AUG/SEPT 2025
DEFER REGISTRATION, SAYS NRAS PAPER
A review of complexity in the scheme recommends deferring any decision on Ahpra registration for audiologists 20
BOOSTING COCHLEAR IMPLANT UPTAKE
Surgeons and audiologists explain how health practitioners can work together to improve adoption 34
VESTIBULAR CONDITIONS UPDATE
Vestibular audiologists and a neuro-otologist discuss latest trends and how to bring a vestibular clinic to life
A review of complexity in the National Registration and Accreditation Scheme (NRAS), which regulates 16 health professions in Australia, has recommended deferring any decision on including audiology in the current NRAS model.
It suggests postponing a decision until a resolution is made on whether there will be a new pathway for allied health professions into the scheme.
Health ministers will decide if audiology should be included in the scheme, informed by advice arising from Queensland’s Audiology Regulatory Impact Statement (RIS). The statement recommends audiology be registered under the NRAS and the Australian Health Practitioner Regulation Agency (Ahpra). While Australia’s health
ministers have agreed in-principle, no formal decision has been made.
In May 2025, independent reviewer and former NSW Health Care Complaints
Commissioner Ms Sue Dawson released Consultation Paper 2: Consultation Outcomes and Reform Directions for the Independent Review of Complexity in the National Registration and Accreditation Scheme.
A Department of Health, Ageing and Disability spokesperson said health ministers would consider expansion of the National Scheme as part of the final report of the review in September.
The paper states: “No decision on inclusion of audiology in the National Scheme should be taken at this time. If Health Ministers determine that inclusion of this
and costing of an Approved Professions Registration Model. The review noted there was ongoing consideration of inclusion of audiology in the National Scheme and further cost benefit assessment was underway.
profession should remain under consideration, the sponsoring jurisdiction has the opportunity to resubmit the proposal for inclusion once it is known whether and when a new pathway into the National Scheme will be established, following completion of Action 2.3.”
Action 2.3 recommends a Health Workforce Taskforce prioritise further detailed design
Early signs of hearing improvement have been observed in an Australian toddler who received gene therapy for congenital deafness, the biotechnology company developing the treatment has confirmed.
And a surgeon involved in trialling the therapy also confirmed encouraging “onset of early auditory responses” in all five patients treated plus a good safety profile for the treatment and procedure.
The company, Sensorion, said the children were treated with its SENS-501 (OTOF-GT) therapy via intracochlear injection.
“Three-month results from a SENS-501 treated toddler in the first cohort demonstrate early promising hearing improvement,” it said in a press release in July 2025.
“In cohort one, early signs of hearing improvement were observed in patient three, aged 11 months at the time of injection.”
A spokesman for the French company told HPA the infant known as patient three is Australian. Another Australian toddler and three other children overseas also received low doses of the therapy in late 2024.
“The clinical response observed (in patient three) was evaluated
using standard hearing tests carried out by the investigators (Auditory Brainstem Response [ABR], Pure Tone Audiometry, and Patient [Parents] Reported Outcomes),” Sensorion said.
Three-month data from the patient include: positive ABR responses at two frequencies, with the best frequency reaching 70 dB; improvement of hearing levels across two speech frequencies with best frequency reaching 90 dB level, per PTA; and meaningful changes in response to sounds and voices as reported by the parents with an IT-MAIS score increase of 16 points (145% relative
A department spokesperson said the paper was not considering specific professions or recommending their inclusion or exclusion but was “proposing a framework for structured decisions about entry to the National Scheme and options for regulation”.
“In mentioning audiology, the review is noting that there may be an additional option for regulation that can be considered in the event that a ministerial decision is taken to include audiology in the
continued page 8
ENT surgeons will have unbridled access to clinical and academic leaders in the field in the inclusive environment of Frontiers 2025 conference in Tasmania in November. HPA previews audiology/otology speakers. page 42
continued page 8
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Giving people wings
Artist Priscila Soares creates magical artwork of characters and people wearing hearing assistive devices.
ADF Industries is a family business that excels in manufacturing soundproof booths and audiometric rooms.
Advancements in diagnosis and treatment including cochlear implants for SSD mean great outcomes can be achieved.
More awareness about dizziness is needed among health and hearing care practitioners and the public.
As HPA went to press, the audiology world lost a giant in the field, Dr Jack Katz from America, who passed away aged 91 in July. His influence on audiologists worldwide, including in Australia, was immense.
Audiology bodies, universities, colleagues, friends and former students paid homage on websites and news outlets with LinkedIn flooded with tributes for a man who everyone said was always kind and smiling.
Dr Katz was editor-in-chief of seven editions of the Handbook of Clinical Audiology, recalled University of Toronto adjunct professor Dr Marshall Chasin in The Hearing Review.
Best known for his development of the Bu alo Model for central auditory processing disorder (APD) assessment and therapy, Dr Chasin said Dr Katz was a researcher, author, speaker and clinician.
The American Academy of Audiology (AAA) remembered a “towering figure in the field of audiology whose influence has left an indelible mark on generations of clinicians, educators and researchers”. It said his legacy endures “in the foundational knowledge, diagnostic tools, and commitment to excellence that define audiology today”.
He was also known for the pioneering Staggered Spondaic Word (SSW) tests, AAA said, adding he left “a legacy of innovation, humanity and a profound dedication to helping others hear and understand the world around them”.
Starkey’s chief hearing health o cer Dr Dave Fabry said generations of students developed a fascination for audiology through Katz' comprehensive text “from being frustrated by masking dilemmas” to “realising the magical way hearing and the brain connects us to each other". An amazing legacy and man, he added.
In a tribute that Dr Angela Alexander wrote on the HPA website, the ex-pat American audiologist who recently lived in Australia and studied under Dr Katz, said the audiology community often joked you could carbon-date a professional by the colour of their “Katz handbook” from graduate school.
But she said the driving passion behind his work was APD, its intricate testing, and transformative treatment.
“I am but one of thousands who proudly consider Dr Jack Katz their mentor. His influence stretched globally… and he was a guiding light for countless audiology professionals,” she said. “There will never be another quite like him, but I firmly believe that if we each strive to embody even a fraction of his compassion, wisdom, and dedication, this world will undoubtedly be a much better place.”
There's no doubt Dr Katz's incredible legacy will live for generations, continuing to help milions.
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Just as HPA went to print, MARK BUTLER, the health minister, announced adults with post-transplant cytomegalovirus (CMV) will have access under the Pharmaceutical Benefits Scheme to Livtencity (maribavir) to treat illness caused by CMV. CMV can cause serious complications in transplant recipients due to their compromised immune systems, and sensorineural hearing loss is one potential consequence. The antiviral medicine is used to treat CMV infections in people post-transplant when other treatments have not worked. Without
the PBS subsidy, they could pay more than $39,000 for a course of treatment. The Therapeutic Goods Administration approved the drug for this indication in October 2022. IN OTHER NEWS, a Macquarie University study in wearers of hearing aids and cochlear implants has identified variability in hearing healthcare from GPs and audiologists. “Some reported positive relationships with their GPs and audiologists, but many felt their needs weren’t being understood as well as they could be,” said senior author, Professor Bamini Gopinath. One concern was GPs often did not raise hearing health during consultations. Participants wished their clinicians had better knowledge
and understanding of hearing health and related problems. Prof Gopinath said findings reinforced it was time to move to an integrated hearing care journey and recognise hearing health as being central to ageing well. FINALLY, five Australian organisations have released a video series, and one has produced an employer handbook, to equip businesses with practical strategies to foster career progression for Deaf and Hard of hearing employees. The series showcases stories of inclusivity from Australia Post, Deaf Connect, The National Disability Insurance Agency, Victorian College for the Deaf, and Western Australian Department of Biodiversity, Conversation and Attractions.
Weird
Scientists have unveiled a new imaging method, FREQ-NESS or Frequency-resolved Network Estimation via Source Separation, that disentangles overlapping brain networks based on their dominant frequency. Their study used this imaging to reveal the brain “dances” to music and doesn't simply register sound but reconfigures itself, reshaping its organisation in real time, in response to sound. The researchers from Denmark’s Aarhus University and the University of Oxford, UK published findings in Advanced Science
Wonderful
A Japanese study has found that sound insulation tiles at school or daycare can help calm crying children. Ikuri Matsuoka from Kumamoto University installed polyester fibreboard onto one classroom’s ceiling and compared it to another classroom without any fibreboard insulation. Children were also louder in the room without the insulation. Findings were presented at the International Congress on Acoustics in May 2025.
Wacky
More than 50% of surgeons experience burnout. ENT surgeons rank among those at higher risk, says clinical psychologist Ms Kirsten McKenna who provides tips to help in the lead up to R U OK? Day. Page 45.
Chinese researchers have enabled ear tissue regeneration in mice by flipping an evolutionarily disabled genetic switch involved in Vitamin A metabolism. They said, in Science on 26 June 2025, that single-cell RNA sequencing and spatial transcriptomic analyses show that regenerative species activate a gene called Aldh1a2. It is critical for producing Vitamin A or retinoic acid (RA), a signalling molecule essential for regeneration. They found that supplying RA externally, or activating Aldh1a2 using a gene enhancer from rabbits, was enough to restore regenerative ability in mice.
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continued from page 3
scheme,” the spokesperson said.
The paper proposes a “coherent regulatory policy framework for the entire health workforce and a manageable pathway for growth of the National Scheme”. “There is not an overarching framework for the regulation of health professions,” the paper said.
Audiology Australia (AudA) welcomed the paper’s release and acknowledged its recognition of challenges faced by self-regulated professions like audiology. “We note that the paper recommends deferring any decision on including audiology in the current NRAS model,” AudA said. “We have advocated strongly for a regulatory model that increases consumer protections and supports improved recognition of audiology including protection of title. We acknowledge and support the intention to explore other regulatory pathways through the proposed ‘Approved Professions Registration Model’.”
AudA said the paper highlighted
important systemic issues that had long impacted the audiology profession.
“These challenges contribute to reduced visibility of audiology within broader health reforms and public programs,” it said.
“Audiology Australia remains committed to working constructively with governments, regulators and the community to ensure that any future model delivers appropriate safeguards, equitable recognition, and improved outcomes for consumers.
"We urge government to continue to provide a transparent and timely process to avoid further delay in addressing long-standing gaps in the regulation of audiologists.”
In its submission to the paper, AudA said it was not opposed to registration under the NRAS, but the process was not completed under best practice consultation principles.
“(We) advise reviewing the criteria and processes to ensure there is less ambiguity and room for varied interpretation and that any application to join is made in full consultation
“THERE
IS NOT AN OVERARCHING FRAMEWORK FOR THE REGULATION OF HEALTH PROFESSIONS.”
SUE DAWSON, INDEPENDENT REVIEWER
continued from page 3
improvement from baseline).
The patient also met expected auditory milestones based on an age-based parent questionnaire and according to the patient’s age.
ENT surgeon, Clinical Professor Catherine Birman OAM, from the Children’s Hospital at Westmead, Sydney delivered the therapy.
"I'm thrilled to report the preliminary cohort one data of SENS-501 in the infants and toddlers treated with this highly innovative therapy,” she said.
“Treatment with SENS-501 had a good safety profile and the onset of early auditory responses observed in patient three and the rest of the cohort is very encouraging, especially given the very low dose of vector injected, which is primarily intended at assessing the safety of the therapeutic and of the intracochlear surgical procedure.
“I look forward to patient three’s next visit and continuing the Audiogene study with the second cohort to assess a higher dose of SENS-501.”
with the health profession/sector in question,” AudA wrote.
In its submission to the paper, Independent Audiologists Australia (IAA) said it “strongly recommended that audiologists and audiometrists be included in regulation by the NRAS and Ahpra “to align with the priorities identified in the paper and to provide transparency around qualifications, scope and professional title as well as to adequately protect the interests of the public.
“A clear, consistent and enforceable set of rules across all health disciplines is what would make sense for the public," IAA said. " IAA strongly advocates for mandatory whole-of-sector Ahpra registration.
"It is recommended that both audiologists and audiometrists be registered under Ahpra and regulated by the NRAS.
"Protection of title, a clear scope of practice in line with minimum qualification levels, and a transparent, accountable reporting process is needed across all health professions.”
Prof Birman said treating children under 31 months of age and naive of cochlear implants was a much-needed undertaking, as restoring hearing in the first three years of childhood had the potential to result in de-novo language acquisition.
Sensorion said Audiogene, its Phase 1/2 gene therapy clinical trial, evaluated a low dose of SENS-501, its first gene therapy candidate for a form of congenital deafness linked to mutations in the OTOF (otoferlin) gene.
The OTOF gene plays a key role in transmission of auditory signals between hair cells of the inner ear and the auditory nerve. When defective, individuals are born with severe to profound hearing loss.
The treatment aims to restore hearing by introducing a functional copy of the gene directly into hair cells via viral vector technology to restore the normal process of converting sound into electrical signals.
