Associations June 2015

Feature 1

JUNE 2015

Congress Edition NATIONAL

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

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Contents

2015

Catch up on recent correspondence: ACAud 15 Registration Brochure

08 14

Oticon Research Article Tinnitus Sound Support: A Flexible Solution for both Patients and Audiologists

Oticon Medical Research Article

22

Clinical Experience with the Oticon Medical Ponto: For Children with Microtia and Atresia at Hear and Say

Severe to Profound Hearing loss:

31

Best practice strategies from a hearing-impaired clinicians’ diary

ACAud15 Academic Program

54

Regulars

05 Presidents Report 06 Membership Matters and Natters

45 Press Release 64 Advertise with Accord

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

Regular 5

Dear Members, Let’s start with the new OHS contract. There has been a lot of discussion about the new contract in particular clauses 29-30 due to take effect on July 1. There has been some confusion about the intent of the clauses and ACAud along with other stakeholders had sought clarification from the Office. At the Sam Camilleri recent PPB meeting the Office had shed some light agreeing the wording in its current form is not clear and at the time of writing this report was is in the process of re writing the clauses. The Office was also able to give some explanation about the intent of the clause saying it is to create transparency of potential financial interests that may influence clinical judgment and decision making.

The contract is between the Office and Service Providers and so will require the disclosure of device arrangements they have. This may be in the form of a Statement in the waiting room declaring arrangements exists, for example, Bla Bla Hearing has preferred supplier arrangements and the sale of some devices may be subject to commission payments.

Applying this type of statement somewhere around your office should satisfy your contract obligations but this is clearly an issue deserving further discussion from all involved in hearing care.

You would all be aware of the recent focus in the media on vertical integration and commission payments. That attention has made most Professional Bodies stop and think. From a Professional Body point of view it comes in the form of reviewing our Code of Ethics/Conduct asking whether or not we conduct ourselves in a manner which is line with current thinking.

All Professional Bodies have Codes which are important statements and guide to members and the community about how we go about providing services. Some Professional Bodies have already updated theirs to reflect current views in relation to avoiding perceived or potential conflict. ACAud has also been looking to update ours though this task is not as simple as it seems. Simply updating the code to reflect current views in the current employment environment puts members in the firing line for disciplinary action. The nature of remuneration for most clinicians providing hearing services is a base salary plus commission, receiving commission payments potentially puts those members in breach of their codes presenting a potential conflict of interest that could improperly influence a clinical decision. As far as I am aware this has not been tested as yet but I feel it will be a matter of time.

The argument is, if commissions do not influence decision making why are they needed as an integral part of the salary structure?

Regardless of an individuals integrity there is no doubt of an increasing concern within the community about the relationships between clinicians and Industry. I think this discussion is beyond just Professional Bodies and requires collaborations with all stakeholders involved in Audiology to discuss and determine the best path forward.

The ACAud executive will discuss the best way to move forward from here and the upcoming Congress will be a

REPORT

great opportunity to hear views of the membership.

We have been very conscious of costs to members and one of the substantial changes during my term was reducing operating costs. These changes have been reported previously and we initially passed on some savings by freezing any fee increases and subsidizing CEP events With the full benefits of the restructure now realized we were pleased to pass on further savings. You would have already received your 2015/16 membership fees and noticed a 20% discount if paid by 30thJune. Costs to members are a continuing focus of the executive and we hope to maintain our low fee structure for some time to come.

Attending a Congress every 2 years is a compulsory CEP requirement and it’s great to see our members supporting the ACAud Congress over others.

On this point I also wanted to take the opportunity to talk about the importance of CEP events. It would be easy in our working day to continue to do the same thing day in day out without giving much thought to what might be happening in our profession. A Congress gives you the perfect opportunity to hear from experts about ideas evolving in our field The reason I brought this up was there are those that feel the Congress should not be compulsory. I wanted to make it clear to members the congress is an integral part of our continuing education program. The ACAud Congress is renowned as one of the best in the country and the executive feel the only way to keep the standard high and our costs down is to spread the costs more evenly across the membership.

Making the congress compulsory means more members attend keeping registration fees lower making it more affordable for all; it’s as simple as that. We do our upmost at keeping fees down and in recent years have offered early bird options making the ACAud congress in comparison one of the most affordable in the country.

A quick reminder for members who hold 4 year overseas bachelor degree, changes to our bi-laws made in early 2015 means that you may be eligible to apply and sit the written Audiology challenge exam. Successful applicants will achieve Audiologists status with ACAud. If you would like further information about the process please contact the ACAud office.

On a brighter note my term as president is coming to an end so this will be my last president’s report. The last 18 months have been eventful to say the least and we have achieved almost all we set out to do. I would like to take the opportunity to thank both members and the executive for their support and in particular the executive who volunteer considerable time and energy whilst still having to juggle their full time work commitments.

Also congratulations to Ian Mawby as the incoming president, Ian will take over the position at the AGM in August. Ian has held the position before and his past experience and background make him a good choice to lead ACAud for the coming 2 years, while my role will be in support as immediate past president Sam Camilleri

Sam Camilleri, President Email: samuel.camilleri@connecthearing.com.au

6 Regular Membership

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

ACAud NATIONAL CONGRESS 2015 ACAud National Congress 2015| 6 – 8 August 2015 | Novotel Twin Waters, Sunshine Coast, Queensland

By 15 OCTOBER 2015 | 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 see enclosed Registration Form.

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

NOVEMBER 2015 BHA EXAMINATIONS

ACAud WEBSITE

Attention Associate Members | We have recently completed our May 2015 BHA Examinations in Brisbane, and are well underway with preparations for our August 2015 BHA Examinations in Brisbane & Sydney I am now looking for expressions of interest for our November 2015 BHA Examinations which will be held in Brisbane.

The schedule for August 2015 BHA Examination is:-

Don’t forget our new ACAud website is up and running www.acaud.com.au If you haven’t registered for the Membership Portal yet, follow the below simple steps to register:- Visit www.acaud.com.au - Click ‘Join ACAud’ tab - Click ‘Register with ACAud’ tab - Complete the form - Click Submit

By 30 SEPTEMBER 2015 | Candidates must have submitted their request to sit BHA Examination and have paid their Examination fee.

Congratulations TO OUR NEW ORDINARY MEMBERS!

•

Vinh Hung Cao

Best wishes, K ylie Dicieri x •

Anna-Marie Marais

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The Australian College of Audiology’s National Congress 2015 will be held at the Novotel Twin Waters, located on the Sunshine Coast Queensland.

Registration fees and payments

Cancellation policy

All registration fees are in Australian dollars (AUD) and are GST inclusive. All ACAud members are eligible for the members rates*.

You are required to provide your ACAud membership number when selecting this option in order to receive member rates.

New ACAud members who have joined within 3 months of the National Congress will have their application fee waivered. For further information please contact ACAud on acaud@acaud.org

All cancellations need to be made in writing to ACAud. Cancellations prior to 1st April 2015 will receive a 50% refund of the total registration fees. Refunds for cancellations after 1st April 2015 will only be made in exceptional circumstances.

* In order to receive ACAud member rates, all ACAud members must be financial.

Member, Non-Member and Student Registrations include: Attendance to all Congress sessions, Full catering for all 3 days, ACAud National Congress satchel (which contains all Congress documentation), attendance at the Welcome Function and attendance at the Gala Dinner.

Exhibitor Registrations include: Full catering for all 3 days, ACAud National Congress satchel (which contains all Congress documentations); attendance at the Welcome Function and attendance at the Gala Dinner.

Day Registration include: Attendance to all Congress sessions and full catering on the nominated day. It does not include attendance at the Welcome Function or Gala Dinner, tickets must be purchased separately for these events.

Accompanying Person Registration include: Attendance at the Welcome Function and attendance at the Gala Dinner. It does not include attendance to the Congress session.

Extra Early Bird Registration: As a way of giving back to our loyal members, not only are we providing you with an early bird registration that extends through to March 2015, ACAud are also offering an Extra Early Bird Member Registration at the low cost of $545. The cut off for the Extra Early Bird is 31st January 2015.

Accommodation refunds are subject to the hotels specific terms and conditions, please contact the relevant hotel for further information.

Liability disclaimer In the event of industrial disruption or other unforeseen circumstances, ACAud accept no responsibility for loss of money incurred by the delegates, exhibitors or sponsors.

Accommodation Given that we are holding our ACAud National Congress at the Novotel Twin Waters, they have provided us with cheaper room rates. Their sister company Grand Mecure Twin Waters (next door to the Novotel) also provide us with cheaper room rates.

See additional information below. Should you be interested in booking this accommodation, please contact the hotels directly and provide them the group booking name ACAud, to access these rates.

Activities for families Novotel Twin Waters has a range free activities for families including: water trampoline, kayaks, catamarans, wind surfers, beach volleyball, bucket and spade sets, putt putt golf, frisbees, bocce ball, football and soccer balls, mini cricket, nature and beach walks, fish feeding, gymnasium, heated pool and spa, deck chairs on lagoon beach, BBQ’s in the gardens and board games. Availalbe for hire are bikes, stand up paddles, surf boards, boogie boards, archery and fishing equipment.

Kidz Cove

Full payment is required upon receipt of the completed registration form.

Kidz Cove offers baby sitting and a number of activities for children such as: cooking classes, arts and crafts, face painting, water and sand play, beach activities, pirates and fairies, playstation/wii games, dvds, dress-ups, board games, foosball/air hockey, fairy house, climbing wall and home corner. For bookings and further information please phone 07 5450 9545.

Novotel Twin Waters

Grand Mecure Twin Waters

Ocean Drive Twin Waters Q 4564, Phone 07 5448 8000

80 North Shore Road Twin Waters Q 4564, Phone 07 5450 6129

Payment policy

Room Type

Room Rate

Single Occupancy inc. breakfast

Resort Room

$169

$191

$231

2 Bedroom Apartment

$345

N/A

N/A

One Bedroom Suite

$259

$281

$303

3 Bedroom Apartment

$388

N/A

N/A

Over Water Lagoon Suite

$371

$371

$393

4 Bedroom House

$888

N/A

N/A

Twin Share inc. breakfast

Room Type

All prices per room per night. Please see attached accommodation form to complete and send back to the Resort.

Room Rate

Single Occupancy inc. breakfast

Twin Share inc. breakfast

Please note: No breakfast included with the Grand Mecure location. All prices per room per night. Please see attached accommodation form to complete and send back to the Resort.

ACAud NATIONAL CONGRESS SUNSHINE COAST 2015

REGISTRATION FORM

IMPORTANT: PLEASE RETURN COMPLETED REGISTRATION FORM AND PAYMENT TO ACAUD. DETAILS BELOW.

Personal details Title: Dr / Prof / Mr / Mrs / Ms / Miss / Other

Surname:

Position:

Organisation:

First Name:

Address: State:

Suburb / City: Postcode:

Country (If other than Australia):

Phone:

Fax:

Email: Mobile:

Other requirements (e.g Dietary, Wheelchair access, Hearing Loop, etc): I authorise ACAud to keep me informed about future events and promotions (Please Tick) I authorise my contact details to be provided to registered exhibitors and sponsors (Please Tick)

Registration details Membership numbers: If you are a member of ACAud please list your membership number: If you are a member of ASA please list your membership number: If you are a member of HAASA please list your membership number:

Payment summary

Registration type: Extra Early Bird Member Delegate Registration Available until 31st January 2015

$545

Early Bird Member Delegate Registration Available until 31st March 2015

$645

Early Bird Delegate – Non-member Available until 31st March 2015

$885

Full Delegate – Member

$695

Full Delegate – Non-member

$935

Student Delegate

$500

Day registrations: Student Only Registration - Thursday

$205

Student Only Registration - Friday

$205

Student Only Registration - Saturday

$205

Thursday Only Registration

$380

Friday Only Registration

$380

Saturday Only Registration

$380

Registration Sub Total

$

Social Program Sub Total

$

Total amount payable

$

Payment details: I would like to make payment by (Please Tick) Cheque Made payable to Australian College of Audiology E.F.T. Account Name: Australian College of Audiology; BSB: 064 001; Account Number: 1087 1723 A remittance advice must be provided for your payment to be credited and please ensure you reference payment with your full name.

Credit Card Card Type:

Visa

MasterCard

Credit card number: Expiry date: Card holders name: Signature:

Social program: Return and further details:

To assist with catering, please indicate your intentions.

Failure to do so will be noted as non attendance.

Please return this form with payment to: Australian College of Audiology (ACAud) Suite 7, Level 4, 201 Wickham Terrace, Spring Hill QLD 4000

I/We will be attending the following Social Event: Complimentary Welcome Function Complimentary Congress Gala Dinner (Please be advised the Gala Dinner will be held in the Eucalypt Clearing undercover, outdoors on grass)

Phone: Fax: Email:

Welcome Function additional tickets Please outline the number of tickets required:

$100

Congress Dinner additional tickets Please outline the number of tickets required:

$180

Accompanying Person

$280

Includes a ticket to both the Welcome function and Dinner

Please outline the number of tickets required:

07 3839 1622 or 1800 803 128 07 3839 1822 acaud@acaud.org

Agreement to terms and conditions: I wish to register for the ACAud Congress and I acknowledge the registration terms and conditions including the cancellation policy.

Signature: ACAud NATIONAL CONGRESS SUNSHINE COAST 2015

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14 Feature

Tinnitus Sound Support: A Flexible Solution for both Patients and Audiologists Annette Mazevski, AuD, PhD

Introduction In 2013, over 1.1 million veterans received disability benefits connected to their tinnitus1.

Similar to previous years, tinnitus is the most common service-connected disability, impacting daily activities and quality of life. It is anticipated that the figures for veterans who report tinnitus as a service-connected disability will increase between 13 to 18% annually2. As mentioned in previous literature, tinnitus can have a significant effect on an individual, including loss of sleep, depression, social isolation, and general wellbeing, and it can be so severe that it can affect job performance or cause suicidal thoughts3.

Most veterans report tinnitus following exposure to loud sounds, usually while on active duty, and is usually observed alongside hearing loss.

