Audacity Issue 10

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Audacity ...a British Society of Audiology Publication

issue 10 September 2017 ...................................

BSA Conference Review 2017

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32

Patient-centred care for older adults with age-related hearing loss

44

10Q: C2Hear – helping first time hearing aid users to help themselves

CELEBRATING FIFTY YEARS OF AUDIOLOGICAL KNOWLEDGE, LEARNING, PRACTICE AND IMPACT

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Editorial W

elcome to the 10th Edition of Audacity, the first for the new editorial team at Betsi Cadwaladr University Health Board in North Wales.

I want to begin by thanking Martin O’Driscoll and his team for the fabulous job they have done over the last four years producing nine excellent editions of Audacity. They will be a very hard act to follow. I believe the quality of the content, structure and design of Audacity has been exceptional and with this in mind we have decided not to make too many changes. Apart from combining a couple of sections to create BSA Today, merging Ear Reach and Ear Globe and a couple of other changes, you’ll notice the magazine looks very familiar. Just flicking through, taking a look through what’s in this latest version and it really is jam packed and difficult to only pick out a few highlights. However we couldn’t have a post conference 50th anniversary without significant reference to both. The conference review, summarises an inspiring two days. If you didn’t get chance to make it this year then seriously consider for next year. We will continue to make the conference a regular Audacity feature with either a conference review or a conference preview, which you can look out for in the next edition. We also plan to include interviews with the BSA prize winners in our post conference editions. Reaching 50 years is no mean feat; we’ve included a series of BSA past, present and future articles that reflect on where we have been, where we are now and where we are heading, in celebration of this significant achievement. We’ve also included some nostalgic reviews: including a brief review of the Caloric test over the last 50 years and looking at 1967 as a ‘revolutionary year for unilateral aiding’. As you may be aware NICE guidance for the assessment and management of hearing loss (adult presentation) has been under development for the last 12 months. Kevin Munro’s article provides a superb summary of the process involved. Take note of Kevin’s reminder that these guidelines will be ready for consultation in November this year. Also in the edition, look out for: Ear Globe with articles from both Ghana and Turkey; 10Q on C2Hear by Mel Ferguson and David Maidment; a great feature article by Gabby Saunders on Patient Centred Care; articles on CBT for CI and VR; updates from our amazing Special Interest Groups and much more.

And finally, if you don’t have time to peruse the press or are not social media savvy don’t miss Ear to the Ground. As mentioned earlier, the Manchester team will be a hard act to follow and the new editorial team have had an interesting time over the last few months navigating our way through the process and learning quickly as we’ve gone along. We couldn’t have done this without the unfaltering support of Caroline at PinPoint, BSA’s very own Laura Turton and from the past editorial team. We’ve enjoyed the challenge to date and very much hope you enjoy this special 50th anniversary edition of Audacity. If you have any ideas about features or articles for future editions of Audacity or would like to submit something please get in touch with the editorial team, details of which can be found in the next few pages. Enjoy the read!

Jane Wild, Editor-in-Chief On behalf of the editorial team E: jane.wild@wales.nhs.uk

editorial

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Contents 3

Editorial

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Chair’s Message

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Expert writing about topical areas in audiology

Ear Globe – audiology around the world

42

Information and updates from all aspects of the work of the BSA

Featured Articles

36

Information and updates on conferences in audiology

BSA Today

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Liz Midgley

Conference Catch Up

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Jane Wild

Find out about the latest charity and humanitarian work going on within audiology, both in the UK and abroad, with some opportunities for you to get involved.

Clinical Catch-up

Short articles on relevant clinical topics.

50 Research Round-up

A spotlight on major ongoing research projects in the audiology community worldwide

59 Ear to the Ground

A guide to all things Ear-related in the media

67 Essentials

Key information for the membership

E: audacity@thebsa.org.uk

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W: www.thebsa.org.uk

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Sueann Meyer, Senior Clinical Scientist

Susannah Goggins, Principal Clinical Scientist

Jane Wild, Consultant Clinical Scientist and new Editorin-Chief of Audacity

Meet the team

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Editor in Chief of Audacity Jane has worked for the NHS in Wales for 23 years. She is currently Head of Adult Audiology Services at BCUHB. Jane is also Vice Chair of the BSA Adult Rehabilitation Interest Group (ARIG) and one of the Clinical members of the NICE Guideline Committee for Hearing Loss. Jane has a particular interest in the development and implementation of patient centred quality services.

Section Editor - BSA Today Susannah is currently the head of adult rehabilitation, adult diagnostic and vestibular audiology across BCUHB. She has worked in North Wales for the past 14 years and has a particular clinical interest in vestibular testing, vestibular rehabilitation and adult diagnostics.

Section Editor - BSA Today Sueann has been working in audiology at BCUHB for 10 years. She achieved a BEng in Mechanical Engineering from Loughborough University in 2003 and, went on to complete her MSc in Audiology at Manchester University in 2007. Her main areas of clinical activity include adult audiological rehabilitation, advanced diagnostic assessments and balance assessment and management.

Sarah Canton, Principal Clinical Scientist

Sarah Bent, Principal Clinical Scientist

Abigail Wain, STP trainee

Section Editor - BSA Today

W: www.thebsa.org.uk

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Abigail is currently an STP trainee based at Wrexham Maelor hospital. She has worked with children as a Speech and Language Therapist, specialising in hearing impairment and cochlear implants. Due to her background she has an interest in paediatric audiology and is finding this aspect of her training particularly enjoyable.

Section Editor - Ear to the ground Sarah completed her PhD in Physics in 2003 and British Academy of Audiology CAC in 2006. Sarah’s professional interests are furthering clinically relevant research in adult rehabilitation in Audiology, in effective and individual rehabilitation for adults with hearing loss, and in the assessment and rehabilitation of adults with dementia or learning disabilities.

Section Editor - Ear to the ground Sarah has worked in Audiology for 14 years. She moved to North East Wales and started her clinical scientist training post at BCUHB in 2003. Although she worked in Paediatric Audiology for a number of years, her current professional interest is development of Audiology services in Primary Care. Sarah is currently the area lead for the North Wales Primary Care Audiology Service (East BCUHB).

E: audacity@thebsa.org.uk

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Matthew Evans, Principal Clinical Scientist

6 Section Editor - Ear to the ground Matthew has worked in Audiology for 12 years, and for BCUHB from 2009-present. Current professional interest is development of Audiology services in Primary Care. His current role is area lead for North Wales Primary Care Audiology Service (Central)

Katie Bentley, STP trainee

Section Editor - Clinical Catch-up Katie graduated from the University of Sheffield in 2015 with a degree in Speech and Language Science. She then started her STP training and is currently based at Glan Clwyd Hospital.

Stephanie Greer, Pre-Registration Clinical Scientist

Shanelle Canavan, STP trainee

Suzanne Tyson, Senior Chief Audiologist

Susan Boon, Chief Audiologist

Section Editor - Clinical Catch-up Susan has been an audiologist, specialising in Adult Rehabilitation for 17 years. She has recently completed a secondment in the North Wales Cochlear Implant Programme, and in April 2017 transferred to the team on a permanent basis.

Section Editor - Clinical Catch-up Suzanne has been in Audiology for over 27 years and is currently Head of Adult Services at Glan Clwyd Hospital in North Wales. She specialises in Adult Rehabilitation, in particular seeing patients that have a unilateral hearing loss. She has also been actively involved with the Audiology charity ‘Hear Aid’ for the past 17 years, and currently holds the post of Chairperson.

Section Editor - Research Round-up Shanelle’s background was primarily in audiological research. However, in 2016 she left her research post (at the University of Manchester) and embarked on the STP training programme. She is currently developing her clinical skills and has a particular interest in adult rehabilitation and complex needs.

Section Editor - Research Round-up Stephanie has worked for BCUHB Audiology since 2012 after completing her HTS training. Her clinical role is split equally between hearing and vestibular work where she delivers services to patients in Wrexham Maelor Hospital and North Powys. She is also actively involved in clinical research.

Audacity is published by: The British Society of Audiology 80 Brighton Road, Reading, RG6 1PS, UK. E: audacity@thebsa.org.uk W: www.thebsa.org.uk

E: audacity@thebsa.org.uk

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Design: Pinpoint Scotland Ltd

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Jenny Townsend, Principal Clinical Scientist

7 Section Editor - Research Round-up Jenny has worked in Audiology for the last 18 years. In 2001 she completed her CAC training at Glan Clwyd Hospital and never left! She went on further to complete her Doctorate in Audiology and for the past 15 years has specialised in diagnostic audiology (auditory & vestibular) and cochlear implants. In 2015 she became head of the cochlear implant and BAHA services for North Wales.

Sophie Wareham, Clinical Scientist

Joanne Goss, Advanced Practitioner Audiologist (Aural Rehabilitation).

Section Editor - Featured articles Joanne has been working for BCUHB since she graduated from The University of Manchester in 2006. Her current role involves working with patients with troublesome tinnitus, those who require more intensive aural rehabilitation and as part of the Cochlear Implant team. Her professional interests are in tinnitus and advanced aural rehabilitation.

Section Editor - Ear Globe Sophie graduated from the University of Manchester in 2009 with a Masters Degree in Neuroscience. She qualified as an audiologist in 2013 and has since completed the Scientist Training Programme (STP). She has worked at BCU since registering in 2016 and currently specialises in vestibular and adult hearing assessment and rehabilitation.

Lauren Parry Clinical Scientist

Section Editor - Ear Globe Lauren graduated in 2012 following a BSc (Hons) Audiology and went on to complete the scientist training programme in 2016.

Bridget Akande, STP trainee

Section Editor - Ear Globe Bridget is completing the Scientist Training Programme and is currently based at Glan Clwyd Hospital. She is in Year 3 and she has just completed her Master’s degree in Clinical Science (Neurosensory Sciences).

The British Society of Audiology publishes Audacity as a means of communicating information among its members about all aspects of audiology and related topics. Audacity accepts contributions, features and news articles concerning a wide range of clinical and research activities. Articles typically emphasise practical rather than theoretical material. Audacity welcomes announcements, enquiries for information and letters to the editor. Letters may be in response to material in Audacity or may relate to professional issues. Submissions may be subject to editorial review and alteration for clarity and brevity. Please email audacity@thebsa.org.uk for further information. Audacity is published in March and September. Contributions should preferably be emailed to: audacity@thebsa.org.uk or sent to; The Editor, Audacity, 80 Brighton Road, Reading, RG6 1PS. Views expressed in Audacity do not necessarily reflect those of The British Society of Audiology, or of the editors. The Society does not necessarily endorse the content of advertisements or non-Society documents included with their mailings. The Society reserves the right to refuse to circulate advertisements, without having to state a reason.

W: www.thebsa.org.uk

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E: audacity@thebsa.org.uk

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chair’s message

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Chair’s Message - July 2017 Were you at the BSA’s annual conference in Harrogate at the end of June? If you were I hope you enjoyed it as much as I did. If you weren’t you missed a treat of scientific talks, posters, commercial exhibitors, Special Interest Group sessions, networking, friendship and our 50th anniversary celebrations with Prosecco! We were particularly delighted and honoured that one of our founding fathers, Arthur Boothroyd , was able to join us virtually with a pre-recorded message and interview. When asked what he thought were the most significant developments in audiology in the last 50 years he said oto-acoustic emissions and immittance measurements. Can you imagine our clinical practice without these inventions? I wonder what the next 50 years has in store for the BSA and the wider audiology community?

Help from all members of BSA would ensure our plans were realised and that we move forward. Don’t hesitate to contact any member of the BSA council if you wish to become more involved.

I really want to thank all our exhibitors and particularly our gold sponsors, Oticon and Otometrics without whom the conference wouldn’t be possible. Thank you also to the sponsors of the 50th anniversary celebration evening, ENT and Audiology News, Phonak, and Amplifon. Thank you too for the organising committee and all the hard work they put in under the leadership of Siobhan Brennan. The success of the conference was largely due to your excellent planning and choice of speakers.

In our 50th Anniversary year it was fitting to honour someone whose vision has shaped, changed and modernised the BSA over the last few years. This is Kevin Munro and he received honorary life membership of the BSA.

Planning has already started for the next BSA annual conference which next year will be in Brighton. Please consider presenting your research as a poster or as an aural presentation. Certainly please plan to attend the meeting as we hope to build on the success of the conference in Harrogate. It really is an excellent opportunity to meet colleagues and learn from each other. At the conference in Harrogate we held our Annual General Meeting( AGM). This had been brought forward to June from September so that we can hold the AGM at our annual conference. This has also meant that our financial year has been changed so that accounts can be presented at the AGM. At the AGM we reviewed the past year (well past 10 months actually) and were pleased to learn that due to the diligence and control of expenditure from our Treasurer the BSA found itself in a stronger and more secure financial position than last year. I believe that the BSA has had a good year and is well placed to take our work forward to improve the lives of people with hearing and balance problems. To help us to focus our activities we have devised a three year Strategic Plan with an action plan for this year. These are published on our website. Please familiarise yourself with these plans and offer to help where you can. The only people who are paid employees of the BSA are our indefatigable Operations Manager and the team at Fitwise, our administration management team. Everyone else who works on behalf of BSA is a volunteer and everyone has busy day jobs.

At the AGM Nicci Campbell came to end of her term as Trustee. Thank you to Nicci for all the work she has done for the BSA. She has rejuvenated the website and been the lead on our communication strategy. She will remain connected with the BSA as incoming chair of the APD SIG. We welcomed Carolyn Dando as a new Trustee who will lead our events and publicity strand of the action plan. We said goodbye and another large thank you to Huw Cooper for his work over the last few years as Trustee, vice-chair, chair and immediate past chair of BSA.

On 4th and 5th of September our research scientist colleagues are organising a conference in Nottingham. This will be an amazing opportunity for researchers and clinicians to meet and share ideas. Watch out for information about the latest BSA member’s benefit, BSA Grow. This is an on line platform for learning and CPD. It is vital that we all keep up to date with the latest developments to inform our research interests and/or clinical practice. The BSA has invested in this platform as a way of supporting learning for members in a cash and time restricted climate. This is the first edition of Audacity that has been produced by Jane Wild and her team in majestic North Wales. I’m really looking forward to reading it. Please submit copy to her to share your ideas, innovations and practice with all members.

With best wishes

Liz Midgley Chair

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WE CAN HELP YOUR TINNITUS SERVICE Resources for professionals Tinnitus Adviser Training Assessment & Management of Paediatric Tinnitus Regional Tinnitus Networks Professional Membership Annual Conference Bursaries Small Research Grants Information resources for patients www.tinnitus.org.uk info@tinnitus.org.uk 0114 250 9933 Registered charity no: 1011145. Company limited by guarantee no: 2709302. Registered in England.

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conference catch-up

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BSA Conference Review 2017 Audiology and the Greater Good The BSA Annual Conference took place at the Majestic Hotel in beautiful Harrogate on 29th and 30th June. The “Audiology and the Greater Good” theme aimed to provide a programme that considered audiology within the context of an individuals’ life but also explored how audiology fits with other services and organisations both within and outside of healthcare. The format neatly wove together keynote presentations in “Hot topic” sessions with parallel tracks and the BSA special interest groups sections; this gave a rich array of research, translational work and service improvement throughout the conference and made it hard to know which tracks to choose – a good position to be in!

Members of the BCU Audacity Team at BSA Conference this year

Jane Wild

Jo Goss

Sarah Bent

Lauren Parry

Suzanne Tyson

Sophie Wareham

Day One Liz Midgely, our BSA Chair, opened the conference recognising the landmark anniversary of BSA in its Golden year. Amanda Hall chaired the first Hot Topic Session on Comorbidities and Epidemiology Frank Lin’s Keynote presentation entitled ‘Hearing, Cognition and Healthy Aging’ gave us a passionate insight into the consequences and impact of age related hearing loss and how these consequences can be effectively addressed. He talked about the public perspective, wanting to age healthily, keep socially active, keep functioning physically and try to avoid injury and how audiology can respond to that. He finished the presentation by detailing the Aging, Cognition, and Hearing Evaluation in Elders (ACHIEVE) work which includes an RCT that is looking to determine if treating hearing loss in older adults can reduce the risk of cognitive decline and dementia.

Elena Calzolari’s presentation on the ‘Coupling and Uncoupling of Vestibular Perceptuo-reflex in Health Participants and Patients with Head Trauma’ gave us an insight into her research on the vestibular perception of self movement and how it is not always coupled with a vestibular response. She suggests that we should be measuring perceptual and reflexive outcomes in patients with chronic dizziness to aid rehabilitation. After the break the conference split into two parallel sessions: one on service development and professional issues chaired by Melanie Ferguson, and the other on implantable devices chaired by Tracey Twomey.

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12 In the Service Development and Professional Issues session, Frank Lin presented on the importance of public health approaches to addressing hearing loss in adults and the need for disruptive change in the profession to meet the modern day needs of our populations; Nicola Phillips outlined the welsh experience of the new role of the audiologist in primary care with both statistics and case studies that impressed the audience; Gemma Twitchen updated us on the situation related to commissioning across England and the support that Action on Hearing Loss and the BSA have been providing and finally Amyn Amlani gave the data on sound quality ratings of the various traditional and over the counter amplification products in the USA.

Agnes Houston MBE shared her personal experiences of living with dementia and the associated sensory challenges. Her emotive speech inspired us all to see past a diagnosis of dementia to develop not only hearing loss care pathways but also to address the altered sensory perceptions that those living with dementia may experience.

During the Implantable Devices session, Iain Bruce discussed the future of CI candidacy and how we can standardise our outcomes in clinic moving forwards; Sara Alhanbali presented her PhD work on perceived and actual hearing difficulty and their prediction of self reported listening effort and fatigue; this was followed by a video link to Colette Mckay in Australia talking about the reasons for variable speech understanding among adult CI recipients. The session ended with Helen Cullington discussing the exciting developments in remote care in the Southampton CI programme and the positive patient outcomes that have resulted. After lunch the conference returned for the second Hot Topic session on Mental and Cognitive Health, a theme that seemed to run throughout the conference. Nicola Wright and David Charnock presented their perspective from outside audiology on patient centred approaches. They reminded us that Charley’s needs are much broader than his hearing loss and individuals are always more complex than we think. They suggested a multi-dimensional care approach may help us to put the puzzle together and better understand the complexity of a person’s life, both for each person that we support and for those with mental health challenges.

The final presentation of this hot topic was by Piers Dawes on the 5 year European SENSE-Cog project which has reviewed the evidence on the “triple threat” of dementia, hearing impairment and sight impairment and are now forming assessment and rehabilitation toolkits for those with a combination of these. Following tea the conference again split up into parallel sessions. This time three sessions, Integrated Care and Patient Centred Practice, chaired by Liz Midgley; Audiology and the Justice system chaired by Siobhan Brennan and a third session a workshop run by Melanie Ferguson and Amanda Hall on research opportunities for audiologists and removing the mystique from research. The Integrated Care and Patient Centred Practice session included Carol Holland presenting on the relationship between sensory impairment and cognitive function in older age and the impacts on engagement and active ageing; a video link to Ennur Erbasi in Australia and then to Gabrielle Saunders in the USA presenting the implications of family and patient centred care for the paediatric and adult populations respectively. The second parallel session, Audiology and the Justice System included Laura Kelly presenting findings from her research around the experiences of people with hearing loss in prison; Sally Austin sharing her experiences of working within the justice system with people with challenging behaviour and hearing loss; Jane Wild presenting details about the set up of an audiology service within a new prison in North Wales; the session ending with Priya Singh walking us through the considerations for NIHL and medico-legal practice in the UK.