“SENS-501, including surgical
ABOVE: Clinical Professor Catherine Birman OAM who performed the gene therapy transfer. Image: Royal Prince Alfred Hospital. Genetic image: vegefox/stock.adobe. com. Image:Health.gov.au
delivery of the gene therapy, shows a good safety profile in all patients treated so far,” Sensorion said.
“Intracochlear administration was uneventful, and no serious adverse events or serious side e ects were reported.”
Treatment and surgical procedure were well tolerated by all participants (aged six months to 31 months) and naive of cochlear implants at the time of the injection. A second cohort of three patients who will be given a higher dose is ongoing and recruitment is close to being completed, Sensorion said.
A paper has proposed a new single point of entry for patients making health complaints in each Australian state or territory.
An independent review into the complexity of the system regulating health practitioners proposed the overhaul, recommending “establishing an e cient and compassionate complaints handling regime” across Australia.
In May 2025, independent reviewer Ms Sue Dawson released Consultation Paper 2: Consultation Outcomes and Reform
Directions for the Independent Review of Complexity in the National Registration and Accreditation Scheme (NRAS).
Under a unified system, complaints about registered – and non-registered/ self-regulated practitioners – could be lodged through a single Health Complaints Entity (HCE) in each state and territory.
From there, the HCE would triage complaints, seeking to resolve matters not warranting disciplinary action. Serious allegations and allegations against registered professionals would be referred to the Australian Health Practitioner Regulation Agency (Ahpra).
The ‘single front door’ proposal was supported ‘in principle’ by Audiology Australia (AudA), and Independent Audiologists Australia (IAA).
IAA said any regulatory measure must be mandatory, citing failures in the UK’s voluntary accredited register model.
Dawson urged an immediate focus on improved management of high-risk matters within the National Scheme.
Currently Ahpra manages more serious complaints about “registered” practitioners.
If less serious, but still requiring action, it must be raised again elsewhere, frustrating consumers who often carry the burden of locating the appropriate authority., it said.
“Professions also confirm a deeply unsatisfactory experience … highlighting the protracted and stressful processes on matters that often could be easily addressed or dismissed at an earlier stage,” Dawson’s paper said.
In submissions to the 2024 paper, AudA and IAA agreed it was necessary to simplify complaints handling.
AudA said consumers should be able
ABOVE: Complaints could be lodged through a single Health Complaints Entity in each state and territory. Image: Seventyfour/stock. adobe.com.
they were registered under the NRAS or otherwise.
AudA said experts would need to be appointed for each profession when dealing with complaints.
IAA added: “The complaints process should reflect the needs of the most vulnerable and time-poor populations, who are most likely to make a complaint.
"One problem is the complex and confusing regulatory system between healthcare sectors making it di cult for patient complaints to be lodged, responded to and resolved with consistency, timeliness and transparency.”
New Australian falls guidelines recommend facilitating access to hearing assessment and management for people in residential aged care facilities on commencement of care and annually. They also urge assessing aged care residents and hospital patients complaining of dizziness and vertigo for vestibular dysfunction. Another suggestion is that when discharging hospital patients with undiagnosed hearing problems, part of good discharge planning is to refer them to an audiologist. The Australian Commission on Safety and Quality in Health Care and NeuRA revised guidance with help from NeuRA. The Preventing Falls and Harm from Falls in Older People Best Practice Guidelines consider three key settings –residential aged care, community care and hospitals, which are the main settings where falls may occur. They look at the importance of interventions and risk assessments.
A Starkey and MED-EL bimodal streaming partnership will enable Apple technology to seamlessly stream to compatible Starkey hearing aids and MED-EL cochlear implants. The companies said DualSync would bring together the strength of Starkey’s industry-leading hearing aids with the innovation behind MED-EL’s cochlear implants, “creating a seamless and unified wireless audio experience for people who rely on both technologies”. DualSync technology provides seamless audio connectivity and synchronised sound from compatible smartphones and media devices, empowering users with more natural, connected hearing, they said. Starkey Edge AI and Genesis AI hearing aids and MED-EL SONNET 3, SONNET 2, SONNET, and RONDO 3 audio processors will be compatible for bimodal streaming. The solution is designed to support a growing ecosystem of devices and will be compatible with future innovations from both companies, they said.
The World Health Organization has issued its first global meningitis guidelines which include recommendations about hearing loss screening and follow-up. They urge formal audiological screening be conducted before hospital discharge in children and adults with acute meningitis from any cause or if not possible in hospital, within four weeks of discharge. When hearing loss is detected, urgent referral for hearing rehabilitation or evaluation for cochlear implantation should be arranged, the WHO guidelines on meningitis diagnosis, treatment and care state. They provide evidence-based recommendations for the clinical management of children and adults with community-acquired meningitis, including acute and long-term care. The guidelines also cover diagnosis, antibiotic therapy, adjunctive treatment, supportive care, and management of ongoing e ects for viral and bacterial meningitis. Royal Children’s Hospital paediatrican Dr Kate Milner and Meningitis Centre Australia chairman Mr Bruce Langoulant AM, contributed.
EssilorLuxottica has announced plans to sell its Nuance Audio Glasses, a “new invisible open-ear hearing solution for those with mild to moderate hearing loss”, at audiology and optometry stores in Australia as well as through its own retail eyewear stores once the product is registered with the Therapeutic Goods Administration (TGA).
An EssilorLuxottica spokesperson confirmed to HPA that the product will be available at independent audiology and optometry stores. The company has submitted it for listing by the TGA, and subject to registration, anticipates it to be available for ordering in Q4 2025.
The company said: “Subject to inclusion on the Australian Register of Therapeutic Goods, Nuance Audio Glasses will be available through independent stores and the group’s retail network including OPSM, Laubman & Pank and EyeQ Optometrists.”
OPSM has nearly 400 stores across Australia and New Zealand while Laubman & Pank has 38 nationwide and EyeQ has 25.
The glasses, which have directional microphones and open-ear speakers embedded in the frame arms, are marketed as an “innovative assistive listening device designed for those with mild to moderate hearing loss”.
Miniature speakers in the temple
hear natural ambient sounds, the company said.
People can choose prescription or non-prescription lenses.
“The Australian hearing solutions market remains underserved, much like the vision market decades ago, where consumers are often hesitant to wear corrective devices due to factors such as stigma, discomfort, cost, and limited accessibility,” EssilorLuxottica said.
“With the introduction of Nuance Audio Glasses, the company aims to overcome these barriers and meet the needs of approximately 5.3 million people in Australia who experience mild to moderate hearing loss.”
EssilorLuxottica unveiled the product in June 2025 at ODMA trade fair in Sydney. It said the display was for professional interest only, stating the product was not currently approved for supply in Australia .
The company said the glasses “seamlessly integrate vision and hearing support”, blending sound engineering and smart eyewear design.
“Directional amplification enhances speech clarity with directional microphones and Beamforming,” it said, adding the microphones limit background noise.
EssilorLuxottica said the glasses were comfortable and easy to set up via an app, required for audio calibration and firmware updates. It said the app enabled users to manage noise reduction level by customising background noise levels. Users could switch between frontal audio mode, to focus on face-to-face conversations, and all-around, to amplify surrounding sounds.
Setting preferred preset options enable a tailored hearing experience with users choosing the one that best suits their hearing needs from di erent pre-configured amplification settings.
The company expects the glasses to be available in two styles, Square and Panthos, and three colours. They come with a charging pad and cable.
The glasses are already available in the US, Italy, France and Germany online and from certain optical and audiology stores.
Healthscope, Australia’s second largest private hospital operator, has entered administration but said the group’s 37 hospitals nationwide, which employ more than 100 ENT surgeons, remain open while a buyer is sought.
Healthscope announced on 26 May 2025 that receivers had been appointed to its parent companies. A statement said all Healthscope hospitals would continue operating “with no impact on hospitals, sta , doctors or patients”, and no redundancies or hospital closures.
“Healthscope’s parent entities have entered receivership, with its lenders appointing McGrathNicol Restructuring to work with Healthscope management to complete an orderly sale of the business,” a media release on its website said. “The operational business, which runs the hospitals, is not in receivership.”
Mr Mark Butler, Minister for Health and Ageing, Disability and the NDIS, jointly announced the business had gone into administration. He said the Government
had met with the administrator and receiver to outline its priorities and expectations but said there would be no taxpayer bailout.
Nationwide Healthscope hospitals employ about 19,000 sta , including 108 ENT surgeons, its website states.
The Commonwealth Bank of Australia has provided a new $100 million funding package to McGrathNicol to support operations during the sale process.
The Healthscope board appointed partners from KordaMentha as administrators to the same non-operating entities, as is common practice. The receivers will assist the administrators as required to fulfil their statutory role, the statement said.
Healthscope said the new funding package is in addition to Healthscope’s current cash balance of $110 million, and substantial additional asset backing across the group. Its existing working capital financier is also providing support, it added.
“Key supplier relationships will remain una ected, with payment terms
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National Capital Private Hospital in Canberra is one of 37 private hospitals affected. Image: Healthscope.
maintained,” the statement said.
Healthscope’s management team, led by CEO Mr Tino La Spina, will continue to lead the business and operations.
“All 37 of our hospitals continue to operate as normal and the appointment of receivers, including the additional funding, ensures a stable path to a sale, with no impacts on any hospitals, sta or patients,” he said.
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NSW audiologist, Emeritus Professor Philip Newall, and Canberra ENT and cochlear implant surgeon Dr Edward Peter Chapman were recognised in the 2025 King’s Birthday Honours List for decades of giving generously of their skills and time.
Prof Newall was awarded the Member of the Order of Australia (AM) in the General Division “for significant service to audiology education and research, and to the community”. Dr Chapman received the Medal of the Order of Australia (OAM) in the General Division “for service to medicine in otorhinolaryngology”.
“I was very pleased and surprised to receive the honour,” Prof Newall said. “My main career was running audiology at Macquarie University. I also helped set up two audiology programs in Manila and one in Beijing.”
Prof Newall has a long history of involvement with NextSense and Macquarie University, dedicating years to practising, lecturing, teaching, and doing research. He taught hundreds of audiology students
over 27 years as a Macquarie University audiology lecturer.
He was coordinator of postgraduate audiology programs at the university from 1980 to 2007 and an honorary audiologist at NextSense Institute for 18 years.
Additionally, he was involved in the National Acoustic Laboratories – Revised, Profound (NAL-RP) procedure used in audiology for fitting linear hearing aids, particularly for people with severe and profound hearing loss.
Prof Newall worked in private practice as
and his wife Mrs Cristy Newall. Image: Philip Newall/Macquarie University.
an audiologist at Attune Hearing, and was an honorary audiologist at Westmead Hospital for 39 years, at Hornsby and Ku-ring-gai Hospital for nine years and Dubbo ENT Clinic for 37 years.
He has committed much time to overseas communities including helping to develop audiological services in the Philippines and Samoa, often travelling overseas to work on a voluntary basis with his audiologist wife Cristy. During 25 visits to Samoa, they have fitted about 450 hearing aids and BAHAs to Samoan children.
A Life Member of NextSense, he is an Audiology Australia Emeritus Member and Certificate of Outstanding Service holder. Dr Chapman was an ENT surgeon at Canberra Hospital for 35 years including director of the hospital’s ENT (Otorhinolaryngology) Unit for four years. He was a cochlear implant specialist with Canberra ENT in the 2010s and a specialist with the Cochlear Implant Service, Royal Institute for Deaf and Blind Children, as well as an ENT surgeon in Orange, NSW.
Withdrawing from social events
Frequently requiring others to repeat themselves
The Hearing Professional Conduct and Complaints Body (HPCCB) has warned against live streaming and/ or audiovisual recording of patient appointments for training purposes, claiming these actions raise significant ethical and legal concerns.
ABOVE: Recording patients for training purposes is also a potential Code of Conduct breach. Image: Have a nice day/ stock.adobe.com.
“It is unethical, and illegal in most cases, to record or view a client appointment without the client’s informed consent,” the body said. It was also a potential breach of the Code of Conduct for audiologists and audiometrists, it said.
HPCCB is an independent organisation to promote ethical hearing service practice and handle complaints against audiologists and audiometrists. It began operating in October 2024 and replaces the previous AudA and ACAud Inc. HAASA Ethics Review Committees.
The new body said that during 2024-2025, it had received anonymous contacts from audiologists and audiometrists who were concerned about the ethics of live streaming and/ or audiovisual recording of client appointments by their employer.
Following the reports, the HCPPB released a document on the issue. “The audiologists and audiometrists describe that these live streaming and/or recordings are to review the hearing aid device recommendations and subsequent sales the hearing practitioner makes by their manager, training, sales and/or marketing teams,” the body stated.