Proper treatment that includes counselling, and the use of amplification and/or use of sound generators, can alleviate the symptoms related to tinnitus.

In the VA, the most common counselling method used to alleviate tinnitus is Progressive Tinnitus Management4 (PTM). A patient-centered approach, PTM assists those with tinnitus using a hierarchal approach (see Figure 1), including triage, audiologic evaluation, group classes, interdisciplinary evaluation, and individualized support. This hierarchal approach provides a path for clinicians to follow when managing a tinnitus patient, with each step providing more support to the patient as needed.

In the higher levels of PTM, the use of a sound generator is typically suggested following group education, as the it is intended to provide soothing, background, or interesting sounds, dependent on which type of sound with which the patient finds relief. Sound generators have ACCORD JUNE | Congress Edition

been used clinically to provide relief since the 1980s; however, limitations involving sound choices and sound shaping have been difficult to overcome in some products, leaving tinnitus patients less than satisfied. In the past several years, combination devices have become more common due to the comorbidity with hearing loss and have benefited audiologists when amplification alone did not alleviate the patient’s tinnitus.

Although there are many solutions available for tinnitus relief, not all provide ample flexibility to the audiologist or preferred sounds to the patient. Other specific features, such as the ability to adjust modulation or mute the microphone so only the sound generator is heard, are not commonplace in many devices. Not only is it important to have the flexibility and control to create an ideal setting to best assist a tinnitus patient, but it is paramount to ensure ease of use and confidence while creating a tinnitus solution specific to your patient.

In this paper, we will discuss Oticon’s tinnitus feature – Tinnitus SoundSupport™ (TSS) – as a means to help provide relief to the tinnitus patient while making the fitting process for the Audiologist easy and intuitive.

Feature 15 Figure 1. Hierarchal progression of PTM. Note that 80% of veterans who report tinnitus fall into the nonbothersome category, and the remaining 20% will fall into the bothersome category, thus entering into the PTM program.

Methods Participants. Seven audiologists who serve veterans were asked to evaluate the Alta 2 Pro with Tinnitus SoundSupport™ as well as the implementation of TSS through Oticon’s Genie Software and the experience of the tinnitus patient. Information was gathered through questionnaires and in-depth interviews.

Audiologists who provided feedback ranged in having little experience to extensive experience with Oticon products and software. Overall, 34 patients were seen by 7 audiologists in 3 locations. Patients who were fit with TSS ranged in age from 24 to 95 (average age was 57.7), were either experienced (n=10) or new users (n=24), had hearing loss that ranged from mild to severe (see Figure 2), and reported tinnitus between 6 months to over 40 years (see Figure 3).

Fitting. Audiologists were asked to leave P1 as hearing aid only and enable TSS in P2 with or without the hearing aid microphone activated.

Since the clinics that participated in this data gathering already had protocols in place, some chose to activate TSS in P1 while others chose to have more than one TSS programmed into the hearing aid (e.g., broadband sounds in P2 and nature sounds in P3). As a guide, clinicians were provided with a quick fitting guide and quick fitting checklist created by Oticon, although the majority of the clinicians used PTM. Once TSS was activated in the software, the clinician had the option to choose from a variety of sounds, labelled under Broadband (white, pink, or red) or Nature (Ocean 1, Ocean 2, or Ocean 3) sounds.

Under Broadband sounds, the clinician had the option to adjust the signal level, the filtering of the sound using high-pass and low-pass sliders, and five modulation settings (Off, Tranquil, Mild, Spirited, and Bustling). Under Nature sounds,

Oceans 1-3 have a random modulation setting, to better mimic the onset and offset of waves at the beach. With both Broadband and Nature sound settings, the audiologist had three additional options: 1.) the ability to link the two hearing aids together once the settings have been set, 2.) to mute the hearing aid microphone such that only the wearer would be hearing the TSS sound that had been chosen, and 3.) to activate Automatic Level Steering, a feature that would identify when sounds reached a particular level in the environment, and therefore allow TSS to taper since the environmental sounds would provide masking to the wearer instead.

Figure 2. Average audiometric data for veterans.

Figure 3. Amount of time the veterans reported having tinnitus.

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

16 Feature Materials and Interviews. The audiologists were asked to provide feedback in the form of interviews and written questionnaires. Questions included feedback on using the Oticon TSS feature, the ease of use of TSS, and their patient’s reaction to the TSS. The questionnaires were filled out by the clinicians after the patients were fit with Alta 2 Pro with Tinnitus SoundSupport™.

The succeeding questions were answered at the first follow-up visit and were asked: “Rate how beneficial your client found the Tinnitus SoundSupport™ for relief of their tinnitus.” and “How would your client rate the overall sound quality of the hearing aid apart from Tinnitus SoundSupport™?”. An oral interview was conducted at the end of the data gathering, which lasted approximately two hours.

Selections. All patients had the option of being fit with either a RITE or miniRITE, though all patients were fit with miniRITEs. After the fitting appointment, patients came back as needed for follow-up, which ranged from several weeks to months. All clinicians were provided with training on the product and software prior to any fittings, and assistance during the fittings was provided, as needed.

Results Questionnaires. To gain a better understanding of the audiologists’ and patients’ thoughts on the TSS, the results below were tabulated from three of the questions on the questionnaire the audiologists had filled out per patient. Not all participants had come back for their follow-up visit prior to the end of the data gathering, and therefore some participants did not answer the fourth or fifth question.

In Figure 4, results were tabulated from audiologists reporting the ease of use of the TSS feature when being programmed. Audiologists reported “Very Good” in 75% of the fittings they completed on their patients and “Good” in 25% of the fittings in terms of ease of use. Many also ACCORD JUNE | Congress Edition

reported the software being intuitive, easy to activate, and easy to manipulate.

In Figure 5, results were tabulated indirectly from the patients by the audiologists during the follow-up visit with their devices, based on how beneficial the patients found TSS for relief of their tinnitus. Seventy-seven percent reported that their relief from tinnitus using TSS was either “Good” or “Very Good”, with 15% being neutral about relief and 8% rating relief as “Poor”. Similar to the previous question, patients reported benefit with the TSS, indicating it was helpful for easing tinnitus, and that it helped when tinnitus was especially bothersome.

In Figure 6, results were tabulated indirectly from the patients by the audiologists during the follow-up visit with their devices, based on how they would rate the sound quality of the hearing aid apart from TSS. Eighty-five percent found the hearing aids to have either “Good” or “Very Good” sound quality, 4% being neutral about sound quality, 8% reporting “Poor” sound quality, 4% reporting “Very Poor” sound quality. Of those who had positive remarks on sound quality, one patient reported feeling less stressed when wearing the hearing aids and noted a definite improvement in quality of life.

Of the 34 patients who tried the TSS feature, two chose not to continue with using the product. One had memory difficulties related to a traumatic brain injury that had occurred and could not remember the settings of the device. The other patient did not specify why he did not like the product, but did return the product saying it did not provide him with benefit.

Interviews. Interviews were held with all the audiologists who had participated in the data gathering for TSS at their respective sites.

Interviews lasted approximately two hours, covering areas related to TSS, the hearing device that housed TSS, implementation of TSS in the programming software, and support materials to accompany use of TSS.

Feature 17 needs in terms of ease and relief, while providing the audiologist with a solution that is easy and flexible to implement. TSS provided benefit to 32 of the 34 individuals who tried and kept the devices. Of the two that did not keep the devices, one was having difficulties with remembering how to use the device due to his traumatic brain injury; the other stated that he did not like the sound quality of the product and did not find relief in wearing the devices.

Figure 4. Rate your overall experience fitting the Tinnitus SoundSupport.

Figure 5. Rate how beneficial your client found the Tinnitus SoundSupport for relief of their tinnitus.

Figure 6. How would your client rate the overall sound quality of the hearing aid apart from Tinnitus SoundSupport?

Discussion Each year, it is reported that tinnitus-related disability increases at a rate of approximately 15% across the veteran population. With the numbers increasing annually for the need to provide services, it is paramount to be able to provide veterans with solutions that best fit their

Another point to consider is how many people benefited from the amplification alone compared to amplification with TSS. In some of the cases, patients reported wearing TSS only a portion of the time, with the remaining time being amplification only, supporting the notion that hearing devices alone may provide tinnitus relief.

However, the flexibility of wearing a combined hearing instrument with a sound generator supports the audiologist’s capacity to tailor the device to the specific needs of the patient with ease and flexibility, without compromising the sound quality of the hearing instrument. Ratings in terms of sound quality for the device were very well-received, with 88% of the patients finding the sound quality “Good” or “Very Good”. In previous surveys of 149 new and experienced participants who wore Alta Pro instruments, 95% of the individuals were satisfied in terms of sound clarity compared to the 79% of respondents who answered the same questions and 7-point Likert scale as the MarkeTrak VIII survey6. The combination of good sound quality and the added feature of TSS make Alta 2 Pro a logical solution for those interested in a combination device to assist in the hearing and tinnitus needs.

Each site was provided with training on the product and software prior to any fitting, and given any assistance that may have been needed during initial fittings with the product.

When audiologists were asked to rate their experiences with TSS, many reported how easy the process was for not only fitting the

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

18 Feature hearing instrument, but using the software.

Many audiologists reported in the comment section of the questionnaire that it was “easy” and “intuitive” to program the devices. One audiologist reported that the programming had “intuitive programming features” that provided “lots of options without being overwhelming.”

As many VA audiologists report having shorter periods of time to provide treatment to patients, ease of use and intuitiveness are preserved without having to compromise confidence during the fitting process.

Many audiologists found the Nature sounds (Ocean 1, Ocean 2, and Ocean 3) to be the most commonly chosen sound. Of the 34 patients tallied, 24 had chosen one of the Nature-like sounds (11 chose Ocean 1, 13 chose Ocean 3) and 10 chose one of the Broadband sounds (1 chose White noise, 1 chose Pink noise, and 8 chose Red noise). The distribution of the Ocean sounds was interesting, as none of the patients chose Ocean 2 as their preferred sound and Pink noise was also the least chosen in the Broadband sound category. Both sound options had a 3dB rolloff per octave in the high frequencies.

Another interesting note is how many patients chose Red noise as their preferred sound, which has similar rolloff characteristics as Ocean 3 (6dB rolloff). Of the 8 patients who preferred Red noise, 6 had some degree of modulation in the program, which could potentially emulate the Ocean sounds. Including the Nature sounds as an option within the TSS feature is beneficial, as everything is integrated within Alta 2 Pro instead of using an intermediary device, such as a phone or other device, to get other sound options that could be desired by the patient. The additional flexibility provided by the Nature sounds gives both the audiologist and patient an extra option to choose from before introducing the need for an intermediary device for other sounds.

Other features, such as modulation adjustment, the ability to shape the broadband sounds, and the ability to mute the hearing device microphone, were also well-received. For those audiologists who chose to use the different broadband sounds, they reported it was easy to adjust the modulation and the shaping, and that the patients found that the adjustments were more comfortable. Some patients preferred to listen to TSS only (no amplification) at the end of the day to help them relax. The automatic level steering was not always activated with the patients; however, there were no reports of this feature sounding irregular or overcorrecting in complex listening environments.

Conclusions With the number of features and the positive feedback from both audiologists and patients, Tinnitus SoundSupport™ has provided strong evidence that suggests ease of programming and flexibility for the audiologist and remarkable user satisfaction for a combination device. As stated earlier, of those who had positive remarks on sound quality, patients reported feeling less stressed when wearing the hearing instruments and noted a definite improvement in quality of life.

Of those who commented on TSS itself, patients found it helpful for easing tinnitus, especially when the tinnitus was bothersome. In conjunction with Progressive Tinnitus Management’s patientcentered approach, Alta 2 Pro can provide the sound quality desired in a hearing aid, and a variety of sound relief to the tinnitus patient.

Acknowledgements Oticon, Inc. would like to thank the audiological staff at Darnell Army Community Hospital, and the Veteran Administration Medical Centers in Tampa, FL and Brick, NJ for their time, expertise, and support they provided during the data gathering of this project.

Disclosure: Annette Mazevski is a paid employee of Oticon, Inc.

ACCORD JUNE | Congress Edition

Feature 19 References: 1.Department of Veterans Affairs (2013).

Compensation: Service-Connected Disability or Death Benefits. Retrieved October 17, 2014 from http://www.benefits.va.gov/REPORTS/abr/ ABR_FY2013_Compensation_07172014.pdf.

2. Hearing Center of Excellence. Stats & Figures. Department of Defense. Retrieved October 17, 2014 from http://hearing.health.mil/ HearingLoss101/StatsandFigures.aspx#foot09 3. Baigi A, Oden A, Almlid-Larsen V, Barrenas ML, Holgers, KM. Tinnitus in the General Population With a Focus on Noise and Stress—A Public Health Study. Ear Hear 2011; 32(6),787–789.

4. Henry JA, Zaugg TL, Myers PJ, Kendall CJ. Progressive Tinnitus Management, NCRAR, U.S. Dept. of Veterans Affairs. 2012. Reviewed/ Updated Date: March 30.

5. Meikle MB, Henry JA, Griest SE, Stewart BJ, Abrams HB, McArdle R, Myers PJ, Newman CW, Sandridge S, Turk DC, Folmer RL, Frederick EJ, House JW, Jacobson GP, Kinney SE, Martin WH, Nagler SM, Reich GE, Searchfield G, Sweetow R, Vernon JA. Ear Hear. 2012 Mar-Apr;33(2),153-76.

6. Kochkin, S. MarkeTrak VIII: Consumer satisfaction with hearing aids is slowly increasing.

Hear Jour 2010, 63(1), 19-27.

Reprinted with permission from The Hearing Review. All rights reserved. Original citation: Mazevski A. Tinnitus SoundSupport: A Flexible Solution for Both Patients and Hearing Care Professionals. Hearing Review. 2015;22(4):24-27.

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20 Feature

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Editorial 21

Rayovac Set To Showcase New Innovations At Acaud Congress Leading hearing aid battery manufacturer is jetting in to Australia for this year’s annual ACAud congress in August.

