the patient. If we are taking a full canal impression, the comfort of the patient, especially when removing the impression, should be a consideration.

Mark Sanford: I think deep impressions are all about comfort level. It is scary the first time you place an otoblock. You can tell it is against the ear drum if the patient is nearly jumping out of their seat, or you hit the vasopharyngeal nerve.

As with anything else, if you are trained and do it well, it can be done safely. There is a comfort level associated with the procedure and if you

have the right tools, it is really not much of a concern. You do the need the right materials.

I think Bob is right; the viscosity of the material is critical, as is using vented otoblocks.

We use the term “brick hands.� There are some people who are not gentle and perhaps should not be doing it. You can do it. Sometimes in the beginning it may take you 20 or 30 minutes, but your skill will improve with practice. It is like being back in graduate school where you were overwhelmed with how much you had to learn.

This is no different.

Questions & Answers How can you fully expand the balloon to the rest of the ear (concha and helix) and limit the pressure that is pushed inside the canal?

This is something that the engineers at Lantos get into, as far as the design of that membrane and how it works. It expands in a way that does not allow it to over expand. It is essentially under the control of a motor inside of the handheld device which monitors how much fluid is applied in versus out. Studies have been performed by that group to know how much pressure is being applied and maintained over the course of the scan, and how it expands into the concha. There are different ways to help mold that conforming membrane to go and push out into the areas that we want to be able to get, although I would argue, particularly for the topic that we are talking about today, the hearing aid manufacturers cut off all that stuff anyway in a traditional earmold.

The benefit of taking the earmold impression and including the canal and concha is simply for the audiologist to grab hold of something and be able to remove it, instead of the earmold impression getting stuck. How much it conforms outside of the ear canal when you are doing an IIC or a CIC may not be necessary information, but rather a matter of causing the membrane to conform in different areas.

Feature 29 Once you have placed the diaphragm into the canal, as far as proximity to the ear drum, it does not expand any further into the canal; all the expansion is to the sides.

Can you please elaborate on the rubber otoblock and also the lowest viscosity impression material available today?

I have been using otoblocks from Starkey. They have different sizes, and they come about 3 or 4 mm thick, and then I spread it out. I put on Merocel because it is less viscous, and as I am inserting that, it is lubricating the canal. It has a vented rubber tube that works very well. There is a flat disk at the end where the cotton is. It allows me to guide the block in there easily. I also use their impression gun. They have different viscosity options, but I have been using the one that is green.

What is the risk of running into the TM with the tip of the scanner?

As Brian mentioned, it acts as a video otoscope as you are placing it in. When you see the TM fill most of the view on the screen, you know you are about 3 mm from the TM. You certainly do not want to go and fill more than that window up with the TM.

Has anyone worked out how to apply the new information you are able to gain by recording the variability of an ear canal when the jaw moves?

Different hearing instrument manufacturers are looking at that data now and are trying to see how they best can use it and what benefits it has.

Mark said this is the wave of the future. I think having this type of information will help shape what can be done differently when we are talking about deep devices and better fitting devices moving forward.

Will the Lantos package include exporting FTP files types or IGS wireframe file types to a 3D printer?

The file type that the Lantos scanner will deliver is an FTP file type, which is an industry standard file for CAD systems and 3D printing systems.

Brian Fligor

Sc.D., PASC, Bob Hartenstein, AuD

Mark Sanford MS, CCC-A

References Arbogast, T., & Whichard, S. (2009). A new hearing aid class: the first 100% invisible extended-wear hearing aid. Hearing Review 16(4), 20–27.

Agnew, J. (1994). Acoustic advantages of deep canal hearing aid fittings. Hearing Instruments, 45(8), 22–25.

Killion, M. E., DeVilbiss, E., & Stewart, J. (1988). An earplug with uniform 15-dB attenuation.

The Hearing Journal, 41(5), 14-17.

Preves, D. A., Fortune, T. W., Woodruff, B., & Newton, J. (1991). Strategies for enhancing the consonant to vowel intensity ratio with in the ear hearing aids. Ear and Hearing, 12(6S), 139S-153S. Staab, W.J. (1994). Clarifying the CIC mystique. Hearing Review, August

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Australian Government Hearing Services Program Office of Hearing Services

Contracted Service Provider Notice:

Voucher-holders relocating between Contracted Service Providers Key Messages Message One Written authorisation is required from the voucher holder in order to transfer client records.