“In some cases, we have heard that the audiologist or audiometrist is asked by the employer to mislead the patient and say that those observing the appointment via the live stream, or viewing the recording later, are also practitioners so that the client ‘feels more comfortable’.
“We have also heard that the hearing practitioners were not aware in some cases that the appointments were being recorded and/or live streamed by their employer."
Rinri Therapeutics has received approval to go ahead with its world first trial in humans of cell therapies that aim to regenerate damaged auditory neurons and reverse sensorineural hearing loss.
The United Kingdom’s Medicines and Healthcare products Regulatory Agency approved Rinri’s clinical trial application for Rincell-1, a first-in-class regenerative otic neural progenitor cell therapy for sensorineural hearing loss.
The company, which has been working on the “potentially permanent and invisible therapy” for more than two decades, said in a media release on 1 July 2025, that the potential treatment was a multi-billion-dollar market opportunity.
It said clinical proof-of-concept data from the trial was expected within 12 months of initiation. “While current standard-of-care treatments like cochlear implants help manage the symptoms of sensorineural hearing loss, their e ectiveness depends on the integrity of the cochlear nerve,” Rinri said.
It said Rincell-1 was designed to regenerate damaged auditory neurons for which no treatment currently exists.
ABOVE: Neural progenitor cells forming synaptic connections. The therapy makes auditory progenitors from stem cells. Image: Arthaphan/ stock.adobe.com.
The trial will involve 20 patients undergoing cochlear implantation for hearing loss; 10 with postsynaptic auditory neuropathy spectrum disorder and 10 with severe-to-profound presbycusis. Patients will receive a dose of Rincell-1 and cochlear implantation, or cochlear implantation alone. The therapy makes auditory progenitors (early forms of mature sensory cells in the cochlea) from stem cells. When therapeutic progenitor cells are delivered to the cochlea, they can become mature (functional) auditory neurons, re-establish nerve connections and reverse neural hearing loss, Rinri said. In preclinical studies, the cells reversed hearing loss and improved hearing threshold by about 40%.
Mr Anthony Albanese became the first Australian prime minister to visit a Cochlear manufacturing facility when he toured the Cochlear Australia facility in Chengdu during his July 2025 visit to China.
the Cochlear Nucleus Nexa System. The Prime Minister witnessed the switch on of Xia’s implant. The system was launched in June in Australia, New Zealand and Bo’ao Media Tourism Pilot Zone, Hong Kong.
BELOW: PM Anthony Albanese with Xia at the Cochlear facility. Image: Cochlear.
He met a four-year-old boy, Xia Suhang who had just received the world’s first and only ‘smart’ hearing implant system,
Cochlear has a significant presence and is actively expanding its operations and market reach in China.
Mr Stu Sayers, president of Asia Pacific and Latin America at Cochlear said: “This visit is a proud moment for Cochlear and particularly our team in China. We are very excited that the Prime Minister had the opportunity to see firsthand how our latest technology, which is designed and manufactured in Australia, is helping people of all ages all around the world to hear and connect with others.”
PRISCILA SOARES is an artist with severe to profound hearing loss who uses her art to create inclusive spaces for children and adults who are hard of hearing. Her paintings, sculptures and mixed media art feature people and characters with hearing differences who use various hearing assistive technologies.
Imagine Rapunzel with a cochlear implant, Peter Pan wearing hearing aids, Snow White using sign language, and Alice in Wonderland with a bone-anchored hearing aid.
These are just some of the characters from 13 loved children’s books that artist Ms Priscila Soares has beautifully transformed in original artworks to become inclusive characters that use hearing assistive technologies.
There’s also Mowgli from the Jungle Book, Cinderella, The Little Mermaid, Beauty and the Beast, Winnie the Pooh, The Princess and the Frog, The
Little Prince, The Wizard of Oz, and The Princess and the Pea.
Soares has painted each with four variations of hearing technology so every child’s favourite fairytale figure can wear the same device as them –or not – in the case of signing.
Poster prints of her paintings grace the walls of audiology clinics, ENT surgeons’ practices, children’s hospitals and schools worldwide along with the private homes of parents who proudly decorate their children’s bedrooms with the pieces.
Living in the world of hearing loss is what inspired the Brazilian-born Californian artist to create accessible paintings that uplift those with hearing di erences.
“I’ve been doing my best to help people with hearing di erences feel seen and represented,” Soares says. “The artwork is for all people with hearing di erences and the professionals who cater to them.”
The fairytale characters are among hundreds of paintings Soares has done of people with hearing di erences. She takes commissions and creates customised paintings of people with hearing loss, including adults, bringing their powerful stories to life and showcasing their passion or hobby.
“I love my work, and it brings me joy,” she adds. “I give some of my characters wings on their ears to give a visibility to an invisible disability. I let them fly.
“Through my art I want to show that having a disability such as a hearing loss doesn’t disempower you, instead it gives you a unique way of experiencing the world around you, and that realisation can be extremely transformative.”
Art has, in fact, become her therapy and is her voice but it wasn’t always this way after facing many struggles accepting her hearing di erence.
Soares’ hearing loss journey started as a teenager in São Paulo, Brazil, when she developed mild hearing loss in her right ear from cholesteatoma. The hearing loss progressed, and surgery inadvertently caused complete deafness in that ear.
She moved to America and started work in the motion picture industry while attending university. A few years later cholesteatoma also developed in her left ear, she believes from childhood infections. Although the surgery
corroded the ear bones in the left ear, she could wear bone-anchored hearing aids which enabled her to hear out of her left ear.
Later, the youngest of her two sons, Jason, was born with bilateral hearing loss unrelated to hers. He received cochlear implants at age three and qualified for a teaching aide to help him at school along with many other forms of assistance.
Soares, who has severe hearing loss in the left ear and profound in the right, had not sought help for herself. Her son's experience made her realise there was a lot of help and support for children with hearing loss, but perhaps not as much for adults. “I was feeling a bit lost; I tried meditation to find a truer version of myself and began to learn to just trust and let go. I started journalling, then began creating art,” she recalls.
“I gave myself a goal of completing one piece of artwork a week over 12 weeks. I shared them online and people with similar experiences began to reach out to let me know how they felt seen through my art. I began asking them to send me their stories so I could represent them as well.”
She has illustrated three children’s book so far and in 2024 had her first solo exhibition. “Aside from the local community, I invited some audiologists and people with hearing di erences,” Soares says.
“They were so chu ed and said I was the only one doing this, portraying people and characters with hearing di erences in a positive way through art.
"They said there was a real need for this, it was crucial and important.”
Patients told her they wished they had seen artwork like hers in audiology and ENT surgeons’ clinics, instead of sterile rooms where they felt lost.
“They said there was a lack of representation of our community of people with hearing di erences on walls. I am here to remedy that,” she says.
Soares is open to requests from the profession such as more representation of elderly people and veterans, she adds.
She attends hearing care, audiology and otolaryngology conferences to promote her work at trade exhibitions and does talks about the importance of art on the walls and shelves of medical environments. She recently exhibited her works in Australia for the first time at the Audiology Australia 2025 Conference in Adelaide where she received a standing ovation during her talk and a warm response from delegates.
Conference delegate, paediatric audiologist Ms Brooke Rose was impressed and bought two pieces. Rose, a cochlear implant recipient and the First Sounds Implant Program surgical lead at The Shepherd Centre, said she had never seen artwork like it before.
“I’ve shown a few parents and audiologists Priscila’s site, and everyone has loved her art,” she says.
“The beauty of art is that it is a unique reflection of the world we live in.
"Being reflected by art and media is incredibly validating and sends children the message that they do belong and that they are seen and valued just the way they are.
“I loved the artwork I bought – the Beauty and the Beast one for myself and the Christopher Robin one for my best friend’s son who is hearing but I thought the cochlear implant would remind him of his Aunty Brooke seeing he lives in another state, and I don’t see him as much as I’d like.”
Rose said Beauty and the Beast was her favourite Disney movie – she even has a tattoo of Belle and the Beast.
“I love Belle with her cochlear implant - it makes me so happy to see deaf people represented in art and media," she says.
“I have my Belle picture at home in my o ce where I can enjoy it. I work travelling around to di erent hospitals and surgeons’ rooms, so my home o ce is my home base. I like that it means that I can see it all the time too, not just when I’m working.
“One child saw it in the background when I was on video camera, so I brought it over for them to see – the child and their parents loved it.”
Soares adds: “My artwork celebrates people with hearing di erences –
hearing aids, cochlear implants, bone-anchored hearing systems – and the vibrant communities around them.
“It’s about creating moments of representation, joy, and connection for kids, parents, audiologists, and advocates who don’t often see themselves reflected in creative spaces.
“In the hearing health space, it’s about bringing more inclusive, empowering visuals to the clinic, o ce, events, or outreach.”
People can view her gallery of artwork and other merchandise at myluckyears.com and priscilasoares.com.
ADF Industries is a leading Australian manufacturer of quality audiometric rooms and soundproof booths. Its custom-made products feature in audiology clinics and hospitals, mining sites and in mobile hearing testing vehicles worldwide.
When Melbourne man Mr John Davies founded his business more than 50 years ago, he always said yes to any manufacturing request that came along.
So, when someone asked him if his sheet metal fabrication company could make a hearing test room, he proceeded without hesitation.
His son, Mr Jono Davies, continues this legacy today, paying homage to the fact his father would give anything a go and loved a challenge.
From manufacturing that first audiometric room 35 years ago, ADF Industries has grown to design, manufacture and install hundreds of custom-made audiometric rooms and soundproof booths across Australia and the world.
Its ‘can do’ attitude, flair for innovation that has enabled diversification into various specialties, and a non-negotiable edge to the quality of its products have ensured the family-owned business has flourished.
Nowadays, a third of its business is audiometric rooms and sound booths. It builds, transports and assembles them in hospitals and audiology clinics. All are engineered and built to Australian or international standards to provide an optimal level of ambient sound, producing lab-type conditions to perform hearing tests.
The company’s humble beginnings were in 1968 when John began an apprenticeship as a sheet metal worker. When the workshop downsized, he lost his job and in 1974 started his own air conditioning company with some of the shop’s former employees.
Later he started a side business building custom boat trailers in the garage of his Dingley house in Melbourne. In the 1980s the business became All Duct Australia, a duct manufacturing shop, but in the recession of 1991, he separated from his business partner and formed another company, All Duct Fabrications (ADF).
This was created to expand on a growing need for total fabrication solutions and become a more general sheet metal jobbing shop, along with making ducts for industrial heating and air conditioning.
“It’s always been a family business. I worked there on weekends. My sister would clean the o ce. Mum would be there when she was needed and still cooks monthly lunches for the team. We had aunties and cousins working there,” recalls Jono, a mechanical engineer and the company’s managing director since his Dad’s passing.
“We built anything and everything including acoustic equipment for CityLink tunnels, Brisbane Airport Link, and many mining sites.
“In the realms of audio booths and audiology, everyone wants to deal with us because we make the best booths. It's taken a lot of hard work to get where we are though.”
In the early days, his father built two hearing test rooms at Cochlear in East Melbourne to meet Australian Standards for occupational noise management auditory assessment for testing patients and testing and development of equipment.
Due to tra c sounds in East Melbourne, ADF brought in an independent specialist to do vibrational analysis as the rooms needed increased attenuation levels to compensate for loud air conditioning and tra c. Smaller windows and duress alarms were also needed.
“Now we set our sights on building 12 large audiology rooms and about 35 single person rooms a year,” Jono says. “All the big hospitals have several large booths and some private practices also take large booths to do paediatric work or they’re ENTs and want to perform free field testing.”
Mining companies often buy single booths for regular workplace hearing tests, and organisations or clinics sometimes have mobile hearing testing vehicles fitted out for remote work and field day attendances.
Jono says ADF has fitted audiometric rooms in just about every hospital in Australia including the Brisbane Women’s and Children’s Hospital, Monash Health and Adelaide Women’s and Children's Hospital, Perth Children’s Hospital and The Royal Victorian Eye and Ear Hospital in Victoria.
“Our customers need the quietest rooms possible for testing; that's what we deliver, the optimum level of low ambient noise for hearing testing for Australian and international standards."
Jono Davies ADF Industries
Cranbourne, Whittlesea and Craigieburn community hospitals in Melbourne all have two booths each. The business has just signed up to do the next Northern Health hospital at Epping, which will be a large addition, and has just finished a private practice in Newcastle.
It also did five audio rooms at NextSense centre for innovation in Sydney. ADF has fitted booths in audiology clinics for larger practices including Connect Hearing and Amplifon but most of its work is with smaller, independent practices that buy audio booths.
Getting quality management system certification in 1995 was a pivotal moment because it confirmed the procedure was repeatable, and the product quality assured from one facility to the next.
“Other assessors do independent testing to prove that what we've installed meets the standards,” Jono says. “It comes down to how we test and certify. If people want it built to Australian standards, we can, or we can provide a booth to meet international standards.