During the three day event, Rayovac will showcase its latest cutting-edge innovations, including its best ever cochlear implant batteries, new and improved ProLine packaging and advanced mercury-free line. The company, which is a division of Spectrum Brands Holdings, invests heavily in research and development to ensure its products constantly push the boundaries in the rapidly evolving hearing aid market.

Glen Rutherford, General Manager at Rayovac, said: “2015 is a really important year for advancements in the hearing industry, as more countries are moving to mercury-free and advanced wireless technology. We’ve been developing our mercuryfree product for over a decade now, and it’s this experience coupled with our dedication to innovation which makes our new Mercury-Free I.C.E. (Innovative Clean Energy) battery our best performing product yet.

“Hearing aids are also constantly evolving to meet the needs of the modern day consumer, with features such as wireless and steaming capabilities putting much more strain on a hearing aid battery. We’re always pushing the boundaries to ensure we can pack as much power as possible into the same, small space and offer our customers the best possible experience.”

But it’s not just about the batteries.

Encompassing the whole range of Rayovac’s premium products is its new ProLine packaging range, offering an array of benefits to both consumers and audiologists.

The new, larger packs are brighter, sturdier and more robust featuring a double-dial which that securely holds the batteries, ensuring they remain in place until the consumer is ready to dispense them, and longer tabs on the batteries make life easier for those with dexterity issues.

A larger ‘customisation area’ on the packaging means that Rayovac ProLine customers looking to personalise their packs have more flexibility than ever before, with a new, full colour imprint option ensuring that even the brightest of logos can be printed directly on to the pack, encouraging customer loyalty.

As well as new packaging, Rayovac will also exhibit its powerful new product for the cochlear implant market.

The new Rayovac Implant Pro+ is the manufacturer’s ‘best battery ever’, providing cochlear implant users with the reliability and consistency they need to live their lives to the full.

The team at Rayovac is looking forward to showcasing its exciting innovations to delegates at this year’s ACAud.

Visit us at the ACAud Congress Booth 39 between 6-8 August

For more information contact Andy Koh at: Andy.Koh@eu.spectrumbrands.com or visit: www.rayovac.eu

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

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Feature 23

24 Feature

ACCORD JUNE | Congress Edition

Feature 25

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| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

26 Feature

ACCORD JUNE | Congress Edition

Feature 27

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

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Feature 29 Good Morning Kylie, Thanks for your email, to confirm our conversation.

HICAPS does not currently carry any Private Health Fund transactions for Audiology, the reason for this is that the Private Health Funds will not accept any claim transactions for Audiology through HICAPS. Whilst I cannot speak for the Private Health funds the reasons are: There are not a lot of Audiology claims and an audiology claim is normally a large claim that the funds prefer to be assessed rather than “auto approved” by some simple business rules.

HICAPS as an organisation does not decide which claims the Private Health Funds will accept this is a decision that the funds make, we will process and present claims to them but it is their decision if they will accept them. This is the case with some other modality’s where some funds will accept claims through HICAPS and other funds will not.

I trust that this helps you.

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Feature 31

Severe to profound hearing loss: Best practice strategies from a severely hearing-impaired clinician’s diary.

The purpose of this article is to examine some of the practical issues involved in working with clients with severe to profound hearing loss acquired early in life following normal language acquisition. This group of clients represent a relatively small percentage of most clinicians’ caseloads but their needs are much more complex and demand higher levels of innovative ‘outside-the-box’ solutions. This article draws on the unique personal and professional experiences of the author, who suffered a severe-to-profound hearing loss during a near-fatal attack of Meningitis at the age of eight. Finally driven by years of social and educational frustration, into professional studies in psychology, rehabilitation, audiology, and eventually private practice, he attempts to summarise eight key ‘best practice’ strategies drawn from his personal and professional experiences. His hope being that other professionals faced with helping clients from this high-needs group might have a few more tips and tools to enhance their clients’ journey towards optimal communication function.

Preamble (1) - Restoring hearing is not the same thing as restoring communication function.

If we assume that the purpose of hearing rehabilitation is to help clients optimize their communication function, then it is important to recognize that restoring communication function is not the same thing as restoring ability to hear.

(Weir 2009). People with normal hearing can exhibit poor communication function even though they can hear perfectly well. Effective

communication function depends on a balanced mix of effective listening and responding skills (receptive and expressive communication abilities) and is therefore a primary skill or tool in the quest for successful social engagement.

Any impedance to the frequency, quantity, or quality of interpersonal communication can have a significant impact on the quality and stability of social engagement, and, if left untreated long enough, a damaging impact on mental health.

It does not matter whether the impedance to social engagement is caused by a hearing loss, speech impediment, language barrier, anti-social behaviour, over-reliance on digital versus face-to-face interpersonal interaction, or a destructive personal communication habit, the result will be the same—a damaging impact on the ability to engage socially with other people in mutually satisfying, relationship-healthy ways. Consequently, remedial audiological or rehabilitative intervention strategies that focus solely on optimizing receptive hearing ability, without considering a client’s expressive communication abilities, will generally fall well short of optimising communication function, even though they may succeed in optimizing hearing ability. Most audiology researchers focus somewhat narrowly on restoring damaged hearing, as if doing so will automatically enable clients to re-engage socially. Of course, for people with mild to moderate hearing loss, this assumption is at least partially true, but when the loss is in the severe to profound category, and also long-standing, (as it is for the client group under discussion here) the collateral damage to inter-personal communication skills,

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

32 Feature personality, self-image and ability to correctly interpret social norms can be so great, that much more individually designed remedial action may be needed to assist clients to optimize their communication function skills as tools to re-establish healthy social engagement.

The need for professional expertise outside the traditional realm of audiology becomes painfully evident when trying to assist people with severe to profound hearing loss acquired post-lingually. Unfortunately, patients with these levels of hearing loss frustratingly discover, all too frequently, that most audiology professionals are only equipped to deal with the restoration of hearing, which is only one paradigm in the overall picture of communication dysfunction.

Preamble (2) - Identity and needs overlaps with the pre-lingually deaf Although their levels of hearing loss puts them closer to the deaf signing community, the fact that their hearing losses were acquired after the age of normal language acquisition, means that most people with acquired severe/ profound hearing losses will prefer to identify themselves as part of the mainstream, normalhearing community, rather than as part of the deaf signing community. Especially when there is a psychological aversion to identifying with a condition that represents the ultimate identity direction they are consciously striving to avoid.

However, audiology or rehabilitation professionals attempting to help this special needs client group need to be aware that there are many overlaps with the communicative behaviours and needs of those with pre-lingual profound deafness that should be taken into account when designing rehabilitation plans. This article attempts to address some of those needs.

ACCORD JUNE | Congress Edition

Preamble (3) - Unique professional skill set needed to address special needs of this client group.

If one need stands out above all others in this discussion, it is that there is a need for the involvement of professional counsellors or psychologists trained in the study of didactic analysis / verbal communication / effective speaking strategies, who will undertake additional studies into the effects of severe hearing loss on functional communication skills, and then research and develop effective remedial strategies and professional tool kits (in co-operation with audiologists) to help professionals and families to address these neglected needs.

What follows is a series of common features of this client group and some helpful strategies developed by the author lifetime of personal and professional experience with post-lingual severe hearing loss.

(1) Reliance upon vision as a key communication conduit.

Both pre-lingually deaf and the post-lingually severely hearing impaired clients are vitally dependent upon a clear view of the speakers’ face and lips during conversation. Since audibility across the full spectrum with this degree of loss is usually impossible, even with amplification, visual information from facial expressions and body language are a far more critical conduit of information than for people with lesser levels of hearing loss who may still be able to follow conversation without necessarily looking at the speakers’ face.

Strategy All hearing professionals should become fully aware, early in their training, of this simple need among all clients. But it can be easy to forget and mumble a few words while working with the computer or adjusting hearing aids while standing behind the client. However, it

Feature 33 is critical to demonstrate empathy by ALWAYS facing the client and using clear speech, without exaggerated lip movements. Male practitioners should be extra careful to be clean shaven where culturally acceptable, or at least ensure that their complete lips are not obscured in any way by facial hair, especially the corners. It is amazing how many lip-reading cues can be destroyed by this one little factor. Also be careful to keep hands and objects away from the mouth while speaking.

(2) The use of sign language as a first or second language.

It is not unusual for post-lingual severely hearingimpaired people to have some degree of fluency in sign language, especially if their hearing loss occurred during childhood. It is possible they have been exposed to it at school or in social activities involving sign language users. There are some notable exceptions to this, namely children who have been educated in strict “oral only” environments where any use of sign language was forbidden, usually because of the educators’ or parents’ belief that exposure to sign language would somehow damage normal language and speech development. Where there is fluency in signing, it is very helpful as a supplementary aid to communicative input in difficult listening environments. Sign fluency is more likely to be rare among late-deafened patients.

Strategy Fluency with sign language can be helpful when working with profoundly hearing impaired clients who are familiar and comfortable with using it as a supplement to their audition. But it can be a sensitive matter that must be approached with care. As a general rule, although I am fluent with signing, I will not use it unless it becomes obvious that verbal communication isn’t working and then I will first ask, in both sign and speech, (total communication method) if they understand signs and would like me to use it to supplement my speech. A hint that sign language might have

been part of their cultural environment can be the presence of a typical “deaf voice” indicating long-standing profound hearing loss. But this isn’t always a reliable indicator. Some deafened people might have grown up in an “oral only” environment where the use of sign language was forbidden and there is a strong aversion to its use. There is a complex and heated history behind the “oral vs signs” debate, so it is wise to always respect the client’s preferred method.

If verbal communication methods simply fail to work and sign language isn’t an option, then the easiest thing to do is to open up a blank Word document on your computer screen and use this to type your questions / statements and allow the client to answer verbally.

(3) Delays in educational development Again, if the hearing loss has occurred during childhood or very early adulthood, delays in educational development could have occurred due to iniquities in access to classroom presentations and audio-visual materials. This was still very common as recently as 10 to 15 years ago.

Thankfully, it is less common today where equal opportunity or anti-discrimination legislation is in force in educational institutions. The impact of educational delays can be profound for any child, whatever the cause, far more so for hearingimpaired children. It commonly produces a deep sense of injustice and resentment and even a fear of further educational or learning experiences. These feelings can translate into a low tolerance for ambiguity in adulthood that in turn, can negatively impact social attitudes and inter-personal communication strategies.

Strategy Clients who have suffered educational delays due to their hearing loss may benefit from some specialised vocational guidance assistance.

Expressing an interest in the clients’ overall welfare by asking questions about how their

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

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Feature 35 hearing loss impacts their family and work life, can trigger a revealing discussion that brings any un-met needs to the surface, particularly in regard to the need for specialised technological assistance beyond hearing aids in the workplace or classroom. Older clients who may have missed out on the benefits of equal opportunity legislation in educational settings, and are interested enough to explore opportunities again, might benefit from a referral to a specialised disability counsellor at a nearby educational facility. Making an initial contact with the counsellor on behalf of the client (if they are too timid to try alone) and offering your expertise to help ensure technological interface needs can be met, can be a valuable contribution to your client’s rehabilitation and further education potential.

(4) Delays to social development and effective communication skills.

We know that when a mild or moderate hearing loss occurs, it is usually the impact on relationships and social function that prompts the sufferer to seek professional help. When the loss is in the severe/profound category, particularly if the onset occurred at a young age, the social impacts are far more severe and significant. An inability to fully participate in social functions, especially during the developmental years, can have a dramatic effect upon perception, personality and social engagement, particularly if the sufferer is living with a family group with normal hearing who are not very accommodating of the need for modified communication strategies. The resulting social isolation is very similar to the experience of new immigrants, not yet fluent in their host country’s language, who find themselves starved of meaningful communication with all except members of their own cultural language group.

Just as inappropriate responses due to language unfamiliarity can result in social exclusion and isolation, so also do inappropriate responses due to mishearing or misunderstanding conversation

within one’s own language group. How a severely hearing impaired person responds when they are uncertain what was said or when they experience communication breakdowns, determines to a very large extent how well they manage to integrate in social or work situations. Thus expressive communication skills, rather than degrees of hearing loss are more significant determinates of an individual’s “Communication Diet” and social integration.1

Strategy Hearing professionals can be instrumental in identifying the need for remedial communication therapy as an adjunct to hearing aid and assistive devices training. To help identify the existence of such needs, this author has devised four questions targeting communication behaviour that can be easily integrated into a clinic’s existing intake questionnaire. (Table 1) Designed to be completed before and after hearing aid and rehabilitation services are delivered, changes in responses to each of the five scenarios assist the hearing professional to identify the specific type of unhelpful communication behaviours to be targeted with communication skills training. If a specialist who can teach effective conversational strategies can’t be found, referral to a self-help group (such as S.H.H.H. or Better Hearing) may be the best resource to use. Even if such groups don’t conduct formal courses in effective conversational strategies for hearingimpaired people, their social meetings can be highly effective at modelling compensative communicative behaviours in an understanding and comfortable environment. Helping clients to improve their “communication diet” doesn’t necessarily need to involve formal sessions with a specialised trainer. Informal association with effective and sympathetic role models can sometimes be all that is needed to achieve a satisfactory transfer of communicative skills.

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

36 Feature gain the co-operation of others in implementing it effectively.

“Hearing And Communication Lifestyle Analysis” (H.A.C.L.A.) © Graham Weir and Associates Pty. Ltd. - 2015 - Email: grahamweir@hearingbiz.com.au Tick one or more boxes that best describe your typical experiences during conversations Never

1

I tend to get left out of discussions because of my difficulties keeping up with the conversation flow.

2

I tend to avoid groups or at best, try to speak as little as possible, because of the risk of embarrassment due to my poor hearing.

3

In groups, I try to avoid the embarrassment of mishearing by doing most of the talking, so other people can’t steer the direction of the conversation.

4

In groups, to avoid the embarrassment of not hearing, I mostly make neutral responses, and rarely take the initiative to steer the discussion.

5

When a conversation I am involved in tends to break down due to my hearing difficulties, my attempts to repair the situation usually fail.

Rarely

Occasionally

After Hearing Aid Fittings

How often do these problems occur now?