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13 Evening Celebration and Awards Ceremony The Golden Anniversary of BSA could not pass without recognition of this significant landmark at the Annual Conference. The night started off with a video from over the years, and the relaying of a touching interview with Arthur Boothroyd by Laura Turton. Arthur Boothroyd was one of the founding fathers of BSA back in 1967 and it was inspiring to hear him talk.You could have heard a pin drop as Arthur reminded us of the society’s origins and the changes that have occurred over the last 50 years. At the evening celebration a number of awards were handed out to members for their significant contributions within their specialist areas. Keep an eye out in the next edition of Audacity for interviews with some of the prize winners. A final award was made to Kevin Munro who was made an Honorary Life member of BSA. Further details of this award can be found within the BSA Today section of this edition. And of course there couldn’t be an anniversary celebration without a cake! Jos Millar Prize for best Audacity Debbie Cain article: ‘The use of mindfulness techniques in patients with chronic dizziness: a preliminary investigation’ Thomas Simm Littler Award for con- Derek Hoare tributions to research on tinnitus and associated hearing related problems Ruth Spencer Prize for contributions Sarah Bent to developing practice in relation to adults with dementia Denzil Brooks Award for develop- Rosie Kentish ing and promoting good practice in management of tinnitus in children and young adults Day Two Day two started with the first set of sessions planned and delivered by the BSA special interest groups (SIGs). The Paediatric (PAIG) special interest group session included presentations on radio aids at first hearing aid fitting; testing

for congenital cytomegalovirus (CMV) in babies identified with permanent hearing impairment though newborn screening; assessment of children with autism and complex needs and vestibular assessment in children. The Adult rehabilitation (ARIG) special interest group used an inspiring interactive workshop format, facilitated by Melanie Gregory, where all those attending had space to reflect on the role and value of adult rehabilitation followed by a video link to Australia where Louise Hickson detailed the evidence behind our discussion, reminding us that we should speak less and listen more! The Balance (BIG) special interest group considered balance and the greater good including presentations on electrical vestibular stimulation as a novel diagnostic for inner ear dysfunction; cognitive behavioural therapy in vestibular rehabilitation; an

2017 BSA Award Winners

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14 audit of driving instructions provided to people with vestibular disorders and the EMBalance decision support system for diagnosis and management of balance disorders. After the coffee break three further BSA SIGs ran three more parallel sessions The Cognition and Hearing (CH SIG) special interest group session focussed on the recommendations that Siobhan Brennan has led for adults with learning disabilities and that Sarah Bent has led for adults living with dementia. The process and progress with the recommendations was explained, along with the background and patient and carer perspectives. The discussion panels included a range of speakers from across the conference and brought out interesting questions from the delegates on consent, specific challenges and personal experiences. The Global Outreach (GO SIG) special interest group session included an introduction about the group followed by a video links to Helen Brough in Malawi, Rachna Gopal in Mauritius and Shannon Kruyt in South Africa presenting on service developments, Audiology services and implementation of m-health and tele-audiology technology respectively. The session also included presentation on: deafness in the 21st century in low and middle income countries; establishing a paediatric audiology service in Zambia and finally on the ENT UK collaborations related to global outreach. The Tinnitus and Hyperacusis (TH SIG) special interest group session included presentations on: equity of tinnitus management across the NHS; tinnitus guidance and quality standards in Scotland and patient preferences in tinnitus care. The session also included a workshop facilitated by Magdalena Sereda and Julie Brady on the recommended fitting procedure for fitting combination hearing aids for tinnitus. After a much needed lunch and space to catch up with exhibitors for one last time, followed by the BSA AGM, the afternoon session began with a sponsor symposium delivered by Cochlear Europe Ltd followed by the notable Ted Evans Keynote. The Ted Evans Lecture was even more special this year as Ted himself was in the audience to listen. Graham Naylor, from the Scottish section of the MRC/CSO Institute of Hearing Research, gave an excellent presentation entitled: ‘What Can the Eyes Tell us about Listening?’ Graham pointed out that there was as lot that we could learn from eye movements that would otherwise be difficult to assess about and that additionally, there was much that we could do with that information to further the care we can provide.

Lionel Fontan on the use of automatic speech recognition in the fine tuning of hearing aids. The Electrophysiology (EPSIG) special interest group session was chaired by Siobhan Brennan included presentations on: measuring evoked responses to speech, a Welsh perspective on the peer review of neonatal hearing assessment; a revisit to the threshold ABR high pass filter; and the high prevalence of Cisplatin-induced ototoxicity in paediatrics in South Africa. The Auditory Processing Disorder (APD SIG) special interest group session was chaired by Nicci Campbell, rounding off the conference with an introduction to the new BSA APD position statement and guidance, and detailed presentations by Tony Sirimanna and Doris-Eva Bamiou on APD in children and adults respectively, showing just how far we have come in our understanding and ability to support those across many different presentations and stages of life. For further details on the SIG sessions at BSA see the SIG updates in the BSA Today section of this edition. Also take a look at Ear to the Ground for a summary of tweets that occurred during and about the conference. Posters and Exhibition The BSA conference was once again well supported by manufacturers and organisation alike. The exhibition was well laid out and included both information and opportunity to talk about requirements, try out equipment, learn about emerging technologies and catch up with familiar faces. The poster exhibition enabled delegates to browse the work of the many individuals, services and organisations at leisure, speaking to the poster authors and asking questions. A few posters caught the Audacity team’s eye, in particular: ‘Reducing isolation in individuals with hearing impairment and dementia within a residential care setting’ by Nisha Dhanda et al; ‘Hyperacusis in adults: a scoping review to assess the current position and determine priorities for research’ by Kathryn Fackrell et al; ‘Choosing and using bimodal hearing: the experience of adults with a Cochlear Implant (CI) and audiologists working in hearing aid clinics’ by Sheetal Athalye et al, and ‘Hearing aid use in UK adults’ by C Sawyer et al. As well of course as the award winning poster award by Magdalena Sereda: ‘Combined amplification and sound generation for tinnitus: survey of UK clinical practice’.

The final session of the day was another parallel session with the Electrophysiology and the Auditory Processing Disorder SIGs leading their sessions alongside a session focussing on basic science.

Finally, we’d like to say congratulations to the programme committee for producing an excellent, thought provoking two days that will support us to take Audiology forward and towards the Greater Good.

The Basic science session, chaired by Christian Fullgrabe included presentations by: Stephan Bleeck entitled ‘Design of a cheap Easily Usable Experimental Hearing Aid’; William Whitmer on applying just noticeable differences to hearing aid fittings and

If you weren’t able to make it this year seriously consider trying to make it next year it really is worth it. The 2018 conference will be in Brighton. Keep an eye on the website and in the next edition of Audacity for further details and a conference preview.

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For more information visit www.thebsa.org.uk Sep_2017_Audacity.indd 17

@BSAudiology1 The British Society of Audiology

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BSA Today

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BSA Today This article was co-authored by Laura Dawes and Kevin J Munro. The primary source of information was the booklet, published by the University of Manchester, called ‘100 years of Deaf Education and Audiology at the University of Manchester, 1919-2019.’ The booklet was authored by Laura Dawes and funded by the University of Manchester.

BSA Past

TS Littler, a founding father of UK audiology Kevin J Munro, Ewing Professor of Audiology University of Manchester, and NIHR Manchester Biomedical Research Centre

Several of the most prestigious prizes that can be awarded to members of the British Society of Audiology are named after TS Littler, but what do we know about the man and his legacy?

E: Kevin.munro@manchester.ac.uk

Perhaps more than anyone else, Littler nurtured the development of audiology as a science in Britain. Professor Ronald Hinchcliffe (1969)1

were being used in schools for deaf children.The university agreed to an arrangement whereby schools could buy, at cost price, the apparatus that Littler built in the university workshop.

Thomas Simm Littler, known in print as TS Littler, was born in Wigan in 1901 and for a time worked in a coal mine. He studied physics at the University of Manchester and worked for a few years at the National Physical Laboratory before taking up a teaching position, in 1929, in the Physics Department of the University of Cairo, Egypt. He returned to the University of Manchester, in 1931, to take up a position in the Human Physiology Department. A chance meeting brought him into contact with Alexander and Irene Ewing, later Professor Sir Alexander and Lady Irene Ewing, pioneers of paediatric audiology. Irene Ewing had been appointed, in 1919, as the University of Manchester’s first Lecturer in Deaf Education. Early in her career she became convinced that a number of her pupils in schools for the deaf had useful residual hearing. The Ewings were looking for a specialist in electroacoustics, and Littler was a perfect fit. He joined the department in the capacity of physicist, taking his PhD at the university in 1934, and later becoming Senior Lecturer in acoustics. Littler set to work developing amplification equipment, his first attempt at a hearing aid (for the personnel use of Irene Ewing) weighing 28 pounds. More successfully, Littler invented and built group hearing aids for use in classrooms (see Fig. 1). By the mid-1930s, Littler’s group aids

BSA Today

Figure 1. TS Littler’s group hearing aid at the Royal Deaf Schools, Manchester ca. 1935 (Source: Dawes, 2014)

The Ewings investigated the use of group aids, demonstrating they allowed children to understand the teacher’s speech more clearly than individual aids, and that the system was particularly useful for group activities and discussions. Littler’s work also led him to investigate acoustic conditions in classrooms for deaf pupils and advise schools on classroom construction to minimise sound reverberation. Like the Ewings, Littler’s work was a family affair: his wife Margaret worked as an assistant in the department’s clinics.


BSA Today

19 The Medical Research Council’s (MRC) Hearing Committee engaged the Ewings and Littler to advise them on the utility of hearing aids to deaf people and to develop methods for determining what types of hearing aids were best suited to particular cases. In their report to the MRC, published in 1936, the departmental team described their work with the pure tone audiometer and with group aids used at the Royal Deaf Schools, advocating strongly that hearing aids were of use, could be safely used, and had the potential to offer great benefit. During the Second World War, in 1942, Littler and Alex Ewing were invited by the Air Ministry medical service to work with Wing Commander (later Air Vice Marshall) Edward Dalziel to investigate hearing loss in aircraft pilots and ground staff. The air force was particularly worried about hearing damage in bomber crews who would take off their helmets during long missions. Littler and Ewing’s wartime work for the air force advising on suitable earplugs and on helmet design built upon these earlier investigations. This began a fruitful line of investigation especially for Littler who, after he finished studies on auditory fatigue, remained as Senior Scientific Officer with the RAF, developing aircraft detection systems. “A quiet, unassuming personality,” said his RAF colleague Dalziel Dickson. “A man of the highest scientific integrity who had a profound knowledge of acoustic methods of evaluating hearing and an authority on hearing aid and audiologic equipment”. Littler continued his work on auditory fatigue and occupational hearing loss after the war, including conducting population studies into noise-related hearing loss. His work helped form the basis of growing appreciation of occupational deafness, formally recognised as an industrial hazard in 1969 by the Industrial Injuries Advisory Council, and led to occupational deafness becoming a prescribed disease for the purposes of workplace compensation in 1975. One of Littler’s most notable contributions to British audiology was his work for the MRC in designing a hearing aid to be issued by the National Health Service (NHS). In 1943, the Ministry of Health approached the MRC for advice on what services it should offer to the public regarding deafness when the NHS would come into operation in five years’ time. In response, the MRC appointed three specialised committees—one on medical and surgical problems of deafness, another on education of the deaf, and one on electroacoustics to which Littler was appointed secretary. The Electroacous-

tics Committee was asked to design an electrical hearing aid that would be small, light-weight, cheap to produce and maintain, and which would give good intelligibility of speech for a majority of deaf adults. The committee was also asked to report on the type of audiometers that NHS clinics should use to diagnose deafness2. The large hearing aid components were a problem for the committee. American laboratories were able to produce smaller and lighter miniature valves and microphones owing to developments there during WWII, but British expertise in miniaturisation lagged behind. One of the recommendations of the committee was therefore to boost British capacity in producing miniaturised electrical components, and also to develop in-ear inserts which American models favoured, rather than a telephone-style ‘earcap’. The committee developed two prototype hearing aids, which were built by the Post Office Laboratory at Dollis Hill outside London.The prototype aids had metal cases, but the first product produced for public release had a moulded plastic case. The MEDRESCO aid (standing for MEDical RESearch COuncil) was produced under contract to the NHS and issued free of charge. In its first year of operation (1948), the NHS issued 3,000 MEDRESCO aids; however, an estimated 120,000 had been issued by 1951. The original model offered a choice between an inserted earpiece or a telephone-style attachment and could be produced for less than £10 each. There were two batteries, each about the size of a cotton reel, although rather heavy, attached to the microphone housed in a black plastic case. The earpiece was connected to the microphone case by another electrical lead. The assembly came with a leather carrying-pouch that could be strapped onto the body (see Fig 2). Littler also worked on new models of MEDRESCO aids, designed in the 1950s and 1960, which extended the range and power and reduced the bulk of the original aid (especially the heavy batteries). MEDRESCO aids, which offered reasonable but not particularly good hearing assistance, continued to be manufactured into the late 1970s by which time they had been superseded by commercial aids.

Figure 2. MEDRESCO body-worn hearing aid. Source: https://wellcomeimages.org/ indexplus/image/L0065923.html (accessed 10/07/2017)

At the invitation of the MRC, Littler left the University of Manchester, in 1949, to establish the Wernher Research Unit, originally located at the National Throat Nose and Ear Hospital, later, in 1953, transferring to King’s College Medical School. Under Littler, the Unit made notable contributions in research into the medical and physical aspects of deafness, mainly in the field of hearing aids, audi

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20 The influence [of hearing and speech] on mental and moral development in the process of civilisation is paramount over all other senses. TS Littler (1965)3 ometry, and age-related and noise-induced hearing loss. During his time as unit director, Littler continued to work as advisor to a number of hearing research groups and charities, as well as continuing his work with the RAF. In 1965, Littler wrote a textbook called The Physics of the Ear. This was a substantial body of work based on the content of his lecture series to the Faculty of Physics, Moscow State University (Fig. 3). He made it clear in the Foreword that hearing and communication are of profound importance to mankind saying, ‘The influence [of hearing and speech] on mental and moral development in the process of civilisation is paramount over all other senses’.

Professor Sir Alexander WG Ewing (1969)4 friend and one-time colleague Professor Sir Alexander Ewing and published in Sound, November 1969 (see Fig 4). When the IX international Congress of Audiology, held in London in 1968, was being planned, Littler was the obvious choice for Chairman of the Organising Committee and largely contributed to its scientific and financial success. “An extremely modest man…with a friendliness that endeared him to all those who met him,” as Ronald Hinchcliffe, an audiological colleague from the RAF and Wernher Unit recalled, Tom Littler “perhaps more than anyone else, nurtured the development of [audiology] as a science in Britain.”

Figure 3. Front cover of the author’s copy of TS Littler’s textbook, The Physics of the Ear, (Pergamon Press, 1965).

Figure 4. A tribute to Littler, by Professor Sir Alexander WG Ewing, published in Sound (1969), a quarterly journal devoted to the study of audiology, by the Royal National Institute for the Deaf.

He was involved with commercial production of hearing aids and audiometers (board member of Alfred Peter and Sons, audiological equipment manufacturers) and served a brief period as editor of Sound (later the British Journal of Audiology and now the International Journal of Audiology). He was taken ill with an inoperable brain tumour and died in 1969. A tribute to Littler was provided by his life-long

BSA Today

Dr Littler was a very unassuming scientist whose life’s work was of national, indeed international importance.

Since the 1970s, the British Society of Audiology has awarded the Thomas Simm Littler Lectureship and the Thomas Simm Littler Prize in recognition of academic contribution(s) to the discipline of audiology. The TS Littler lectureship is awarded by the Trustees to a member in recognition of a sustained academic contribution to the discipline of audiology. It is awarded biennially and consists of a cerFigure 5. The author’s, now faded, certificate after being awarded the tificate and honorarium. TS Littler prize in 2001. Professor Sir Alexander Ewing gave the inaugural lecture commemorating his colleague life-long friend and one-time colleague, called ‘The place and functions of audiology in the community’. The Thomas Simm Littler prize is nominated by the membership and is awarded in recognition of an academic contribution to the discipline of audiology (see Fig. 5). A list of recipients of the awards is provided in the Appendix (lectureship and prize, respectively). Unfortunately, I have been unable to identify a photograph of this unassuming scientist who contributed so much to the scientific foundation of UK audiology.


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21 Appendix

Acknowledgements I am immensely grateful to the following sources of information on TS Littler: Dawes L. 100 years of deaf education and audiology at the University of Manchester, 1919-2019. Published by The University of Manchester, 2014, 57 pages. www.lauradawes.org Ewing AWG. Dr TS Littler obituary, Sound, 1969, 3, 108-109. Note Please inform kevin.munro@manchester.ac.uk of errors and omissions.

References 1. Papers of Sir Alexander and Irene Ewing, EA/11/1 BSA Society Transactions In Memoriam by R. Hinchcliffe 1969, Manchester University Archive. 2. Radley WG, Bragg WL, Dadson RS et al. Hearing aids and audiometers, report of the committee on electroacoustics, MRC Special Report 261 HMSO, London, 1947. 3. Littler TS. The physics of the ear. Pergamon Press, London, 1965. 4. Ewing AWG. Dr TS Littler- obituary. Sound, 1969, 3, 108-109.

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22 BSA Present

An agenda of transformation Laura Turton Operations Manager BSA

From the first days when Kevin Munro took over as Chair I remember noticing as a member that a transformation was underway. I hope as members of the BSA you have realised that this work on modernisation has been far-reaching. As we reach our 50th year I have spent some time amongst the archives looking back through our history. Long gone are the days of light blue paper correspondence from the Reading office or Recommended Procedures in small A5 folders. Equally, the days of only a few key individuals working tirelessly for the BSA have also passed; we have now moved to a point where 1 in 4 full members are active with the BSA in one capacity or another. This has been an exceptional achievement and I want to thank all of you who sit on Special Interest Groups, committees, Council and in specific roles to help us achieve our aims and vision. The BSA Council have worked hard through Kevin’s reign, then Huw Cooper’s and now Liz Midgley’s to

embrace change and renew the vision and spirit of the BSA. We want to be viewed as an inclusive, vibrant and dynamic organisation which puts the evidence base and scientific research at the heart of all hearing and balance services. We are the only organisation which is fully multi-disciplinary and welcomes members of the public. Do you really know who the BSA are? Or do you only know us for the Recommended Procedures and Practice Guidance? To help clarify who we are we have recently created this infographic. Recent achievements Nearly 2 years ago Council took the decision to close the Reading Office and move to a new administration team with Fitwise, based in Scotland and employ a part time Operations Manager (of which I for one am pleased with that decision!). This has allowed us to progress with a number of important activities. During recent years we have developed two new Special Interest Groups for Tinnitus &

Hyperacusis and in Global Outreach, we have fully reviewed our membership scheme and delivered new benefits asked for by you, we have increased our communication through the e-newsletter, Audacity, the updated website and social media. We have re-branded and focussed on producing more practice guidelines across all areas of Audiology. We have taken a new focus on our annual conference covering new research and hot topics whilst giving each SIG a dedicated session. There has been the introduction of Lunch and Learn webinars and Lightning Updates and do you know we now have over 60 of these for members stored as a library? We have been active in policy making and being a voice within the rationing of hearing aids across England. Earlier this year the BSA Council met at the Ear Foundation for our Strategy Away day. This gave us time to discuss the progress we have made on past action plans and refocus for the coming 18 months. The main output from this day was a new action plan (which

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23 student forum will be released so that all our student members can feed in to each other about placements, research and clinical issues. In July, we released our online learning community BSA Grow for all our members. We listened to your requests for flexible, bitesize learning for CPD, libraries of key evidence from our SIGs and affordable courses to fit around you (in addition to free resources as a membership benefit). If you haven’t logged on yet, please take some time to do so and you will start getting regular updates on new content as it is added. We are going back to the heart of how we want to support and deliver research for all members, no matter what your expertise, experience, seniority and have been developing a new research strategy that makes it clear what we want to do and how we intend to achieve this. We are seeking new funding opportunities to support this strategy and are aiming to become a member of the Association of Medical Research Charities to demonstrate our commitment to research within hearing and balance science. The Adult Rehabilitation Special Interest Group are currently piloting a website “Sound Practice” to collate and highlight innovations and good practice within adult hearing rehabilitation which will be launched in the autumn and they hope will become a go to place for sharing and discussing new ways of practice. If this is successful, we hope this will also be adopted by other special interest groups to widen this resource.

feeds in to our overall 4-year strategic plan) that helps us remain accountable to you as members for what we plan and hope to achieve. If you haven’t read this please consider accessing this through the members section of the website, but a summary of our themes is shown below

We continue to grow, last year we had a membership drive attempting to recruit an ambitious 300 new members and came close to this with 290 new members! Each year we want to attract new members to the BSA, but ultimately, we want to retain you all as members and so if you have any ideas we should consider then please feed this back to us at any time, and specifically in the autumn membership survey we send out each year.

What can you expect from us in the next couple of years? 2017 and 2018 are exciting years for us as there is a lot of things going on, which should benefit you as members and the wider Audiology community.

We have widened our focus and are developing key collaborations both within and outside the hearing loss / balance sector to benefit you as a member (in terms of sharing information, attending events and having access to new resources) both in the UK and the wider world. We have also chosen strategic relationships to help develop health policy and drive quality at a high departmental level and many of these relationships will come to fruition this year and beyond.

We have already started to invest in our student memberships and this year our Student team are looking at ways in which students can interact and support each other as well as access resources from the BSA. In the summer, a new

So, I hope you can see we have been and continue to strive to be inclusive, vibrant and dynamic organisation and I believe we are one not only to watch but to be actively involved with!