“An o sider or I come to the first site meeting to do measurements. We’ve just started Dubbo Hearing, and I flew there, measured it up and came back to start the process. We take care of everything from start to finish so practitioners don’t have to worry about anything.”
Jono says the business has perfected its method of building booths, so it covers all pain points. If there are problems, it designs around them.
“It’s a point-of-di erence because we like to manage all the people that need to work on it, whether it’s electricians, meetings with acoustic engineers or organising fire sprinklers,” he says. “We learnt a lot of this working with big builders where there's many di erent inputs.
“We do the drawings and there are meetings for everything from air conditioning to the carpet. That's how we evolved, and we source everything so customers get a turnkey project.
“We've built all sorts of weird things to hold speakers, televisions that hang from the roof, extra LED lighting – if the customer wants it, we can give them 95% of the things they want.
“There's a lot of things people ask for, and we’ll always look into it; it’s part of who we are.”
Improvements can be made too. For example, the interior panels of large booths can be removed and cleaned after this adjustment was made when a child vomited on one.
Jobs at hospitals take about a year from initiation due to the design process, he adds. “The paperwork can take months but once the drawings are signed o , we can have a big booth manufactured in eight weeks, depending on our workload, then after that it only generally takes us a week to do the installation.
“At MARCS Institute for Brain, Behaviour and Development, Western Sydney University, we designed, manufactured and installed 21 booths for di erent purposes from studies on equipment to testing of patients. This was in the middle of the COVID pandemic,” Jono recalls.
“It took 10 semi-trailers to transport them. It was amazing, the biggest in Australia and the most booths that have ever been done for one place in the Southern Hemisphere.”
ADF o ers three styles of single person booths. “They’re set and forget to a certain degree, we let customers choose their colours, but we have them ready so they can go straight o to paint and come back.
“There are little variations on every booth because we need to know if they're a right- or left-handed opening door but there’s not a long wait for installation once they’re ordered and we always have two versions of each in stock.”
The micro booth will fit through any space, and a modular version can be installed panel-by-panel if it can’t fit through a tight hallway or space.
“We can pull it apart when it arrives and put it back together as we install it,” he says.
To install a large room, such as at a hospital, ADF employees need the space to themselves for about a week, but small rooms are delivered and pushed into place immediately. “Practitioners at independent practices don’t need to close their clinic at all,” Jono says.
At Perth Children's Hospital, ADF manufactured six rooms for di erent purposes for paediatric testing, built to meet international standards. “This was our first foray into working with international standards,” he adds.
“New community hospitals all have international standard booths now that everyone is going in that direction because it helps with paediatric testing and future technologies.”
Smaller practices generally go for Australian Standards, which are fit for purpose for what they need, he says.
“Our customers need the quietest rooms possible for testing; that's what we deliver, the optimum level of low ambient noise for hearing testing for Australian and international standards,” he adds.
ADF has also built and fitted booths worldwide including in New Zealand, Singapore and Europe. It built Samoa’s first audiometric rooms and a trailer with a hearing booth which travels to schools for hearing checks. The project, alongside ENT surgeon Associate Professor Bernard Whitfield, was for Aid Australia and the Royal Australasian College of Surgeons.
“That was extremely rewarding because we’re giving children a chance to get back on track including with their education which is wonderful,” Jono says.
ADF recently exhibited at Audiology Australia’s 2025 Conference. “It was the first time we’d advertised. Response was great, everyone was coming up saying, ‘you're the booth guys, I’ve seen your work’, or ‘I've been in your rooms, you build great stu ’,” he says. “Sometimes they say we’re expensive but that’s because we don’t compromise on quality.
“We’re sheet metal fabricators and boilermakers but when we build an audiology room, we're building a product that gives back. It can improve someone’s life with hearing aids or a cochlear implant – that testing’s done in our room. We're giving people a chance and we’re very proud of that."
Sydney ENT surgeon Clinical Professor CATHERINE BIRMAN OAM achieved an incredible milestone in 2025, performing her 2,000th cochlear implant operation, the second most in Australia, and a rare feat worldwide.
From the moment Clinical Professor Catherine Birman saw her first ear ossicle glistening under the microscope 35 years ago, she was “hooked”.
The three delicate inner ear bones are the tiniest bones in the body and push sound vibrations from the eardrum to the cochlea to help people hear.
“I fell in love with ENT surgery as a resident seeing my first ossicle in an ear operation,” she says. “It was so tiny and remarkable, and I was hooked from then on. ENT surgery is very positive surgery and to provide hearing is such a privilege.
“The anatomy is complex, and the work is fascinating and evolving. What’s not to love about this area?”
Fast forward three decades, and Prof Birman is one of the world’s most experienced cochlear implant surgeons, having operated on patients aged three months to 95 years.
In April 2025 she performed her 2,000th cochlear implant operation at Macquarie University Hospital on a 72-year-old-man, who, despite other health issues, was eternally grateful to receive the gift of hearing and be able to communicate again.
“He’s a delightful person and a cochlear implant will make a big di erence to him and his family,” she says.
“In Australia, Professor Bill Gibson, now retired, has done 2,300 cochlear implants, but I’m the next most experienced with 2,000. Overseas there would be a few with similar figures but not many. I’m not planning on retiring just yet, so I have that record in my sights.”
It’s a far cry from when Prof Birman did her first implant as a qualified ENT surgeon in 1997. In the early days the Children’s Hospital at Westmead and Royal Prince Alfred Hospital had funding for 10 public procedures each a year. At one stage, Prof Gibson, who she trained under, had a five-year waiting list at RPAH due to the funding restriction, she says. Never in her wildest dreams did she imagine she would perform thousands.
“This sort of number was never in our mindset, we were just hoping to get more funding so all eligible children and adults could get a cochlear implant in a timely manner,” she says.
“It's been a lifelong advocacy and joy and we've gone from only profoundly deaf people to people with more residual hearing also benefitting from a cochlear implant. It’s a wonderful honour and privilege for me to have helped people hear better. I am so grateful for this opportunity over these decades.”
Funding has improved for public and privately funded patients over the years with bilateral cochlear implants becoming available for children. In 2017 the NSW Government agreed to fund a single cochlear implant for each adult public patient without a quota per year. Private health insurance funding has also evolved and funds bilateral children and adults.
Nowadays Prof Birman does about 100 implants a year; a-third are in children at the Children’s Hospital at Westmead, and two-thirds are adults at RPAH and Macquarie University Hospital.
“I love that ENT surgeons are physicians and surgeons because we care for patients through medical therapy and surgery; we help all ages from babies to the elderly; we perform a wide variety of procedures and work closely with colleagues such as audiologists, nurses and anaesthetists, plus our patients and their families,” Prof Birman says.
“Ear surgery is very delicate. I was always good with my hands, loving craft, and doing industrial arts at high school where I learnt to use a drill, and then I
changed schools and did sewing, which ended up being very useful.”
As a registrar she was involved with using Cochlear’s Nucleus CI22M, a very early commercially available multi-channel cochlear implant. “I’ve seen great improvements in electrode array designs and soon steroid eluting arrays; speech processors and speech perception outcomes; hearing preservation surgery and techniques,” she says.
“There’s now greater understanding of the depth of insertion, giving broader range of pitch stimulation; array design; smaller, smarter speech processors; computers filtering out background noise; easier recharging; and Bluetooth capability.
“Outcomes have improved but cochlear implants have been a phenomenal sensation from the start.”
Devices are also smaller. “When I started, the processor was worn as a body pack on the person’s chest and mums would make their kids a singlet with a pocket sewn on it.”
Surgery is faster, and microscopes and drills better. “Everyone's anatomy is di erent, and it’s a remarkably well tolerated, straightforward procedure,” Prof Birman says. “Testing of the implant at the operation’s end has evolved and will continue to become faster and easier.”
Prof Birman has also been involved with a trial in 17 patients at RPAH to improve hearing clarity, a collaboration with Professor Gary Housley and his team at the University of NSW, Macquarie University, NextSense, Cochlear and the Bionics Institute.
DNA is inserted into the cochlea via a pump and electrical pulse. The cells in the cochlea then produce neurotrophins (acting like fertiliser for nerve endings), then a routine cochlear implant is inserted. Tiny nerve endings which had withered due to hearing loss grow towards the cochlea.
“We could see evidence that they were sitting closer to the cochlear implant, which might get clearer responses," Prof Birman says. "We need a
multi-centred trial to adjust the dose, but the study showed it was safe and has great potential.”
In future she imagines treatment combinations of gene or stem cell therapy with cochlear implants. HPA has reported that she was Australia’s first surgeon to inject gene therapy into two infants with congenital deafness at the Children’s Hospital at Westmead.
“It’s still experimental but it showed the Otoferlin gene (which is deficient in a specific form of congenital deafness) can be produced and we can get a hearing response,” she says. “It’s early days, we might need di erent doses, but it looks very promising and that we’re able to treat genetic hearing loss with gene therapy is amazing.”
Indications for cochlear implants have also evolved with better outcomes, she says. “Cochlear implants are now indicated when hearing aids are not enough and that tipping point of where hearing aids are not su cient, and a cochlear implant would give more hearing has changed over time because cochlear implant outcomes are better,” Prof Birman says.
“We know people will do better with a cochlear implant stepping in earlier, rather than waiting until they've got no hearing – with severe rather than profound hearing loss.”
One of her published studies found those with severe hearing loss preoperatively had better outcomes than those with profound deafness due to neuroplasticity as “the brain is still listening”.
“An analogy is knee replacements,” she says. “If you wait for the muscles to wither and you've lost motor skills it’s going to be a harder road to build up those muscles, and it’s the same with the brain. If it has stopped listening to that ear because there's no stimulation, it takes more auditory training to get the brain listening again.”
Bimodal options of a hearing aid in one ear and a cochlear implant in the other have also increased in popularity, boosting options for people with
severe hearing loss.
Outcomes nowadays mean hearing thresholds with a cochlear implant are often in the normal to mild hearing loss range. Speech perception in quiet is often excellent but hearing in noise can still be di cult and music quality can be somewhat tinny, she adds.
“Most patients have greatly improved hearing through the cochlear implant but there is still work to do to get better outcomes for everyone. I can only dream of the changes that will occur in decades to come.”
Prof Birman pays tribute to her “lovely and inspirational mentors”, the ENT surgeons who taught her, particularly Dr Ted Beckenham, Dr Barry Scrivner, Prof Bill Gibson and Associate Professor Glen Croxson. “I always had support and encouragement from them. But I was the third female ENT surgeon to train in NSW and about the eighth in Australia and it was a bit of juggle as a woman," she recalls.
“At one stage when my kids were young, I was working part-time but my medical indemnity insurance was $70,000, more than my wage, because it didn’t take into consideration part-time work.”
Many memorable patients
It is unfair to say any one patient stands out, she adds. But many are memorable such as a man who was deaf for 30 years who had a great outcome with understanding of sentences from the moment the implant was switched on, to a doctor who could keep practising due to a cochlear implant, and a patient who became an audiologist with Hearing Australia – a “phenomenal role model”, Prof Birman adds.
“There are many children who I have provided cochlear implants and I watch their progress with a deep sense of excitement and joy at all that they achieve,” she says.
“It’s been incredibly rewarding – from children with very complex di cult anatomy, learning to hear, speak and sing with cochlear implants, despite the odds; to children who have grown up, knowing only hearing through their implants and speaking so well, excelling in their chosen areas, telling the world who they are confidently.
“I’ve also been fortunate to work with adults who were able to take what they see as a risky step to have an implant, who now hear so much more, can stay in their chosen work, and even use a phone; to older adults who can communicate with their families, making life richer for them, their children and grandchildren because they can speak with them, even as they are in hospital chatting at the end of their life.”
There are many more she thinks about, and she’s glad they can hear better, even if it’s not perfect.
“It’s an honour to help so many people obtain better hearing,” Prof Birman says. “My thanks to the patients, their families and the teams I’ve worked with throughout so many surgeries. I look forward to helping many more with this life-changing technology."
Only one in 10 adults who could benefit from cochlear implants in Australia receive them, a figure that has not changed in 25 years. Clinicians say creating more awareness and referrals is everyone’s responsibility.
One of Dr Phillip Chang's oldest cochlear implant recipients, Helen, 92, was told for more than four decades she wasn’t a candidate for an implant, despite meeting audiological criteria. “Fortunately, she had an independent audiologist who advocated for her and reached out to us,” he says. “We were finally able to o er her a cochlear implant.”
Dr Chang admits even he was initially hesitant because of her age.
“But once I met her, it was clear she was medically fit, socially engaged, cognitively sharp, and surrounded by a supportive family," he says..
“Hearing loss was the only barrier to her continued independence. In the end, these qualities mattered far more than the number of candles on her birthday cake.”
Following activation, Helen was overwhelmed. “She cried and said, ‘I’m back.’ Not long after, her daughter told me she was playing the piano again,” he adds.