Message Two Please ensure your records are current, and you are not sending maintenance claims to clients who have relocated.

CSPN – 2014/05

Dear Service Providers The Office of Hearing Services (the Office), has recently received a number of complaints from clients and contracted service providers (provider) regarding relocated or relocating clients.

Relocating clients Rule 12(1) of the Rules of Conduct 2012 (the Rules) requires that a provider must not request a voucherholder’s records from another provider without written authority from the voucher-holder. The online portal has a tick-box for you to certify that you have this authority.

This written authority must be kept on a client’s file for audit purposes.

Providers unable to provide evidence to support this certification may be subject to compliance actions.

Client records The client’s complete original record must be forwarded to the requesting provider, with copies of the original claim forms.

Original claim forms should be kept by the previous provider, for seven (7) years following the date of the last claim. After this time they can be destroyed as instructed by the Office.

Contacting relocating clients

For further information visit: www.health.gov.au/hear email: hearing@health.gov.au telephone: 1800 500 726

Please remember, it is the client’s right to choose the provider they wish to visit. Clients should not be contacted and pressured into staying with a current provider, if they have chosen to relocate.

Batteries and maintenance claims and contact lists A number of clients have received batteries and maintenance claim forms in the mail for them to sign and return to providers. After completing and returning these forms, clients have then realised that these forms are not from their current provider.

This practice is confusing and upsetting for clients.

Rule 7 of the Rules and Outcome 8 of the Hearing Rehabilitation Outcomes for Voucher-Holders (HROs) requires that client records are complete and current. This also applies to mailing lists and general records in relation to voucher-holders. Please ensure that a relocated client is removed from these records at the time the client file is transferred from your practice to avoid them being contacted by your company in future.

Providers should be aware that maintenance claims are subject to audit and that they will be required to refund the client and the Commonwealth for these maintenance claims if the client has relocated.

Thank you for your co-operation in these matters.

Yours sincerely

Tracey Duffy National Manager Office of Hearing Services 28 February 2014

Australian Government Hearing Services Program Office of Hearing Services

Contracted Service Provider Notice:

Manual claims via email Key Messages Message One Manual claims can now be emailed to the Office for processing.

Message Two The Office will return queried claims to each senders email address.

CSPN – 2014/06

Dear Service Providers The Office of Hearing Services (the Office) will now accept and process manual claims emailed to ohsclaims@health.gov.au. Claims can be emailed from individual sites or sent in bulk from a central point, depending on your organisation’s policy. An individual email will be required for each client, containing all claim items and supporting documentation as necessary/required.

Email identifier To enable Office staff to store and locate your claim, all emailed manual claims must contain the following information in the email subject line: Provider No. – Voucher No. – Client Name – Item No(s) eg. Subject: 012345A – 165000000A – Jane Doe – 635,777 Attachments All attached documents should also be clearly labelled as follows: Voucher number - Client Name - Item No. (or file description) eg. 165000000A – Jane Doe – Case Notes Returned Claims If the Office wishes to query a manual claim sent in by email, it will return the original claim with an explanation, to the sender’s email address.

When resubmitting a queried claim, it is important that the subject line information remain the same as the original claim. This will require you to delete [Re: FW: Returned Claim] from the front of the subject line before you resend your claim.

Voucher issue date Where a service is being claimed against a previous voucher, please provide the issue date of the previous voucher on the manual claims form.

A flowchart that illustrates the claims process has been published on our web site.

Yours sincerely

For further information visit: www.health.gov.au/hear email: hearing@health.gov.au telephone: 1800 136 817

Carey Lonsdale Director, OHS Governance Office of Hearing Services 3 March 2014

Announcement 35

OHS Claims Process OHS CLAIMS PROCESS

Check criteria for claiming under the Contract.

Initiate a claim.