Almost Always

Always

Never

Rarely

Occasionally

Almost Always

Always

Table 1. Suggested questionnaire design for identifying potentially destructive, expressive communication behaviours.

Question 1 targets the degree of social isolation experienced; Question 2 targets the extent of passive communicative behaviours; Question 3 targets the extent of aggressive communicative behaviours; Question 4 targets the extent of neutral or non-committal behaviours and Question 5 targets the degree of success with the clients’ existing conversational repair strategies.

(5) Environmental barriers to communicative interaction.

People with normal hearing or even mild hearing loss can usually communicate satisfactorily in a variety of spatial layouts and acoustic environments, such as restaurant or conferences, without the need to change seating positions in order to see speakers’ faces and minimise acoustic interference. However, people with acquired severe/profound hearing losses often find seating arrangements and poor room acoustics tend to severely degrade their receptive communication abilities, even when wearing hearing aids. If they have developed a culture of “learned helplessness” from years of passive compensation strategies, such as bluffing or avoidance, it can be difficult for them to learn new compensative habits unless they can personally experience the benefits of technology advances, such as wireless systems in hearing aids, and observe someone demonstrate the confident assertiveness and scripting needed to ACCORD JUNE | Congress Edition

Strategy Clinicians must be knowledgeable of how acoustic conditions can degrade speech reception for clients with severe / profound losses. Remedial approaches can be three- pronged: (1) Counsel the client regarding expectations in difficult acoustic conditions; (2) Recommend hearing aids with wireless accessories and educate the client about the potential of these devices to minimise negative experiences in noisy places and, better still, set up a working display of wireless accessories in your clinic and give the client hands-on experiences during their fitting. (3) Some clients may feel powerless to assertively express their needs to event hosts, and may need some counselling or role plays to help them develop effective scripts to deal with potentially difficult listening scenarios confidently. Including questions about client’s communicative environments in initial intake questionnaires and interviews will flag the need for wireless accessories and counselling.

(6) Media Barriers We live in an increasingly media dominated world. Ability to use this technology routinely is critical to employment and social engagement.

Conventional telephone use presents insurmountable barriers to people with severeprofound hearing loss, since their aided residual hearing levels usually remain insufficient to enable error-free telephone communication.

The same can be said of intercoms and two-way radios. Severe / profound levels of hearing loss, even after amplification, still present a degree of residual handicap (albeit a lesser one) that needs supplemental help from vision and text-based technologies to achieve optimal restoration of communication function.

Feature 37 Strategy Wireless and hard-wired interfaces between hearing aids and a wide variety of other technologies should be the first point of reference for the clinician dealing with severe hearing loss. These devices help enormously to optimize signal-to-noise ratios and the quality of audio input through the hearing aids. For television viewing, it may sometimes be necessary to recommend a combination of wireless hearingaid interfaces and open or closed captions to maximise comprehension for the most severely hearing impaired clients.

Thankfully, the proliferation of text-based communications such as emails and social media present acceptable alternatives to voice based telephony. – Captioned telephony (“CAP-TEL”) technology is also advancing but at the time of writing this article, still suffers from significant delay in voice to text conversion. The technology behind real-time video telephony such as Skype and some newer mobiles, is rapidly reaching a point of technical precision good enough to ensure its’ common usage in all telephone types including mobiles, without the annoying delays in lip and voice synchronization that make lip-reading very difficult, if not impossible, for severely hearing impaired clients. Clinicians need to keep up to date and utilize these technologies to ensure their clients’ communicative function is optimized.

(7) T he “Communication Diet” may be significantly impoverished.

responses, negative non-verbals and other signs of lack of focus or interest, are communicative behaviours that all combine to create deprivation of communicative nutrition. Relationships thus affected, inevitably cool off and die.

Severe hearing loss directly affects these variables in a similar way to inequality in language proficiency. For example, a non-English speaker will have great difficulty moving beyond a superficial communicative relationship with a native English speaker, simply because it is very difficult to make appropriate responses if a message is confusing or hard to understand.

Severe hearing loss makes messages difficult to understand. Even with optimal amplification there is often still a high level of residual handicap.

Consequently, development of meaningful relationships, especially in noisy environments, can be very difficult. Uncertainty or confusion surrounding spoken messages and non-verbals can too easily produce inappropriate responses that only serve to slow down, or completely halt, normal relationship progression from a superficial level to a deeper, more meaningful level. Repeated communication failures will sometimes lead to compensative communication behaviours that may be seen by people with un-impaired hearing as unusual, inappropriate or even aggressive.1

Strategy The presence of an impoverished communication diet will not always be evident without targeted questioning and careful listening to the patient. Such questions (as in table 1) used in an intake questionnaire can be helpful in flagging a poor communication diet, especially if amplification solutions don’t result in much change in the clients responses to these five critical questions at post-fitting follow-up. In this author’s experience, the majority of clients with mild to moderate hearing loss will record positive changes to all five of these targeted questions at post-fitting follow ups.

Mental health for anyone, hearing-impaired or not, is significantly impacted by the frequency, quantity and quality of communication interchanges with relationship partners. No relationship can survive for long on a diet of superficial communication. There must be healthy amounts of meaningful and personal interaction on a regular basis, to maintain relationship health and for love to flourish. Indifference, inappropriate, minimal, or confusing verbal | ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

38 Feature

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Feature 39 (8) W hen up-grading amplification, begin by matching REM of existing aids.

Transitioning to new hearing aids can be exceptionally difficult for experienced users of high power instruments. Severely hearing impaired users with typical left corner audiograms commonly get most of their audibility from bass sounds. If there is no usable hearing above 1000Hz then typical fitting rationales that attempt to amplify above this point have no impact except to increase the likelihood of feedback, therefore it may be better to turn those channels completely off to allow optimal levels of audibility in their smaller operational range. Additionally, it is not uncommon for such users to prefer sound levels within their audibility range to be significantly over real-ear targets. Therefore, attempts to match formulae real-ear targets such as NAL-NL1 / 2 or even NAL-RP can still fail to produce user satisfaction, even with a great deal of adaptation counselling.

Strategy If a patient with severe hearing loss is reasonably happy with their existing hearing aids, but needs to up-grade to newer improved technology, first measure the REM results of their existing hearing aids and use that as a starting point target for their new instruments. Set a second / third program with noisy environment settings such as fixed directional microphones, slightly reduced bass and slightly increased mid frequency settings and maximum noise reduction / wind reduction to ensure a significant contrast between programs is perceived. You may typically find that such settings are well above formula REM targets, but it will be easier for the patient to be comfortable with the initial set-up. While gradual correction of settings closer to formulae targets may be an agreed long term aim, early acceptance is more important to optimise the perceived benefits of addition of accessories such as FM / blue tooth, etc. Sometimes, the incremental improvement

gained from the use of such accessories will be the most that can be achieved towards the goal of optimizing the patients’ hearing with newer super-power technology. For most people with severe-profound losses, the degree of residual hearing handicap even with hearing aids, remains a significant barrier to communication function.

Optimal use of other methodologies must be utilised in the quest to optimize social integration through restoration of communication function.

Access to a manual volume control is also important because, even when using a second program with a fixed directional microphone setting, background noise can still mask speech.

Reducing the overall volume within the noisy environment program, will optimize the ability to hear speech in close proximity. Although in large, noisy groups, participation can quickly become impossible on anything other than a superficial level.

(9) A Note on Cochlear Implant Candidacy The jury seems to be still out regarding the development of a universally applicable, candidacy criterion for adult cochlear implants.

Some manufacturers suggest the presence of a bilateral, severe-to-profound sensoryneural hearing loss. Others specify a bilateral moderate-to-profound sensory-neural loss. What is clear is that multiple elements are involved dealing with audiometric thresholds, speech recognition performance, age, auditory progress with hearing aids, etc. 3 However, as with my earlier contention that the predominant focus on the restoration of hearing, needs expansion to include the larger picture of restoration of communication function, 1 the same argument can be applied to the candidacy criteria for all types of hearing implants. It cannot be assumed that the restoration of hearing, whether via conventional hearing aids, or implants of any kind, will automatically lead to a natural restoration of communication function. While in many cases it might, if someone has suffered from a near life-long severe-profound hearing loss with all

40 Feature the social and relationship hindrances resulting from it, then any learned inappropriate coping or communication behaviours are not suddenly going to disappear overnight. To say the least, the learning curve will be steep, the brain must not only learn to identify and process new auditory stimuli but also learn to observe and adopt “new” expressive communication behaviours based on improved auditory input – e.g. What to say, how to say it, and when to say it. Implant candidacy assessment criteria needs to be expanded to include objective measures of potential to learn and adopt revised expressive communication behaviours. Implant rehabilitation programs also need to be expanded to include classroom and experiential exercises designed to facilitate the development of culturally appropriate listening and responding skills, particularly in relation to group participation. A positive, ‘cando’ personality is always a good predictor of adaptability, so a measure of this factor could also be helpful in the candidacy assessment battery. There can be no doubt that the lifechanging benefits of cochlear implants are well proven and widely reported, however, it is more than unfortunate that for a minority of cases the desired outcomes have not occurred and their lives have ended up much worse for the experience. One rarely reads about such failures. Only the spectacularly successful seem to make it into mainstream media. Unfortunately, while implants can be removed, hearing in the implanted ear remains destroyed and the patient is left to cope as best they can with a worse condition and no significant professional help. An example of this type of outcome is well illustrated in the correspondence I received from a long-time friend of mine with a life-long profound hearing loss.

“I continue to have a lot of trouble with my hearing, both with the cochlear implant and hearing aid, despite my hearing threshold remaining the same. I wish that I had never had the implant because my hearing has never been the same since. I have a number of friends in the same ACCORD JUNE | Congress Edition

age group who are having similar problems post implant and nobody seems to be able to help, or seems particularly interested, including the manufacturers of the processor.

Despite being ignorant consumers, we have a fair idea why this has happened. Consider this: the protocols involving ‘switch on’ of the implant means that after a lifetime of minimal hearing in my case – 68 years, we are suddenly assailed by a cacophony of sound that our auditory systems are quite unused to. In my case, the experience was akin to being in a church bell tower with the bells going full on and also having a static radio going full blast at the same time. The experience was horrendous and continues to be so. We believe this upsets the auditory apple cart, and are of the conviction that introduction to the sound levels should have been far more gradual for those of us who have been deaf for a very long time. Unlike a hearing aid where the recipient has control over the sound levels, this is much less so with a cochlear implant. I was eventually forced to ask my audiologist to alter the mapping to its lowest denominator. However this has not made a difference and I still have a horrible sound experience, since we believe the damage has already been done. This experience is akin to living with my head in a metal bucket.

This daily experience involves hearing sound reverberating off the sides of the bucket and is particularly bad in an auditory incompatible area. I have visited my hearing aid audiologist to change the frequencies of the aid and many different settings have been tried, to no avail. I have also been to see my ENT specialist, who told me that my discriminating abilities have diminished as a result of age, but I am well aware that this is not the case – and naturally, if one has one’s head in a metal bucket, one’s ability to discriminate would naturally be affected. As a result of these experiences I do not wear my hearing aid or implant as much as I should.”4 In January 2015 my friend wrote to me again with the following terrible news:

Feature 41 “Five days after returning from a holiday, I woke up and put my hearing aid on, to discover that what little residual hearing I had left, had degraded further to the extent that I only have very minimal hearing in my right ear and can hear almost nothing. During that morning I tried all the usual things, including a new battery, ensuring my ear was clear of wax – to no avail. I then put on my implant processor in my left ear. The result was almost the same. I had hoped the cochlear implant would improve my ability to hear, but this has had a minimal effect. The experience I am left with sounds as if my ear is full of wax or my head is in a bowl of thick soup – the sound so muffled it is almost impossible to discriminate.

The head in a bucket was bad – but it was not as bad as the thick soup!!!! Tinnitus has also been a post implant experience – never had it before. If I use the hearing aid / implant I usually finish up with tinnitus, when I remove them. Fortunately, except on a few occasions it has subsided by the next day. Pre cochlear implant I never experienced any of these symptoms and despite my profound deafness, I managed reasonably well for 68 years. My own conclusion is that due to a lack of research and careful analysis of a 68+ year old impaired auditory system, the auditory processing centre in my brain may have been irreparably damaged. I have been to another ENT for a second opinion. I had a CAT scan of my sinuses and middle ear which indicated that these systems were clear – he thought the problem was in my inner ear. There was no suggestion that the problem could be cerebral.

I have a referral to an implant audiologist in the private sector with a reputation of being “very good”. So we will see what she can come up with – but I am trying to be optimistic”.4

socially has been significantly degraded, and now appears to have suddenly become profoundly deaf again with no help from his implant or his hearing aid. He even suspects now that the implant is to blame. It remains vitally important therefore, to minimize the possibility of such occurrences by using a continuously evolving battery of multi-discipline, evidencebased assessment tools that include subjective / objective predictors of personality and ability to develop modified listening and responding skills. Post-implant rehabilitation programs need to add classroom and experiential exercises designed to optimize communication skills and social re-integration.

(10) A Quick And Simple Strategy For The Dispensing Clinician Dispensing clinicians, unless working in an implant facility, seldom have the opportunity or the time to conduct the kind of comprehensive diagnostics assessments mentioned here, so what is a baseline criteria they can use to decide whether to refer a patient for a full implant assessment?. I have a number of patients in the severe/profound category and have referred several of them for full implant assessments.

From the reports I have received, all of them have been very successful. My own degree of hearing loss puts me well within implant referral criteria (see audiogram below) My speech discrimination with audio alone, particularly speech-in-noise, is almost zero, yet nearly 100% when combined with vision. In spite of these indicators, I remain most reluctant to proceed with an implant, primarily because of my perception of my level of social integration.

My friend’s experience is a most regrettable outcome, not only for himself, but also for the professionals involved in his initial assessments.