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24 BSA Future

Listening out for the future Nathan Clarke BSA Student Advisor

When asked to write this article contemplating the future of the BSA, I was reminded of a famous quote: “prediction is very difficult, especially if it is about the future”. The future is a big place. It’s very easy to get lost. Being newly minted in my BSA student advisory role, the prospect of having my potentially naïve predictions immortalized in print was a daunting one. However, after a little research and some illuminating conversations with other BSA members and experts, it became clear that the field of audiology is anything but predictable; audiology, hearing-aids and even hearing science itself have had a way of throwing up surprising developments. Setting aside the brisk technological advancements that saw the ear-trumpet transformed into in-the-ear amplification, we can fast forward to even the recent past; few audiologists would have predicted that they could potentially be advising people to put batteries into their ears (in the shape of new devices such as the Phonak Lyric). Similarly, the rise of the now ubiquitous smart phone was hard to foresee; yet, hearing-aids are now increasingly merging with this modern necessity, creating assistive listening devices that are hidden in plain sight. Today’s science is Tomorrow’s technology, and one of the most exciting aspects of audiology is the increasingly fast-pace of technological developments for hearing-aids. Audiology provisions and services also have a track-record of veering into unfore-

seen areas. This was recently seen in the NHS Clinical Commissioning Group (CCG) for North Staffordshire’s decision regarding eligibility for hearing-aids, excluding provision for those with less than a moderate loss. In stark contrast in the United States, the Food and Drug Administration (FDA) has recently issued guidance that essentially deregulates hearing-aids as a medical device. The decision enables individuals over 18-yearsold to buy a hearing-aid without medical assessment or signing of a waiver, opening the doors for an ‘overthe-counter’ category of hearing-aids. Clearly future developments for UK hearing-aid provisions are difficult to anticipate, depending on political outcomes as much as those in research. However, suggested developments for audiology services have included a voucher-style top-up system (such as that implemented in Australia). This type of scheme could provide NHS hearing-aid users with the chance to obtain the benefits of continuing technological advancements through subsidised pathways. Though less hopeful scenarios are also possible, in which recent hearing-aid rationing decisions cause a domino effect within service delivery. With an advancing retirement age and growing elderly population, emerging evidence concerning the links between hearing loss, cognitive health and quality of life needs to remain at the forefront of this provisional debate. Given the unpredictable nature of

changes in audiology and service delivery, it is reasonable to consider what the BSA needs to achieve to stay relevant for a further 50 years. An immediately obvious answer concerns the increasingly multidisciplinary nature of fruitful audiology and hearing science; this collaborative shift is mirrored in the BSA’s current membership composition. The makeup and the identity of the BSA has evolved from that of a ‘learned society’ (with its arguably fusty connotations) to an altogether more inclusive society with a variety of professionals, united under a common interest in audiology and hearing science. The BSA is also the only society to include interested members of the public in its membership. In an age of increasing patient-awareness and informed healthcare choice, this may prove to be a popular admissions policy. Maintaining the relevance of the BSA for the foreseeable future will require building on successes of inclusivity and continuing to engage newly qualified members, thereby resisting stagnation within the organisation.The multidisciplinary ethos can also be seen in research and transitional centres of excellence that are pioneering collaborative efforts, such as the Manchester Centre for Audiology and Deafness (ManCAD) and the newly re-launched National Institute of Health Research Biomedical Research Centre (NIHR BRC). Multidisciplinary centres such as these stand to help both audiology services within the UK, and hearing science generally through influencing policy and decisions by

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25 filling evidence gaps concerning the benefits of hearing-aids. Supporting such collaborative efforts represent a crucial role that the BSA needs to carry on performing to maintain its relevancy. At a time when CCGs are considering restricting access to hearing-aid services, informing policy through highlighting their increasing importance as a cost-effective means of remediating social and potentially cognitive health is vital. For all the difficulty and potential embarrassment that comes with making predictions, there are a few safe bets that can be made for the BSA over the next 50 years. These predictions are easy to make, given the evident dedication and passion of the volunteers involved in running the organisation. Amongst these is the continued focus on research that has made the International Journal of Audiology amongst the top hearing science journals. By supporting research via grants and prizes, the BSA will continue to aid UK hearing science and related translational research in maintaining its record of advances in audiological delivery (a pedigree that has included advancements in areas such as otoacoustic emissions, dead regions and immittance audiometry). Through this unique aspect of the BSA, evidence-gaps in the literature can be addressed and ultimately policy may be influenced, with tangible improvements for people with hearing-impairment. The future sees the BSA poised to tackle these ambitious goals, while continuing to maintain a diverse community, brought together by a common interest in the importance of effective communication through hearing.

Prof Kevin Munro receives honorary life membership of the BSA

At the AGM of the BSA in Harrogate on June 30th 2017 it was proposed and unanimously accepted that Prof Kevin Munro should receive honorary life membership of BSA for the significant contribution he has made to the organisation. Kevin is a long standing member of the BSA. Through his academic and research career he has made and continues to make a very positive contributions to the furthering of the science of audiology, the advancement of education in audiology, the furthering of research in audiology and raising awareness and improving the understanding of audiology. In particular during his time as Chair of the BSA he had the vision and foresight to suggest, follow through and begin implementation of major changes to the way the BSA operates. This was in order to modernize the society to ensure that the BSA was equipped to carry out its important work in the 21st Century. The largest impact on the work of the society was the proposal to appoint an Operations Manager. This was because Trustees of the Society were becoming more pressurized by their daily work which was leaving less time to spend working on behalf of the BSA. The Operations Manager was appointed in 2014 and has worked with Trustees to modernize the society since then. Without this person in post the BSA would not be the dynamic, influencing, important society that it is today. During his time as Chair of the BSA, Kevin also instigated the development of a strategy and action plan to define the priorities of the society and to make sure work was focused on these areas. The strategy and action plan have been updated several times since but remain an integral part of the running of the society. We are absolutely delighted to be able to honour Kevin in this way to celebrate his work and the 50th anniversary of the BSA.

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26 Adult Rehabilitation Interest Group (ARIG) Mel Ferguson, Adult Rehabilitation Interest Group (ARIG) E: melanie.ferguson@nottingham. ac.uk

The enthusiasm and work of ARIG continues apace. We held an interactive workshop at the BSA Annual Conference in June entitled “Inspiring AR audiologists: The Rules of Attraction (Warning: Adult Content)”. And interactive it was - no twiddling of thumbs for the workshop attendees here! Mel Gregory (CEO, The Ear Foundation) ran the workshop, bringing forth her substantial expertise to define the role and value of Audiologic Rehabilitation. Mel worked closely with the attendees to look at elements of the clinical encounter, the clinical environment and patient-centred care, with an insightful ethnographic video of a patient’s experiences to get the discussion started.This was rounded off by a pre-recorded webinar “Language matters, what you say and how you say it” from Prof Louise Hickson, University of Queensland, who neatly summarised the workshop. This fantastic talk can be seen on the new BSA Grow. The workshop feedback was excellent, with attendees coming out ”buzzing”, and a sea of tweets promoting the value of AR. Jane Wild is leading an innovative development to complement the BSA Practice Guidance “Common Principles of Rehabilitation for Adults in Audiology Service”, published in October 2016. Sound practice is an online resource that aims to promote good, evidence-based clinical practice and innovations within UK audiology. Case studies are being collated, and this is being piloted prior to the formal launch of Sound Practice at the BAA Annual

SIG updates

Conference in November. Oticon have kindly agreed to sponsor the development of Sound Practice. Look out for calls for case studies demonstrating good practice. We want to hear about all the great AR work that is going on around the country. Look out also for our survey on Outcome Measures, which will form the basis of our soon to-be-developed Outcomes Toolkit. The survey is being carried out through a Freedom Of Information process as we want to get an insight into what, how, when and why outcome measures are being used in all adult rehab services across the UK. Our pilot suggests that the CCGs who receive the FOI will strip out all references to the BSA, so any information on outcomes you are required to return is almost certainly from us. It’s for a good cause, as we need to be able to show the value of all the really good work that is being done every day in AR clinics. Running parallel and crossing over with the ARIG work, there are lots of other national initiatives. For example, the development of the NICE Guidance on Adult Onset Hearing Loss (draft due out for consultation in October) and the Action Plan on Hearing Loss groups delivering on research, living well, prevention and other areas. We have dedicated a section on BSA Grow to UK Adult Rehab. Here, you will find information relating to the cuts for hearing aids, including an upcoming Cochrane Review on the effectiveness of hearing aids for adults with mild to moderate hearing loss, and other research evidence. There is a comprehensive list of systematic reviews of AR interventions and other information to support AR delivery. As this SIG continues to develop, I look forward to continuing working with a great group of people to implement some useful initiatives that will enhance adult rehabilitation and the hearing healthcare for adults with hearing loss. I feel inspired!

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28 Balance Interest Group (BIG) Andrew.Wilkinson Balance Interest Group (BIG) E: Andrew.Wilkinson@UHBristol.nhs.uk

In recent months, it’s been ‘all change’ at the Balance Interest Group, not least at all with staffing. We have been sorry that the multi-talented Katy Morgan has stepped down from the role of Chair and now formally left BIG. We would like to formally thank Katy for the tireless effort she has put in (frequently in her own time) over a great number of years. This leaves me as the new Chair with large shoes to fill! I am joined at the helm though by Richard Rutkowski who replaces me as Vice Chair. We have been very fortunate in recent times to develop the committee membership with broader scope. We have had longstanding input from representatives from clinical science (audiology; clinical engineering), the academic and teaching sector (Paul and

Ghada), and audiovestibular medicine (Dr Peter West, who has also recently departed the fold, and should be greatly thanked for his huge input to the committee, with his keen eye, warm humour, and newfound guilty pleasure of a King’s Cross McDonalds three times a year). However, we have been excited to now also have input from physiotherapy and neurology. Over the forthcoming months, it is anticipated that there may be other departures from the group, so with contingency planning please “watch this space” for advertisements for new blood to the group. The group have been working hard on written documents. Following the publication (2016) of the Recommended Procedure (RP) for Positioning tests, we have very nearly completed the update/amendments to the RP for Calorics (which quickly progressed from an ‘update’ to substantial rewrite (!); hopefully to be published soon), and are writing a combined RP document for VEMPs, to include both cervical and ocular techniques. We look forward to the exciting challenges that lie ahead as we move further into 2017 and beyond…

Paediatric Audiology Interest Group (PAIG) Verity Hill Paediatric Audiology Interest Group (PAIG) E: verity.hill@uhcw.nhs.uk

PAIG have just come back from a brilliant BSA conference in Harrogate. The PAIG programme was put together by the PAIG members and included 2 invited speakers and 2 professionals who submitted free papers. The feedback we got was good and gave us a new empowerment to keep moving forward with the PAIG. So a massive thanks for Wendy McCracken, Kate Johnston, Kieran Joseph and Soumita Dasgupta for being our speakers and contributing to a very positive session. One of our objectives for the PAIG this year was to recruit a new PAIG member and compile a group of people who would consider being part of the PAIG steering and advisory group. After the PAIG programme at the BSA conference we were approached by 2 delegates who expressed an interest in being PAIG members and a couple more were keen to be on the advisory group. So this was excellent

and we look forward to working with these professionals in the future. We are still currently working on new BSA guidelines for BOA and Distraction and we hope to forward these for comments by September. We have also written to the EP SIG chair as at our last PAIG meeting we were discussing that there may be overlap with some of the NHSP guidelines the EP SIG may be currently reviewing or planning to review soon. We asked the EP SIG if they felt that it would be useful for the PAIG to be involved in any guideline review. Writing to the EP SIG was very timely as they have started editing the”Guidelines for the early audiological assessment and management of babies referred from the Newborn Hearing Screening Programme” and were looking for more members of a working group to look at specific parts. They felt that there are specific parts that PAIG’s input would be particularly valuable and asked if anyone from PAIG like to be part of these working groups. Of course we were happy to work on this and we look forward to working with the EP SIG with these documents this year. On a personal note I am enjoying my time as Chair of the PAIG and I put this down and give great thanks to the wonderful and enthusiastic members of the PAIG SIG team who support me and the wider work of the PAIG.

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29 Electro-physiology Interest Group (EPIG) Dr John E FitzGerald Electro-physiology Interest Group (EPIG) E: john.fitzgerald@nnuh.nhs.uk

This is my first report as the new Chair of the Electro-physiology Interest Group, having taken up the reigns from Dr Siobhan Brennan at the BSA Annual Conference in June. My first action is to thank Siobhan, who as the first chair of the group and one of its founding members, has steered the group from its early beginnings in 2014 towards the strong and dynamic group that it has become today. During Siobhan’s chairmanship we have seen BSA adopt the ABR guidelines for newborns from the NHSP Clinical Advisory Group and the EPIG has been pro-active in keeping these up to date. The group have helped establish the principles of external ABR peer review which is now a requirement in the national commissioning documents for newborn hearing screening. The group have also worked hard on establishing the recommended procedure on Cortical Auditory Evoked Potential (CAEP) Testing which was published in 2016. As I take up the reigns the ongoing work includes a number of guidance and procedural documents that are either with

the PGG (Professional Guidance Group) or due to go out to membership consultation imminently; • Formalising the ABR Peer Review document into a ‘Position Statement’ by BSA. • A recommended procedure for ABR in Older Children and Adults. • A recommended procedure for Otoacoustic Emissions (OAEs) Testing in paediatric and adult audiology. Work is also under way with a number of other documents; • Tim Wilding at the University of Manchester is leading a group to develop a BSA recommended procedure for ASSR. • All the ABR guidelines for new borns are now due for review and a working group has been formed with Dr Guy Lightfoot leading on the editing of the ABR testing documents and Siobhan leading on the Early Assessment Guidelines. With the launch of The BSA Grow I hope that the EPIG can utilise this new and exciting development to provide some e-learning opportunities to BSA members on topics such as optimising EP recordings through patient preparation, best electrode placement and consideration of noise. Finally if you are interested in being involved in any of these areas of work and would like to take an active part in the EPIG please contact me to be included in future mailings and meetings. It’s a great opportunity to meet others interested in this area of work and a great way to develop your own interests and skills in EP work.

Learning and Events Group (LEG) Carmel Capewell Learning and Events Group (LEG) E: carmel.capewell@gmail.com

At the conference at the Majestic Hotel in Harrogate on June 29/30 2017, the BSA on-line platform, GROW, was launched. This members’ online learning community provides access to a range of materials and learning resources. It provides the opportunity to participate in learning activities at a time and place to meet individual needs. There is a

small charge for some activities. One advantage of GROW is that it provides wider access than is possible in face-toface events, especially in times of limited budgets, as there are only in-house travel costs. We encourage all members to look at the section on the web-site under the GROW heading. New material is being added all of the time. There is a Library of resources. Make sure you watch the Lightening Update on the website by Laura Turton for full details. The Annual Conference was well attended and there were some really interesting speakers. This year we had a wide range of exhibitors who were able to discuss individual needs with delegates and demonstrate their products and services. Some of the speakers presented via pre-recorded presentations or by video link. This gave delegates access to speakers from across the world while still providing the

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30 opportunity to ask questions. The SIGs provided a range of interesting topics. Our key note speakers covered hot topics with a particular emphasis on the impact of age-related hearing loss, cognition and healthy ageing. We have plans to record some of the sessions and make them available to members. There will be a small cost for those who did not attend the Annual Conference. As ever, Conference provided a great opportunity to meet and network with others from a range of backgrounds. The BSA celebrated its 50th Anniversary with a dinner and really interesting review of the society’s origins from the last surviving founder, Arthur Boothroyd. Recognition was made to those who have made a contribution to the BSA, with prizes awarded to Debbie Cane, the Jos Millar Prize for best Audacity article, ‘The use of mindfulness techniques in patients with chronic dizziness: a preliminary investigation’. The Thomas Simm Littler Award for contributions to research on tinnitus and associated hearing-related problems went to Derek Hoare for his meta-analysis examining tinnitus management. The Ruth Spencer prize for her work in developing practice in relation to adults with dementia was awarded to Sarah

Bent. Rosie Kentish was awarded the Denzil Brooks Award for extensive work developing and promoting good practice in the management of tinnitus in children and young adults. Kevin Munro was made an Honorary Life member. The Poster Award went to Magdalena Sereda. Next year’s conference is in planning and is to be held in Brighton. An E-Conference is planned for the first week of December based on the TED talk format. The SIGs have been involved in the content. We are looking to have a wide range of international and national speakers. We do not see this event as replacing the annual Conference but rather as offering a format that can provide access to our members, who might otherwise not be able to attend a face-to-face event. Look out for more information on this event in the near future. We are keen to meet the needs of our members for training and development opportunities. Should you have ideas or suggestions for events then please do get in contact with me: carmel.capewell@gmail.com.

Tinnitus and Hyperacusis Group (TH SIG) Derek Hoare Tinnitus and Hyperacusis Group (TH SIG) E: derek.hoare@nottingham.ac.uk

The last few months have been about change and decision for the TH SIG. I was appointed Chair of the group in November, David Stockdale became the new vice chair, and work continues with a dedicated group of steering and advisory members. Our objectives are to develop evidenced based guidance, to raise standards across the private and public sector, to promote relevant research and CPD opportunities, to raise awareness of tinnitus and hyperacusis, and to advise professionals and the BSA council on all matters relating to tinnitus and hyperacusis. Some will be aware of recent work by the Scottish Tinnitus Advisory Group to develop practice guidance and a quality standard for tinnitus in Scotland (presented at this year’s BSA conference), and the European multi-disciplinary practice guideline for tinnitus diagnosis, assessment, and treatment developed by members of TINNET (http://tinnet.

tinnitusresearch.net/) working group, including myself. However, with the exception of tinnitus in children, BSA guidance and recommended procedure on both tinnitus and hyperacusis is still needed. As a group we decided to prioritise the development of three documents this year. These include ‘Clinical practice guidance for tinnitus in adults’ led by myself, and a ‘Recommended procedure for measuring sound sensitivity in people who have tinnitus or suspected hyperacusis’, led by Pete Byrom. Both of these documents are now in development and we aim to have them available for consultation later this year.The third document is a ‘Recommended procedure for fitting combination hearing aids for tinnitus’ led by Magdalena Sereda and Julie Brady. The development of this document was always going to be challenging so we planned to include a number of evidence gathering steps. The first was a survey of BSA members to determine a current level of knowledge about combination hearing aids for tinnitus, and very many thanks to the 90 members who completed it. The survey results were presented at this year’s BSA conference and even picked up the poster prize. Also at the conference we held a workshop exploring topics that should be included in the recommended procedure. The final stages of evidence gatherings are a survey of combination hearing aid users, and a Delphi survey of clinicians

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31 experienced in fitting combination hearing aids, both supported by a BSA Applied Research Grant. Altogether this evidence will inform the final content of the recommended procedure. Next year we will develop practice guidance and recommended procedures for hyperacusis. In the meantime there is important groundwork ongoing. Members of the SIG are providing BSA representation on the recently initiated Hyperacusis Alliance, a US-led project to scope out all research activity on hyperacusis happening worldwide and then work with researchers to identify what is needed to increase capacity in hyperacusis research. Here in the UK there are plans for a James Lind Alliance Priority Setting partnership to generate a top-10 priority research questions on hyperacusis. Many SIG members are involved in this initiative and it has also been supported by a BSA Applied Research Grant. The initiative will launch in September 2017.

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If you have any comments, suggestions, or questions for the TH SIG or would like more information on any of the initiatives described then please do get in touch.

More information about our Special Interest Groups and its members is available on the BSA website.

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Patient-centred care for older adults with age-related hearing loss CD

Author and Correspondence

Gabrielle (Gaby) Saunders, Ph.D. Associate Director for the VA RR&D National Center for Rehabilitative Auditory Research (NCRAR) in Portland, Oregon, USA. E: gabrielle.saunders@va.gov

Introduction Few audiologists would question the positive value of providing patient centred care, i.e. care which is respectful of, and responsive to, individual patient preferences, needs and values, and which ensures that the patient’s values guide all clinical decisions (Institute of Medicine, 2001). However, implementation of patient-centred care can be more difficult than it might seem at first glance. To understand why, and to establish ways to facilitate implementation, it is necessary to understand the key components of patient-centred care (see Figure 1). Essentially, Figure 1 implies that when successful, patient-centred care will result in patients who feel respected, and who are well-informed and empowered to take a shared role in making decisions about their own care. For this to occur, clinicians need to be good communicators who are skilled in managing the dynamics of shared decision making, and who respect the patient’s values and preferences.