Dr Chang, a Sydney-based cochlear implant surgeon, says many of his patients face delays of 10 to 20 years before accessing the technology.
“They’re met with myths like: ‘Your hearing isn’t bad enough’, ‘Cochlear implants are only for children’, ‘They’re too expensive’, ‘You’re too old’, ‘They sound robotic’, or even ‘They’re dangerous and can cause meningitis'.”
Many only reach his clinic after years of frustration, either through their own persistence or advocacy from relatives. “It’s hit or miss,” he adds. “And not everyone has someone pushing for them.”
He believes there’s an urgent need for better public messaging. “We must empower individuals, clinicians and the community with accurate, up-to-date information about cochlear implants for adults,” Dr Chang says.
The reality is most adults who struggle with speech perception despite hearing aids benefit from cochlear implants and the cost of the device is usually covered publicly or privately, he adds.
The device has come a long way since Professor Graeme Clark AC implanted the first multi-channel cochlear implant in Melbourne in 1978. Since then, about 15,000 Australians and more than one million people globally have received implants.
Early body-worn devices were large and cumbersome. Advances have made them smaller, more powerful, and easier to use.
Eligibility has evolved too. “Three decades ago, implants were for profound hearing loss,” Dr Chang says. “Today, we assess moderate to severe cases, focusing on speech discrimination, functional hearing, and life quality.”
Yet uptake remains low. “Only around 10% of eligible adults receive one,” he says. “And I’m ashamed that figure hasn’t changed in 25 years.”
This feature also includes insights from ENT surgeon Professor Catherine Birman OAM and audiologists Dr Jaime Leigh and Mrs Annemarie Narraway.
Everyone’s responsibility
Responsibility for recognising when a patient may benefit lies with the entire hearing health community and doctors, says Dr Chang. “Whether you’re a GP, audiologist, audiometrist, or ENT specialist, we all share the duty to start that conversation.
“We haven’t done enough to keep our medical and audiological colleagues up to date on the basics of adult cochlear implantation. The professionals entrusted to care for patients with hearing loss too often don’t recognise when cochlear implantation should be considered,” he says.
When giving lectures to audiology students, Dr Chang tells them “cochlear implants aren’t the domain of a few elite clinics anymore. Every audiologist will care for a patient who has or needs one. It’s part of their specialty now.”
This year, he invited two patients to present.
“One was an 80-year-old man from Sydney who lost his hearing to meningitis in London,” he says. “An Australian-trained audiologist there told him to come home immediately because our cochlear implant system is the world’s best. Here he was able to access treatment in weeks, not months or years.
“The other was a teacher, aged 50, from regional NSW. Her audiologist had guided her for more than a decade, reminding her that if her hearing declined, a cochlear implant might be necessary. That ongoing conversation meant she was informed and prepared when the time came.”
Both shared their journeys and the impact was profound. “They said more to the students than I ever could,” Dr Chang says. “The teacher is thriving – still in the classroom and now back for her second implant. By the end, the students’ jaws had dropped. They walked out thinking, ‘this is my responsibility’.”
Long-term guidance from audiologists is crucial. “The audiologist is the custodian of hearing," he says. "They know when hearing aids are no longer enough, and the patient trusts them. They are central to the cochlear implant journey – before, during, and after surgery.”
Thanks to remote technology, follow-up care is more accessible.
“We can return patients to their local clinician for continuity of care and even program their implants,” he adds.
Dr Chang has dedicated 25 years to advancing cochlear implant care.
He established a leading paediatric program through The Shepherd Centre and Sydney Children’s Hospital, and founded Hearing Implants Australia network focussed on adult cochlear implant services.
“For children, the pathway is clear, well-funded, and consistently prioritised,” he says. “A baby born with profound hearing loss in Australia receives universal newborn hearing screening, timely MRI imaging, counselling, and streamlined care. With the understanding of the family, cochlear implantation routinely occurs between six and nine months of age. This model is considered international best practice and is replicated worldwide.”
But the adult experience is fragmented, delayed, and riddled with myths and inconsistent advice, Dr Chang adds.
“Adult-onset hearing loss is more complex and can emerge gradually. "Hearing aids may work well for years, but when hearing – and especially speech clarity – deteriorates, a cochlear implant may be the best solution. Yet too many adults never get referred, stalled by dead ends, outdated beliefs, and clinician hesitancy.”
Unlike paediatric care, adult hearing services are decentralised and diverse. “Adults are everywhere – seeing audiologists in hearing retail chains, independent clinics, government services and diverse clinical practices across rural and urban settings,” he says. “Hearing care professionals must be informed, supported, and confident in recognising when to refer.”
Education, collaboration, and decentralisation are key.
“Unless we actively involve all hearing professionals who’ve been walking alongside these patients –often for decades – adults will keep missing out," Dr Chang says. "With broader education and a more integrated, inclusive model of care, cochlear implantation can become as timely, routine and successful for adults as it is for children.”
Over 65s the biggest group
Fellow Sydney cochlear implant surgeon, Clinical Professor Catherine Birman OAM, agrees more awareness and access is needed for adults but says those over 65 are now the largest group undergoing cochlear implantation in Australia due to more people realising implants are for all ages.
She says all children who need them can receive them early due to neonatal hearing screening and Hearing Australia’s long term follow-up with provision of hearing aids and hearing testing.
“I think people have become more comfortable in coming forward for a cochlear implant over the past 10 years. They’ll have a knee replacement and can see that a hearing implant will also help them so they're happy to go ahead with it,” she says.
Surprisingly, working adults aged 20 to 65 are the group most likely to delay the surgery, she adds.
“In the past, people maybe thought it was neurosurgery but it’s not surgery into the brain, it’s in the inner ear,” Prof Birman says.
“Often a person might not realise they have an alternative to hear more with a cochlear implant than what they can hear with their hearing aids. "Hearing loss also has far-reaching consequences. Studies linking it to anxiety, depression and dementia risk have huge implications for the timely provision of better hearing through a cochlear implant.”
Prof Birman says cochlear implants are a huge success story. “In one study I compared recipients aged 65 and over with those under 65, and found seniors had the same great outcomes as middle aged or even younger people so age is not a factor,” she says.
One screening tool is the 60/60 rule of when to refer for cochlear implant candidacy evaluation. If the better ear unaided monosyllabic word score is less than 60% and pure tone average is 60dBHL or less, candidacy evaluation for a cochlear implant is indicated, she adds.
“Audiologists need to send these patients for assessment and GPs are also important in raising this with patients,” she says.
Hearables such as ear pods of various brands can act like a mild hearing aid getting people used to hearing better and are a good idea as hearing drops slightly, she believes. As hearing deteriorates, people progress to hearing aids and will demand to stay at a good hearing level. As hearing aid e cacy reduces, they’ll hopefully happily progress to a cochlear implant if needed, as they have maintained good access to sound all along.
NSW in March 2021. “I thought - what services can I provide that my community needs to make the world a better place, make life easier for my clients and lessen the environmental and emotional impacts of current practises?” she says.
“Our nearest ENT specialist and closest cochlear implant clinics were three hours away in Canberra or Nowra. For the first year post implant, patients need almost monthly mapping which could be a barrier if you're over 80 and have to travel.”
Since then, she has referred and followed up eight cochlear implant recipients. Narraway regularly provides information sessions at local venues to spread awareness about the implants. She puts up fliers around town advertising the talks and wrote a newspaper column. Cochlear also assists with invitations through its engagement team.
“From observation, it takes several mentions (three or four times) before clients consider looking at it as an option,” she says. “So, if I find someone whose hearing loss is deteriorating or if their speech discrimination score isn’t good, I start mentioning it right away.”
In February, 11 clients whose hearing had become poor enough for her
to recommend an implant assessment attended a talk with their partners. Existing CI recipients also presented and told their powerful stories.
One man with Ménière’s disease, aged 80, now has bilateral implants.
“He and his wife were in tears afterwards as it has changed their lives to such an extent,” Narraway says.
“I do a lot of testing including speech testing before we consider candidacy. The hoped-for result after a year of practising with the cochlear implant is 75% correct word recognition. For him, within three months, he was scoring an unbelievable 90% and now he’s at 97%!”
Her oldest recipient, aged 90 when she received her implant, is also doing well, Narraway says. “Before the surgery, she scored her ability to hear in noise as two out of 10 in a group setting, and a year later, she scored it eight out of 10!
“She used to go out and couldn’t follow the gist – I saw her at the club with a blank look on her face but now there's no blank look, she's out in the community and involved, and it’s so good to see. It’s not perfect but it's so much better.”
Narraway lends the best hearing aids to people to trial before they sign up for an implant.
“This is another way to make sure it’s not a faulty/lower quality aid that is keeping them from getting good speech perception results. It helps with realistic expectations and helps us know that we have tried everything,” she says.
Narraway works with several surgeons and hospitals who do Cochlear and MED-EL implants and has had great support from both with all training provided. “The benefit is, you keep your clients for life as you keep o ering something after hearing aids don't work anymore,” she says.
“I love the challenge and the privilege of being on the cutting edge of technology, being able to o er great service closer to their homes and for clients who are even further away such as in Eden, I'll use the remote care feature to adjust implants from a distance.
“Cochlear and MED-EL work with me to improve the lives of our local hearing-impaired people and their loved ones. To see such improvement is a privilege.”
Audiologist Dr Jaime Leigh, clinical lead of the Victorian Cochlear Implant Program at The Royal Victorian Eye and Ear Hospital, says a key barrier is fear, particularly of surgery.
"People think it's major surgery, which it isn’t,” she says. “There’s no penetration through the skull or into the brain. It’s a straightforward, hour-and-a-half procedure, often day surgery, but many hear ‘implant’ and assume it's high-risk or not suitable for them due to age or other health issues.”
A recent scan across Australia confirmed only about 10.5% of adults who are eligible for the implants receive them, she adds, so there's significant unmet need to improve awareness and access in the adult population.
She stresses referral is for assessment, not surgery. “Only once someone has completed their audiological, medical and anaesthetic workup can we make a recommendation about surgery,” she adds.
Misunderstandings around hearing preservation are another obstacle. “Historically, implants meant loss of residual hearing but now about 80% of people retain some level post-surgery, thanks to improved electrodes and surgical techniques,” Dr Leigh says.
Assessing candidacy involves comparing a person’s hearing performance with well fitted hearing aids against large-scale cochlear implant outcome data.
“We map that person's current performance against average outcomes with a cochlear implant to advise whether they’re likely to perform better
with an implant than their current hearing,” Dr Leigh says.
“We only recommend an implant if we’re confident they’ll hear better with it than with hearing aids. If someone isn’t suitable now, the assessment sets a baseline for future consideration if hearing declines.”
However, less than half of those assessed proceed to surgery, she says, as sometimes current hearing aid benefit is su cient. “In those cases, we advise staying in touch and reassessing if hearing changes.”
Another major influence on pursuing an implant is the guidance of their community audiologist or audiometrist.
“We know patients trust their community clinician,” says Dr Leigh.
“But there’s still a knowledge gap about current cochlear implant outcomes and the assessment process. Many clinicians aren’t confident talking about it, which means patients may never be referred.”
To address this, the Eye and Ear runs education sessions, webinars, and case study workshops with community audiologists.
“One of the most e ective strategies is asking clinicians to bring in real patient cases they’re unsure about. We work through barriers together and equip them with practical resources they can use immediately,”
Dr Leigh says.
Eye and Ear sta demonstrate the implants and give the community clinicians tools and resources to assist with their own patients. But engagement must be ongoing.
“You might see a spike in referrals after a training session but it drops o unless we maintain contact. Building lasting relationships between implant centres and local providers is key,” Dr Leigh adds.
Community audiology sites
Accessibility has also been a longstanding issue as services were historically centralised in Melbourne.
Since 2020, the Eye and Ear has rolled out a decentralised model through the Victorian Cochlear Implant Program. It now partners with 28 community audiology sites statewide which saves patients travelling long distances for pre and post implant care.
“Patients can now be assessed and supported locally,” Dr Leigh says. “Community clinicians are upskilled, trained and mentored by our team, and all recommendations are reviewed centrally. It means quality is maintained while access improves.”
So far, nine partnering services cover all Victorian regions. “Access across the state is now well established – the next big push is continuing to build awareness among patients and clinicians,” she says.
Programs from across Australia and internationally are taking interest in Victoria’s approach, though Dr Leigh notes service delivery models vary widely. “Victoria’s has been unique in its centralisation,” she says.
“Other states have di erent service delivery models with more service providers operating independently and they don’t operate under a statewide model, so it's quite hard to compare state to state.”
This makes a national approach harder, but that may change soon as national adult cochlear implant guidelines are in development which Dr Leigh believes will help streamline practices and improve consistency nationwide. Dr Chang says one reason children do so well with cochlear implants is due to neuroplasticity of the developing brain, which is primed to adapt and form new connections, making early intervention so e ective. At the other end of the age spectrum is what he calls 'neurofragility' – a decline in language, cognition, and higher brain function that can occur when hearing is lost and left untreated.