While they can carry on their lives as normal and forget about such failures, He remains stuck in a worse situation that affects his whole quality of life, particularly in that his ability to integrate | ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

Feature 43 (Question 1) Rank your ability to take part in social experiences with one other Person in quiet surroundings. – When NOT wearing hearing aids - Circle your answer) 0

1

2

3

4

5

6

7

8

9

10

Excellent

Very Poor

(Question 2) Rank your ability to take part in social experiences with a small group of three or four people in quiet surroundings. – When NOT wearing hearing aids. (Circle your answer) 0

1

2

3

4

5

6

7

8

Very Poor

9

10

Excellent

(Question 3) Rank your ability to take part in social experiences with a large group of people, in very noisy surroundings, such as a restaurant, or party. – When NOT wearing hearing aids (Circle your answer) 0

1

2

3

4

5

6

7

8

Very Poor

9

10

Excellent

Table 3: Social Integration Scale – Pre- hearing aid fitting (Question 4) Rank your ability to take part in social experiences with one other Person in quiet surroundings. – When USING your hearing aids. (Circle your answer) 0

Table 2: Graham Weir’s Audiogram

On an imaginary scale of 1-10, where 0 equals complete isolation, and 10 equals a hundred percent social integration, I would rank myself around nine in a small group of one to three people, and probably around three in a large, noisy crowd, (such as an audiology convention) – I can continue to live with this level of social integration, and thankfully, my wife can too, and is very supportive of this decision.

The lowest determinate in this equation would have to be the audiogram, the second, the audio-plus-vision speech performance in quiet, and the highest would be my ranking of my social integration performance. Since this most important determinant would have to be based on the patient’s own perception, we could put this equation into a simple pre and post-fitting scale, similar to some of the IDA motivational tools,5 It could look like this:

1

2

3

4

5

6

7

8

9

10

Excellent

Very Poor

(Question5) Rank your ability to take part in social experiences with a small group of three or four people in quiet surroundings. – When USING your hearing aids. (Circle your answer) 0

1

2

3

4

5

6

7

8

9

10

Excellent

Very Poor

(Question 6) Rank your ability to take part in social experiences with a large group of people, in very noisy surroundings, such as a restaurant, or party. – When USING your hearing aids (Circle your answer) 0

1

Very Poor

2

3

4

5

6

7

8

9

10

Excellent

Table 4 “Social Integration Scale – Post-hearing aid fitting.

Table 3 can be included in an initial intake / history questionnaire to be completed by the patient in the waiting room – This scale can be given to all patients as another good indicator of the need for amplification. Table 4 can generally be used as a post-fitting measure of social integration improvement for all patients, but may be particularly useful in conjunction with speech discrimination testing, as a fairly reliable indicator of the need for implant assessment for hearing aid users with severe-to-profound losses. While an audiogram and speech discrimination tests are a helpful indicator of the potential for implant assessment, For the busy dispenser, the Social Integration Scale may be a simple quick and reliable indicator to assist in the decision to refer to an implant facility for further investigation.

Scoring: A high score of 5 or above when using hearing aids, would indicate a reasonable level

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

44 Feature of social integration, which would be unlikely to improve with an implant. Conversely, a low score below 5 when using hearing aids, would indicate room for improvement, before assuming with a recommendation for an implant however, it would need to be determined whether the low score was due to poor audibility or poor social skills. The HACLA scale (follow-up) (Table 1) helps determine this distinction.

At this stage, the Social Integration Scale is my own creation based on my years of dispensing experience, and my own personal experiences with profound hearing loss. It is not yet a wellresearched, peer-reviewed, evidence-based tool, but I do believe it is worthy of a focused research study and I would like to challenge budding researchers to “give-it-a-go”, as we say in the fine land “Down-Under.”

Summary Although the number of clients with post lingual, acquired severe to profound hearing loss is small, these clients have unique and specific requirements. Approaching the aural rehabilitation process in same way as clients with lesser degrees of hearing loss is not best practice and will largely leave their specific needs unmet.

Being aware of the 8 issues specific to this client group, and suggested best practice strategies to overcome these issues, can potentially be life changing.

References Weir, G. 2009 http://www.audiologyonline.com/ audiology-ceus/course/readers-picks-hearinghearing-loss-aural-rehabilitation-counselingadults-communication-diet-theory-extendedfoundation-14347

1

Sockalingham, R; Lundh, P and Schum, D. Severe to Profound Hearing Loss: What Do We Know and How Do We Manage It? Hearing Review Jan

2

2011 http://www.hearingreview.com/2011/01/ severe-to-profound-hearing-loss-what-do-weknow-and-how-do-we-manage-it/

4

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Gifford, R. “Who is a Cochlear Implant Candidate?” The Hearing Journal, June 2011, Vol 64 pp 16-18 22 http://journals.lww.com/ thehearingjournal/Fulltext/2011/06000/Who_ is_a_cochlear_implant_candidate_.7.aspx

3

Name withheld by request, personal communication, January 2015.

4

5

“ The Line” Ida motivational tool, Ida Institute, Copenhagen ht tp://idains titute.com/ tool_room/motivation_tools/#/tool_room/ motivation_tools/motivation_tools/?type=1337

Author’s information: Graham Weir suffered a bilateral, severe to profound hearing loss from a near-fatal attack of meningitis at the age of eight, and has experienced the significant educational and social barriers such a loss produced. He graduated from Gallaudet University in 1980 with a Masters’ degree in counselling of the hearing impaired, and subsequently attempted a diploma in audiology at Macquarie University in Sydney, Australia, only to be forced to drop out due to accessibility difficulties caused by his hearing loss. He is the owner of two hearing-aid clinics in Western Australia where he practices as a Hearing Rehabilitation Specialist. – Correspondence can be directed to grahamweir@hearingbiz.com.au

PressFeature Release 45 45

Bernafon Supremia A Powerful New Perspective Bern (May, 2015) – With the Supremia Super Power BTE to be launched in May 2015, Bernafon is pleased to offer adults and children with severe to profound hearing losses a new perspective in hearing. Supremia’s contemporary design, strong performance, sophisticated features, and complementary wireless accessories, together have the power to inspire and support your clients every day.

Supremia is Bernafon’s brand new Super Power BTE hearing aid available in the 7¦3 performance categories. It is specifically designed for adults and children with severe to profound hearing losses. With its special design, high performance, and powerful feature set, Supremia can be a reliable partner in helping your clients overcome their hearing limitations as much as possible.

and the SoundGate Mic. In combination with the new SoundGate 3, clients can use the SoundGate App that works on all common smartphones to discreetly change volume and program settings.

These features all help maximize speech understanding and listening comfort, reduce listening fatigue, and provide options for a carefully selected fitting for each and every client.

Be part of a powerful change of perspective with Supremia.

Design and Durability Supremia is extremely easy to operate. It is designed to be robust and durable, and to meet the highest quality standards. Supremia has been tested under adverse conditions and has been IP58 rated.

Performance Supremia provides top-level gain with a peak MPO of 143 dB SPL as well as incredible gain in the low frequencies. The long-lasting size 13 battery, in combination with Supremia’s battery management system, has the energy to provide power for up to 184 hours.

AudioEfficiencyTM Technology Supremia’s powerful feature set includes Speech Cue Priority™ to preserve the crucial speech envelope cues and the contrasts between soft and loud sounds. Supremia can also be connected to all Bernafon wireless accessories, including TV, phone, the RC-N remote control,

Supremia

Contact: Brad McConville National Sales and Marketing Manager Bernafon Australia Pty Ltd 629 Nudgee Rd, Nundah QLD 4012 Phone: 07 3250 0368 Email: bmc@bernafon.com.au The complete press documentation with product pictures and the Bernafon logo is available online for download: http://www.bernafon.com/press

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

46 Press Release

New Hearing App Breaks Down Barriers to Healthy Hearing Online support kit gives hearing professionals tools and resources to reach more patients February 9, 2015 – Kitchener, Canada – Unitron, a global innovator of advanced hearing solutions, is providing hearing healthcare professionals with a new online support kit that will help them break down barriers and improve access to hearing health for people with hearing loss.

Central to the online support kit is uHearTM 2.0, Unitron’s popular new screening app, which enables patients to assess their hearing on an iPhone® or iPad® in less than 10 minutes. The hearing app tests for hearing sensitivity, speech in noise and everyday listening performance, while offering patients: - three sophisticated screening tests - a new background noise calibrating meter - a built-in clinician locator to find the nearest clinic The screening app is supported by the uHear online support kit, which provides hearing healthcare professionals with tools and resources to educate and engage a broader online audience of people who may be reluctant to seek treatment. “The impact of untreated hearing loss cannot be ignored,” said Dr. Don Hayes, Director of Clinical Research for Unitron. “On average, hearing aid users wait 7- 10 years after their initial diagnosis to be fit with their first set of hearing aids. uHear was developed with the goal to lower barriers to seeking help.” The kit

ACCORD JUNE | Congress Edition

provides hearing health care professionals with a variety of downloadable educational content, including digital awareness tools—like web badges, dynamic infographics and social media content—and print material that can be used to empower people with hearing loss to seek the necessary care. The World Health Organization estimates that 360 million people worldwide suffer from disabling hearing loss. In America alone, that number is 36 million, and only 20 per cent of those people who might benefit from hearing aids actually seek help. Most delay taking action until they cannot communicate even in the best of listening situations. Early and careful evaluation and support show great promise in mitigating the consequences of hearing loss on long-term health and quality of life. Unitron’s online support kit is available at: unitron.com/uhearapp

About Unitron Unitron is a global company that understands the hearing healthcare business is built on strong, personal relationships. We work closely with hearing healthcare professionals to improve the lives of people with hearing loss. A member of the Sonova Group, Unitron has a proven track record of developing hearing innovations that provide natural sound with exceptional speech understanding. Headquartered in Canada, Unitron distributes its full line of hearing instruments to customers in more than 60 countries. For more information, please visit us on the web at unitron.com.

Feature 47

www.bestsound-technology.com.au

. A complete portfolio offering a real binaural hearing experience.

The next generation of BestSound Technology – now available in RIC, BTE, and ITE housing types.

binax™, the world’s first technology to outperform normal hearing,* is now available in all hearing aid housing types and in three performance levels: 7bx, 5bx and 3bx.

And now even CIC wearers can benefit from improved directional speech understanding in noisy situations – with radically innovative binaural OneMic directionality. binax actually increases the natural directionality provided by the outer ear, delivering wearers a previously unknown level of speech understanding, especially in challenging situations.

To learn more about binax visit us at ACAud’s 2015 National Congress, booth 27-28.

The new e2e wireless™ 3.0 technology is capable of data rate transfers that are 1000 times faster than previous platforms. This enables binax to transfer audio signals from one hearing instrument to the other with only a

fraction of the power drainage demonstrated by comparable competitors’ hearing aids.

In addition, the binax feature set has been extended: Four new tinnitus therapy signals called “ocean waves” let tinnitus patients enjoy various natureinspired wave formations. And the new adaptive streaming volume now automatically adjusts the volume of streamed audio if the volume level of the wearer’s surrounding changes.

Offer your customers a most natural hearing experience with binax, the next generation of BestSound Technology.

* Two clinical studies have shown that binax provides better than normal hearing in certain demanding environments (University of Northern Colorado, 2014; Oldenburg Hörzentrum, 2013): Speech Reception Thresholds (SRT) in cocktail-party situations improved up to 2.9 dB for wearers with mild to moderate hearing loss using Carat binax or Pure binax hearing aids with narrow directionality, compared to people with normal hearing.

Life sounds brilliant.

48 Press Release

PHONAK Press Release Research by Eargroup: Roger Pen gives Naída CI users up to 78.6% more speech recognition in conversations in noise with multiple speakers First study of its kind by Belgian scientists demonstrates the benefits of Roger Pen wireless microphones for cochlear implant recipients – participants went from being isolated to being able to participate fully in conversations Staefa, Switzerland (May 21, 2015) In a study published today in the European Archives of Oto-Rhino-Laryngology and Head & Neck, the Belgian researchers from Eargroup, Antwerp, describe how multiple wireless microphones allow cochlear implant recipients to hear and understand exceptionally well in one of the most challenging listening environments: having a conversation with multiple talkers in high background noise. The study participants, all Naída CI recipients, could recognize speech 78.6% better when using Roger Pen in a multi talker conversation with the background noise being slightly louder than the speech. Using Roger Pen, they could participate fully in the conversation, while without Roger Pen, they were completely isolated from the conversation.

Speech understanding in background noise is a challenge for cochlear implant recipients in general, particularly in everyday life situations such as at a restaurant, where they are surrounded by noise. Personal FM systems have traditionally been recommended for improving the Signal to Noise Ratio. So far, research with wireless microphones investigated only situations with just one talker. In real life however conversations often take place with multiple talkers. This is a more difficult listening situation, even more if there is background noise. The scientists at the Eargroup in Antwerp-Deurne led by Paul Govaerts, Ph.D., designed a new test set-up with seven loudspeakers to evaluate speech understanding scores for this complex listening ACCORD JUNE | Congress Edition

situation, as so far no standardized protocol did exist.

The study at a glance: • Test group: 12 adult Naída CI recipients, equipped with a dedicated Roger 17 receiver • Study design: • Randomized prospective study in a situation that simulated four persons having a meal at a noisy restaurant, one of them the CI recipient and the other three talking non-simultaneously • Testing in two conditions: no wireless (without Roger Pen) and three wireless (with three Roger Pens in a network) • Background noise level ranging from 55 to 80 dB • Major findings: • 78.6% improved speech recognition in conversations in noise with three speakers using Roger Pen • With Roger Pen, the CI recipients could participate fully in conversations from which they were completely isolated before.

A randomized, prospective study was set up in an everyday life situation. A test situation was created to simulate four persons having a meal in a noisy restaurant, one of them being the CI user while the three companions were talking non-simultaneously. The three companions were mimicked by three loudspeakers. Noise was coming from four speakers placed in the corners of the room. The 12 participants were equipped with a Naída CI Q70, the latest sound processor from Advanced Bionics, with a dedicated Receiver Roger 17. The Roger Pen from Phonak served as wireless microphone. The Roger Pen uses digital adaptive technology, possessing the feature of multiple microphones that can be

connected in a multi talker network to a single or multiple receivers. The Roger Pen communicates directly with the Roger 17 receiver attached to the Naída CI Q70 speech processor.