Audiologists and their patients report a preference for patient-centred care and for wanting to engage in shared decision making during auditory rehabilitation. Studies show that audiologists consider it important to acknowledge their patients as individuals, support patient-centred traits and actions, to build rapport with their patients, and to work to select interventions which work for their patients’ lifestyles. Similarly, patients want their audiologist to acknowledge them as an individual, understand and meet their needs, support patient-centred traits and actions, ensure their comfort, and convey information clearly (Laplante-Lévesque et al., 2014; Poost-Faroosh et al., 2015). However, studies also suggest that the style of communication used by audiologists can be a barrier to this process. For instance, audiologists often disregard the emotional content of their patients’ talk, they have preset the agenda for appointments, they want to maintain control of the conversation, information exchange tends to be unidirectional (audiologist to patient), and

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33 often the information provided is highly technical and is perceived by the patient to be too complex (Ekberg et al., 2014; Grenness et al. 2015; Pryce et al., 2016; Sciacca et al., 2017). It is relevant then, to consider how two-way communication and shared decision making within the context of hearing health care can be facilitated. Decision support materials One approach is to use decision support materials, such as patient decision aids, that provide information about intervention options, the potential outcomes, benefits and risks of each, the frequency and likelihood of each outcome, and that provide tools to help the patient clarify their personal values and participate in decision making. For instance, a decision aid for whether or not to obtain a hearing aid versus using another form of intervention might ask the patient to consider their views on being seen wearing a hearing aids, and on the extent to which finances will play into their decision. It might also ask the patient whether he/she understands their options, whether they are clear about what matters to them regarding a hearing intervention, whether they have all the information they need, and if not, what additional information they would like. The patient and clinician then use

the decision aid as a tool for coming to a shared decision about an intervention. Decision aids can be provided to patients in advance of an appointment, or given to them to take home so the patient and family can deliberate about the decision, and then return to ask questions and discuss a choice at a later appointment. A systematic review of decision aids for older individuals (van Weert et al., 2016) found evidence that, relative to usual care, decision aids increased knowledge and accurate risk perception, resulted in lower decisional conflict, and in greater patient participation in decision making. Decision aids and audiology There are a few decision aids available to assist patients in selecting audiological interventions (see http://optiongrid.org/ option-grids/grid-landing/27; http://www. harlmemphis.org/clinical-applications/ decision-aid/; and https://decisionaid. ohri.ca/AZsearch.php?criteria=hearing&search=Go) however, formal research with these tools is sparse. Laplante-Lévesque and colleagues (2010a, b) used decision aids to examine why adults with acquired hearing losses selected various intervention options and to identify predictors of those intervention choices. More recently, Pryce and colleagues (2016) conducted a study to identify gaps in audiologist-patient com-

munication to determine what information patients want in order to participate in a shared decision about hearing interventions. These studies revealed that patients like being involved in the shared decision making process and felt engaged when the audiologist listened to them, but that patient preferences were often not explored by the audiologist, and insufficient information was provided for the patient to make an informed decision. There are many unanswered questions regarding the use of decision aids in audiology. Some examples are ‘Is outcome improved when interventions are selected using a decision aid and shared decision making? ‘What aspects of outcome are improved – self-efficacy, performance, self-report, use?’ and ‘Is the intervention selected using a decision aid ultimately the preferred intervention?’ Sherri Smith Ph.D. and I are developing a decision aid to guide patients through the decision to use a traditional service model versus an over-the-counter (OTC) service model for a hearing aid purchase, so we can answer the question do patients select the service model that suits their self-management capabilities? We suggest that if an OTC service provision model is to succeed, patients who select this approach must have insight into the fact it requires considera-

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34 ble independence and self-management capabilities and that a well-designed decision aid will be able to assist in this. Decision making and help seeking There is a large population of older adults with hearing difficulties who would benefit from some form of audiological intervention but who do not seek help from an audiologist. The above approach therefore is not useful for them however, in some recent work, we developed an intervention to motivate this population to seek help for their hearing that involved increasing their role in the decision-making process. Specifically, rather than providing the message ‘you should get help for your hearing’, the intervention aimed to motivate the patient to want to seek help by making them aware of the negative impacts of their hearing loss, providing them with information about how to seek help (increasing their self-efficacy) and by giving them a prompt to do so (a cue to action). We chose to address these factors because prior data had shown these variables to be predictive of readiness to seek help (Saunders et al., 2016). The intervention is designed for use in any health-care setting in which a health-care provider (e.g. a general practitioner, community nurse, or social worker) can facilitate a conversation about hearing. The intervention does not require audiological expertise or testing equipment and takes just a few minutes of the provider’s time, as follows. On arrival at a health-care facility, patients are

provided with nine emotionally evocative color photographs to prompt reflection on ways in which hearing difficulties might impact them. During a discussion with a health-care provider, patients who identify negative impacts of their hearing loss are encouraged to consider having a hearing test and are given a list of local hearing health professionals. Figure 2 is a schematic representation of the intervention. To determine whether the intervention was effective we conducted a study in which 87 individuals who reported noticing hearing difficulties and yet had not sought help and who had recently attended a primary care visit were randomly assigned either to receive the intervention or to a no intervention control group. Six months later, participants were contacted to see whether they had undergone a hearing test within the prior six months. Twenty nine percent (12/41) participants in the intervention group and 15.2% (7/46) participants in the control group had done so. Although a chi-squared test showed these numbers did not differ significantly, the odds ratio of having had a hearing test were 2.3 times greater for those who received the intervention than for those who did not. We conclude that the intervention has the potential to change behaviour because it provides the individual with intrinsic motivation to seek help rather than relying on extrinsic motivation provided by a healthcare provider (Saunders et al., 2017).

Take home message Audiologists can improve patient satisfaction and outcome by implementing patient centred care and shared decision making in their daily practice. Patient decision aids and the intervention described above are potentially valuable tools for facilitating this.

References • Institute of Medicine (IOM). (2001). Crossing the Quality Chasm. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press. • Ekberg K., Grenness C. & Hickson L. (2014). Addressing patients’ psychosocial concerns regarding hearing aids within audiology appointments for older adults. Am J Audiol. 23, 337–350. • Grenness C, Hickson L, Laplante-Lévesque A, Meyer C, Davidson B. (2015). Communication patterns in audiologic rehabilitation history-taking: audiologists, patients, and their companions. Ear Hear. 36(2):191-204. • Laplante-Levesque A, Hickson L, Worrall L. (2010a). Factors influencing rehabilitation decisions of adults with hearing impairment. Int J Audiol. 4:497-507. • Laplante-Levesque A, Hickson L, Worrall L. (2010b). Predictors of rehabilitation intervention decisions in adults with acquired hearing impairment. J Sp Lang Hear Res. 54:1385-1399. • Laplante-Lévesque A, Hickson L, Grenness C. (2014). An Australian survey of audiologists’ preferences for patient-centredness. Int J Audiol. 53 Suppl 1:S76-82 • Poost-Foroosh L, Jennings MB, Cheesman MF. (2015). Comparisons of client and clinician views of the importance of factors in client-clinician interaction in hearing aid purchase decisions. J Am Acad Audiol. 26(3):247-59. • Pryce H, Hall A, Laplante-Lévesque A, Clark E. (2016). A qualitative investigation of decision making during help-seeking for adult hearing loss. Int J Audiol. 55(11):658-65. • Saunders GH, Frederick MT, Silverman SC, Nielsen C, Laplante-Lévesque A. (2016). Description of Adults Seeking Hearing Help for the First Time According to Two Health Behavior Change Approaches: Transtheoretical Model (Stages of Change) and Health Belief Model. Ear Hear. 37(3):324-33. • Saunders GH, Frederick MT, Silverman SC, Nielsen C, Laplante-Lévesque A. (2017). Development and pilot evaluation of a novel theory-based intervention to encourage help seeking for adult hearing loss. J Am Acad Audiol. January 31 [Epub ahead of print]. • Sciacca A, Meyer C, Ekberg K, Barr C, Hickson L. (2017). Exploring Audiologists’ Language and Hearing Aid Uptake in Initial Rehabilitation Appointments. Am J Audiol. 13;26(2):110118. • Thodi C, Parazzini M, Kramer SE, Davis A, Stenfelt S, Janssen T, Smith P, Stephens D, Pronk M, Anteunis LI, Schirkonyer V, Grandori F. (2013). Adult hearing screening: follow-up and outcomes. Am J Audiol. 22(1):183-5. • van Weert JCM, van Munster BC, Sanders R, Spijker R, Hooft L, Jansen J. (2016). Decision aids to help older people make health decisions: a systematic review and meta-analysis. BMC Med Inform Decis Mak. 16: 45. • Yueh B, Collins MP, Souza PE, Boyko EJ, Loovis CF, Heagerty PJ, Liu CF, Hedrick SC. (2010). Long-term effectiveness of screening for hearing loss: the screening for auditory impairment--which hearing assessment test (SAI-WHAT) randomized trial. J Am Geriatr Soc. 58(3):427-34..

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Audiology in Ghana: a situational analysis FACTFILE... Ghana is a middle income country and the second most urbanized country in sub-Saharan Africa, with an annual live birth of 700,000 (Olusanya, 2008) and a population of about 27.41 million (World Bank, 2015).

CD

Authors and Correspondence Yaw Nyadu Offei Audiologist. MSc. (UC, London, 2016): D.Phil (UniKoeln, Germany, 2013).Centre for Hearing and Speech Services, University of Education, Winneba, Ghana. E: ynoffei@uew.edu.gh; E: ynyaduoffei@gmail.com

Sesi Collins Akotey Audiologist (MSc) 2013 Centre for Hearing and Speech Services University of Education, Winneba, Ghana. E: scakotey@yahoo.com Cyril Mawuli Honu-Mensah Audiologist (MSc) 2015 Centre for Hearing and Speech Services University of Education, Winneba, Ghana. E: cylogh@yahoo.com

The Genesis The provision of audiological services in Ghana dates back to the early 1970s when Andreas Markides, a Briton, assumed post as Director of the Deaf Education Specialist Training College at Mampong - Akuapem in the Eastern Region of Ghana. The focus then was for educational purposes. In the mid-1980s, a number of Ghanaian teachers of the Deaf were sent to the United States of America and trained as Audiologists and Speech Therapists. These included Joseph Essel (Audiologist), Grace Yawo Gadagbui, Emmanuel Appiah, and Albert Osei Bagyina (all Speech Therapists). In 1993 however, the hearing assessment centre at Mampong Akuapem relocated to Winneba and began operation as a unit within the Department of Special Education of the University of Education, Winneba (UEW). In Kumasi, the second largest city in Ghana, there were attempts to set up an audiological facility as well. In the 1980s, Prof Sir, Dr. Dr. G.W. Brobbey began to lobby the Commonwealth Society for the Deaf (CSD) (Now Sound Seekers) of UK to set up an audiology centre in Kumasi. On June 9, 1993, Otumfuo Opoku Ware II, the Asantehene commissioned the KATH Assessment Centre that was built with funds from the CSD. At about the same period, Ms. Grace Ocansey, a peripatetic teacher at the Ghana Education Service (GES) introduced the idea of school hearing screening to students living in Kumasi. Again, in the mid-1980s, a young Audiologist, Geoffrey K. Amedofu (now Professor) joined the Komfo Anokye Teaching Hospital (KATH) after training in USA. In 2005, Mr.

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37 J.A Kuffuor, President of the republic of Ghana, commissioned the Korle-Bu Teaching Hospital Hearing Assessment Centre (KTHHAC) in Accra. This feat came through the hard work of Prof. E.D. Kitcher, and Prof. Frimpong Boateng under the sponsorship of the Latter-Day Saints Church of the USA.

intervention programmes for children with hearing loss in place. This has implications for the academic achievement of infants and children of school going age who may be living with educationally significant hearing loss but, many of whom do not have any prospect of ever having their hearing checked.

The Current Situation Currently, there are 9 public and 4 private hearing assessment centres in Ghana. Of the 9 public facilities, 3 are situated within special schools for the Deaf, 4 are located in public hospitals (KTHHAC, KATH, 37 Military Hospital and the Tamale Teaching Hospital), 1 at the University of Education, Winneba and 1 at the National assessment centre in Accra. The 4 privately owned facilities are all located in the Ghanaian capital, Accra. With regard to audiologists, there are currently about 20 audiologists in active practice in Ghana.

Audiology in Ghana is confronted with several challenges that could be categorized broadly as personnel, equipment, public education and services available.

Training Training is offered at the University of Ghana and the Kwame Nkrumah University of Science and Technology for MSc in Audiology and Speech pathology. Additionally, the University of Allied Health Sciences at Ho is offering a BSc programme in Audiology and Speech therapy. New-born Hearing Screening Programmes In Ghana currently, only two facilities have rolled out Universal Newborn hearing Screening using Otoacoustic Emission. These are; KTHHAC (OAE and ABR) and KATH (OAE).There are also school hearing screening programmes mainly in the Central and Ashanti Regions. Awareness Creation It appears that there is very scanty information about audiological services in Ghana. This is not surprising because there are just a handful of audiologists, audiological services and training programmes available. This requires a lot of public education and awareness creation. Mobile Audiology Services Available Mobile Audiological Services are available in Ghana. At the moment, there are four mobile vans that serve mainly, deprived communities. The University of Education, Winneba, and the Kwame Nkrumah University of Science and Technology have a mobile van (the HARK) each, while the other two belong to Ghana National Medical Outreach Service, popularly known as “Onuado”, an initiative of the government of Ghana. In the Central Region alone, the HARK has been used to screen thousands of individuals in rural communities. Prevalence It is estimated that, in Ghana the prevalence of hearing loss is 16.8% in rural communities and 12.9% in urban communities (Ghana Statistical Service, 2013), compared to global estimates (WHO, 2012) of 5.3%. These estimates suggest that the prevalence of hearing loss in Ghana is quite high. Challenges Ghana has not got any systematic early identification and

• Audiological services are mainly concentrated in the Greater Accra, Ashanti and Central Regions of Ghana (all urban communities located within the southern sector of Ghana), thus depriving the rural communities, particularly those within the northern sectors of essential audiological services. With a current population of 27.41 million (World Bank, 2015), the ratio of audiologists to the national population is 1:1.3 million. • Most of the audiology centres are not well equipped. Assessment batteries in use are mainly pure tone audiometry, tympanometry and in very few Centres, the Otoacoustic emission (OAE) testing. • Many Ghanaians are not aware that audiology services are available in Ghana. • Very few private audiological centres in Ghana have qualified audiologists. Most of them employ staff who they train on-the-job thus, it appears there is no uniformity in practice across Centres in the country. Prospects The following are some of the prospects of audiology in Ghana: • Mobile Audiology services (HARKs) which are now available will be used to provide audiological services at the doorstep of infants and children especially, those living in rural communities. • Public awareness of audiological services will be increased by delivering public lectures, engaging the media in discussions, producing and distributing flyers on issues related to ear care. • Ensure ongoing infant hearing surveillance or screening and monitoring in situations where babies are either not enrolled on NHS or get lost to follow-up (Neumann, Coninx, Schäfer, & Offei, 2012; Olusanya et al., 2004). Conclusion Audiology has come a long way to address the hearing needs of Ghanaians however, there is still more to be done.The future looks good but there is the need for hard work, commitment and dedication on the part of hearing professionals and for existing facilities to be equipped.

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38 4. Olusanya, B.O. (2008). Priorities for early hearing detection and intervention in sub-Saharan Africa. International Journal of Audiology (Suppl. 1): S3-S13.

References 1. Ghana Statistical Service (2013). 2010 population & housing census: National analytical report.

5. Olusanya, B.O., Luxton, L.M., & Wirz, S.L., (2004). Benefits and challenges of newborn hearing

2. Accra: Ghana Statistical Services. Available online at http:// www.statsghana.gov.gh/docfiles/2010phc/National_Analytical_Report.pdf

6. screening for developing countries. International Journal of Pediatric Otorhinolaryngology 68, 287-305.

3. Neumann, K., Coninx, F., Schafer, K., & Offei, Y. N. (2012). The littlEARS Auditory Questionnaire a screening tool beyond Newborn Hearing Screening. Paper presented at the Global Coalition on Hearing Health Annual Meeting, Pretoria, May 30 to 31, 2012. Book of Abstracts 14.

7. The World Bank (2015). Ghana: Country at a glance. Accessed on 22 May, 2017 from 8. http://www.worldbank.org/en/country/ghana

Audiology in Turkey FACTFILE... Population: 74.93 million (as of 2013) Total area: 783.562 km² Capital: Ankara Prevalence of hearing impairment: 3.7% (TUIK)

CD

Author and Correspondence Mustafa Enes Özer Undergraduate student (3rd year) Istanbul University, Cerrahapaşa Medical Faculty, Fatih/ Istanbul (university) Seyyid Ömer Mahallesi, Hüseyin Kazım Sokak, 32/2 Fatih/Istanbul (home) E: enes.ozer.tou@gmail.com

Biography Enes is an audiology undergraduate student (3rd) in Istanbul University. Supported by the Erasmus programme, he completed a voluntary internship at the NIHR Nottingham Biomedical Research Centre from August 2016 to October 2016, under the supervision of Prof. Deborah Hall.The article was edited for use of English language by Krysta Siliris (research audiologist, Nottingham University Hospitals NHS Trust). Why the article is of interest to professionals in audiology This article informs professionals in audiology about the status of Audiology in Turkey; the history of professional training and the role of the Audiologist. Website recommendations Hearing Speech Scientists Association (HSSA) http://ikbd.org.tr

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View of Eminönü, Turkey

Turkey serves as a geographical and cultural bridge between Europe and the Middle East. To the west lies Greece and northwest Bulgaria, to the south Syria and Iraq, and to the east Iran. The history of modern Turkey begins with the foundation of the republic in 1923. The Constitution asserts that Turkey is a democratic and secular republic, but there is no separation between State and religion (Islam, by majority). Turkey has a population of approximately 75 million people. In Turkey, the professions of Audiology and Speech and Language Therapy are relatively young. As a result, the roles of therapists in this country are substantially different from those in the UK and in most European countries. In Turkey, in order to access audiological services, an individual first has to be seen by an ENT doctor. Turkey has universal health care under its Universal Health Insurance (Genel Sağlık Sigortası) system. The charge for an audiological examination varies between public hospitals and the private sector. Public hospitals will perform examinations for free while private hospitals will charge a fee. However, both public and private healthcare sectors will provide a charge for supplying rehabilitative devices including hearing aids and cochlear implants as only 30% is paid by the Social Security Institution (SSI). These cost deductions are only in regards to a diagnosis of presbyacusis. Under the Universal Health Insurance system all residents registered with the SSI can receive medical treatment free of charge, in those hospitals that are contracted to do so. The purpose of this article is to summarise the status of Audi-

ology, the history of the professional training and what the role of Audiologist entails. The content has been inspired by an article written by Prof.Dr. Erol Belgin [1]. History of professional training In Turkey, audiology training is available at undergraduate and postgraduate (Masters and PhD) levels. Undergraduate training is usually 4 years, while Masters is usually 2 years. Audiology education began in 1968 under the leadership of Prof.Dr. Nazmi Hoşal at Hacettepe University, Ankara, delivered through the ENT Clinic. Several audiologists from USA (Drs. Richard Israel and Jack Katz) supported the first official graduate training programme in Audiology which was four years in duration. An Audiometry programme for technicians was established by Prof.Dr. Erol Belgin in 1984, delivered through the Vocational Health High School, Hacettepe University, Ankara. This is a 2 year associate degree course. Subsequently in 1986, Prof. Dr. Ferda Akdaş established an Audiology Clinic in the Faculty of Medicine at Marmara University, Istanbul. A Masters training course started in 1987 with PhD training following in 1989. Under the leadership of Prof. Dr. Erol Belgin in the Institute of Health Sciences, Hacettepe University, Ankara, in 1992, a Masters training course in Educational Audiology. Insufficient numbers of audiologists qualifying via the graduate training programme led to the first university department dedicated to Audiology, established in 2010 in the Istanbul University Faculty of Health Sciences, Istanbul. Recently, several undergraduate courses in audiology have been established in Hacet-

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40 tory training or whether cochlear implants may be beneficial. The Newborn Hearing Screening Protocol (NHSP) makes early diagnosis possible. Today, Turkey has the ability to carry out the NHSP in all of its cities. The initiation of NHSP at birth allows for the diagnosis of hearing loss as early in life as possible. This aids in the implementation of auditory habilitative programs in an efficient and timely manner. Audiometry technicians Audiometry technicians work under the responsibility of an ENT doctor or audiologist. They are responsible for conducting pure tone and speech audiometry, conducting acoustic immittance tests, otoacoustic emissions and vestibular tests. With respect to hearing aid fitting, they make ear mould impressions and set the device fitting parameters. They also take part in hearing screening programmes and ambient noise measurements.

audiometry and tympanometry test room

tepe University as well as numerous private universities. On 22nd May 2014, the Ministry of Health published Audiology regulations in a health professional gazette [2]. Audiology Audiologists work in the areas of audiological assessment, electrophysiological measurements, hearing aid and cochlear implant fitting and (re)habilitation, tinnitus diagnosis and management, diagnosis of speech and voice disorders, and vestibular assessment and therapy. Audiologists are responsible for implementing diagnostic tests under the guidance of specialist physicians in the diagnosis of diseases related to balance, and identifying candidature for relevant listening devices, hearing rehabilitation and for device fitting. Roles can also extend into the realm of prevention of hearing loss, with hearing screening, measuring ambient noise levels, and giving advice on hearing protection. Audiologists also have responsibility for auditory implants, setting up the devices during surgery during and aftercare. Advanced training is available in Speech and Voice Disorders and Educational Audiology, such that audiologists often work as part of a multidisciplinary team. Educational audiology Educational audiologists are specialists who work in the areas of auditory processing disorder, auditory neuropathy, speech delay, and developmental or acquired speech and language disorders in children. The main purpose of the Educational Audiologist is to provide expertise in paediatric hearing and speech disorders by evaluating communication skills, devising and implementing an appropriate rehabilitation programme. Newborn hearing screening Early diagnosis of hearing loss in children has been recognised to aid in the development of language, social, emotional, and academic skills in regards to their peers with normal hearing limits. Thus, it is important to recognise as early as 3 to 6 months of age if hearing aids are adequate with additional audi-

Concluding remarks Within the healthcare sector the social awareness of hearing, speech, and balance disorders has become remarkably important. Recently, there has been increased popularity for receiving a degree in speech pathology and audiology as the need for qualified Audiologists and Speech Pathologists has risen. However, these degree programs are guided by professors who aren’t experts in Audiology and Speech Pathology which could have an impact on the quality of education and training an ultimately on patients care. Due to this, concern has developed amongst the graduates who provide audiological and speech pathology services to a large patient population. Thus, raising the standard of theoretical and practical training has become the most important issue. References 1. Belgin, E., Şahlı, A.S. Temel Odyoloji, Odyolojinin Dünü, Bugünü, Yarını, Güneş Tıp Kitabevi, Ankara, Xİ-XVİ, 2015. 2. 2014 “Sağlık Meslek Mensupları ile Sağlık Hizmetlerinde Çalışan Diğer Meslek Mensuplarının İş ve Görev Tanımlarına Dair Yönetmelik” 3. http ://www.re s migaze te .gov.tr/e s kile r/2 014/05/ 20140522-14.htm [accessed 27 November 2016] take home message • In Turkey, the increasing need for qualified professionals in Audiology has accelerated the opening of degree programmes for training. • Although many national regulations have been made in Audiology, there is still more work to be done by the Social Insurance Institution (SII).