“But neuroplasticity doesn’t disappear with age,” Dr Chang says. “The brain can rewire itself and learn new skills throughout life. It may take a little longer as we get older, but we’re never too old to learn to lip-read, adapt to hearing aids or benefit from a cochlear implant. That’s the key ingredient for hearing success – at any age."
Advancements in diagnosis and treatment for single sided deafness mean great outcomes can be achieved. The work of audiologist DR DAYSE TÁVORA-VIEIRA has been pivotal in gaining regulatory approval for cochlear implants as a treatment for children and adults who are deaf in one ear.
When Dr Dayse Távora-Vieira began researching cochlear implants as treatment for single sided deafness (SSD) 17 years ago, her work challenged conventional thinking. Fortunately, the Perth audiologist was undeterred and progressed with her pioneering work that has helped change the landscape for this group of patients.
In that time, she has become a world-renowned expert in the field. She has also played a leading role in advancing cochlear implant care for SSD at Fiona Stanley Fremantle Hospitals Group including Fiona Stanley Hospital, plus Royal Perth Hospital and Sir Charles Gairdner Hospital, where she is the head of statewide tertiary audiology services.
“Our non-user rate remains below 5% and we are very proud of that,” she adds.
“The initial misconception was that there was no need to address the deaf ear if the other ear has normal hearing. It was also assumed that with natural hearing on one side, and a cochlear implant on the other, the brain wouldn’t be able to integrate the two signals.”
Dr Távora-Vieira, also Adjunct Associate Professor at the University of Western Australia and an Associate Professor at Curtin University, says that since the 1980s, studies have showed that unilateral hearing loss in
LEFT: Dr Dayse Távora-Vieira (seated right) with Emma Pickering, 13 years after she received a cochlear implant at age five, becoming the first Australian child with SSD to receive a cochlear implant.
children impacted their development by a ecting school and academic performance, plus psychological, emotional and social development. When researching tinnitus as a potential PhD topic, she came across a Belgium group trialling cochlear implants for tinnitus relief in patients with SSD.
“They were not looking at what the implant could do for hearing,” she recalls. “I started reading more about single sided deafness and realised its e ects had been under-estimated for too long.
“My PhD question became, ‘What happens if we provide a cochlear implant to single sided deafness patients in terms of hearing?’.” Her PhD in adults with SSD investigated integrating the two signals, and whether people could hear using combined normal hearing and a cochlear implant.
“We found the improvement they were achieving was massive in terms of hearing; we proved that the brain can put the two signals together and their hearing and quality of life improve after hearing is restored on the deaf side,” she says.
Her team expanded the research and found that while people with long duration of deafness did well with the implant, it took longer to achieve the same outcome as those who were deaf for less time. Deafness onset was also important, with those losing hearing at a younger age faring worse than those with later onset who had a well-developed neural pathway pre-surgery.
In 2015 the Therapeutic Goods Administration (TGA) in Australia approved cochlear implants as SSD treatment.
“Our publications were the main body of literature for the TGA approval and we’re very proud of that,” Dr Távora-Vieira says. “A few years later, we were asked to provide evidence for US researchers to do a trial seeking FDA approval so we also laid the groundwork for approval in the US and later Europe.”
The team has published more than 40 articles on SSD, including over 20 on understanding the role of symmetrical brain activation and the e ect of mapping. It also developed an assessment and evaluation framework and guidelines for SSD rehabilitation.
While many countries have now approved cochlear implants as SSD treatment, Dr Távora-Vieira says not all fund it. In Australia, funding is state based, and not all public hospitals provide it, but private health insurance may cover it, she says. There are some exceptions for children.
Auditory training for single sided deafness is di erent from bilateral deafness, she explains.
“If a person is completely deaf, the brain has no reference point, but SSD
“Our publications were the main body of literature for the TGA approval (of cochlear implants for SSD) and we’re very proud of that.”
Dr Dayse Távora-Vieira
Fiona Stanley Fremantle Hospitals Group
is di erent because the brain compares one signal with another.
“If you don't provide a reasonably good signal, the brain will likely ignore it. We did studies using EEG looking at how the brain processes the signal when providing two di erent inputs and we use that to create a protocol to program the implant.”
Dr Távora-Vieira says that poor outcomes in SSD can be due to programming deficiencies. “People with SSD have di erent needs because the brain has a reference point that's normal hearing, so you need to work on providing a symmetrical signal to the brain to make it easier for the brain to integrate the two signals,” she adds.
“SSD cannot be looked after the same way we look after bilateral deafness. And this might be why some become non-users of an implant along with other reasons such as traumatic surgery, partial electrode insertion or patients not willing to commit to rehabilitation. If we cannot make hearing symmetrical, patients may become non-users.”
Mapping the implant more accurately by brain activity with evoked potential equipment available in many larger clinics or hospitals provides immediate improvement, she says.
Rehabilitation is also vital and requires a structured program where patients actively teach the brain to recognise the sound. This is di erent
Emma Pickering was the first child with SSD to receive a cochlear implant in Australia and Lucas Gallop the first baby, under the care of Dr Dayse Távora-Vieira.
Emma was diagnosed at kindergarten. "I could hear perfectly well in my left ear but a nerve in my right ear was too thin which impacted my ability to hear out of that ear," she says.
"My parents decided to take part in a trial for SSD with the research investigating how a cochlear implant could help restore hearing on the impacted side. I was just five when I had the surgery at Fremantle Hospital.
"It was sometimes di cult. Kids can be cruel so I used to try and hide it under my hair so no one could see it."
Thirteen years later, Emma is studying professional writing at Curtin University. "Looking back, it was the best thing to happen in my life. I'm no longer ashamed of my implant – it has become part of my identity."
Significant milestones
After receiving a diagnosis of profound SSD when Lucas was five weeks old, his mum Ms Jenn Gallop came across Dr Távora-Vieira and her team.
"The research was in its infancy and while the team had used the implant on only a handful of adults with SSD, they hadn't done the surgery with any children," she says.
"We were moved to see the di erence it had made to one particular adult so we decided to go ahead and anxiously waited to see what the results would be for our 16-month-old who underwent six-hour surgery to implant his cochlear device.
“There have been ups and downs but Lucas understands the benefits of wearing the implant now – it's made a huge di erence to his confidence whether it's listening in class, chatting with friends or learning guitar."
Dr Távora-Vieira says Emma and Lucas have achieved significant milestones through follow-up and rehabilitation support from their families and dedicated professionals. Their progress provides valuable insights for ongoing research and future advancements.
"For Emma and her family, they have demonstrated remarkable resilience and commitment to her rehabilitation journey which has profoundly transformed her life, enhancing her hearing abilities and overall quality of life," she says.
"Lucas and his family hold a special place in the hearts of the audiology team at Fiona Stanley Hospital. We shared moments filled with tears of anxiety, fear, and excitement as we celebrated each milestone and every sign of progress he achieved.
"Lucas' journey is a testament to the bravery and dedication of his family, and the transformative power of research and evidence-based care. His story continues to inspire us.”
*Courtesy of South Metropolitan Health Service .
from bilateral deafness where daily life is training, she adds. “If you don’t actively train the implanted ear, the brain will give preference to the normal hearing ear,” she adds.
The reported incidence of congenital SSD is 1:1000 births, and among adults, SSD prevalence is estimated at about 0.14%, Dr Távora-Vieira says. Studies have shown that almost half of newborns with SSD have no auditory nerve so are ineligible for cochlear implants. But the other half do, and CI is an option.
At Fiona Stanley Hospital, children and adults with SSD can receive cochlear implants.
“When everything comes through one ear, the brain can’t separate the signal from the noise,” she says. “With binaural hearing you can localise sound, you know where sound’s coming from and hear much better in noise because the brain filters out what you don't want and concentrates on the signal you want.”
People with SSD say they don’t need help hearing in quiet settings but as soon as they are in noise they struggle, she adds. “Over and over again we see people aged in their 30s who think they can cope come back in
Audiologist Robyn Shakes, MED-EL’s managing director for Australia.
their 40s wanting the surgery," Dr Távora-Vieira says.
"When you’re younger, you create coping strategies but that diminishes with age.
"Teens often return in their 20s seeking an implant when they’re working, studying, or have children and are struggling to cope in noise.
"As soon as the environment is more challenging, they struggle.”
Older adults return seeking help after they become fatigued and exhausted from trying to concentrate in noise for years, she adds.
Dr Távora-Vieira urges audiologists to refer these patients to their local implant clinic with experience in SSD.
Above: MED-El says it aims to get as close as possible to Natural Hearing with individualised electrode array selection and insertion depth.
Audiologist Ms Robyn Shakes, MED-EL’s managing director for Australia, says its OTOPLAN software for individualised implantation and 3D visualisation plus anatomy-based fitting are key advancements in the field.
“One of the big di erences with our cochlear implants is that they're individualised. We have a large variety of electrode array lengths to best fit the various cochlear duct lengths in individuals,” she says.
“Our OTOPLAN software uses the pre-surgery MRI or CT scans to measure the cochlear duct length giving valuable information to surgeons.
“The MED-EL speech encoding strategies have evolved over time as we continue to learn more about the processes involved with the normally hearing ear. We attempt to get as close as possible to Natural Hearing with our individualised electrode array selection, our Fine Structure Processing (speech coding strategy) and our Anatomy Based Fitting (technology).
“These enhance the temporal aspects of hearing that are so important for natural pitch matching, hearing in noise and sound localisation.”
Shakes says adults with SSD are aware of its debilitating e ects and challenges that they face include fatigue, poor sound localisation and di culty in social situations.
Children struggle in school
Research shows children with SSD can struggle in school and are more likely to repeat a year, she adds. “It’s an invisible disability that can a ect social interactions and scholastic achievement. Early intervention and counselling are very important.
“Some patients try hearing aids first while others go straight to a cochlear implant depending on degree and aetiology of the hearing loss,” she says.
“We’ve known for a long time of people born with single sided hearing loss and others who gradually or suddenly lost their hearing in one ear. Until relatively recently there were not many options for treatment.”
Adults who were born deaf might not have developed auditory pathways so they might be unsuitable for a cochlear implant. But if people develop hearing loss later in life, it's generally not that di cult to reignite their existing pathways, Shakes says. “Those patients particularly do well with cochlear implants for bilateral or single sided deafness.”
Children born deaf in Australia are identified during newborn screening. “We need to make cochlear implants available to these children while those auditory pathways are being laid down, just as we do for children born deaf in both ears,” she says.
She says the first cochlear implants for SSD in Belgium showed significant unexpected benefits such as improved hearing in background noise and better directionality. “The initial intent was to relieve unbearable tinnitus by amplifying background outside noise.
“The amazing by-product was they could hear speech – it didn't just abate the tinnitus. Recipients were getting really good hearing too, very good outcomes quickly. It was quite miraculous.”
Similarly, Dr Távora-Vieira’s group has had outstanding results with more than 95% being full-time wearers of their sound processor, leading the way worldwide, Shakes adds.
She says audiologists have an important role in identifying candidates who may benefit from cochlear implants for SSD.
“There's growing awareness that we can do something for adults and children with single sided deafness and they can achieve excellent results. But more awareness is required for candidates that there is a solution, and among professionals that it is worth referring them for an assessment,” Shakes says.
MED-EL runs workshops and has resources for audiologists to learn about cochlear implants for SSD, and patient resources including its free ReDi app to practis-e auditory and speech skills. Practitioners can email help@medel.com.au for advice on patients.
The world’s first and only ‘smart’ hearing implant system by Cochlear was launched in Australia in June and is already having an impact on patients and practitioners. The system features internal memory and upgradeable firmware.
The future-proofed nature of the Cochlear Nucleus Nexa System is a major drawcard that practitioners like Perth ENT surgeon, Dr Stephen Rodrigues, believe may inspire potential patients to have an implant sooner rather than later.
Dr Rodrigues has performed more than 500 cochlear implant surgeries during the past 22 years at Sir Charles Gairdner Hospital, Hollywood Private Hospital and Perth Children’s Hospital.
At the time of writing, he had performed six Nexa implant surgeries since first available in Australia on 16 June 2025 – four in the first week, two in adults and two in children – and another two patients after that.
“The exciting thing is that one of the discussion points that frequently comes up when counselling someone is, ‘should I do this now or should I hold o in case something new and better comes out in the future?’,” Dr Rodrigues says.
“It's tricky because you can't hold o a lot of the time, particularly in children. You can't wait five years because you will have missed that critical window (for building the neural pathway and learning).
“But being able to tell people that if there's new technology in the future, their current Nucleus Nexa implant will be able to incorporate it, that is important.”