Testing was done in various conditions including ‘No Wireless’, without Roger Pen, and ‘Three Wireless’, with three Roger Pens in a network at a necktie position relative to the companion speakers. The CI user was wearing the Naída speech processor and for the wireless conditions this processor was connected to a Roger 17 receiver. Sentences were presented randomly from one of the three companion loudspeakers at a normal conversation level. The background noise level ranged from 55 to 80 dB SPL. When the background noise was slightly louder than the speech, the three Roger Pens improved speech recognition by 78.6%. While without Roger, the participants were completely isolated in the test situation, with Roger they could participate fully in the discussion.

Paul Govaerts, Ph.D., director of the Eargroup, a private clinical and research entity in Antwerp, Belgium, that specializes in Otology and Audiology, comments on the study findings: “We were impressed to find that, with 15dB SRT improvement, CI recipients using multiple Roger Pens really enter into competition hearing peers in loud noise.”

Previous research by Linda Thibodeau, Ph.D., from the University of Texas at Dallas already showed Roger technology giving hearing aid users up to 62% more speech recognition than normal hearing listeners in noise and over distance**.

What is Roger?

Roger by Phonak is the new digital standard that bridges the understanding gap in noise and over distance, surpassing the performance of standard FM systems by up to 54% and Dynamic FM technology by 35%.

It uses cutting-edge wireless microphones to pick up the voice of the speaker and transmit it wirelessly over 2.4 GHz to miniature ear-level receivers. Roger is hassle-free and adapts its own settings automatically to the noise and speakers around the use.

Feature 49

About Advanced Bionics

Advanced Bionics is a global leader in developing the most advanced cochlear implant systems in the world. Founded in 1993 and working with Phonak under the Sonova Group since 2009, AB develops cutting-edge cochlear implant technology that restores hearing to the deaf and allows recipients to hear their best.

With sales in over 50 countries and a proven track record for developing high-performing, state- of-the-art products, AB’s talented group of technologists and professionals from all over the world are driven to succeed, work with integrity and stay firmly committed to quality.

To learn more about AB, please visit www.advancedbionics.com.

About Phonak Headquartered near Zurich, Switzerland, Phonak, a member of the Sonova Group, has developed, produced and globally distributed state-of-the-art hearing systems and wireless devices for more than 60 years. The combination of expertise in hearing technology, mastery in acoustics and strong cooperation with hearing care professionals allows Phonak to significantly improve people’s hearing ability and speech understanding and therefore their quality of life.

Phonak offers a complete range of digital hearing instruments, along with complementary wireless communication systems. With a worldwide presence, Phonak drives innovation and sets new industry benchmarks regarding miniaturization and performance.

For more information, please visit www.phonakpro.com or Contact: Katherine Toats Phonak Australia Tel: 02 8868 1800 Email: katherine.toates@phonak.com Phonak – Life is on We are sensitive to the needs of everyone who depends on our knowledge, ideas and care. And by creatively challenging the limits of technology, we develop innovations that help people hear, understand and experience more of life’s rich soundscapes.

Interact freely. Communicate with confidence. Live without limit. Life is on.

50 Industry Feature News

Updates in Cochlear and Bone Conduction Implant Candidacy Sylvia Tari and Arielle Umansky, The Royal Victorian Eye and Ear Hospital Candidacy criteria for cochlear implantation has changed greatly over the last ten years, and is continuously expanding. It is well known that cochlear implants are an excellent option for patients with severe or worse hearing losses.

However, over the past few years with advances in technology, and studies of outcomes, we now know that patients with more residual hearing can also benefit.

It has been reported that only about 6% of patients who are candidates for a cochlear implant actually receive one. It is also our experience that many people are being referred much later than when they could be.

How A Standard Cochlear Implant Works The cochlear implant is a system consisting of an internal implant (requiring about a two hour operation and one night stay in hospital) plus external device (sound processor), worn over the ear.

1. Microphones on the sound processor pick up sounds and the processor converts them into digital information.

2. This information is transferred through the coil (via a magnet) to the implant just under the skin.

3. The implant sends electrical signals down the electrode into the cochlea.

4. The electrode array in the cochlea picks up the signals and sends them to the brain, giving the sensation of sound.

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The cochlear implant is different to a traditional hearing aid because hearing aids can only amplify the remaining natural hearing, whilst an implant can provide electronic/artificial hearing for all sounds in the speech range and therefore restore clarity to speech.

The best outcomes are obtained for patients with acquired deafness and for babies/children with a congenital hearing lost who are implanted at a young age. Clients of any age or aetiology can be referred. The poorer hearing ear is usually implanted to preserve the better hearing on other side.

The median audition alone speech perception scores for adults using a cochlear implant is; 75% phonemes, 90% sentences in quiet and 74% sentences in +10 SNR (The Royal Victorian Eye and Ear Hospital, Cochlear Implant Clinic). Based on this, our criteria has been developed to ensure patients have a higher chance of improving their overall hearing with a cochlear implant.

Industry News 51 Patients need to attend post-operative appointments for programming of the device and rehabilitation and will require ongoing annual reviews. (They can continue to see their current hearing aid provider for ongoing care of their contralateral hearing aid.)

Appointments are usually covered by state and federal government funding. Cochlear implant surgery and the prosthesis are fully funded by the government for public patients, and by private health insurance companies for private patients.

Some patients who fall outside of our standard criteria may still be considered for a cochlear implant on a case by case basis.

Each recommendation is discussed by our multidisciplinary team of ENT surgeons, audiologists and speech pathologists.

Some of the cases that may fall outside of the standard criteria but may still benefit from using a cochlear implant include:

Steeply Sloping Losses Patients with steeply sloping hearing losses, who can’t access high frequencies through a hearing aid can now benefit from implant technology.

Years ago, these patients would not have been considered for cochlear implantation, based on having too much natural hearing in the low frequencies. There are now different types of electrode arrays that aim to preserve natural low frequency hearing; some are thinner and aim to be less traumatic upon insertion into the cochlear, others are shorter—and aimed at stable high frequency losses. Although the preservation of hearing cannot be guaranteed, if successful, patients may be able to wear a hybrid device, ie a combination of acoustic gain for low frequency sounds and electrical stimulation through the cochlear implant for high frequency sounds. Even when the low frequency natural hearing has not been maintained, most patients have reported an overall benefit and an improvement in clarity and understanding of speech.

Unilateral Hearing Losses There is now TGA government approval in Australia, for cochlear implants as a recognised treatment for unilateral hearing losses. In the past, a cochlear implant wouldn’t have been recommended for people with a unilateral hearing loss. It was previously thought that the signal from the hearing aid or normal hearing ear may interfere with the ability to adjust to the different signal provided by an implant. Recently however, there has been a trend worldwide to consider cochlear implantation for people with a unilateral hearing loss.

The aim is to provide some improvement in hearing to the deaf ear, with the knowledge that it won’t be as good as the hearing on the other side. Research worldwide has also shown benefits for binaural listening, localisation, and reduction in tinnitus.

This is not to say that all patients in these situations will want, or are suitable for, a cochlear implant.

Proceeding with a cochlear implant in these cases is not a straightforward decision and we will always discuss the different options available, including: not intervening; CROS aids and bone conduction implants as well.

Conductive/Mixed Hearing Losses Whenever a patient is referred with a conductive component to their hearing loss, all options are investigated. Patients will be seen by an ENT

| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

52 Industry News surgeon to discuss all surgical options (e.g. may end up having a stapedectomy or other middle ear surgery/device).

• Avoidance of social gatherings because of the impact of noise.

Bone conduction implant assessments and trials may be offered when appropriate. The more recent implantable bone conduction devices that connect via a magnet rather than a percutaneous abutment are an attractive option for those patients with normal - mild bone conduction thresholds in at least one ear.

• Frustrated or depressed because of their hearing loss.

• Difficulty holding down a job.

When writing referrals, please include the following information if possible:

Moderate Losses Patients whose hearing loss is in the moderate, or moderate to severe range, with poor aided speech perception scores may also be candidates for cochlear implantation. As these patients may have features of auditory neuropathy spectrum disorder or retrocochlear pathology, it is difficult to predict how much improvement in speech perception will be gained. Careful counselling is required and an implant may be offered with some reservations.

Referrals Please consider referring your clients if they have: • A moderate-to-profound hearing loss in the poorer hearing ear or/and less than 55% speech perception in the poorer ear.

• Limited speech recognition ability with hearing aids.

• Complaints that people mumble or aren’t speaking clearly.

• Reliance on lip-reading or other visual cues like subtitles on TV. • Difficulty understanding people over the telephone.

• Aetiology of hearing loss —if known • Recent audiogram—past audiograms are helpful too • Details about hearing aid use and fitting — if hearing aid fitting is not optimal for any reason, please give details (eg intolerance) • Details specific to patient —any special considerations eg. ESL (incl. AUSLAN), preferred contact details/person If you have a query or would like to send us a referral, please contact our clinic directly: Cochlear Implant Clinic, The Royal Victorian Eye and Ear Hospital Locked Bag 8, East Melbourne 8002, Victoria Phone: (03) 9929 8624; Fax: (03) 9929 8625; E-mail: cic@eyeandear.org.au In other states please contact your nearest Cochlear Implant Clinic as appropriate.

53 Feature

Feature 53

NATIONAL

CONGRESS SUNSHINE COAST 2015

ACADEMIC PROGRAM ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 6-8 AUGUST, 2015 | NOVOTEL TWIN WATERS

THURSDAY 6TH AUGUST 2015 TIME

SPEAKER | CHAIR

PRESENTATION

7.00am – 8.45am

Delegate Registration | Wandiny Verandah

9.15am – 9.30am

Dr William Vass

Official Congress Opening and Tribute to Geoff Lewis

9.30am – 10.30am

Dr Marshall Chasin, Au.D. Chair: Ms. Gayle Dicieri

Musicians and the Prevention of Hearing Loss

10.30am – 11.30am

Morning Tea | Trade Exhibition

Sponsored by: National Hearing Care

11.30am – 12.30pm

Mr Curtis Alcock Chair: Ms. Gayle Dicieri

Future-Proof Hearing Care (Part 1) “The Tools to Survive…”

12.30pm – 1.30pm

Lunch | Trade Exhibition

1.30pm – 2.30pm

Dr Kim Tillery, Ph.D. Chair: Ms. Gayle Dicieri

Types of CAPDs and Reliable Testing – The oldies but goodies and the up and coming

2.30pm – 3.15pm

Dr Robert Patuzzi, Ph.D. Chair: Ms. Gayle Dicieri

Life After Death – Predicting the future of hearing support and clinical audiology

3.15pm – 4.00pm

Dr Christopher Lind, Ph.D. Chair: Ms. Gayle Dicieri

Talking about talk (Part 1): Involving family members in adult hearing rehabilitation

4.00pm – 6.00pm

Welcome Function | Trade Exhibition

Sponsored by: Sennheiser

FRIDAY 7TH AUGUST 2015 TIME

SPEAKER | CHAIR

9.00am – 10.00am

Morning Tea | Trade Exhibition

10.00am – 10.45am

Dr Christopher Lind, Ph.D. Chair: Dr William Vass

Talking about talk (Part 2): Involving family members in adult hearing rehabilitation

10.45am – 11.30am

Mr Curtis Alcock Chair: Dr William Vass

Future-Proof Hearing Care (Part 2) “…and the Vision to Thrive”

11.30am – 12.15pm

Dr Kim Tillery, Ph.D. Chair: Dr William Vass

Reliable differential diagnosis of CAP, Attention Deficit and Non-Verbal learning disorders to Effective Intervention

12.15pm – 1.15pm

Lunch | Trade Exhibition

Sponsored by: Phonak

1.15pm – 2.00pm

ACAud AGM/SGM

2.00pm – 2.45pm

ACAud Executive

2.45pm – 3.45pm

Afternoon Tea | Trade Exhibition

3.45pm – 4.30pm

Dr Marshall Chasin, Au.D. Chair: Dr William Vass

Music and Hearing Aids

7.00pm – Midnight

Gala Dinner | Eucalypt Clearing

Sponsored by: William Demant Holding

8

PRESENTATION

ACAud Q and A Session

ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015 | Novotel Twin Waters | Australian College of Audiology

SATURDAY 8TH AUGUST 2015 TIME

SPEAKER | CHAIR

9.00am – 10.00am

Morning Tea | Trade Exhibition

10.00am – 11.00am

Platinum Sponsor Technology Update Chair: Mr Ian Mawby

PRESENTATION Oticon | Dr Ben Fernée Au.D Tinnitus Treatment with Hearing Aids Bernafon | Dr Steven J Aiken Ph.D Hearing Aids at the Edge: Optimal Strategies for Severe-Profound Hearing Loss Sonic Innovations | Mrs Jan Pollard Noise isn’t what it used to be Interacoustics | Mr Trong Nguyen Balance Assessments within Private Practice – Is it possible?

11.00am – 11.45am

Dr Brent McMonagle, MBBS Chair: Mr Ian Mawby

Surgical options for hearing loss: The present and the future

11.45am – 12.00pm

Ian Mawby, ACAud President

Official Congress Close

* Please note this is the FINAL ACAud National Congress 2015 Academic Program as at 31st July 2015 and remains subject to change at the organisers discretion.

SPEAKER ABSTRACTS AND BIOGRAPHIES Thursday 6th August 2015 | 9.30am – 10.30am

DR MARSHALL CHASIN AU.D

to Canada and for volunteer work with the National Youth Orchestra of Canada (NYOC) and is the 2013 Jos Miller Shield winner from the British Society of Audiology (BSA).

Musicians and the Prevention of Hearing Loss ABSTRACT: Music exposure can pose a problem, especially with the advent of “portable” music. Despite the complexity of the human auditory system, it does not know the difference between industrial noise and music. Indeed, many of the factors can equally affect music exposure as well as industrial exposure. This talk is an overview of those factors affecting hearing for musicians as well as environmental strategies and hearing protection to minimize the potential damaging effects of music.

BIOGRAPHY: Dr. Chasin Au.D, is an audiologist and the Director of Auditory Research at the Musicians’ Clinics of Canada.