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clinical catch-up

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NICE guideline on assessment and management of adult hearing loss CD

Author and Correspondence

Prepared on behalf of the NICE Adult Hearing Loss Guideline Committee by Professor Kevin J Munro University of Manchester and NIHR Manchester Biomedical Research Centre

What is a NICE guideline? The National Institute for Health and Care Excellence (NICE) is an independent public body that provides national guidance and advice to improve health and social care in England. NICE does this by providing evidence-based recommendations on a broad range of topics e.g., preventing and managing specific conditions. The Department of Health, in England, has asked NICE to produce a guideline on the assessment and management of hearing loss in adults. Decisions on how the guidelines apply to other UK countries are made by the Welsh Government, Scottish Government, and the Northern Ireland Executive. The guideline is aimed at commissioners of health and care services, healthcare professionals, and people who use the services. It will make recommendations on the care and services that are suitable for people with adult onset hearing loss. In addition to the specific recommendations, the guideline will provide a summary of the evidence, and how this was used, to generate the recommendations. What topics will be covered in the adult hearing loss guideline? The key areas that will be covered include: • Initial assessment/presentation e.g., What signs and symptoms require urgent referral to a specialist? • Further assessment e.g., How should hearing and communication needs be assessed? • Management e.g., What is the clinical and cost effectiveness of unilateral compared to bilateral hearing aid prescription and fitting? The link provided towards the end of

this article will take you to all the relevant documents including the full scope. Who is responsible for managing and developing the guideline? The National Guideline Centre (NGC) is commissioned and funded by NICE to produce guidance. The NGC is hosted by the Royal College of Physicians (RCP), but is a partnership between a number of Royal Colleges (physicians, nurses, GPs, and surgeons). The role of the NGC is to manage the development of the guideline by providing technical expertise and support to the guideline committee. The technical team of health service researchers include the guideline lead, project manager, editorial assistants, information scientists, research fellows and health economists. So far, NGC has produced more than 30 guidelines and all NICE guidance can be viewed at: www.nice.org.uk/guidance The guideline is developed by an independent and unbiased advisory board of experts, who are known as the Guideline Committee (GC). A topic-specific GC was formed for the adult hearing loss guidance, including service users, and the members are listed at the end of this article. Around 200 stakeholders, including the British Society of Audiology, have registered their interest in the guideline topic with NICE. Registered stakeholders comment on the draft scope and draft guideline. What are the main stages in the development of a guideline? The time taken from the start of the scoping exercise to the guideline publication varies from 12 to 27 months. The development of the adult hearing loss guideline started in September 2015 when NHS England referred the guideline topic to NICE. The scope of the

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43 The draft guidelines will be available for consultation in November 2017 and the expected date of publication is May 2018

guideline (i.e., an overview of what the guideline should include and the key clinical issues) was developed during spring 2016 and the final version was published in July 2016. The key clinical issues listed in the scope were then translated into around 15-20 clear, focused and well-formulated questions (following the PICOS framework: Population of interest, Intervention, Comparator, Outcome and Study design). Systematic identification, review and assessment of the quality of the evidence commenced in July 2016. In addition to clinical effectiveness, health economists assess cost effectiveness. The writing of the guideline is an iterative process that is on-going and the GC has been meeting approximately every 6 weeks since June 2016. The draft guidelines will be available for consultation in November 2017 and the expected publication date is May 2018.

Information and documents about the adult hearing loss guideline can be obtained at: https://www.nice.org.uk/guidance/gid-cgwave0833/documents/html-content Any queries about the adult hearing loss guidelines should be emailed to hearingloss@nice.org.uk Acknowledgements Many thanks to Gill Ritchie (guideline lead) and Katherine Harrop-Griffiths (Chair of Guideline Committee) for helpful comments on an earlier draft of this article.

APPENDIX Membership of Hearing Loss Guideline Committee Chair Katherine Harrop-Griffiths, Consultant Audiovestibular Physician Full members • Graham Easton, GP • Melanie Ferguson, Consultant Clinical Scientist • Julia Garlick, Lay Member • Richard Irving, ENT Surgeon

SCOPE

 CLINICAL QUESTIONS

 REVIEW SEARCH PROTOCOLS

 EVIDENCE REPORT

 RECOMMENDATIONS

• Ted Leverton, GP (retired) • Kevin J Munro, Professor of Audiology (Early GC member) • Rudrapathy Palaniappan, Audiovestibular Physician • Linda Parton, Lay Member • Neil Pendleton, Professor of Medical Gerontology • Jane Wild, Consultant Clinical Scientist Topic expert members • Michael Akeroyd, Director, MRC Institute of Hearing Research • Chris Armitage, Professor of Health Psychology • Steve Connor, Consultant Neuroradiologist • Helen Gallacher, Staff Nurse • Caroline Carr, Social Worker

Figure 1. The guideline development process

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44

Q&A: C2Hear – helping first-time hearing aid users to help themselves CD

Authors and Correspondence

Melanie Ferguson, PhD Research Lead NIHR Nottingham Biomedical Research Centre 113 The Ropewalk Nottingham NG1 5DU E: melanie.ferguson@nottingham. ac.uk

As an audiologist, are you confident that all the information and advice you offer your first-time hearing aid patients is understood, absorbed, and then acted upon once they leave the comfort of your clinic? If not, read on….

C2Hear Online can be used with smartphones and tablets

1. As an audiologist, I keep hearing about C2Hear. What exactly is it? C2Hear is a series of multimedia videos for hearing aid users. We call them reusable learning objects or RLOs – and that’s not to be hifalutin – they really are more than just videos that can be filmed with your smartphone. C2Hear comprises 10 short RLOs that cover a range of practical and psychosocial aspects of hearing aids and communication. Hearing aid users and audiologists helped co-create C2Hear to ensure the end users’ views and opinions were at the heart of its development. David Maidment, PhD Research Fellow NIHR Nottingham Biomedical Research Centre 113 The Ropewalk Nottingham NG1 5DU E: david.maidment@nottingham. ac.uk

2. Ah right. So not just some quickfire video to show how to insert and clean an earmould? Absolutely not! The RLOs contain animations, photographs, video clips, sounds and testimonials from hearing aid users, and all are subtitled. In addition to obvious topics, such as what a hearing does and how to maintain it, C2Hear also covers subjects such as communication tactics, acclimatisation and expectations. The development was based on learning theory principles, with an interactive quiz for each RLO. So C2Hear aims to not only supplement the information that you would typically give to patients receiving hearing aids, but also aims to enhance learning, motivation as well as patient outcomes. 3. Bit fancier than I thought – I’ll put my iPhone away then. But does C2Hear work? Glad you asked as patient benefit is at the heart of what we do. We ran a randomised controlled trial to evaluate C2Hear in 203 first-time hearing aid users at the Nottingham Audiology Services. Our results showed that take-up and adherence with C2Hear was high (78%, 94%), and patients gained substantial benefits from C2Hear. Results showed statistically significantly greater knowledge of hearing aids and communication, and better hearing aid handling skills in the group that had C2Hear compared to standard care. Hearing aid use was also higher

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45 in patients who did not wear their hearing aids all of the time. 4. Statistics heh? That’s all very well, but were the results clinically effective? Yes, we know what you mean about statistics. What is it that they say…. “Lies, damned lies, and statistics”. Well, we showed that these positive effects had large clinical effect sizes. That means that they were of clinical benefit to patients.

“All the C2Hear Online RLOs are freely available on our Youtube channel”

5. I’m liking the sound of this. So what did the patients say about C2Hear? They were pretty complimentary actually. Patients rated C2Hear as 9 out of 10 for usefulness, 94% reported that they enjoyed C2Hear, and 82% reported that C2Hear improved their confidence in using their hearing aids and communication. Interestingly, over half the patients went back to watch C2Hear 2 or more times, some as many as 7-8 times! We take that as suggesting that patients used C2Hear to self-manage their hearing loss. C2Hear was also watched by family members and friends.

ogists were not confident that all the important information that patients needed was understood, absorbed and acted up once they left the clinic. Until the audiologists saw C2Hear that is, and then they were pretty much all in favour that C2Hear would be beneficial for patients. 7. So if I wanted to show this to my patients, how do I get hold of C2Hear? We want C2Hear to be accessed as widely as possible. All the C2Hear RLOs and testimonials are freely available on our YouTube channel www.youtube.com/c2hearonline. Patients can also access C2Hear Online on their smartphones and iPads. To date, C2Hear Online has received over 50,000 unique views, with more than 5,000 views per month in 2017. We have had views from all over the world, with about a third from the USA. Basically, we would like to see more and more people benefit from C2Hear! 8. Online is the way to go, but not all my hearing aid patients have access to a computer or the internet. How much does it cost to give patients a C2Hear DVD? We can provide your Audiology department with a C2Hear master DVD free-of-charge, which you can copy and distribute to as many of your patients as you’d like. We also think that audiologists recommend-

ing C2Hear to their patients is key. Just ask them to google ‘C2Hear Online Youtube’. We can send you our C2Hear Audiology Starter Pack to help you promote C2Hear to patients. Email nhbru-enquiries@nottingham.ac.uk or look at our website www.hearing.nihr.ac.uk/research/ c2hearonline. You can also demonstrate our short 20-30 second demo clips - the C2Hear highlights! If your Trust won’t allow you access to YouTube, we can send you the demo clips in mpeg format to put on your server. 9. Cool. Can we put a link to C2Hear videos on our department’s website? Yes, please feel free to do this – over 20 departments have done this already. You don’t need to ask our permission for this, just go ahead. You might also like to add our demo clips as well. 10. So what are your plans for the future? And where can I read up more on the research you are doing? We currently have a grant that looks at personalising C2Hear to meet patient’s individual needs with mHealth technologies (m2Hear), using short, 1-2 minute clips based on health behaviour change theory (COM-B). Other research is looking at making C2Hear more interactive, and is using C2Hear for ‘joint-work-

6. Well it seems to me that in these days of austerity and cuts C2Hear is a really useful way to ensure patients get all the information they need to be successful with their hearing aids, yes? Exactly! You’re definitely getting this. There is simply is not enough time to get all this important information across in clinic appointments, and besides, information is often forgotten. In fact a student project showed that the majority of audiol-

C2Hear RLOs cover practical and psychosocial aspects of hearing aids and communication

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46 ing’ between hearing aid users and their communication partners. Studies have also shown benefits for non-audiological health and social care professionals (carehome assistants, nurses). A recent study showed that offering C2Hear at the hearing assessment significantly improved patients knowledge and self-efficacy (i.e. confidence) to use hearing aids before they had even got them! Finally, we are in the process of translating the videos into American English and Chinese. That will keep us out of mischief for a while. For further reading, see the references. We hope your patients get as much benefit from C2Hear as ours have. Thanks for your interest!

References • Ferguson MA, Brandreth M, Brassington W, & Wharrad H. 2015. "Information retention and overload in firsttime hearing aid users: an interactive multimedia educational solution". American Journal of Audiology, 24: 329-332 • Ferguson MA, Brandreth M, Brassington W, Leighton P, & Wharrad H. 2016. "A Randomized Controlled Trial to Evaluate the Benefits of a Multimedia Educational Programme for First-time Hearing Aid Users". Ear and Hearing, Mar-Apr; 27(2): 123136. • Maidment D, Brassington W,Wharrad H & Ferguson M. 2016. Internet competency predicts practical hearing aid knowledge and skills in first-time hearing aid users. American Journal of Audiology 25: 303-307.

• Ferguson M. 2017. Knowledge is power: the power of mobile technologies to enhance hearing-related knowledge. ENT and Audiology News, Mar/Apr, 26(1):82-84.

Acknowledgments Thanks to Will Brassington and Nottingham Audiology Services and Heather Wharrad and the Health and Elearning Media group at the University of Nottingham. This article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0909-20294 and PBPG-815-20019). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Innovations in cognitive behavioural therapy in vestibular rehabilitation CD

Author and Correspondence

Dr Sarah Whitaker Clinical Psychologist Correspondence address: Audiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX E: sarah.whitaker2@nhs.net

People with dizziness and balance problems and the clinicians who work with them, regularly identify that the impact of these symptoms extend much further than simply affecting an individual on a physical level. Being dizzy has a pervasive impact on someone as a whole; physically and emotionally. People find that they struggle to keep up the roles they used to participate in (e.g. work, relationships, hobbies) and so life can start to shrink and feel stuck. Cognitive Behavioural Therapy (CBT) is currently the main evidence based approach to reducing the impact of symptoms on mood and quality of life. It aims to help people identify cycles they get stuck in, where difficult thoughts create feelings such as anxiety and this leads to unhelpful behaviours, e.g. avoiding certain situations, which then maintains the cycle.

More recently third wave CBT recognises the paradox that trying to avoid difficult internal experiences, such as thoughts and feelings, actually builds and strengthens connections between specific situations and the internal responses they trigger. This leads to an increased sensitisation of the system as there is no delete function that breaks these connections. These third wave approaches combine the behavioural approaches of CBT with mindfulness based approaches.This combination aims to help people move away from attempts to change or alter emotional states (e.g. feel happy, be in less pain, be less anxious) and move towards doing things that enable them to live well, even with dizziness symptoms and difficult emotions. This is particularly relevant within Vestibular disorders as the role of the nervous system is so important. Dizziness can

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47 and also the sensation of the body as a whole, in this moment. This process can both decrease the sensitivity to the unwanted sensations and also increase someone’s skill in taking a step back and noticing their choices.

Figure 1: Artist unknown

trigger the threat or alarm response in the individual. This is a natural emotional response, given how scary and unpredictable being in a dizzy state can be, and how vulnerable it can make people. However, the brain pathways involved in balance are also involved in processing anxiety (an extensive explanation of this can be found in Balaban & Thayer, 2001). This repeated activation of the body’s alarm system and sympathetic arousal results in increased sensitisation.

These approaches aim to help people move towards doing things that enable them to live well, even with dizziness These approaches also work in a way that has a more experience driven focus on movement and action. This explicitly seeks to decrease the threat response and detune the alarm system, rather than to stop the system being activated in the first place. Detuning the alarm system can occur with repeated exposure to the dizziness sensations with a curious stance of leaning into these sensations, rather than a stress/avoid response. This means that even in the presence of negative thoughts, dizziness, sensations, emotions etc, we still have a choice about how we act and that by connecting to the deeper value behind

our actions, behaviour change becomes more meaningful. By using a compassionate approach towards flexible exploration, it is possible to reprogram the nervous system to focus more on values and what is important to the individual. This process is often started in clinic consultations by actively connecting with what is important to the individual, (e.g. being independent or spontaneous) and noticing what the barriers are to acting on this (e.g. fear of symptoms or urge to control their environment). We also spend time mindfully scanning the body to compassionately notice both the unpleasant sensations (such as dizziness)

Physiologically, this creates a transition from activation of the sympathetic nervous system to the parasympathetic nervous system (Chaskalson, 2012). When the threat response (sympathetic nervous system) is activated, the body goes into the fight/flight/freeze response, releasing lots of adrenaline and cortisol into the body. However, when the parasympathetic nervous system is activated, the body engages in its repair, rest and digest activities. This is consistent with the compassionate mind model of human motivation (Gilbert 2009), which discusses how there are 3 systems that are associated with the ‘threat’ response and sympathetic arousal; parasympathetic arousal associated with a soothing/affiliative system (called ‘let’); and a ‘get’ response associated with increased dopamine, resulting in the person being more curious about exploring new opportunities, achievement and pleasure. ACT aims to help people work more in the ‘let’ and ‘get’ systems in order to build resilience and overall increase quality of life, even

The path away from what we want to avoid does not lead to where we want to go!

Figure 2: With thanks to Lorraine Nanke for this picture

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48 in the presence of difficult internal experiences. Mindfulness is an approach that often underpins this work as it helps people to compassionately draw their attention to the present moment and accept all their experience as it arises, whilst noticing opportunities for change. Mindfulness also creates space for a deeper connection within the whole body, rather than creating separation between the physical symptoms and mind as distinct entities. This therefore creates the opportunity in sessions to work actively on reducing avoidance of internal distress and increasing creativity and curiosity, which engages the parasympathetic nervous system.

The next steps I am excited about taking with our team is increasing the amount of joint working we do in clinic together. When we have had the opportunity together it seems to help the person using the service to move forwards with understanding the complex interplay of their body and mind and take action to enrich their life.

References • Balaban, C.D. & Thayer, J.F. (2001). Neurological bases for balance-anxiety links. Journal of Anxiety Disorders, 15, p53-79

Dedication I would like to thank all my colleagues in the Community Health Psychology Team and Vestibular Rehabilitation team for their support in building these approaches within our clinical work. I also particularly want to thank Dr Lorraine Nanke, Principal Clinical and Health Psychologist for her consultation and wise feedback that has significantly influenced this article and my work more generally.