Dr Rodrigues says recipients will be able to reap benefits from future technologies like Bluetooth, LE Audio technology and Auracast when available with the new implant system in the future.
While it's still too early to receive feedback on functionality – given that switch-on has only just occurred or is yet to happen – he says the surgical procedure and recovery experience have been consistent with previous models. He has seen a growing awareness of cochlear implants; whereas few people were familiar with them in the past, some patients now proactively ask whether they might benefit from one.
“This awareness will help in that discussion that we're having about whether people do it now or wait. I think people will be asking about it more, particularly if they've heard the ‘future-proof’ buzzword,” Dr Rodrigues says.
“We don’t know what’s coming but we're being assured that we're ready for it with firmware that can be upgraded in the internal implant to incorporate future technologies.”
Another benefit of the Nexa implant is that if patients lose their sound processor, their hearing map is stored in the implant, he says. “We can reboot it by putting on a blank sound processor that the patient can pick up or we can mailzit to them,” he says.
Newer instruments are also improving processes, he adds, such as the Nucleus SmartNav System which advises how quickly electrode insertion is occurring and the angle. It also performs a placement check, showing if the electrode has been inserted and positioned correctly, reducing the need for imaging post electrode insertion.
Additionally, SmartNav provides data on electrode function and sound levels which is particularly helpful for babies who can’t tell a practitioner at switch on whether it’s too loud.
Dr Rodrigues says while the number of children who receive cochlear implants has remained stable along with the number of babies who are born deaf, the number of adults receiving implants has increased.
“We’re seeing more adults now, particularly in their 70s and 80s who are
being implanted because even if you're 80, there's a good chance you're going to live to close to 90 and that's a long time to not hear,” he adds.
His implant audiology colleague at Medical Audiology Services in Perth, physiotherapist-turned-audiologist Dr Andre Wedekind, says that since media coverage of the Nexa System, people have been calling asking about it.
“There's been a lot of public awareness which I haven't seen in the implant space for a long time which is great,” he adds.
Dr Wedekind did a master's in audiology and a PhD with the UWA School of Surgery, looking at cortical reorganisation and single sided deafness after cochlear implantation.
“Cochlear implants are a big part of what we do,” he says. “We also service remote areas through telehealth. We align in-person appointments so patients travelling from a long way away can have an assessment with us in the morning and the surgeon in the afternoon followed by a multidisciplinary team meeting perhaps the week after.”
'Amazing' all day battery life
To reduce travel burden, the clinic uses Cochlear’s Remote Check, a tool that lets patients complete hearing tests from home via the Nucleus Smart App on their compatible smartphone.
“It checks impedance, hearing, and even speech-in-noise ability, all through the implant,” Dr Wedekind says. “Many can't a ord extended time o work, so we make it as e cient as possible."
Another tool, Remote Assist, allows device programming changes to be made via telehealth.
“The Nexa implant’s internal memory means I can save maps directly to the device." Dr Wedekind says. "That way, if a processor is lost, I can mail a blank processor to a patient in, say, Geraldton five hours away.
"They put it on, and it automatically loads their settings. This reduces downtime for me and clinic visits for patients.”
The approach also streamlines clinical operations. “Clinic sta can hand
over a blank sound processor without pulling me out of an appointment. It’s a time saver and lets me focus on more meaningful patient care, like counselling."
Cochlear says battery life is now all-day for more users and Dr Wedekind says feedback on the Nexa System has already been positive. “Battery life is amazing, especially since the devices are smaller than previous generations,” he says.
Nucleus SmartNav also automatically uploads surgical data like impedance and implant type straight into his software, saving him from chasing it up or entering it manually.
Having worked with cochlear implants for 11 years, Dr Wedekind has seen a shift in patient attitudes. “The first question used to be, ‘Will it go o at the airport?’ Now, it’s ‘Will it help me?’ It’s no longer seen as a burden but as a solution,” he says. “With Nexa, both processor and implant are now designed to move forward together.”
All clinicians should refer
Dr Wedekind encourages general audiologists to be confident in discussing cochlear implants, even if they don’t map them. “Patients are hearing about cochlear implants earlier. It’s important for audiologists to be informed, even if the patient isn’t a candidate yet,” he says.
“Technology like this won’t replace audiologists. We’re still essential for counselling, setting realistic expectations, and guiding families through the journey.”
Founder and clinical director of DeciBelle Hearing in Wollongong, independent audiologist Dr Julitta Amponsah, agrees and believes all audiologists should refer patients for cochlear implants if needed.
“It’s important for us to recognise when the patient isn't getting the outcome they deserve from hearing aids and be aware that there are other products that could potentially help them hear a lot better and improve their quality of life,” she says.
“My portfolio includes everything, so I want to be able to help everyone on that hearing journey and if something’s not working, we move on to the next thing.”
Dr Amponsah worked as an audiologist in the UK’s National Health
Audiologist Dr Julitta Amponsah and the demo cochlear implant she keeps on her desk with hearing aids to show patients.
System and in private practice in Harley Street, London in paediatric and adult audiology before moving to Australia five years ago.
Like most other audiologists, she doesn’t work directly with cochlear implant patients but discusses the technology and refers patients for assessments.
“I previously helped with mapping cochlear implants for children so I’m aware of how important it is to know the limitation of hearing aids and put people on the path to cochlear implantation if needed,” she says.
“I have a tray of hearing aids and a demo cochlear implant on my desk as part of my consultation. I show patients and sometimes give them a cochlear implant booklet and put them in touch with the (Cochlear engagement) team for information purposes.”
Dr Amponsah says when speech discrimination is poor and outcomes of hearing aids are not great, she will have the conversation about cochlear implants and recently referred two clients aged in their 80s. One has chronic ear infections and cannot wear hearing aids “He's been without his hearing aids for about 10 months and it's impacting his life,” she says.
She believes the new implant may attract more patients because it's “smart” and allows for firmware upgrades.
To make hearing easier, Cochlear says the Nucleus Nexa System intuitively responds to changing needs with its Forward Focus feature which uses advanced algorithms to enhance sound clarity in noisy environments. This feature can be user-controlled or automated and is available through the Nucleus Smart App for existing cochlear implants and on the new platform.
“People with profound hearing losses have the most di culty in speech discrimination when in background noise so to have a smart processor detect that and give them a clearer sound is,” Dr Amponsah says, “I think, a game changer.” Cochlear says the Nucleus Nexa's world first smart implant system reimagines the internal technology, which is a hearing health advancement that will continue to provide benefit to recipients.
*As Bluetooth LE Audio compatible devices become available, a firmware update will be required to use certain features. Auracast broadcast audio capability is subject to third party adoption of the Auracast protocol. Forward Focus is a clinician-enabled feature that can be user-controlled or automated. For information regarding the compatibility of Cochlear’s sound processors, implants, operating systems and devices with Apple or Android devices, Cochlear Remote Care, Smart Apps and support apps, visit www.cochlear.com/compatibility.
Artificial intelligence is rapidly reshaping the audiology landscape. Across the industry, hearing aid manufacturers, hearing care professionals and patients are embracing AI to tackle one of the most persistent challenges in hearing health: helping to hear better in complex, noisy environments.
The most recent to embrace the technology is Specsavers
Audiology, who has released hearing aids that put the long-term hearing health of patients first and use AI technology to enhance, not replace, the human experience of hearing.
This approach reflects a shift in thinking: AI is not here to take over, but to support and empower patients to live life the way they choose.
By combining the brain’s natural processing power with intelligent algorithms as seen in this latest generation of hearing aids, AI is proving to be a gamechanger for professionals and patients alike.
Specsavers says that for many hearing aid users, hearing challenges aren’t completely solved with hearing aids. So much so, that hearing care professionals are trained to set expectations with patients when they first fit their hearing aids.
Ms Kathryn Launchbury, audiologist and senior professional services manager at Specsavers Audiology Australia and New Zealand, says AI-powered hearing aids change everything.
“Our goal was to make hearing feel e ortless,” she says. “With our latest Advance 65 hearing aids, the AI technology adapts seamlessly to the wearer’s surroundings, spotlighting speech while maintaining awareness of ambient sounds. It means wearers can stay engaged in conversations even in the presence of background noise. It’s about restoring confidence and connection.
“This adaptability is especially valuable in dynamic environments – think of a family dinner, a team meeting, or a walk through a busy shopping centre. In these scenarios, Advance 65 hearing aids help wearers stay engaged and present, reducing the cognitive load required to follow conversations in noisy environments.”
“It was very important to us that the AI in Specsavers’ hearing aids didn’t listen to the patients who were using them. We value patient privacy and would never recommend a product that listens to conversations.”
Kelsie Bailey Specsavers Audiology
ABOVE: Advance 65 hearing aids from Specsavers Audiology contain artificial intelligence including a Deep Neural Network chip.
Utilising AI for hearing aids was no mean feat, and Specsavers Audiology product manager, audiologist Ms Kelsie Bailey, says that while the company was keen to use the technology to benefit patients, it was paramount that it did so in a responsible way.
“It was very important to us that the AI in Specsavers’ hearing aids didn’t listen to the patients who were using them,” she adds. “We value patient privacy and would never recommend a product that listens to conversations.
“Instead, unlike traditional hearing aids which have one processing chip, the AI hearing aids contain a second processing chip, called a Deep Neural Network chip. This chip is trained on more than 13.5 million real-world sound samples, enabling it to distinguish between di erent noises and speech. As a result, it can responsively adjust the user’s environment, reducing unwanted background noise.”
Bailey says this dual-chip architecture is what makes Advance 65 hearing aids special. It mimics the way the human brain processes sound and feels like there is a little sound engineer inside your hearing aid adjusting levels to give you the best result, she adds.
“Advance 65 is built to work with the brain, not against it. The result of the Deep Neural Network chip integration is a hearing aid that doesn’t just amplify sound, it understands it,” she says.
Specsavers’ Advance 65 AI hearing aids are already making a di erence in clinics across Australia, Specsavers says.
Launchbury says that while formal patient data and insights are still due to be collected, feedback from Specsavers hearing care professionals has been very positive.
“As an audiologist myself, I tested the hearing aids with significant background noise to see what the impact could be on my patients,” she says. “Engaging in conversations became noticeably easier due to the reduction in background noise, which was not only less intrusive but also more natural.
“This subtle shift created a more relaxed and pleasant atmosphere, allowing for clearer communication and a more enjoyable overall experience. I can’t wait to see how this translates to improved patient outcomes.”
Specsavers’ vision for AI in audiology
Utilising AI isn’t just a technological leap; it’s a signal for the future of audiology, Specsavers believes.
For hearing care professionals, automatic environmental adaptation means fewer fine-tuning appointments and more time for meaningful patient engagement.
“With AI-powered hearing aids, patients feel more confident and satisfied as they experience improved hearing in di cult listening situations,” Launchbury says.
“Clinicians are also able to better support patients to achieve their listening goals through a focus on counselling and communication strategies rather than just spending time on hearing aid settings. This is the direction that we want to head in as an organisation that is dedicated to patient-centric care.
“I think safe and e ective use of AI has great potential to transform how hearing care professionals work. It’s just the beginning and I'm really excited to see what's going to happen in this space to improve both the experience and e ciency of the hearing care professional, but also people's experience of hearing care as well.”
Specsavers Audiology’s embrace of AI is part of a broader vision – one that sees technology as a partner in care, not a replacement for it. By integrating AI into its products, Specsavers says it is embracing a new standard for hearing care that’s intelligent, empathetic, and accessible.
“We believe AI should enhance the user’s experience, not complicate it,” Launchbury concludes. “Advance 65 is a testament to that belief – it’s smart, seamless, and centered on the patient.”
As AI continues to evolve, Specsavers says it is committed to continually develop, test and release solutions that empower audiologists, support patients, and change lives through better hearing.
LEFT: Starkey hearing aids undergoing testing in a soundchamber. Starkey devices are put through more than 50 durability tests and withstand over 500 hours of high stress testing.
technology that automatically adjusts the hearing aid to any situation. This makes it easier for wearers to pop them on and forget, without having to fiddle with adjustments. And in the case of DNNs, these e ectively dampen background noise by enhancing the speech of people talking.
Starkey says customer and practitioner feedback indicates breakthroughs like these deliver a superior hearing experience with wearers amazed at how crystal clear and natural speech sounds through the devices.
Despite its global presence, the Starkey business is still family owned. Remarkably, Austin remains involved as the company’s chairman. He, along with co-chair, Mrs Tani Austin, are committed to providing hearing healthcare access to underserved communities and people in need through Starkey’s corporate social responsibility program, Starkey Cares and through the non-profit, Starkey Hearing Foundation.
Hearing aids from Starkey sit proudly on the shelves of audiology practices across Australia and the world, and in the ears of their clients. HPA explores its history of innovation and the rigorous testing its devices undergo to deliver meaningful outcomes.