MANUAL CLAIM

Provider completes the Manual Claim form and ensures that: • The correct Item Number for service’s provided • The Date of Service is correct • The Site ID and Practitioner Number are correct • The Device Code is provided (if applicable) • The Date of Fitting is correct • The payment amounts match the Schedule of Fees • 3 Frequency Average Hearing Loss (FAHL) have been checked and entered • All claim forms are signed by client (with exception to all non-follow-up claims) and held of file • An authorised person has signed the form Providers need to check that: • If claiming a Spare Aid/Remote Control – a Remote Control/Spare Aid form is completed and attached along with a copy of the manufacturer’s invoice.

• If claiming an item 1 or 2 –include the device codes and ensure the date of service is the same as the date of fitting.

Submit Manual Claim • Via email: ohsclaims@health.gov.au (please refer to CSPN 2014/06 for the correct submission format) • Via post: Manual Claims: MDP 113 GPO BOX 9848, Canberra ACT 2601.

E-CLAIM

Submit Claim to Medicare via E-claim System

Accepted: Processed & paid

E-claim Rejected: Incorrect /Incomplete Returned to Provider

Need help?

Contact OHS Claims on 02 6289 5138 or email ohsclaims@health.gov.au your query.

REFERENCE GUIDE

Rejected: Incorrect /Incomplete Returned to Provider

NO

Correct Manual Claim Submitted?

• •

YES

Accepted: Processed & paid

Refer to Claiming Rules specified in the Contract before submitting a claim.

Refer to the Schedule of Service Items for correct items and amounts.

**All fittings and re-fittings must meet the Minimum Hearing Loss Threshold (MHLT). Supporting case notes, refit criteria must be kept on the client file and is subject to Audit**

Australian Government Hearing Services Program Office of Hearing Services

Contracted Service Provider Notice:

New privacy laws Key Messages Message One New privacy laws come into effect on 12 March 2014.

Dear Service Providers Privacy Principles (APP) are a single set of principles that will cover both the public and private sectors when amendments to the Privacy Act 1988 come into force next week. Administrative responsibility for the APP lies with the Office of the Australian Information Commissioner (OAIC). There are 13 APP covering the following topics: • APP 1 — Open and transparent management of personal information • APP 2 — Anonymity and pseudonymity

Message Two

• APP 3 — Collection of solicited personal information

Providers must comply with these laws.

• APP 4 — Dealing with unsolicited personal information

Message Three Providers should visit the Office of the Australian Information Commissioner website for further information.

• APP 5 — Notification of the collection of personal information • APP 6 — Use or disclosure of personal information • APP 7 — Direct marketing • APP 8 — Cross-border disclosure of personal information • APP 9 — Adoption, use or disclosure of government related identifiers • APP 10 — Quality of personal information • APP 11 — Security of personal information • APP 12 — Access to personal information • APP 13 — Correction of personal information

CSPN – 2014/04

Contracted service providers must comply with these new principles like every other business in Australia. The OAIC has released guidelines about the APP which outline minimum compliance requirements and they are available on the OAIC website at: www.oaic.gov.au/privacy/applying-privacy-law/app-guidelines For further information visit: www.oaic.gov.au Email: enquiries@oaic.gov.au Telephone: 1300 363 992 Yours sincerely

For further information visit: www.health.gov.au/hear email: hearing@health.gov.au telephone: 1800 500 726

Tracey Duffy National Manager Office of Hearing Services 28 February 2014

Hearing Nepal Program

Passing it forward!

We encourage all those who have benefited from our service, to pass the kindness forward. This can be achieved on the spot if they make a donation to the charity “box” at the clinic or hearing camp site.

This money is then spent in the area where it was collected, and helps the recipients feel the joy of giving to others, as we do.

The most effective “expression of gratitude” manifests when an act of kindness received becomes the motivation to pass another act of kindness to a being in need.

This visit to Nepal has again been a wonderful occasion for HNP, NAHOH, NAFA and JOY to work together, each as they do best… for the benefit of others.

NAFA Notes: Nepal Australia Friendship Association - Inspiring and supporting us.