• Chaskalson, M. (2012). MBSR handbook. Mindfulness Works Ltd

• Gilbert, P. (2009). The Compassionate Mind: A New Approach to the Challenge of Life. London: Constable & Robinson

• Naber, C.M., Water-Schmeder, O., Bohrer, P.M., Matonak, K., Bernstein, A.L. & Merchant, M.A. (2011). Interdisciplinary Treatment for Vestibular Dysfunction: The Effectiveness of Mindfulness, Cognitive Behavioral Techniques and Vestibular Rehabilitation. Otolaryngology – Head and Neck Surgery, 145(1), p117-124

State of the evidence? There is very little research investigating the impact of mindfulness based approaches when included with vestibular rehabilitation (a literature review found only 1; Naber Take Home message: et al, 2011). However there is a growing Innovative CBT approaches dizziness involves helping people spot patterns evidence base for the value of mindfulin their body & behaviour that feed vicious cycles and helps make space for ness for promoting resilience, health and symptoms and live alongside them. well-being in a range of contexts. BSA_A5_Landscape_Membership_Advert.V1.qxp_Layout 1 30/03/2017 12:14 Page 1

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50

The natural history of tinnitus CD

Author and Correspondence Dr Derek Hoare DipN, BSc(Hons), MRes, PhD Associate Professor in Hearing Sciences NIHR Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropealk, Nottingham, NG1 5DU E: Derek.hoare@nottingham.ac.uk There is evidence that tinnitus severity decreases over time that can cautiously be used when counselling patients. Part of the counselling provided to tinnitus patients involves reassurance that tinnitus severity generally reduces over time. Anecdotally at least, this seems to be the case. Whether research evidence supports this effect is another question. We therefore conducted a systematic review to quantify the change in tinnitus severity that generally occurs over time in patients who receive no treatment. The review involved a systematic search of the literature. Studies were included if they reported data for a group of patients who undertook repeated measures of tinnitus severity using standardized clinical questionnaires but who received no treatment between measures. Typically this meant patients on a waiting list or in a no-intervention control group. Percentage change and the effect size (we used Hedge’s g) in each group were calculated for all the reported time intervals. The effect size in each study was calculated as the difference between the group mean questionnaire score at baseline and after the no-treatment period in that study, divided by the pooled standard deviation. In this way, a positive effect size indicates tinnitus improves over time. Some studies used multiple tinnitus severity questionnaires at the same time point so for those we calculated an average effect size. We found 25 studies, involving 977 patients with tinnitus who had received no treatment, that were suitable for inclusion in the review. The no-treatment period varied from 1-52 weeks and the average was 12 weeks. Across all studies, and taking the longest no-treatment period in each, there was an average decrease in tinnitus severity (questionnaire scores) of 2.3%, i.e. tinnitus improved. Strikingly, within individual studies the effect was always either not statistically significant (there was no change in tinnitus severity) or significant and positive (tinnitus improved over time); for an example analysis see Figure 1. In none of the included studies did tinnitus get worse over time. When we pooled all the individual effect sizes together the

This is a summary of research supported by a BSA Applied Research Grant and published in The Laryngoscope Phillips, J. S., McFerran, D. J., Hall, D. A., & Hoare, D. J. (2017). The natural history of subjective tinnitus in adults: A systematic review and meta-analysis of no-intervention periods in controlled trials.The Laryngoscope.

There is evidence that tinnitus severity decreases over time that can cautiously be used when counselling patients. effect size was small, but significant and positive. When we explored the data, we found that the effect seems to decrease when there is a longer interval between measurements. This is likely a limitation of the measurement instruments used (i.e. clinical questionnaires may be less reliable when there is a large interval between measurements). In short, we found that patients in research studies generally demonstrate a reduction in tinnitus severity over time even when receiving no treatment. This provides statistical evidence that tinnitus does indeed improve over time, albeit the effect is small and highly variable across individuals. Nevertheless, this evidence can cautiously be used when counselling patients.

Figure 1. Effect sizes (squares) in 23 no-treatment groups after 2 months without any treatment. Note all are either positive (significant improvement in tinnitus severity), or neutral (confidence interval [CI] crosses the zero-line indicating no significant change in tinnitus severity).

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51

Cognitive behavioural therapy in cochlear implant users – PhD project CD

Despite many years of research and medical developments, tinnitus is still a poorly understood problem and science cannot completely cure troublesome tinnitus. In many cases, using hearing aids can reduce tinnitus symptoms. This is because people who use hearing devices are more able to concentrate on other sounds than their tinnitus and they are often better able to adjust to the unpleasant noise. In modern tinnitus treatment, it is therefore most important to first improve the hearing ability of the patient before treating the tinnitus. Cochlear implants (CI) are devices that can restore hearing in the profoundly deaf. As of December 2012, approximately 324,000 devices have been implanted worldwide. There are about 10,000 people in the UK with cochlear implants according to the Ear Foundation and the number is growing every year. Although implantation reduces tinnitus in most cases, some CI users still suffer from tinnitus after implantation.

Authors and Correspondence

Dr Eliza Tucker University of Southampton

Prof. Stefan Bleeck University of Southampton

Of the various social and psychological problems caused by tinnitus, usually the biggest problems are impaired sleep and

depression caused by the patient’s constant focus on tinnitus. This may lead to a lack of understanding by the patient’s family and withdrawal from social life. Tinnitus can create a vicious circle that is difficult to break for some patients: tinnitus causes stress and anxiety which cause fatigue, followed by depression and anxiety which often exacerbate the symptoms of tinnitus. It is important to break this vicious cycle by offering treatment to patients, which includes understanding the problem, being empathetic and offering coping strategies for the tinnitus. One of the most effective treatments is Cognitive Behavioural Therapy (CBT). CBT is a psychotherapeutic approach that aims to influence dysfunctional emotions, behaviours and cognitions through a goal-orientated, systematic procedure. The assessment procedure used in CBT involves structured interviews, a daily diary and self-report questionnaires. Treatments include applied relaxation, imagery and distraction techniques, advice on what to listen to and how to listen, management of sleep and

Subject

Age

Implanted ear

Implant year

Affected ear

Cause of deafness (*)

Duration of deafness

Duration of tinnitus (years)

1

46

R

2009

R+head

WVA

40

30

2

59

L

2009

L+R

Infection

10

15

32

68

L

2008

L+R

Flu

40

54

7

59

R

2009

R+head

Nerve deafness

30

33

8

66

L

2004

R

Heredity

30

45

26

60

R+L

2004

R+L

Meningitis

7

6

14

63

L

1994

R+L and head

Ménière’s disease

24

5

10

59

L

2009

R+L

Unknown

52

49

42

50

R

2009

R

Unknown

4

5

11

76

R+L

1999/2002

R

Unknown

30

9

49

49

R

1995

R+L

Accident

15

31

41

59

R

2003

L

Unknown

30

20

Table 1. Profiles of the participants in the control group (*data according to the participants, taken at the time of the Tinnitus Workshops in 2011)

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52 Subject

Age

Implanted ear

Implant year

Affected ear

Cause of deafness (*)

Duration of deafness

Duration of tinnitus (years)

54

37

R

2010

R+L

Nerve deafness

progressive from birth

25

23

61

R

2008

L+R

Unknown

2

7

21

72

l

2008

R

Otosclerosis

40

43

29

59

R

2009

R+head

Congenital

progressive from birth

Approx 20

6

76

R

2006

R+L

Childhood abscesses

66

64

22

56

L

1998

head

Congenital

56

since implantation

27

44

R

1994

R+L and head

Meningitis

24

27

31

68

R

2007

R+L

Unknown

12

4 years in R, longer in L

Table 2. Profiles of the participants in the research group (*data according to the participants)

100

TotalQPRE TotalQPOST

80

60

40

20

0 control

research

Figure 1. Differences in Tinnitus Questionnaire scores between the groups.

anxietyPOST anxietyPRE 12.5

10.0

7.5

5.0

2.5 control

research

Figure 2. Differences in anxiety (HADS) scores between the groups.

depressionPRE depressionPOST

12.5

10.0

7.5

5.0

2.5

0.0 control

research

Figure 3. Differences in depression (HADS) scores between the groups.

cognitive restructuring of thoughts and beliefs associated with tinnitus. The effect of psychological treatment according to CBT principles has been investigated in several studies and shows promising results in reducing the annoyance of tinnitus, as well as a more understanding attitude towards tinnitus symptoms. Despite the success that CBT has in the treatment of tinnitus, it is not clear if CI users could benefit from it as well, because CBT has not been used specifically to treat CI patients suffering from tinnitus. Possible differences in aetiology and everyday life with the implant means that CI users might have different needs and require a modified therapy structure. Our research aimed to investigate CBT’s effectiveness for CI users. Using a randomized control trial, we investigated whether a two-hour Tinnitus Workshop for the control group (N=12) was equally as effective as CBT for the research group (N= 8) where both groups were CI users. See Table 1 and 2 for participant characteristics. We also explored if either type of treatment for CI users needed any modifications to make them more suitable for this group of tinnitus sufferers. Using open questions to explore patients’ histories, experiences, behavioural and emotional reactions to tinnitus and coping strategies, we created a profile for CI patients with tinnitus. Data was gathered using four different questionnaires (TQ, VAS, HAD, SF-36) preand post-intervention (see Figures 1-3). The results from the open questions showed that CI users were affected by tinnitus in a similar way to non-CI users. Scores on the Tinnitus Questionnaire and Visual Analogue Scale showed a larger decrease in tinnitus distress in the research group but a larger sample size is needed for statistical certainty. Cognitive Behavioural Therapy for cochlear implant users is not widespread as a method of easing tinnitus distress and essential modifications are needed. First of all, there is a need to increase the popularity of this kind of treatment among CI users.The low take-up of CBT by cochlear implant users may be associated with the fact that they are excluded to some extent during the rehabilitation process, where the most important thing is to restore and rehabilitate hearing ability. Sometimes tinnitus

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53 is viewed as an insignificant symptom and is left to be treated later, when it becomes a distressing problem. CBT as an effective treatment has been implemented in many health services, where it has been shown to be beneficial to patients. In this study, the Tinnitus Workshop was offered as an alternative means of support. Therefore, it would be beneficial for any future research to investigate this kind of treatment as an interim source of help for patients who may be on waiting lists or cannot attend CBT for other reasons. The practicality

of conducting CBT was hampered by obstacles such as participants’ difficulties with following CBT techniques and the venue, as well as the participants’ hearing limitations. Most participants complained about the difficulty of listening to music through cochlear implants, as well as having to ease their tinnitus by masking it with music. Difficulty of CI implantees with listening to music in a pleasurable way is widely discussed in the literature and this area needs more scientific research. One element of the CBT programme includes relaxation methods; however, it was impossible to

conduct any type of relaxation using background music because of this very problem. Therefore, relaxation methods for cochlear implant users should also be investigated further. Overall, both interventions need some modifications to their protocols in order to be more effective for this type of tinnitus sufferers. Further studies may also reveal more details about tinnitus in cochlear implant users and may investigate why implantation sometimes results in severe tinnitus.

Second ENT & Audiology News Free Study Day

THE EAR AND TECHNOLOGY in conjunction with the ENT Masterclass® 8 CPD Points awarded by ENTUK

Saturday February 10, 2018 • Doncaster Royal Infirmary, Doncaster, UK. Designed for practising otolaryngologists, including consultants, senior trainees and audiologists, with an interest in a comprehensive update on advances in medical, surgical and rehabilitative care of diseases of the ear. Delegates will have the opportunity to learn from the masters within their field and gain hands-on experience in the latest techniques and technologies during the breakout workshops. Topics include: • The assessment and management of tinnitus in the ENT clinic • Mechanical stimulation of the auditory pathway • Non-vestibular causes of vertigo • Medicolegal • Dementia and hearing loss • Optimising outcomes in cartilage tympanoplasty • Endoscopic ear surgery – a practical guide

COURSE DIRECTOR: Prof M Shahed Quraishi, OBE, FRCS, FRCS (ORL, H&N)

Faculty

Prof Gerard O’Donoghue

Prof David Baguley

Mr Richard Irving

Prof Peter Rea

Dr Piers Dawes

Prof Simon Lloyd

Mr Arun Iyer

Visit www.earandtechnology.com to register & Organised by ENT audiology

Sponsored by

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54

Calorics; past and future CD

Author and Correspondence Stephanie Greer Pre-Registration Clinical Scientist, Wrexham Maelor Hospital Wrexham, Wales E: stephanie.greer@wales.nhs.uk 1967. The Doors, Jimi Hendrix and Pink Floyd release their debut albums. Puppet on a String wins Eurovision. The Vietnam War is raging. Che Guevara is executed. Dr James Bedford becomes the first person to be cryogenically preserved.The space race is on and this fascination is reflected by Audiology journals focusing on the effects of gravity and space flight on the vestibular system. Although the presence of the caloric response had been known for over 50 years since being discovered by Robert Bárány in the 1960s the impact of different variables on responses was still fairly relatively unknown. It was still common practice to use the duration of nystagmus as the main measure of vestibular function although the validity of this was beginning to be doubted. In many clinics and research centres calorics would be carried out either with fixation or using Frenzel lenses as electro-oculography was not yet widely available. Ronald Hinchcliffe (1967) proposed normal values for caloric testing using electro-oculography of slow phases greater than 6 °/s and with a difference between ears of less than 20°/s. He also theorised that hot (warm) irrigations alone can be used to indicate whether vestibular losses are peripheral or central in origin; this idea has shaped our current monothermal screening criteria. Cecil Hart (1967) discussed the benefits and differential effects of fixation on the caloric response and outlined a modification to the traditional Fitzgerald and Hallpike (1942) irrigation procedure

to enable measurement of caloric response with and without fixation during a single irrigation. This procedure forms the basis of our current BSA procedure for bithermal caloric irrigation and, although not specifically calculating the optic fixation index, lays the foundations for establishing this in the future. The first air caloric machine was proposed by Aantaa (1967) with direct comparisons made between the responses produced by water stimulation for both normal ears and dry perforations. This was a major step forwards in vestibular testing for patients with this population for whom calorics had previously been contraindicated. Fast forward 50 years and calorics are still the gold standard to which many clinicians and researchers refer; however their limitations are readily acknowledged. Videonystagmography is widely available enabling accurate measurement of nystagmus velocity in the absence of fixation. Video head impulse testing has taken major steps forward in recent years and although arguably not a replacement for the caloric test the use of vHIT has reduced the number of calorics completed in many vestibular clinics. Looking back over the last 50 years I can see how far we have come and am excited by what we still have left to achieve. References • Aanlaa, 1967, Caloric test with aid: Preliminary Report. Acta Oto-laryngologica, 63, sup 224. • Fitzgerald, G. & Hallpike, C.S., 1942. Studies in Human Vestibular Function: 1. Observations on the directional preponderance (“Nystagmusbereitschaft”) of Caloric nystagmus resulting from cerebral lesions. Brain 65 (2). • Hart, C., 1967. Ocular fixation and the caloric test. Laryngoscope 77 (12) • Hinchcliffe, R., 1967. Normal values for caloric tests using electro-oculography. The Journal of Laryngology and Otology.

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Developing Innovative solutions for delivering Tinnitus Therapy CD

Authors and Correspondence

Eldre Beukes MSc in Audiology, PhD researcher and Graduate Teaching Assistant at Anglia Ruskin University, Department of Vision and Hearing Sciences, Faculty of Science and Technology, Anglia Ruskin University, Cambridge CB1 1PT E: eldre.beukes@anglia.ac.uk T: 01223 698847

Prof David Baguley PhD on Tinnitus Professor in Hearing Science, University of Nottingham E: david.baguley@nottingham.ac.uk

Prof Gerhard Andersson PhD in Clinical Psychology and Otorhinolaryngology Professor of Clinical Psychology at LinkĂśping University E: gerhard.andersson@liu.se

This article gives background to an Internet-based intervention for tinnitus, designed to provide additional access to tinnitus interventions, thereby, enabling clinicians to see the patients most distressed by their tinnitus. Introduction Audiological professionals play a major role in offering support to patients experiencing tinnitus. Their drive to provide excellence in care is often hampered by budget constraints and immense pressure to treat more patients with reduced resources. Many patients with tinnitus also remain without access to specialist care as only an estimated 37% are referred for these services by their General Practitioner (El-Shunnar et al, 2011). Creative ways of addressing these obstacles brought a team of tinnitus experts together to trial a possible innovative solution. The proposal was made to develop an Internet-delivered treatment pathway, based on a model that has been incorporated into clinical care in Sweden (Kaldo-SandstrĂśm et al., 2004 and Kaldo et al., 2013). This treatment pathway could provide tinnitus treatment to those who are unable to access tinnitus services due to geographical or health-related constraints. The aim would be to triage certain tinnitus patients to receive treatment via the Internet, therefore freeing up clinicians to see patients that most required specialist care. Project Team This project was carefully designed in sequential stages to ensure that robust methodological principles were used. One strength of the design was the incorporation of a multi-disciplinary collaboration. This team included Gerhard Andersson and Viktor Kaldo due to their expertise in developing Internet-interventions in Sweden. David Baguley was included due to his expertise in clinical audiology. George Vlaescu was the web-designer and Vinaya Manchaiah and Peter Allen advised on research design. EldrĂŠ Beukes took lead on the project management and delivery as part of her PhD research. Project development The first phase was developing the intervention with the objective of presenting only evidence-based, informative, accurate and interesting content within the intervention. Cognitive behavioural principles formed the evidence-based for the intervention, as these have the most evidence of effectiveness in minimising the effects of tinnitus (Hesser et al., 2011; Cima, 2016). The tinnitus CBT self-help programme, designed by Kaldo et al. (2007) was used as the theoretical base and covered a broad and comprehensive spectrum, consisting of 21 modules. A new web platform was designed to pres-

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56 An Internet-based tinnitus intervention has been developed with the aim of providing an additional cost-effective tinnitus treatment pathway

in the evaluation of the intervention. Technical problems were identified and the intervention was refined accordingly. Both groups were asked to rate the intervention for acceptability and satisfaction. Similar ratings high-ratings were given, regarding the content, suitability, presentation, usability and monitoring aspects of the intervention (Beukes et al., 2016).

ent the materials in an attractive, easy to navigate and visually stimulating design, as seen in Figure 1. An interactive approach was utilised by including quizzes and worksheets. A variety of learning methods were combined by supporting text with images, diagrams, videos, expert opinions and demonstration of techniques, thereby reinforcing information retention. A key element was providing therapeutic support to those undertaking the intervention. They can, therefore, contact a clinician via a secure messaging system to ask questions. The clinician would also provide feedback on worksheets completed and monitor progress. This support has previously been provided by Clinical Psychologists. It was felt that in a UK context, using Audiological support would be more appropriate, as this is the profession largely managing tinnitus patients.

Feasibility of Internet-based delivery The next phase was to determine whether an Internet-based intervention is feasible in the UK, where patients are accustomed to a model of going to see a clinician for clinical care. A group of 37 adults with tinnitus participated in a single-group open-effectiveness trial. Feasibility was established in terms of recruitment, compliance, drop-out rates and using an Audiologist to guide the intervention (Beukes et al., 2017a). Larger scales studies were therefore undertaken.

Technical functionality and acceptability of the intervention After developing the intervention, we set out to establish its technical functionality and identify barriers that may impede the usability of this intervention. Two user groups, namely five expert reviewers group (Audiologists and tinnitus support group members) and a group of 29 adults with tinnitus were involved

Efficacy of this Internet-based intervention An efficacy trial determines whether an intervention produces the expected results under ideal circumstances in a controlled trial. This was the first trial to investigate the efficacy of a cognitive behavioural therapy Internet intervention for tinnitus in the UK and the first using Audiological support for this particular intervention. To ensure a methodologically sound design was applied a randomised control trial with 146 participants was undertaken (see Beukes et al., 2015 for the study protocol). Results indicated that undertaking the intervention led to a significant improvement in tinnitus distress as seen in Figure 2. Improvements were also found for other related comorbidities (i.e. insomnia, depression, hyperacusis, cognitive failures and life satisfaction) over a weekly monitoring control group. It also indicated that improvements were maintained after a two month period. We are presently investigating whether these results can be maintained one year after doing the intervention.

Figure 1: The home page for selecting modules when undertaking the Internet intervention

Comparison to standard clinical care The gold standard in evaluating a new intervention is comparing it to standard clinical care. We have therefore launched a multicentre randomised control trial to determine how effective iCBT is compared to that of face-to-face hospital-based clinical care. Our thanks is extended to Norfolk and Norwich University Hospital, Hinchingbrooke Health Care NHS Trust and Milton Keynes University Hospital for partaking in this research.The tinnitus clinical leads at these hospitals, are Claire Gatenby, Julie Lloyd, and Rachel Robinson respectively. They are supported by Alexander Ryan, Samantha Nutt, Corinne Bailey and Emma King. This research has provided an opportunity for clinicians and researchers to work together to test the effectiveness of the intervention in a clinical setting. We have recruited 92 participants who have been randomly assigned to receive either Internet-based intervention or face-to-face clinical care.The aim is to establish whether an internet intervention is at least

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57 • Beukes, E.W., Vlaescu, G., Manchaiah, V., Baguley, D.M., Allen, P.M., Kado, V. and Andersson, G., 2016. Development and technical functionality of an Internet-based intervention for tinnitus in the UK. Internet Interventions; 6: 6-15.