He is also the Coordinator of Research at the Canadian Hearing Society, Adjunct Professor at the University of Toronto (in Linguistics), Adjunct Associate Professor in the School of Communication Disorders and Sciences at the University of Western Ontario, and Adjunct Research Assistant Professor at the State University of New York (SUNY) at Buffalo. Dr. Chasin received his B.Sc. in mathematics and linguistics at the University of Toronto, his M.Sc. in Audiology and Speech Sciences at the University of British Columbia, and his Doctor of Audiology (AuD) degree from the Arizona School of Health Sciences. Dr. Chasin serves on the board of several hearing loss prevention organizations and is the editor or a member of the editorial board of several industry and scholarly peer reviewed publications. He is the editor-in-chief of the Canadian Hearing Report. Dr. Chasin has been involved with hearing and hearing aid assessment since 1981 and is the author of over 200 clinically based articles. Dr. Chasin books include “Musicians and the Prevention of Hearing Loss”, “CIC Handbook”, “Noise Control- a primer”, “Hear the Music”, “Hearing Loss in Musicians (2009)”, and in 2010, Consumer Handbook of Hearing Loss and Noise.

Dr. Chasin has been the recipient of several awards including the 2009 Presidents award from the Canadian Academy of Audiology, the Professional Achievement Award from the Audiology Foundation of America (2003), as well as the 1991 Eve Kassirer Award for outstanding professional achievement from the Canadian Association of Speech Language Pathologists and Audiologists (CASLPA). More recently, Marshall is the 2012 recipient of the Queen Elizabeth II Silver Jubilee Award for service

Thursday 6th August 2015 | 11.30am – 12.30am

MR CURTIS ALCOCK Future-Proof Hearing Care [Part 1] – “The Tools to Survive…”

ABSTRACT: Like many professions today, hearing care has found itself in the throes of relentless and unprecedented change.

Our traditional models of hearing care have become increasingly challenged by unfamiliar consumer behaviour and expectations, whilst competition both old and new constantly threaten to rewrite the “best-practice” rulebook and sideline those who “do it right”. Our generation is witnessing technology evolve with such rapidity that we could be forgiven for wondering what our place will be in the future! Deep down we know our profession has to change, but what really needs to change? And how?

In this timely and provocative presentation international speaker and hearing care champion Curtis Alcock will introduce a dynamic and practical “toolbox” specially developed for hearing care professionals to not only future-proof their own role but to stimulate the creative-thinking needed to take the profession to new heights.

BIOGRAPHY: Curtis Alcock, spent the first 12 years of his career in design and marketing before making the transition into hearing care almost 14 years ago, qualifying with distinction in both theoretical and practical hearing aid audiology. He now runs an independent hearing care practice in the United Kingdom and is founder of an online think tank for hearing called Audira, which aims to create a new social norm for hearing in which the majority respect their hearing and do all they can to keep their hearing working at its best. He has presented in the United States, Canada, Denmark, the UK and to members of the European Parliament on the subject of changing society’s attitudes to hearing technology and the role that hearing care plays within society. In April 2013 he won the Ida Institute’s award for the best public awareness campaign to promote hearing health. He lives in Devon, UK with his wife and three children.

ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015 | Novotel Twin Waters | Australian College of Audiology

9

Thursday 6th August 2015 | 1.30pm – 2.30pm

DR KIM TILLERY PH.D Types of CAPDs and Reliable Testing - The Oldies but Goodies and the Up in Coming ABSTRACT: This session will provide useful information as to how to reliably diagnose the types of CAPDs. Because it is no longer appropriate to indicate that a general CAPD exists the CAPD Models (two internationally recognized and one promising) will be discussed. The types of CAPD are the same for adults and children; however some types are more commonly seen in the presence of attention or learning disorders. Attendees will have an understanding as to which test scores point to the types of CAPD and the benefits of an interdisciplinary approach in differential diagnoses.

BIOGRAPHY: Dr. Kim Tillery Ph.D, Professor at Fredonia State University of New York, USA has worked in the Central Auditory Processing Disorder (CAPD) has 22 years of research and clinical expertise involving the relationship of auditory processing, nonverbal learning, and attention deficit disorders; including reliable CAPD diagnosis leading to appropriate therapeutic measures; and Ritalin’s effect on CAPD. She has been honored to present 144 workshops or presentations at international, regional, and national conferences, and authored and coauthored numerous chapters and journal articles on CAPD. She is one of the five editors for the esteemed 2014 7th Edition of the Clinical Handbook of Audiology, and an invited manuscript reviewer for Journal of Speech-Language-Hearing Research, Neurocase, Child Neuropsychology, American Journal of Audiology, Educational Audiology Association Journal, Ear and Hearing Journal, Jones and Bartlet Publisher, Speech and Language Services in the Schools; and a previous Associate Editor for the Journal of Educational Audiology, Canadian Hearing Report and the Canadian Audiology Journal. Dr. Tillery was honored to receive the 2014 New York State SpeechLanguage and Hearing Association (NYSSLHA) Distinguished Award for her excellence in teaching and clinical research; the 2008 Distinguished Alumnus Award from Illinois State University and the 2009 State University of New York Chancellor’s Award for Excellence in Teaching.

Besides teaching and researching she served as the 2014 NYSSLHA President and the 2015 Immediate Past President along with several other professional boards. In the past twelve years she has participated in the Healthy Athlete Special Olympic Program by providing hearing screenings to athletes in Canada, New York and China.

Thursday 6th August 2015 | 2.30pm – 3.15pm

DR ROBERT PATUZZI PH.D Life After Death | Predicting the future of hearing support and clinical audiology ABSTRACT: All things must change, and support for hearing impairment is no exception. In a previous ACAud presentation I outlined the differences between audiology and audiometry, and noted that only 15% of an audiologist’s skill-set relates directly to adult hearing aids, while 85% covers many other issues, including paediatric testing, diagnosis and rehabilitation, educational hearing support, tinnitus, and community and workplace issues. Because most money can be derived at present from adult hearing aid sales, audiologists sometimes perceive audiometrists as “cherry picking”, leaving audiologists to bear the burden of the other non-profitable community needs. This situation has not been helped by the progressive privatization of Australian Hearing, the vertical

10

integration of the hearing aid industry to control retail outlets (diluting the cross-subsidisation from adult hearing aid work to other areas), and the lack of political support for these other areas of hearing health care. In future, however, all of these considerations are likely to be turned on their head. So far, the adult hearing support industry and profitability have centred on the hardware, but with mass production and online sales, and the development of progressively more intelligent hearing aids with self-test, inbuilt calibration and even pure-tone and more sophisticated speech testing (including self-contained convergence to a sophisticated functional fit), it is unlikely that either the hearing aid industry, audiometry or audiology can stay the same. If the progressive changes in the recording industry, camera industry and mobile phone industry are any indication, hearing support (hearing aids) are likely to move to be one component of a more integrated audio-visual system (based largely on today’s mobile phones). Along with this progressive change must come a change to audiology itself, and a shift in focus from test and rehabilitation hardware, from bricks-and-mortar buildings, and from local service. It is not clear whether the dominant business model will be that based on hardware or software, but it is likely that it will be neither, and audiology will need to develop into a separate consultative profession, that will include all aspects of hearing assistance, or better still “hearing optimization”. It may even be that “hearing impairment” as a category will be subsumed into the continuum of hearing assistance (e.g. noise cancellation for the normally hearing, 3D enhancement in noisy environments, real-time gaming, language translation). If these changes come to pass, there will be no explicit hearing aids, no hearing aid industry, no significant income to be gained from sales of those components (just as no-one is becoming a millionaire based on CD players or digital cameras). The community will benefit greatly from these changes, with the hearing optimization industry going global, penetrating previously unassisted markets locally (the 85% of Australians who do not now use hearing aids but could benefit from assistance) and internationally (the 85% of people globally who have no hearing health care at all). All of these issues will be discussed, with information gleaned from other industries, and in the context of how audiology education must adapt to this new world order.

BIOGRAPHY: Dr Robert Patuzzi Ph.D, completed electronics engineering at UWA before researching auditory biophysics for his PhD in the three-man team that discovered the highly sensitive and sharply tuned vibration of the organ of Corti, and its biological lability (the cause of most sensori-neural hearing loss). Since then he has investigated the fundamental causes of deafness, and cost-effective methods for screening and diagnosis, including those for neonatal deafness, auditory neuropathy and central auditory processing disorder. He established the Master of Clinical Audiology program at UWA in 2000, with its graduates now accounting for the majority of audiologists in WA, and with students of the auditory research laboratory now running four out of the seven audiology programs in Australia and New Zealand (and some in Malaysia). While Dr Patuzzi’s key research area is the fundamental hearing mechanisms in various species (from crickets to humans), he is also interested in epithelial physiology and the neurological control of breathing and rhinitis. Current hearing projects include the regulation of cellular mechanisms in the inner ear, including mathematical modelling. The more than 100 past research projects for the Master of Clinical Audiology program have ranged from the fundamentals of cochlear function and efficient diagnostic methods, to the sociology of deafness, educational audiology, audiology teaching, and noise induced hearing loss.

He is presently an academic in Physiology at UWA, teaching physiology, neuroscience and molecular biology, is Director of the UWA Audiology program, and chairman of the scientific advisory panel for the Australia’s HearingCRC.

ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015 | Novotel Twin Waters | Australian College of Audiology

Thursday 6th August 2015 | 3.15pm – 4.00pm Friday 7th August 2015| 10.00am – 10.45am

DR CHRISTOPHER LIND PH.D Talking about talk: Involving family members in adult hearing rehabilitation ABSTRACT: Adult acquired hearing impairment has its most profound negative effects on access to everyday talk. It impacts not only on HI individuals but on their families and social circles. There is an increasing body of knowledge about what aspects of talk are influenced by adult HI and how people deal with them. It is expected that successful hearing aid fitting and / or other rehabilitation intervention will lead to improvements in interaction for both HI individuals and those around them. Yet little effort is given to communication partners’ views of these benefits. This presentation will focus on methods by which clinicians might engage adult clients and their familiar communication partners in discussion of their everyday conversation needs and later the benefits of intervention on their everyday talk.

BIOGRAPHY: Dr Christopher Lind Ph.D, is Senior Lecturer in Audiology at Flinders University in South Australia. He completed his PhD at the University of Queensland in 2006. Christopher has practiced, taught and researched in adult aural rehabilitation for more than 25 years, working at the HEAR Service, Victorian Deaf Society from 1987 until he took his first teaching position in 1996. His major research interests include conversation repair and psychosocial aspects of adult hearing impairment. Christopher has been an invited speaker at conferences in North America, the UK, Scandinavia and Europe. He has been on the Faculty of the Ida Institute in Copenhagen since 2010 and was International Scholar-in-Residence at the Faculty of Health Sciences’ National Centre for Audiology, University of Western Ontario in Canada between May and August, 2013.

Friday 7th August 2015 | 10.45am – 11.30am

MR CURTIS ALCOCK Future-Proof Hearing Care [Part 2] – “…and the Vision to Thrive” ABSTRACT: The key to hearing care thriving in the future is to make it absolutely indispensable to society. Yet even though Australia leads the world in many areas of Audiology it still encounters the same resistance and indifference amongst the general population as the rest of the world. We often assume there must be an inherent “dislike” of hearing care and hearing technology that we must somehow overcome. But research into how attitudes work reveal a different story: that hearing care has not only been accidentally reinforcing outdated attitudes and negative stereotypes in society, but we have been actively telling people to avoid us! In this presentation we are going to envision a different future: one where people are doing all they can to keep their hearing working at its best, where hearing care plays a central role in society. We’re then going to see the simple – yet crucial – steps we need to take to make that future a reality.

Because the more people who value and respect our services, the more future-proof our profession will be.

Friday 7th August 2015 | 11.30am – 12.15pm

DR KIM TILLERY PH.D Reliable Differential Diagnosis of Central Auditory Processing, Attention Deficit and Nonverbal Learning Disorders Lead to Effective Intervention ABSTRACT: This second session will focus on a brief overview of the co-morbidity of CAPD, ADHD and NVLD, as well as new methodologies in therapy implementation using current technology and tools. Participants will leave the sessions with an understanding of strategies and tools that may be integrated into their everyday practice to facilitate success when working with those with central auditory processing and related disorders.

Friday 7th August 2015 | 3.45pm – 4.30pm

DR MARSHALL CHASIN AU.D Music and Hearing Aids ABSTRACT: Music and speech have some differences which include spectral shape, intensity and “crest factors”. Most modern digital hearing aids cannot handle the more intense inputs that are characteristic of music.

Four available technologies and four clinical strategies will be provided to optimize hearing aids for music as well as for speech.

These technologies are designed to circumvent some problems associated with the analog-to-digital conversion process- a major weak point with modern hearing aids.

Saturday 8th August 2015 | 10.00am – 10.45am

DR BEN FERNÉE AU.D Oticon | Dr Ben Fernée | Tinnitus Treatment with Hearing Aids ABSTRACT: When a hearing impaired patient presents with tinnitus, it can be challenging as a hearing care professional to know what to do.

There are multiple treatment approaches that do not necessarily suit all patients. This presentation will present a structured hearing aid based tinnitus support program, and discuss how the program can be used. An analysis of the program will also be reviewed with a patient case study.

BIOGRAPHY: Dr Ben Fernée, Au.D, currently serves as National Audiology Manager at Oticon Australia, managing product introductions, audiological and technical issues as well as training. Up until July 2013, he was the Product Manager in Oticon Paediatrics, Denmark. In his work as Product Manager at Oticon Denmark, Ben was involved in the development of all new paediatric hearing instruments from Oticon, including hearing aids and FM systems. He completed a Bachelor of Speech Pathology, then a Master of Audiology at the University of Queensland. He went on to complete his Au.D in the US. He has worked as an Audiologist for many years in both the clinical setting and also in manufacturing, in Brisbane, and Toronto and Vancouver in Canada. Ben has a special interest in new hearing instrument technology and how this can be match to patient needs.

ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015 | Novotel Twin Waters | Australian College of Audiology

11

DR STEVEN J AIKEN PH.D

MR TRONG NGUYEN

Bernafon | Dr Steven J Aiken | Hearing Aids at the Edge: Optimal Strategies for SevereProfound Hearing loss

Interacoustics | Tron Nguyen | Balance assessments within private practice – Is it possible?

ABSTRACT: Research focused on:- Brainstem responses to speech sounds | The impact of audiological and ontological interventions on speech understanding | Improving the link between diagnostics and rehabilitation.

BIOGRAPHY: Dr. Steve Aiken, Ph.D, is an Associate Professor of Audiology, Surgery, Psychology and Neuroscience at Dalhousie University. He received a master’s degree in Audiology from the University of Western Ontario and a PhD in Medical Science from the University of Toronto. In addition to his role as a professor, Dr. Aiken has practiced as a clinical audiologist at the Canadian Hearing Society as the in-house audiologist for Bernafon Canada.

His research focuses on measures of speech fine-structure encoding in the auditory system, binaural function and the impact of audiological and otological interventions on speech understanding, He is also a past-president of the Canadian Academy of Audiology, associate editor of the Academy’s official journal, a founding member of the Dalhousie Hearing Aid Assistance Program, and founder and chair of the Canadian Infant-Hearing Task Force.

MRS JAN POLLARD Sonic Innovations | Mrs. Jan Pollard | Noise isn’t what it used to be ABSTRACT: The most common COSI goal of our clients is to be able to hear in a noisy situation. The complexity of the competing factors degrading the target speech signal has meant that digital processing requirements for hearing aids at their highest to provide client satisfaction. We have come a long way from analog directional hearing aids in the ways to improve the signal to noise ratio and quality of the processed signal. Environment classification is a method of acoustic signal analysis that attempts to recognise a complex set of patterns typically encountered in auditory environments. Analysis of periodicity, modulation rate, signal-to-noise ratio, inter-aural time and level differences results in categorisation of the input into an environment type of Speech in Noise, Speech in Quiet, Noise or Quiet or Wind. Binaural Coordination merges independent functionalities to create a single, unified and natural listening experience for the hearing aid wearer. Prioritisation and synchronisation of the environmentally classified categories then occurs between the two hearing instruments to optimise the advantages of inter-aural information being retained. Reverb Reduction and Impulse Noise Reduction further enhance the quality and acceptability of the complex signal. The result is a full 360⁰ binaural optimisation of the auditory environment and a hands-free, unified auditory experience for the listener in dynamic environments.

BIOGRAPHY: Jan Pollard, has been part of the Sonic team for over 12 years and is their Chief Audiologist. Prior to this she was the Head of Audiology at the Royal Children’s Hospital and Melbourne. Over the years Jan has worked in a diverse range of areas and has built an expertise in areas such as hearing aids, training, diagnostic audiology, pediatric audiology and newborn hearing screening.

12

ABSTRACT: Balance assessments through VNG can often be neglected in private clinics given the perceived amount of time to perform them and the expense to the professional. Since the introduction of the Video Head Impulse Test (vHIT), we now have the opportunity to assess the full semicircular canal function independently in a more efficient and less invasive manner. This presentation will describe how the vHIT works, look at the comparisons between standard VNG testing as well as discuss how it can be used in current practice which may not be currently performing VNG assessments.

BIOGRAPHY: Mr Trong Nguyen is an audiologist and product consultant with Interacoustics and lends his hand in education and support to clinics over the full diagnostic test battery. Trong has a strong diagnostic paediatrics background with his initial work at the Children’s Hospital at Westmead. His interests in evoked potentials have lead him to broaden his skill set over the full EP tests as well as the vestibular assessment battery.

Saturday 8th August 2015 | 11.00am – 11.45am

DR BRENT MCMONAGLE MBBS Surgical options for hearing loss: the present and the future ABSTRACT: The causes of hearing loss are many and varied. While hearing aids remain the main rehabilitation option, there are a large number of surgical options available. From middle ear prostheses to implantable hearing aids, we are now spoilt for choice. As our population ages, there will be increased demand to manage hearing loss for longer periods of life. Advances in molecular neurobiology are unlocking the potential for growth factors and stem cells to be used in the cochlea. While the present looks and sounds good, the future looks even brighter.

BIOGRAPHY: Dr Brent McMonagle MBBS, was born on the Gold Coast, and educated at The Southport School, graduating from the University of Queensland Medical School in 1996. I received my surgical fellowship in 2004 having completed my training in Queensland, and then undertook post-fellowship training in 2005/6 in Sydney, London, and Adelaide in the areas of otology, neurotology, skullbase surgery, and advanced sinus surgery.

Whilst having had broad training in all areas of my specialty, I have special interests in otology (including bone anchored hearing aids and cochlear implantation), neurotology (especially facial nerve disorders), skullbase surgery (such as acoustic neuromas and pituitary tumours), and advanced sinus surgery (and its extension to the orbit and skull base). I have written numerous articles and chapters on basic science and clinical research, and presented both nationally and internationally.

In terms of research, I have just submitted a PhD thesis through Griffith University on Nasal derived Olfactory Ensheathing and Stem Cells in Peripheral Nerve Repair and Regeneration. This work has involved developing alternative methods of peripheral nerve repair, and this technology has also led to applications in neurological disease and the human spinal cord injury trial at Princess Alexandra Hospital. I also serve as the scientific director of the Perry Cross Spinal Research Foundation, a not for profit charity involved in fund raising to support spinal cord research.

ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015 | Novotel Twin Waters | Australian College of Audiology

Nepal Newsletter 59

News From Hearing Project Nepal The hearing clinic had been running well up until Anzac Day and is now back to normal again. We are very pleased with the response for donated recycled BTEs as we now have enough stock to continue for another year or more. A big Thank you all those who contributed.

Progress on the new “Ear Hospital” is well on track and fortunately our region sustained only minor damage from the quakes. We are anticipating an official opening sometime in November.

The management committee are now seeking qualified volunteer staff to spend some time working in the hospital. If you would like an exciting an interesting experience working with other clinicians ENTs and medical staff from around the world please let me know.

ANZAC DAY 2015 I was sitting upstairs with two friends working on a promotion idea for the hearing clinic. We felt a vibration and heard rumbling sounds. It got more intense and we ran down the stairs and into the garden. The ground was moving violently beneath our feet. This was the first of the three earthquakes and hundreds of minor aftershocks to hit Nepal over the next few weeks.

During that time the clinic remained open on a part time basis. We spent most of our time helping to raise funds and mobilize relief supplies to send to remote rural villages. With nearly 9,000 killed and 600,000 homes destroyed there was lots to do. There still is !!!

Back at home in Townsville I have initiated a “Rebuild Nepal Campaign” with the aim to fund the replacement of as many homes as possible. Our group, including some Nepalese are planning to rebuild with straw bale homes which are used in other earthquake areas around the world.

If you would like to help send a donation to; Daybreak Townsville Rotary Club BSB 034 231 ACCT 196 927 Westpac Banking Corporation Castletown Branch Or phone David Hine 042 896 1744

CBD Office Space for Daily Hire Perfect for small meetings or conferences Centrally located in Brisbane CBD Close to Roma Street Train Station and various car parks Daily room hire fee $200.00 for ACAud Members Daily room hire fee $250.00 for Non ACAud Members ** Cleaning Fee will be charged if premises are not left clean and tidy Location – Suite 7, Level 4, 201 Wickham Terrace, Spring Hill, QLD, 4000 For Bookings Contact:- Kylie Dicieri acaud@acaud.org (07) 3839 1622

60 Announcement

Office of Hearing Services

Advertising of Hearing Devices and Promotion of Services Do you know your obligations if you are offered a gift, bonus, trip, commission in doing your job (or are a device supplier/service provider offering such incentives to hearing practitioners)?

New material is available on the Office of Hearing website to assist you in navigating these complex issues.

Over the last 6 months several issues have been referred to the Office of Hearing Services for advice on any frameworks in place which govern the interactions between the device industry, hearing service providers and hearing practitioners, including the advertising and promotion of hearing devices.

There are a range of scenarios which could be considered within this context including: • Advertising of hearing devices to hearing practitioners and consumers; • Promotion of hearing devices through the offer of a gift by a device supplier to hearing practitioners who meet specified sales targets; • Service providers offering commissions, bonuses, trips etc to staff who reach certain thresholds for selling hearing devices; • Service providers advertising their service and offering new clients an inducement, such as a gift certificate / opportunity to win a prize etc.

ACCORD JUNE | Congress Edition

In many of these scenarios, the target audience is the practitioner.

There are a number of obligations on the device industry, hearing service providers and hearing practitioners which are imposed through arrangements administered bv a range of bodies, including the Commonwealth, state/territory entities, professional associations and industry self-regulatory bodies. The application of these requirements can also depend on whether the interaction is part of an activity under the Hearing Services Program and in some cases responsibilities can overlap. The Office has therefore developed a series of questions and answers (Q & As) on this topic which is available at Advertising of hearing devices and promotion of services.

These questions and answers also cover the obligations of device suppliers and service providers. However, as the Office has highlighted in the Q&As, it is not always possible to respond in a definitive way and in that case a common sense approach should be taken to what would reasonably be expected by the community, in particular where Government funding is involved.

Any other questions around such interactions which hearing practitioners wish to be addressed can be emailed to hearing@health.gov.au and the Office will update the Q & As accordingly.

Thinking audiology… think Sonic & MedRx HID

*

(Plug and Play)

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Audiometry/REM Combination: Combining the power of Audiometry and Real Ear Measurement into one impressive system • 2-Channel Diagnostic Audiometer • Binaural Live Speech Mapping, Real Ear Measurement System • USB PC-based • Small Footprint - approx. 20 cm x 13 cm x 3 cm *HID (Human Interface Device) technology – choose any USB port and your computer will recognize the device consistently after initial installation.

One-stop-shop for all your audiological needs www.sonici.com.au Freecall 1800 639 263 Sonic Innovations Pty Ltd | 629 Nudgee Road Nundah Q 4012 | P 07 3250 0369 | F 07 3256 8088 | E enquiries@sonici.com.au

62 Announcement

Notes from the Office It has been one year since the Hearing Services Online (HSO) website and portal was released to hearing services providers in February 2014 and to the public in May 2014. The Office continues to enhance the online portal, the most recent occurring in March 2015, as detailed in CSPN 2015/05. The next enhancement to the portal will occur around mid-2015.

Some interesting statistics from this first year: • 3,331 Service Provider Users have logged into HSO; • On average, 295 users are logged into HSO concurrently each day; • On average, 1,602 unique visitors are visiting the website each day; • 1,000+ calls to our call centre per day reduced to approximately 185 per day; • 1,500+ paper applications per day received by the Office reduced to approximately 30 per day; The Service Provider Consultative Group (SPCG) continues to support portal release processes.

Identification of priorities as well as release notifications and supporting documentation (user guides, fact sheets, frequently asked questions) are done in consultation with the SPCG to ensure changes are beneficial and appropriately communicated to service providers. More information on the SPCG can be found in CSPN 2014/19 or on the website http://hearingservices.gov.au Other recent news from the Office that may be of interest to practitioners:

New Service Provider Contract As the current Service Provider Contract is due to expire 30 June 2015, the Office prepared and published on our website, a proposed new ACCORD JUNE | Congress Edition

Contract to cover the period 1 July 2015 to 30 June 2018. A consultation period until 24 April allowed for comment and feedback. The Office will consider responses and a new Contract will be formally offered in May 2015. Key proposed changes to the documentation are described in CSPN 2015/06.

Statutory Declaration Commonwealth statutory declarations are used when a client has lost their device/s and is requesting a replacement item. Statutory declarations may be completed on behalf of a client, and must be signed in the name of the person completing them. Only an authorised person - usually a Justice of the Peace [JP] - may witness a statutory declaration, however, it is against relevant Codes of Conduct to witness a document where there may be a conflict of interest. Additional information, including a list of parties approved to witness a statutory declaration can be found via CSPN 2015/07.

Free Promotional Postcards The Office continues to make available (at no cost) two promotional postcards, which promote and encourage access to hearing services. One postcard has been developed for individuals affected by hearing loss, and the other for family and friends of individuals with perceived hearing loss. Both postcards can be viewed on the website, additional information and details on how to order can be found in CSPN 2015/01.

Hearing Awareness Week The Office looks forward to participating in activities during National Hearing Awareness Week, occurring 23-29 August 2015.

Keeping up to date with information from the Office.

Announcement 63 You can keep up to date with all that is going on from the Office through the ‘What’s New’ page on our website. A Rich Site Summary (RSS) Feed is available for subscription; more information on how to subscribe to the RSS feed is in CSPN 2014/22.

To send us your feedback or to seek any further assistance about the program, you can email hearing@health.gov.au, or use the ‘Feedback’ link on the website.

The Office welcomes any feedback and suggestions on the website and online portal.

SUPERVISORS WANTED I am an overseas trained audiologist registered with ACAud as an Associate member. I need to undergo a period of supervision as per the ACAud requirements. Therefore, I am currently seeking a qualified audiologist willing to undertake the role of a supervisor preferably located in Melbourne or surrounding areas. I am hardworking, energetic, keep good knowledge of the field and have prior experience in the field.

Indu Palasseri Contact Information Mobile: 0422898596 Email: indu.aslp@gmail.com

Name: Claire Chandler Contact Information Mobile: 0439 959 476 Email: clairechandler0@gmail.com Location: WA Infomation about me: Recent graduate with Diploma in hearing device prescription and evaluation from Tafe NSW. I am keen to begin my career in audiometry and am looking for a provisional position. I have over 18months of work experience with a supervisor at Hearing Life where I was able to work with a number of their clients to determine their audiometric thresholds though pure tone audiometry and create a personalised rehabilitation plan. It would be a fantastic opportunity to be considered for a position with one of the WA companies and I hope to become one of your team members in the near future. | ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

64 Feature President

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Preferred positions are: – Inside front cover – Centre or spread – Inside back cover or spread – Back page – O ther specific requested position Guest editorials Guest editorials are invited, encouraged and welcomed from all categories of Membership and will be published as space permits.

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| ACAud NATIONAL CONGRESS SUNSHINE COAST 2015 | 6-8 August, 2015

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