1. Rod and Deb, Ross and Brenda, and Peter (NAFA) met with Keshab and Antje (HNP) at the disabled home to discuss ways of improving the quality of life of the residents. See comprehensive notes below 2. Brenda (NAFA) attended our hearing camp at the Kopan Ani Gompa, to see how we do it now!

PALPA HEARING CAMP Notes: Palpa Boys Home is operated by PA Nepal, caring for the children who were imprisoned with their mother, or motherless children whose dad is in prison. It is situated in the Palpa rural area. “By the way” benefits of the hearing camp at the home included….

1. PA Nepal’s Indira improves her relationships in a previously sometimes hostile environment when relating to local officials, not keen on the home in their area.

2. Keshab to visit prisons in Ktm, as a result of contacts made when taking our services to the Ladies and Mens prison in Palpa 3. Keshab will also work with Indira in other sites. Indira must find sponsors for these camps

Regular 39 Time out in Pokhara 1. Keshab learnt to sail, can now take wife Saraswoti on sailing excursions on lake.

2. Sue and Katie supported deaf-blind weavers.

3. We visited Sophie, a NAFA sponsored cochlear implantee, and checked her processor, also supplied her with an electronic dryaid system.

Cochlear Implant recipients in Nepal As a result of getting involved Sophie, it was decided to meet with the Nepali service providers and see if we can work with them for everyone’s benefit. Sue, Keshab, Katie and lew had a positive meeting, establishing protocols that will enable HNP to make available donated parts to the Nepali service provider, which will then be issued to the recipients for a “minimum donation” to HNP Inc. Sue will also provide / arrange technical support.

Kopan Ani Gompa (Nunnery) Hearing camp for the Kopan area, Jan 2014 OOPS...Look what Keshab found in my ear. A small ball from a toy “pop” gun!

An a bonus for the Nunnery Clinic...

Hearing Health posters were left by request at clinic after completing hearing care camp at the Nunnery.

JOY Notes: A Nepali Foundation, working tirelessly for improvements for the “differently abled” Keshab ( HNP Inc – NAHOH) has arranged camps with Pradip, JOY’s social mobiliser.

JOY will arrange sponsors for transport and medicines; NAHOH will of course supply primary ear care, education materials and hearing devices as appropriate.

Disabled Home: Where our “sister” Kumari now lives Building restoration- waterproofing. NAFA and JOY taken an active role with home administration to rebuild ??? or fit new roof to home, so that the occupants rooms are dry. Picture shows concrete “cancer”.

And the people in the home….how do we help??

1. NAFA presented jumpers to residents of the home, when they went to visit Kumari. They were demonstrating their keen interest in assisting with the building repairs, the need observed on a previous visit by Tanya and lew 2. Physiotherapy: Kumari’s physiotherapist was offered the opportunity to learn some relatively new, less painful complementary treatments for Kumari, from Katie who is a massage therapist in Australia. Subas the physio was very interested to learn a technique that is very gentle and painless as an adjunct to his normal physiotherapy techniques. Subas also presented several residents with other physical challenges (spinal cord injury, brain injury, muscular dystrophy) to discuss how the techniques could also benefit them. Introductory notes were left and future support promised.

3. Knitting classes for 8 residents! NAFA and Joy shall progress these later next month.

40 Regular

4. Ganesh from local bakery, who was asked to bake a birthday cake for Kumari has offered ongoing gifts of cakes and/or bread. He also offered chocolates for the Disabled Home in addition to the birthday cake.

5. HNP Inc “Fluffy” distribution ~ rugs from Katie and her Mum, fluffy toys from friends in Australia.

This was on a day when many from remote areas were also gathered for a rally, so the smiles were broader.

NAHOH – Training Thankyou Antje, who came from Germany to train Keshab, Sarita and Dorje in hearing testing, Hearing aid fitting and Mould manufacture. What a blessing!

Dear Lew and Sue Namaste I attach some photo of Toys distributed .

Today hearing aid fitted Boys name is Kushal S. 10yrs/M Moderate Sensory Neural hearing Loss fitted with Siemens Music pro S Both ear and Samrat S. 4 yrs/M Profound Hearing Loss fitted with Unitron 360e both ear, they are same family from Chitwan,Khairani-4.

With regards Keshab Himalayan Ear Health

Carry on Keshab!