Figure 2: Graphical illustration of the improvement in tinnitus severity after undertaking the Internet intervention compared to weekly monitoring

as effective as standard clinical care (Beukes et al. 2017b). The next steps Due to the positive impact reported by those that have undertaken the intervention, it holds potential to be utilised to increase access to evidence-based tinnitus treatment routes for those with tinnitus who are unable to access tinnitus care. Numerous future research themes are still required before such an Internet-Intervention can be considered as an additional intervention route. One is establishing predictors of outcome to guide for which groups of patients this will be a suitable intervention (Anderson & Hedman, 2013). Perhaps the greatest research challenge is identifying factors that can aid acceptability and credibility of Internet-interventions by clinicians, patients, and stakeholders, as without this, additional treatment routes will be difficult to implement. Acknowledgement We are most grateful to the British Society of Audiology Applied Research Grant for funding Phase III of this clinical trial and for supporting this research. Disclaimer: Anglia Ruskin, Lamar and Linköping Universities and NIHR supported the undertaking of this research but the views expressed are those of the authors and not of these institutions. No conflict of interest declared. References • Andersson, G. and Hedman, E., 2013. Effectiveness of guided internet-based cognitive behavior therapy in regular clinical settings. Verhaltenstherapie, 23(3), pp.140-148. • Beukes, E.W., Allen, P.M., Manchaiah, V., Baguley, D.M. and Andersson, G., 2017a. Internet-based intervention for tinnitus: outcome of a single-group open trial. Journal of the American Academy of Audiology, 28(4), pp.340-351. • Beukes, E.W., Baguley, D.M., Allen, P.M., Manchaiah, V. and Andersson, G., 2017b. Guided Internet-based versus face-to-face clinical care in the management of tinnitus: study protocol for a multi-centre randomised controlled trial. Trials, 18(1), p.186.

• Beukes, E.W., Manchaiah, V., Allen, P.M., Baguley, D.M. and Andersson, G., 2015. Internet-based cognitive behavioural therapy for adults with tinnitus in the UK: study protocol for a randomised controlled trial. BMJ open, 5(9), p.e008241.

• Cima, R.F., 2016. Managing Tinnitus in Adults: Psychological Strategies. In Baguley, D.M. and Fagelson, M. ed. Tinnitus. Clinical and Research Perspectives. San Diego: Plural, pp 309-326. • El-Shunnar SK, Hoare DJ, Smith S, Gander PE, Kang S, Fackrell K, Hall DA., 2011. • Primary care for tinnitus: practice and opinion among GPs in England. Journal of evaluation in clinical practice, 17(4):684-92. • Hesser, H., Weise, C., Westin, V.Z. and Andersson, G., 2011. A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress. Clinical psychology review, 31(4), pp.545-553. • Kaldo, V., Cars, S., Rahnert, M., Larsen, H.C. and Andersson, G., 2007. Use of a self-help book with weekly therapist contact to reduce tinnitus distress: a randomized controlled trial. Journal of psychosomatic research, 63(2), pp.195-202.. • Kaldo, V., Haak, T., Buhrman, M., Alfonsson, S., Larsen, H.C. and Andersson, G., 2013. Internet-based cognitive behaviour therapy for tinnitus patients delivered in a regular clinical setting: Outcome and analysis of treatment dropout. Cognitive behaviour therapy, 42(2), pp.146-158. • Kaldo-Sandström, V., Larsen, H.C. and Andersson, G., 2004. Internet-Based Cognitive—Behavioral Self-Help Treatment of Tinnitus Clinical Effectiveness and Predictors of Outcome. American Journal of Audiology, 13(2), pp.185-192.

Take home message: Creating additional tinnitus management routes, such as Internet-based interventions, are required to increase access to tinnitus interventions and free-up clinicians to see patients that most require face-to-face care.

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58

1967: A Revolutionary Year for Aiding Unilateral Hearing Loss CD

Author and Correspondence Shanelle Canavan Trainee Clinical Scientist Wrexham Maelor Hospital Wrexham, Wales E: Shanelle.canavan@wales.nhs.uk

1960 was the decade of love. The slogan ‘love not war’ was commonplace during this era, and in 1967, hearts were changed – quite literally – when the first human-to-human heart transplant was performed. Additionally, 1967 saw the first person sail single-handedly around the world and the world’s very first ATM was installed in London. These are all great feats, but what developments were occurring in audiology at this time? CROS technology (contralateral routing of signals) is today commonly used in aiding for those with a unilateral hearing loss. Despite this, it wasn’t until 1967 that the concept was developed into a wearable device. This year saw one of the earliest publications on CROS hearing devices and its content highlights the developments in hearing prostheses over the past 50 years. CROS hearing aids consist of a microphone, which is positioned on the ear with a hearing loss, and a receiver, via which the sound is transmitted to the normal hearing ear. In 1967, this was done via a headband, or by a wire disguised by spectacles. Since 1967, there has been much advancement in CROS technology – although the basic concept remains the same. One of the most notable changes has been the progression from analogue to digital hearing aids, which has been made possible via developments in digital signal processing technology. Another significant development has been in the cosmetic changes of CROS aids. Wireless technology has enabled signals to be transmitted between aids without the need for a cable, and this has significantly increased their practicality and appeal. We are now also, of course, able to fit BiCROS aids, which en-

able an individual to achieve a sense of binaural hearing even if they have a hearing loss in one ear as well as an unaidable ear. Finally, Green et al.’s (1967) journal demonstrates the progression not only of hearing aid technology, but of society in general. One particularly striking thing about the publication is its reference to a society which upheld strong gender roles. Although the feminist movement of the 1960s and 70s saw an increasing amount of women being able to drive, the article still makes reference to ‘the male, who usually drives when passengers are present’ and ‘the female who accompanies a male driver’. In 2017, things are much different, and the 21st century has seen male drivers become a minority for the first time (Sivak, 2013). Despite the limitations of CROS hearing aids, the past 50 years has provided options for those who, previously, would not have had any. Additionally, the popularity of CROS and BiCROS aids has highlighted that amplification for those with single-sided deafness can be of benefit – something which was, prior to the development of CROS technology, often disputed. In 2017 we now have new options for dealing with single-sided deafness – including BAHA and in some cases cochlear implantation – so watch this space for the next 50 years!

CROS technology (contralateral routing of signals) is today commonly used in aiding for those with a unilateral hearing loss. Despite this, it wasn’t until 1967 that the concept was developed into a wearable device

References • Green, D.S., Yanagisawa, E. & Smith, H.W. (1967). CROS Hearing Aids: A Breakthrough for the Unilaterally Deaf Patient and for Others with Special Hearing Problems. Connecticut Medicine. 31(12), 855-858. • Sivak, M. (2013). Female Drivers in the United States, 1963– 2010: From a Minority to a Majority? Traffic Injury Prevention, 14(3), 259-260.

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59

Ear to the ground

for all things ear-related in the media This issue of Ear to the Ground begins with an interesting study on Fibromyalgia and Hearing Loss showing an increased prevalence in sufferers of this musculoskeletal disease. We also include articles highlighting the damage of modern living and recreational noise on the hearing system. Tinnitus has been in the media lately with well known musicians talking about the impact of both tinnitus and hearing loss on their daily lives. One featured article illustrates the devastating consequences that can happen when tinnitus becomes unbearable and highlights the need for rehabilitation and support. On a lighter note we have included an article on hearing restoration in deaf mice highlighting the advancement in gene therapy, an app which can be used to check hearing via a smartphone. We also explore the latest audiology news and views in the ‘twittosphere’.

Fibromyalgia increases the risk of hearing loss

Fibromyalgia is a chronic, widespread musculoskeletal pain disorder, which may be associated with an overall dysregulation of the central nervous system.This Norwegian study involved 44,500 participants and was published in the journal BMC Muskuloskeletal Disorders in December 2016. Results found that people with fibromyalgia are 4.5 times more likely to suffer from hearing loss than people without the illness. Participants with no pain-related problems were also included in the study as a control group, so it was possible to make a comparison. For information about the article go to: https://fibromyalgianewstoday.com/.../ probability-hearing-loss-higher-fibromyalgia The published study can be found at: https://bmcmusculoskeletdisord.biomedcentral.com/articles/ 10.1186/s12891-016-1331-1

Hearing lost and found......

Journalist Bella Bathhurst has published a book ‘ Stories of Hearing Lost and Found’, which covers her personal 12 year journey into gradual hearing loss through otosclerosis. Following successful surgery her hearing returned almost to normal. In the book she interviews people who were born deaf and those who have lost their hearing. She examines the psychological impact that losing your hearing has on a person and the association between hearing loss and poor mental health. Read this article at: https://www.theguardian.com/books/2017/may/04/ sound-losing-recovering-miracle-hearing-bella-bathurst

Primary Care Audiology in the news

Primary care audiology services in North Wales were featured in a recent ITV news article discussing improvements in the Welsh NHS. The audiology service was used as an example of how different models of working can increase effectiveness, and improve outcomes for patients. Original news article can be found at: http://www.itv.com/news/wales/2017-04-07/ culture-of-steady-and-sustained-improvement-in-welsh-nhs/

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60 Smartphone App designed to detect hearing loss makes a big noise in South Africa

A ‘hearScreen’ app has been developed by the University of Pretoria in South Africa. It is the first smartphone-based hearing test that allows acoustic calibration of test stimuli according to prescribed national and international standards. Original use was to screen hearing in remote African communites as all it requires is a smartphone and some headphones. It now has a wider global appeal and at present it is being used in 25 countries. https://www.theguardian.com/global-development/2016/dec/29/ app-designed-to-detect-hearing-loss-makes-a-big-noise-in-south-africa

The damage of modern living

The Independant highlights the fact that noise exposure accounts for over a third of all cases of hearing loss in developed countries, with city dwellers known to be more ‘at risk’. This article in ‘The Independant’ mentions a recent study in The Lancet which highlights a 64% increase in hearing damage if you live in a noisy city. Noise induced hearing loss is becoming a huge public health issue. The damage to hearing from noise exposure, increased risk of tinnitus and hyperacusis can impact quality of life and increase likelihood of a more serious hearing loss in older age. Work in Nottingham at the MRC is looking at ways to detect early hearing loss so that appropriate advice concerning ear protection can be issued. The article referred to in The Lancet was published in 2015 and titled ‘ Hearing Loss: a global health issue’. Volume 385, Issue 9972. To read the full article follow the link: http://www.independent.co.uk/life-style/health-and-families/ health-news/modern-life-is-damaging-our-ears-probably-more-than-we-realise-a7679786.html

Inspiral Carpets drummer took his own life after 20 years of ‘unbearable’ tinnitus

Inspiral Carpets drummer Craig Gill, 44 committed suicide following a prolonged struggle with tinnitus. His widow Rose Marie Gill issued a statement that her husband’s tinnitus became “so unbearable he felt there was no cure” and urged more awareness of the problem and men’s mental health. This tragedy highlights the impact that tinnitus can have without rehabilitation support. Data from the Samaritans also shows that the highest suicide rate in the UK was for men aged 40-44. Report from the Samaritans: http://www.samaritans.org/sites/default/files/kcfinder/ files/Suicide_statistics_report_2017_Final.pdf To read the full article follow the link: https://www.theguardian.com/society/2017/ may/05/inspiral-carpets-drummer-craig-gill-inquest-tinnitus

Hack my Hearing (podcast)

Interesting 28 minute podcast highlighting the damage caused by recreational noise from the viewpoint of a music lover. It covers their personal journey of hearing loss through to hearing aid fitting. The physiological aspect of noise induced hearing damage is covered and the podcasts includes interviews with other hearing professionals. It highlights the stigma that still surrounds hearing aid use, the delay in people seeking help with their hearing and the developments of modern hearing aids to help combat this. To listen to this podcast go to: http://www.bbc.co.uk/programmes/b03nt1st

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61 Advice on Cotton Buds

Dr Luisa Diller’s column in the Guardian highlights recent guidelines from the American Academy of Otolaryngology advising patients to stop using cotton buds to clean their ears. The advice for patients with occluding wax is to use eardrops (preferably oil based as they are less likely to irritate the ear) and have the wax removed professionally if needed.The risks involved in “ear candling” are also mentioned. Ernst (2004) assessed the scientific basis for ear candling, in particular the claim that inserting a hollow candle in the ear, lighting the other end, and burning for 15 minutes creates a “chimney effect”, creating capillary action to draw the wax out. They found that this mode of action is scientifically implausible, and that there is potential for injury through burns, and in a similar manner to cotton buds, potential to push wax deeper or perforate the tympanic membrane. Link to articles mentioned Ernst E. Ear candles: a triumph of ignorance over science. J Laryngol Otol. 2004 Jan; 118(1):1-: http://www.entnet.org/content/clinical-practice-guideline-cerumen-impaction To read the original article go to: https://www.theguardian.com/lifeandstyle/2017/may/22/ should-i-use-cotton-buds-to-clean-ears

Deaf mice have hearing restored

An article in the Daily Mirror highlights a new gene therapy technique which was found to restore hearing to near normal in profoundly deaf mice. Results were published in two articles in the journal ‘Nature Biotechnology’. The mice had a condition similar to a hereditary hearing loss in humans and after the gene therapy were reported to hear down to levels of 25dBHL. There are over 100 genes know to cause deafness in humans and in the second paper they treated mice carrying the mutated gene found in Ushers Type 1 C which is known to cause deafness and blindness. For the full article go to: http://www.mirror.co.uk/science/cure-deafness-discovered-scientistsafter-9768342

Deaf Singer Wows Reality TV Judges

Mandy Harvey, 29, was given the program’s rare Golden Buzzer by Simon Cowell, with an original song titled “Try”. Mandy has been singing since the age of four, but left music after losing her hearing. After being put through to the live shows, she told reporters “I figured out how to get back into singing with muscle memory, using visual tuners and trusting my pitch”. She was helped by a sign language interpreter to translate the judge’s comments, and removed her shoes to feel the music’s rhythm through the floor. The audience cheered the performance with Deaf applause – holding the hands in the air and twisting rather than clapping, which Mandy hailed on Twitter as “a small gesture of another broken barrier of communication”. Article can be found here: http://www.huffingtonpost.com/entry/deaf-singer-wows-americas-gottalent_us

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With the BSA conference in recent memory, in this edition we focus on the concise stand out messages shared by delegates on Twitter with the limit of 140 characters per tweet. For our featured profile, we share historical images from a key member of the BSA team.

Tweets on the first day of the conference focussed on international speaker @DrFrankLin Sarah Riches Music @sarahrichessong . Jun 29 Great opening talk on “Hearing, Cognition & Healthy Ageing” by Dr Frank Lin at BSA 2017 Conference @BSAudiology1 #BSAConf BritishSocAudiology @BSAudiology1 . Jun 29 Healthy ageing is the driver through work on hearing loss for Frank Lin #BSAConf Hearing & Dementia @HearingDementia . Jun 29 Hearing loss may be a late life moifiable risk factor for cognitive decline and dementia. ACHIEVE study in US looking to test this #BSAConf ENT & Audiology News @ENT_AudsNews . Jun 29 By 2050 1 in 30 will be effected by dementia, Dr Frank Lin #ENTAuds #BSAConf Professor Iain Bruce @Prof_IainBruce . Jun 29 Enjoyed listening to Frank Lin’s talk on hearing loss as a potenitally modifiable late-life risk factor for dementia @BSAConf @BSAudiology1

But there were many excellent speakers throughout the whole conference Hearing & Dementia @HearingDementia . Jun 29 Groundbreaking benefits of primary care audiology in Wales - Sudden hearing loss treated same day! Tinnitus supported same day! #BSAConf Sarah Hughes @SarahHughesSLT . Jun 29 @BSAudiology1 “our world isn’t linear” Hearing health care and complexity theory. Dr. DAvid Charnock

Twitterarty Sarah Bent @HearingDementia, updates on and attempts to demystify the audiology Twitter community known as #audpeeps

Sebastian Hendricks @Hearing4Kids . Jun 29 PDAs can help patients to make decisions, but we need to give them #TimeToThink in order to be partners in the process @BSAConf #BSAConf BritishSocAudiology @BSAudiology1 . Jun 30 AS the noise increases the focus moves from looking at people’s eyes to their mouth - Graham Naylor #BSAConf #TedEvansLecture

The second day included excellent sessions run by each of the BSA special interest groups – including Cognition in Hearing (CHSIG)… Nicola Wright @DrNicolaWright . Jun 30 @HearingDementia outlinging the process adn importance fo clinical guidelines for audiologists in working with dementia Dr David Charnock @davtravb . Jun 30 @DrNicolaWright talks about the value of collaborative working as part of a new MIN for hearing in Nottingham #BSAConf

Adult rehabilitation (ARIG) Laura Turton @LauraFromTheBSA . Jun 30 Patients should be heard more, #audpeeps should be heard less #BSAConf @Louise_Hickson Mel Ferguson @Mel_Ferguson1 . Jun 30 @Louise_Hickson Language Matters. Addressing psychosocial concerns on HL is essential aspect of PCC. #arig #BSAConf

Paediatric SIG...

Jeff Davies @Dr_jeffdavies . Jun 29 Dr Frank Lin: Additional models of accessible hearing health care needed #Apple #Siemens are knocking at the door! @BSAudiology1 @BSAConf

Sebastian Hendricks @Hearing4Kids . Jun 30 Filtering familiar songs to specific frequency band allows children recognise them & make assessments frequency specific @BSAConf #BSAConf

Mel Ferguson @Mel_Ferguson1 . Jun 29 @agnes_houston gives personal account of dementia and sensory problems. Real world challenges. #BSAConf #BSAConf

Sarah Riches Music @sarahrichessong . Jun 30 Excellent work going on at Guys & StThomas NHS Trust in testing children with complex needs. Showcased at @BSAudiology1 #BSAConf #Audpeeps

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63 Balance (BIG)... BritishSocAudiology @BSAudiology1 . Jun 29 Elena Calzolari talks about Coupling perception and reflex #vestibular #BSAConf @BSA_BIG BSA BIG Forum @BSA_BIG . Jun 29 #bsaconf Electrical vestib stimulation, CBT in vestib rehab, instructions re. Driving, EMBalance decision support. Balance Interest Group

Tinnitus SIG...

For the 50th year of the BSA our featured #audpeep is Laura Turnton, @LauraFromTheBSA, with her regular throwback Thursday (#TBT) images from the history of the BSA

BritishTinnitus @BritishTinnitus . Jun 30 Prefs for treatment centred around control & tailored/ curated info #BSAConf BritishTinnitus @BritishTinnitus . Jun 30 Minimum standard of practice agreed + tinnitus therapy guide now available with protocol #BSAConf #tinnitus #MRC

Auditory Processing Disorder SIG...

Laura Turton @LauraFromTheBSA . Jul 13 #TBT Prof Ted Evans was @BSAudiology1 Chair 19982000 and attnded @BSAConf 2017 to hear the Ted Evans lecture by Graham Naylor @MRCihr

Hearing & Dementia @HearingDementia . Jun 30 Final session of @BSAudiology1 conference with APD special interest group - processing sound depends on attention, memory, fatigue #BSAConf Sebastian Hendricks @Hearing4Kids . Jun 30 Environmental modifications, compensory strategies, remediation activities based on APD problems #audpeeps #BSAConf @BSAConf

And the new Global SIG... Sebastian Hendricks @Hearing4Kids . Jun 30 Bhavisha @SoundSeekers found sound proved room an dstarted paediatric audiology clinic Lusaka in Zambia @BSAConf #BSAConf Sebastian Hendricks @Hearing4Kids . Jun 30 Interested giving your professional time to improve global hearing health? tinyurl.com/zcryvjf @BSAConf #BSAConf #hearmalawi

Tweets were very positive about the whole conference Donna Corrigan @Corrigd_17 . Jun 29 Great first day #BSAConf @BSAudiology1 informative and interesting presentations and posters #loveaudiology!

Laura Turton @LauraFromTheBSA . Jun 8 Programme content of 2nd @BSAConf @BSAudiology1 turns 50

Laura Kelly @DrLauraMargaret . Jun 29 Fab day so far at the @BSAudiology1 conference (including delicious dessert)! Learnt loads already that is relevant to my research #BSAConf Hearing & Dementia @HearingDementia . Jun 30 Fantastic conference @BSAudiology1 @LauraFromTheBSA The litmus test is the size of the to do list resulting from the networking - IT’S HUGE! Sebastian Hendricks @Hearing4Kids . Jun 29 The 2017 @BSAConf #BSAConf has come to an end. Excellent and back in Brighton 07+08 June 2018. THAnK YoU!

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64 Laura Turton @LauraFromTheBSA . Jun 8 #TBT with just over a month to go for @BSAConf lets take a look at the first BSA Conf #Dundee #1971

No day trip programme for partners at #BSAconf 2018 (!) but there will be seaside – hope to see you there. Laura Turton Retweeted BritishSocAudiology @BSAudiology1 . Jun 30 See you all in Brighton for #BSAConf 2018 for ‘Inspiring Connections’

Laura Turton @LauraFromTheBSA . May 4 #TBT as @BSAudiology1 turns 50 @DrDavidBaguley gets the Thomas simm Littler prize in 1993 @hearingnihr @ENT_AudsNews

Join us on Twitter @BSAudiology1

Laura Turton @LauraFromTheBSA . Jun 8 Did you know that @BSA_BIG was the first @BSAAudiology1 Special Interest Group #TBT #1991

Laura Turton @LauraFromTheBSA . Jun 15 1992 the first European conference held by @BSAConf #TBT as @BSAudiology1 turns 50

Laura Turton @LauraFromTheBSA . Jul 6 #TBT :John Knight #foundingfather is the only member to get the BSA Gold Medal for a lifetime fo distinguished service @BSAudiology1

Follow us on Twitter to keep up to date with BSA courses, meetings and conferences. Find out about relevant events and conferences worldwide; as well as all the latest news from the world of audiology. Get involved by sharing meeting photos and contributing to regular discussion points and surveys.

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British Academy of Audiology

14th Annual Conference

16-17 NOVEMBER 2017 Bournemouth International Centre

Early bird price valid until:

2nd October 2017

@BAAudiology | #BAAConf British Academy of Audiology

More information is available on

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66 PRES S RELE ASE Organisational Changes at Sivantos Limited New Appointment: David Smith – Managing Director Effective July 1st David Smith will become the new managing director at Sivantos Limited, Crawley, UK. David has 28 years of experience in the hearing aid industry. He joined Sivantos (formerly Siemens Hearing Instruments) as Cost Accounting Manager in 1989 becoming Company Accountant and Commercial Manager before Finance Director in 2004. Prior to Sivantos he worked for Duracell in several sales and technical marketing management positions promoting and selling technical battery solutions to UK government suppliers. Initially qualifying as a chemist, David is also a Member of the Chartered Institute of Purchasing and Supply (MCIPS) and has a MBA from Kingston University. With his extensive experience of the UK hearing market we believe David will be able to strongly contribute to our group ambition of becoming the number one hearing instrument provider globally.

Departing: Trevor Andrews After ten years as Managing Director at Sivantos Limited (formerly Siemens Hearing Instru-ments), Trevor Andrews has left the organisation to pursue new opportunities. Trevor, with his team, has lead the company through great periods of change as well as representing the company on many industry bodies. We would like to thank him for his support and contribution during this time and wish him well with his future endeavours.

Sivantos Limited formerly Siemens Hearing Instruments Ltd (Crawley, West Sussex) provides a comprehensive range of digital hearing instruments and software, patient management systems and audiology equipment to the National Health Service, independent retail dispensers and national chains in the UK. It is the UK operation of Sivantos Group, which is one of the world’s leading manufacturers of hearing instruments, With 5,000 employees. Sivantos’ international sales organization supplies products to hearing aid specialists and sales organizations in more than 120 countries. Particular emphasis is placed on product development. The owners of Sivantos are the anchor investors EQT together with the Strüngmann family as co-investors. Sivantos Limited is a Trademark Licensee of Siemens AG. Further information can be found under www.sivantos.co.uk

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Essentials Council Members / Meeting Dates Officers Mrs Elizabeth Midgley – Chair Dr Ted Killan – Vice Chair Dr Gareth Smith – Secretary Mr Barry Downes – Treasurer Elected Trustees

BSA COUNCIL MEETNGS Council (3rd Tuesday of the month) – all Trustees and (Advisors when requested / required) All Council Meetings are planned to run from 10.30am – 4.30pm unless notified otherwise

Dr Peyman Adjamian Ms Siobhan Brennan

19th September 2017

Dr Carmel Capewell

5th December 2017 27th March 2018

Mrs Carolyn Dando

26th June 2018

Dr Piers Dawes

25th September 2018

Mr John Day Dr Christian Fullgrabe (Council Advisor for Cognition in Hearing Special Interest Group)

Dr David Greenburg Dr Imran Mulla

4th December 2018

Meeting dates and venues may be liable to change

Mrs Yvonne Noon Dr Sudhira Ratnayake Council Advisors Dr Michael Akeroyd (International Journal of Audiology Representative) Dr Nicci Campbell (Auditory Processing Disorder Special Interest Group) Mr Nathan Clarke (Student Advisor) Mrs Donna Corrigan (Professional Guidance Group) Dr Mel Ferguson (Adult Rehabilitation Interest Group) Mr John Fitzgerald (Electrophysiology Special Interest Group) Ms Verity Hill (Paeditric Audiology Interest Group) Dr Derek Hoare (Tinnitus & Hyperacusis Special Interest Group) Prof Kevin Munro (INsternational Journal of Audiology Representative) Miss Charlotte Turtle (Social Media Coordinator) Ms Gemma Twitchen (Global Outreach Special Interest Group)

For more information, please contact BSA Tel: 0118 966 0622 Fax: 01506 811477 Email: bsa@thebsa.org.uk Web: www.thebsa.org.uk British Society of Audiology Blackburn House Redhouse Road Seafield, Bathgate, EH47 7AQ

Mrs Jane Wild (Audacity Magazine Editor) Mr Andrew Wilkinson (Balance Interest Group)

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Essentials Examination Passes The following students have passed accredited BSA courses over recent months: July 2017

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (Mary Hare Training School) Paula Lancashire

Michelle Bladys

Jill Still

Lesley Brown

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (Starkey) David Jackson

Laura Ainsworth

Jessica Brazier

Robert Johns

Stacey Angel

Peter Avery

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (T J Audiology) Darren Bethnall

Katarzyna Bethell

Adam Naperty

Innes Jackson

Victoria Nickless

Caroline Smith

Joanna Carter

Kira Smith

Kate Marshall

Scott Wilson

Karen Tse

Gary Wong

Jackie Mok

Linus Ma

Cygnus Wong

Isabel Wong

Yvonne Ngai

Joanna Ng

Amanda Hall

Angela Barker

Arran Smith

Helen Barth

Mozlufa Begum

Sam Wray

Debi Fletcher

Eleanor Brown

Sharon Bingham

BSA Certificate in Industrial Audiometry (Albacare) John McKenzie

Dorothy McRobbie-Dalchow

Lorna Cantley

Lisa Ward

Hayley Gerrard

Lisa Cooke

Mathew Burton

Larry Fottles

Mary Walsh

Joanne Henshall

Andrew Holliday

Ian Hughes

Eryl Bradfield

Val Saxon

Lauren Johnston

Charity Craig

Aoife Carroll

Colin Johnson

Cherith Campbell

Tom Malone

Cherith Campbell

Blinne McComiskey

Bernadette Gallagher

Gemma Wylie

Susan Price

Samantha Jane Mayor

Julie Beath

Eileen McMillan

BSA Certificate in Industrial Audiometry (PROHMS) Ester Gilbert

Wendy Renwick

Sandra Babbings

BSA Certificate in Surveillance Audiometry (recently replaced the Certificate in Industrial Audiometry) (PROHMS) Kiran Sidhu

Przemyslaw Hankus

Tom Humphries

Kallum Lee

Lee May

Christian Cardwell

Kelly Symonds

Oliver Compton

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69 Continued

BSA Certificate in Industrial Audiometry (T J Audiology) Alison Bell

Kathryn Edwards

Dee Lloyd

Eleri James

Polly Barber

Carley Paton

Tracie McKelvie

BSA Certificate in Basic Audiometry and Tympanometry (T J Audiology) Selbyen Gadong

Kate Haining

Stephanie Franklin

Karen Tse

Linus Ma

Joanna Ng

Isabel Wong

Yvonne Ngai

Hinson Wong

Congratulations to all candidates Details of all accredited course providers, together with information on providing accredited courses, are available from the BSA office and via the BSA website www.thebsa.org.uk. The BSA also retains a list of delegates who have completed accredited courses. BSA have recently replaced the BSA Certificate Industrial Audiometry with the BSA Certificate Surveillance Audiometry.

BSA Connections and Collaborations where we represent you March 2017

May 2017

2 March, Midlands Health Psychology Network 13th Annual Conference as a Keynote speaker in Coventry

3 May, Nottingham Attended the Ear Foundation’s AGM

3 March, London Action Plan for Hearing Loss review 10 March Meeting with Hear the World 14 March Meeting with the National Community Hearing Association 22 March Meeting with the British Society of Hearing Aid Audiologists

July 2017 4 July Attended the Healthcare Science

5 May Ongoing work with the Ida Institute

Strategy meeting hosted by

5 May Meeting with the Coalition for Collaborative Care

12 July, Newport

12 & 13 May, Colchester British Society of Hearing Aid Audiologists Congress 15 May Visit to PC Werth June 2017

NHS England

Attended the Nesta Post Truth Event August 2017 7 August Ongoing work with the Coalition for Collaborative Care September 2017 4 September, Nottingham

24 March Visit to Starkey

1 June Attended the launch of the Nottingham Biomedical Research Centre

27 March Meeting with the British Tinnitus Association

6 June Attended the launch of the Manchester Biomedical Research Centre

Attended the British Tinnitus

April 2017

9 June Meeting with the Starkey Foundation

14 September

3 April Meeting with the British Academy of Audiology 28 April Meeting with Combat Stress

23 June, Swansea Attended Audiology Cymru 29 & 30 June, Harrogate Hosted the BSA Annual Conference

Attended the BSA Basic Science Meeting 7 September Association Conference

Attended the quarterly meeting of the Coalition for Collaborative Care 21 September Attended the Action Plan for Hearing Loss oversight group

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Essentials Organisational Members

Corporates Third and Public Sector Departmental

The partnership with Organisational Members of the British Society of Audiology (BSA) is of fundamental importance to the Society. As the largest multidisciplinary society concerned with hearing and balance in the UK, the BSA seeks to include commercial colleagues and organisations in its mission to promote knowledge, research and clinical practice in these areas. Being an Organisational Member places an organisation in close dialogue with senior members of the BSA, supporting meetings and publications. The outworking of this are yearly meetings between the Officers of the BSA and the Organisational Members to share information and perspectives on the strategic direction of the BSA. Organisational Members have direct input to the Learning Events Group, and their input is especially valued in the organisation of meetings and supporting exhibitions, these being a crucial element of successful events. ACOUSTIC METROLOGY LIMITED Manufacturers of VRA systems. Repair service of Audiometers, tympanometers and acoustics instruments. E: info@a-met.com W: www.a-met.com

INDUSTRIAL ACOUSTICS COMPANY LTD World leader in the design, supply and installation of high performance, state-of-the-art of Audiometric Rooms. E: info@iac-acoustics.com W: www.industrialacoustics.com/uk

PHONAK UK Phonak offers latest product information, an interactive content about hearing and a specific children section W: www.phonak.com

ADVANCED BIONICS A Sonova Brand – is a global leader in developing the most advanced cochlear implant systems in the world. Founded in 1993 and a subsidiary of the Sonova Group since 2009, AB develops cuttingedge cochlear implant technology that allows recipients to hear their best. E: info.uk@advancedbionics.com W: www.advancedbionics.com

INTERACOUSTICS

PURETONE LIMITED Manufacturers of quality digital and analogue hearing aids, tinnitus management systems. E: info@puretone.net W: www.puretone.net

AUDITDATA LIMITED Auditdata provides office management systems for hearing clinics, innovative audiometry fitting systems, and hearing instrument testing. E: uksupport@auditdata.com W: www.auditdata.com

OTICON LIMITED Oticon designs and manufactures both hearing solutions for adults, and specialized paediatric instruments. E: info@oticon.co.uk W: www.oticon.co.uk

QUIETSTAR With over 100 years collective experience within the design, manufacture, delivery and installation of noise control products and services, QuietStar Limited is fast becoming the UK’s leading noise control provider. E: info@quietstar.co.uk W: www.quietstar.co.uk

BIOSENSE MEDICAL LIMITED Biosense Medical supply specialist equipment for use in Audiology, Vestibular and Balance, Neurophysiology, Pressure Measurement, Human Movement and Biomechanics W: www.biosensemedical.com

OTICON MEDICAL

SIVANTOS LIMITED Leader in the provision of digital hearing systems to the NHS and private hearing aids dispensers. E: info-hearingaids.shi.ukhealthcare@siemens.com

OTODYNAMICS LIMITED Otodynamics Ltd. pioneered OAE screening 25 years ago and sells a wide range of OAE screening and diagnostic instruments and makes in-house research and development its top priority E: sales@otodynamics.com W: www.otodynamics.com

SPECSAVERS Specsavers is largest provider of the free NHS digital hearing aids and 60% of its 17.3m customers in the UK are from the NHS. W: www.specsavers.co.uk

P C WERTH LIMITED PC Werth supplies calibrate and service the UK’s leading range of instruments for every diagnostic and audiology need. E: sales@pcwerth.co.uk W: www.pcwerth.co.uk

THE TINNITUS CLINIC The Tinnitus Clinic is the leading provider of the latest evidence-based tinnitus treatments in the UK. W: www.thetinnitusclinic.co.uk

ECKEL

From product testing to research laboratory, Eckel noise control has played an integral role in technological advances in science, industry and commerce. Today, engineers and scientists utilise Eckel anechoic chambers and noise control products to improve the technology that affects our lives and the environment for our future. E: info@eckeleurope.co.uk T: +44 (0)1276 471199 W: http://eckeleurope.com

GUYMARK UK LIMITED Guymark is a distributor of GSI audiological equipment, Vivosonic ABR equipment and Micromedical Technologies balance equipment E: sales@guymark.com W: www.guymark.com

Interacoustics is the world’s leading provider of solutions for measurement and diagnosis within hearing and balance. With more than 45 years’ experience, Interacoustics prides itself on listening to and supporting its customers to deliver the very best diagnostic solutions for their patients. This is accomplished by maintaining a continuous dialogue with healthcare professionals working in all sectors of audiology, neurology and physiotherapy.

W: www.interacoustics.com

Oticon Medical is a global company in implantable hearing solutions, dedicated to bringing the magical world of sound to people at every stage of life. As a member of one of the world’s largest groups of hearing health care companies, we share a close link with Oticon and direct access to the latest advancements in hearing research and technologies. E: info@oticonmedical.com W: www.oticonmedical.com

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72 WIDEX

Widex is a family owned company founded in Denmark in 1956. Today, it is one of the world’s largest manufacturers of hearing aids. Widex hearing aids are sold in more than 100 countries around the world, and the company employs over 4,000 people worldwide. We develop digital technology at a level of quality that few can match, and this has forged our reputation as one of the most innovative manufacturers in the industry. W: www.widex.co.uk

AUDIOLOGY, NHS FREEMAN HOSPITAL

ACTION ON HEARING LOSS

DEAF EDUCATION THROUGH LISTENING AND TALKING (DELTA)

THE BRITISH TINNITUS ASSOCIATION The British Tinnitus Association (BTA) is a world leader, with a trained team of friendly and experienced advisers for anyone who experiences tinnitus or those simply seeking guidance or information about the condition. E: info@tinnitus.org.uk W: www.tinnitus.org.uk

Our highly skilled and experienced Audiologists provide a comprehensive Audiology and Hearing Aid Service for the Newcastle, North Tyneside and Northumberland region. We provide a range of specialist tests and individual management plans W: www.newcastle-hospitals.org.uk/services/ent_ services_audiology-and-hearing-aid.aspx

NATIONAL COMMUNITY HEARING ASSOCIATION We are the voice of community hearing care throughout the UK and are committed to better hearing care for all.

DELTA is a voluntary association of young deaf adults, the families and teachers of deaf children and is a national charity which supports and develops the Natural Aural Approach to the education of deaf children. Both the Approach and the Association trace their origins back to a group of teachers of the deaf working together from 1980 to improve the outcomes for deaf children. W: www.deafeducation.org.uk

E: info@the-ncha.com W: www.the-ncha.com

THE EAR FOUNDATION The Ear Foundation – bridging the gap between clinic-based services, where today’s exciting hearing technologies, such as cochlear implants & bone conducting hearing implants are fitted, and home, school and work where they are used in daily life. E: info@earfoundation.org.uk W: www.earfoundation.org.uk

INSTITUTE OF HEARING RESEARCH, THE MEDICAL RESEARCH COUNCIL (MRC) MRC improves the health of people in the UK – and around the world – by supporting excellent science, and training the very best scientists. We are a non-departmental public body funded through the government’s science and research budget. W: www.mrc.ac.uk

Action on Hearing Loss is the largest UK charity helping people confronting deafness, tinnitus and hearing loss to live the life they choose. Action on Hearing Loss enables them to take control of their lives and remove the barriers in their way, giving people support and care, developing technology and treatments, and campaigning for equality. W: www.actiononhearingloss.org.uk

AUDIOLOGY, NHS TAYSIDE

Our aim is to provide a high quality, patient focused, comprehensive service for Audiological and Vestibular impairments. Using the most up to date equipment our specialist teams provide a wide range of assessments, rehabilitation and habilitation in Adults and Children with various Audiological and Balance disorders. W: www.nhstayside.scot.nhs.uk/ OurServicesA-Z/AudiologyandBalanceServices/ index.htm

Previous digital versions of

Audacity are available at:

www.thebsa.org.uk

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The research at Aston University...

Under Pressure: NHS Audiology across the UK. "Tectorial membrane in a 'near live' position on top of the outer hair cell steriocilia. Photo courtesy of Andrew Forge, UCL Ear Institute."

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Cerebellar Ataxia with Neuropathy and Vestibular Areflexia Syndrome...

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audacity@thebsa.org.uk

issue 8 May 2016 .........................

Auditory training can improve cognition and communication....

The Role of the School Entry Hearing Screen....

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...a British Society of Audiology Publication

SPECIAL FOCUS

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Audacity

...a British Society of Audiology Publication

Hearing aid provision in the NHS

OAEs: they just keep coming back

Audiology in India

Audacity issue 6 May 2015 ..........................

issue 5 December 2014 ..................................

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Teach a man to fish and you feed him for a lifetime...

The Dichotic Hearing Test - a brief history

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Can drugs make you hear better?

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Essentials Audacity Advertising rates THE BSA ADVERTISING RATES : 2017 / 18 The following rates are in to force on 1st June 2017 and will be in place for 12 months. The British Society of Audiology provides different methods of advertising opportunities which are listed below. All prices are subject to VAT Website Advertising Cost (£) Jobs listing x 1(1 month)* £ 225 (2 month) £ 375 Commercial courses/events** £ 125 Commercial courses (without website) £ 80 Non-commercial external courses/events** £ 90 Non-commercial external courses (without website) £ 60 *

includes e-update listing / **includes website for 1 month

All courses are listed on our events page in day order and can be found here www.thebsa.org.uk/events/event The website has on average 3,600 users each month and 14,500 unique page views. We collate statistics on the website on a quarterly basis which we can share with you.

Audacity Magazine: (per issue) Discounts - 15% series discount for 2 editions (sponsors receive 35% discount) 1/4 Page colour 1/2 Page colour Full A4 Page colour Double page spread colour Full page colour inside front or back cover Product News (125 words max + 1 small jpeg image)

£ 200 £ 350 £ 650 £ 1100 £ 1100 £ 135

Loose Inserts up to 100g up to 200g Max size: A4 (1300 flyers provided by the customer)

£ 500 £ 900

BSA Grow (available to Corporate Members only) Launched in July 2017 to all BSA members, BSA Grow is an online learning community. It is a flexible online and cost-effective way for people to stay up to date with the evidence and underatke their CPD. A full tour of corporate opportunities with this system can be found here https://secure.icohere.com/BSA?pnum=QXQ55135

Banner Advertising

£ 295

Company Webinar (opportunity to present a programme of your choice for up to 20 mins)

Recorded for you by BSA Recording provided by you

£595 £495

Print ready artwork Pass4Press PDF – Adverts must be supplied as Pass4press PDFs. To download settings for InDesign & QuarkXpress please visit www.pass4press.com. PDFs generated with these settings will be compatible with our commercial printer. Please note that we do not accept the following: RGB, colour-managed or ICC profiles, non-embedded fonts, images lower that 200dpi and transparency. If any of these elements are in the artwork then a report will be generated, sent to the client and a replacement must be sent. Adverts to be typeset by publisher Word document - Please supply the raw text as a word document and supply any images and EPS, TIFF or JPG files separately. Production charges will be applied to adverts typeset by the publisher. For further information please see www.thebsa.org.uk/ wp-content/uploads/2015/12/Audacity-Advert-Spec.pdf

2017 - 18 AUDACITY PUBLICATION SCHEDULE Advertisements (copy date deadline)

Audacity (dispatch date)

1st January 2018 1st July 2018

15th March 2018 15th September 2018

For more information please contact the BSA Administration Team by:

Catriona Rice E: catriona.rice@fitwise.co.uk T: 0118 966 0622 E: bsa@thebsa.org.uk W: www.thebsa.org.uk

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