It has become apparent that for political expediency we need to supply our services under a generic name when outside of Nepal.

After lengthy discussion, Sue, Keshab, Katie, Tsundu and lew we have agreed on the above name. There will be separate accounting records and independent funding sources. Katie will set up a separate web page, which will of course link back to the parent HNP Inc. page. If our program is to benefit as many as possible, not restricted by borders, then we need this separate section.

Funding can then clearly be directed to the areas as the donor intends, and transparency will be maintained.

And so, when left alone to do that which he does best…Keshab reports his activities

Katie will liaise with Tanya as to how best we can achieve the above.

1. So not only was the training highly successful, it is going to be repeated in Ladakh this June.

2. Saraswoti (Keshab’s wife) and Sarita now have much more confidence when speaking English…thanks again to their association with Antje. Saraswoti will now be able to actively participate in our program, and will be a great asset in Ladakh, because she can also speak Hindi.

All good…lew

Announcement 41

Practitioner Professional Bodies Memorandum of Understanding with the Office of Hearing Services The Office of Hearing Services has a Memorandum of Understanding (MoU) with the Practitioner Professional Bodies (PPBs).

The MoU formalises the relationship between the Office and the PPBs. The Office has the same agreement in place with each of the PPBs. Some of the topics covered in the MoU include membership and qualification requirements, continuing professional education and development and the exchange of information between the PPBs and the Office.

Why does your PPB publish articles from the Office?

The MoU provides for PPBs to distribute program information materials supplied by the Office to their members through either magazines or websites.

This helps the Office to support practitioners by providing another source of information for important updates and changes to the program.

Article topics are chosen for a variety of reasons including responding to inquiries received by the Office seeking clarification such as audit concerns and responding to any article requests from the PPBs. You may have already seen some articles from the Office in your PPB magazine about changes

to the Office’s audit and compliance activities, record keeping under the program and DVA clients and top-up hearing devices. The Office will continue to prepare similar articles over the coming year.

Where can I get more information?

If you have any questions or feedback about the Memorandum of Understanding or the Office’s program information materials please contact your PPB listed below: Audiology Australia Limited info@audiology.asn.au Australian College of Audiology acaud@acaud.org Hearing Aid Audiometrist Society of Australia haasa@haasa.org.au Visit the OHS Website http://www.health.gov.au/hear/

Be involved in the bloom™ customer journey At bloom™ we understand that it is our people who are our most important asset as it is our people that make a difference in the lives of those affected by hearing loss.

open

smart

courteous

We are honest and direct – but always in a friendly and optimistic manner.

Our aim is for our customers to think of us as people with an infectious optimism that always makes them feel strong and empowered.

We pride ourselves on learning and development as a focus for our team, so our Hearing Specialists can remain up to date with the latest in technology and practices.

We always want to be there for our customers, and we understand that “helping them help themselves” is the best way we can help improve their hearing.

Due to our continued growth the following opportunities have arisen:• If you’re looking for a relaxed beach side experience apply for the Audiologist/Audiometrist role in Coolum QLD • Alternatively if you’re after a quaint community experience apply for the Audiologist/Audiometrist – Wagga Wagga NSW, Albury NSW and Ballina NSW • Full Time Audiologist/Audiometrist – Mona Vale NSW To succeed in these roles you will need to have the ability to self manage and pride yourself on your attention to detail. As an experienced practitioner, you will come with experience fitting hearing aids, be results driven and most importantly a desire to make a difference to our customers’ lives.

In return for your dedication and experience you will be rewarded with: • A competitive remuneration package • Ongoing training, sponsorship for conferences and continuing professional development • The opportunity to be part of a dynamic growing company • Valid drivers licence and willing to travel between sites

Open, smart and courteous form the core values at bloom™, to ensure a quality service experience second to none for our customers.

All applicants must hold a current QP number and be a full member of the Audiological Society of Australia Inc (ASA) or Australian College of Audiology Inc (ACAud).

If you are interested in becoming a valued member of bloom™, please contact our People & Culture team today on careers@ widex.com.au. or phone (03) 9411 2954.

www.bloomhearing.com.au

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