Nearly six decades ago, Mr William ‘Bill’ Austin opened a small hearing aid repair shop in America o ering fixed prices for all makes of hearing instruments. It was an industry first in 1967.
From humble beginnings, Professional Hearing Aid Service in Minnesota has grown to become an AU$1.5 billion company called Starkey. Much of this is down to a relentless pursuit of innovation – and an ability to improve the lives of people with hearing loss with meaningful solutions and dependable service.
Starkey has been innovating ever since Austin saw potential in the inaugural fixed price o er. But what the company’s hearing aids deliver today would have been unimaginable back then when artificial intelligence (AI) and deep neural networks (DNNs) – which have revolutionised its devices – were little known concepts.
Today, the company’s latest iterations, Edge AI and Genesis AI, feature AI
The company’s president and CEO Mr Brandon Sawalich is the most tenured current CEO in the hearing industry, and the Hearing Industries Association board chairman. He’s celebrating 31 years with Starkey and leads a global team of more than 5,000 employees, including in Australia, with facilities in over 29 countries.
Under his leadership, Starkey has maintained its reputation for ground-breaking products. By incorporating integrated sensors, AI and health and wellness technology, his vision of hearing aids becoming high-tech health devices has ensured Starkey remains at the vanguard of hearing product development.
Starkey was the industry’s first to introduce on-ear sensors, coupled with health and wellness features such as on-board fitness and activity tracking. Such innovations are inspiring an evolution in the benefit of hearing aids beyond aural rehabilitation.
There are also world first features like the Balance Assessment Tool to help prevent falls, and a fall detection alert that tells the wearer’s emergency contacts in the event of a fall.
The My Starkey app on the patient’s phone for Edge AI and Genesis AI devices also helps adjust hearing aid settings, stream calls, find lost hearing aids, and track personal health metrics. There’s also an AI personal assistant to help adjust hearing aids or ask questions such as “what’s the weather today?”
Mr Ganesh Borra, Starkey’s director of engineering/mechanical hardware, says Genesis AI products, and the following Edge AI devices, were engineered from the inside out to create a waterproof hearing aid. This unprecedented waterproof protection to one metre is available in standard and custom rechargeable devices.
Borra, who has more than 12 patents, leads the team that designs, develops and tests the mechanical and electro-mechanical systems, sub-systems, and components for all Starkey hearing aids. This includes developing new industrial designs and formulating novel test methods tailored to customer and market needs.
In a white paper detailing the new designs and testing his team implemented for Genesis AI, and later Edge AI, he says the industry-leading improvements to design assure reliability of devices through their lifespan.
“Our continuous dedication to quality and reliability ensures our products can withstand even the most rigorous environments,” he says. “Starkey hearing aids are medical-grade hearing healthcare devices that are built for superior sound quality and to encourage our hearing aid wearers to live a more active lifestyle.
“While most hearing aids today are designed to withstand wear and
tear associated with being in constant contact with the wearer’s skin, in or around the ear, Starkey hearing aids continue to push the limits of the lifestyles that wearers maintain.”
With this in mind, the company is happy to provide an overview of “the industry’s most comprehensive quality control process” that it has developed, so that every pair of Starkey hearing aids performs as reliably on day one as day 1,000 – and beyond.
“We push endurance and durability to the max so our technology can be fit and worn with confidence,” Starkey says. “The devices are put through more than 50 durability tests, withstand over 500 hours of high stress testing and have industry leading battery-life.”
These tests go beyond the IP68 rating, the highest level of dust and moisture protection according to the Ingress Protection Code (IP Code). These include waterproof tests, heat tests to 70 degrees Celsius, humidity tests, salt mist tests, salt brine immersion tests, rain spray tests and sweat drip tests, ensuring devices perform in all types of environments, exercise and weather conditions.
Nanocoating technology protects by acting as a first layer of defence from liquids, oils, and solids that may degrade components over time. But Starkey didn’t stop there.
“Multiple ingress protection barriers were put in place for standard and custom products to ensure reliability,” Borra states. “Starkey’s Pro8 HydraShield technology consists of an elaborate design and additional layers of protective barriers specifically targeting ingress and corrosion, o ering additional protection in even the harshest environments.”
The Pro8 HydraShield waterproof system, rated beyond IP68, is the company’s proprietary approach to quality design improvements for rechargeable products. Thorough testing ensures it protects rechargeable devices from moisture ingress to make them waterproof. When Genesis AI was introduced with a new case design, it was an opportunity for the company to double down on protection.
“Genesis AI RIC RT and mRIC R case design benefits from a ground-up re-imagination of quality design compared to our legacy RIC products,” Borra says. “Moisture ingress to the battery is the largest concern with rechargeable products, therefore a completely encapsulated lithium-ion battery compartment was instituted, as well as silicone seals for the charging contacts.”
An ethylene propylene diene monomer (EPDM) compression seal was also added to the RIC receiver connection for extra moisture ingress protection.
Rechargeable products also undergo extended reliability tests to simulate years of use to ensure they’re robust enough to withstand exposure and handling through the years.
Starkey’s quality and design team realised the traditional IP68 test did not thoroughly examine what moisture can do to a hearing aid over time. Knowing this, they invented multiple ways to stress-test the hearing aids to reenact everyday use-cases that can cause wear and tear on a hearing aid.
“These validate that Starkey hearing aids will not only survive varied states of moisture conditions in the short term but will continue to function as expected for the lifetime of the device,” Borra says.
The high humidity test simulates accelerated aging over five years. And to simulate liquids with high salt concentration such as sweat, chlorinated water, and humid environments, hearing aids are tested in a highly corrosive environment with salt spray for 48 hours.
“Hearing aids are heavily exposed to moisture and humidity due to their location in the ear canal or over and behind the ear,” Borra says. “Our extended reliability test in a high-humidity chamber exposes hearing aids
Starkey’s director of engineering/ mechanical hardware Ganesh Borra in the laboratory.
to 95% relative humidity at 35 degrees Celsius.”
The salt mist chamber simulates highly corrosive conditions that could be attributed to an active lifestyle through the years.
Devices are subjected to real-life handling, such as intermittent automated switch activation (user control short press), and charge cycles in test chambers.
“Starkey hearing aids are also subjected to a battery of tests to stress various parts of the hearing aid, so potential weaknesses and failures can be investigated and improved upon,” Borra explains.
“The corrosion and ingress stress tests are targeted, short-term aggressive tests to ensure the ability to test the design to failure so comparisons and continuous refinements can be made to improve product quality.”
In the sweat drip test, artificial sweat solution is dripped every second for 24 hours on standard hearing aids without nanocoating protection. They are oriented in di erent positions to simulate di erent handling situations and expose potential ingress seams.
For this test, Genesis AI hearing aids achieved a 100% pass rate on its full charge cycle of more than 50 hours.
The rain spray test simulates rain shower on a hearing aid worn on an artificial ear. A novel test with 10 rotating nozzle heads sprays water continuously as it moves in an arch around the ear and hearing aid setup.
The acoustic response to specific input tones is analysed in real-time as a measure of device functionality. Post-test, the device is analysed for acoustic, wireless, switch (user control), and charging performance. All devices had a 100% pass rate.
The salt brine immersion test focuses on isolating ingress paths of RIC R hearing aids to failure when exposed to sweat and humidity after prolonged use. Moisture sensitive indicators in targeted areas inside the device monitor for moisture ingress. Devices showed no signs of ingress in the targeted areas after being immersed in salt brine for an hour.
“Starkey’s continued dedication to quality and reliability remains a top priority to continue helping patients hear better and live better for years to come,” Borra concludes.
Neurologist and neuro-otologist
Dizziness, vertigo, and imbalance can wreak havoc on lives. HPA asks four practitioners who specialise in vestibular disorders for an update on the field and how to bring a vestibular clinic to life.
Sydney audiologist Dr Celene McNeill, who has worked in the vestibular field for more than 30 years, believes every audiologist can become proficient in vestibular care if they have the interest and commitment.
“Vestibular knowledge isn’t exclusive or unreachable – it’s just a matter of training and curiosity,” she says.
“I strongly believe the vestibular field has been overlooked in Australia in favour of hearing rehabilitation. There’s a large gap between the number of people experiencing dizziness and the number of clinicians trained to assess and treat vestibular issues.”
Dr McNeill says many patients are misdiagnosed or dismissed before reaching a clinic like hers. “I would absolutely encourage audiologists to consider further training in this area; it’s intellectually stimulating and incredibly rewarding. With the right mindset and preparation, audiologists are uniquely positioned to lead in vestibular diagnostics and care,” she says.
In 2024, an Australian study of people aged 55 and over found dizziness/ vertigo was a frequent and detrimental symptom in the community.
Cumulative 10-year incidence of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo were 39%, 27%, and 11%, respectively.
Other Australian research estimates 10%-30% of older community-living people report dizziness often leading to functional disability and psychological distress.
Dizziness is often caused by problems of the inner ear with common causes including benign paroxysmal positional vertigo (BPPV), migraine and vestibular neuritis.
In Dr McNeill’s clinic, BPPV is possibly the most common but she also sees many Ménière’s disease cases, one of her key areas of interest.
“Di erential diagnosis is essential, especially in distinguishing Ménière’s
from conditions such as vestibular migraine, vestibular neuritis, labyrinthitis, persistent postural-perceptual dizziness (PPPD), and other chronic balance disorders,” she adds.
There does seem to be an increase in cases, she says, likely due to greater awareness and improved diagnostic capabilities. More patients are seeking help earlier, possibly driven by online information and word-of-mouth.
Dr McNeill has noticed an increase in word-of-mouth and self-referrals. She also receives referrals from ENT specialists, neurologists, GPs, physiotherapists, and fellow audiologists, which have remained steady over the clinic’s 20-plus-year history.
Her interest in the field began early in her career in Brazil, where there’s a strong tradition of research into vestibular diagnostics and rehabilitation.
“When I arrived in Australia, my first position was as chief audiologist at St Vincent’s Private Hospital’s Hearing Research and Diagnostic Clinic, which at the time was the only private audiology clinic in Sydney o ering vestibular testing,” she recalls.
She received further training at the Royal Prince Alfred Hospital balance clinic under neurologist Professor Michael Halmagyi, a global leader in vestibular disorders. When she opened her practice in Bondi Junction in 2003, she included a comprehensive vestibular service.
Dr McNeill o ers audio-vestibular assessments, interprets results, explains findings, and creates individualised management plans. “We provide in-house vestibular rehabilitation and refer for medical evaluation when red flags appear,” she adds.
“Education and counselling are central to what I do; helping patients understand their diagnosis and prognosis is just as important as testing.”
She recalls major diagnostic advances over the past two decades including development of ocular/cervical vestibular-evoked myogenic potentials (VEMPs) and video Head Impulse Testing (vHIT) which has allowed more precise assessment of individual otolith and semicircular canals function.
“Infrared video goggles also have made BPPV diagnosis more accurate and accessible,” she adds. In treatment, vestibular rehabilitation has gained traction, and there’s growing recognition of psychological aspects of dizziness, particularly its relationship with anxiety.
“Virtual reality is an emerging tool for rehabilitation which is promising and I’ve explored.”
Wearable tech, including mobile phone cameras for monitoring nystagmus, along with mobile apps and AI-supported diagnostics, are starting to play an important role, she says.
Setting up a vestibular clinic requires clinical expertise and strategic planning, she adds, especially because equipment is costly. This can be a barrier for small independent clinics but she started by buying second-hand machines and upgrading as the clinic grew.
“When I founded Healthy Hearing & Balance Care, my goal was to create a full-scope audiology clinic. I had extensive experience in vestibular testing and CPD has always been a priority – I attend conferences and seminars to stay current,” she says.
“Vestibular rehabilitation was a natural progression after diagnosis. There are many manoeuvres and targeted vestibular exercises that fall well within an audiologist’s scope.”
Lack of Medicare funding
Dr McNeill believes funding remains a significant barrier to expanding vestibular services. Since Medicare doesn't allow audiologists to bill vestibular tests, medical oversight is needed from an ENT, neurologist or neuro-otologist.
“A key issue is Medicare’s lack of recognition of audiologists’ expertise. We’re not allowed to bill vestibular tests under our own Medicare provider numbers,” she says. “Only hearing tests qualify. In contrast, ENTs, neurologists, and even GPs can bill vestibular tests, often performed by audiologists, nurses, or physiotherapists on their behalf.
“To provide Medicare rebates, I must work under the ‘supervision’ of a medical specialist who is responsible for the test results. This is not only unfair to audiologists but also places an unnecessary burden on already busy specialists and increases patient costs by involving two professionals where one would su ce.”
Patients can claim up to $636.06 in rebates when vestibular tests are billed through a specialist’s provider number but receive no rebate if billed through an audiologist.
She says another frustrating discrepancy is that hearing tests billed under a medical specialist’s Medicare number attract a fee 20% higher than those billed by audiologists despite the fact most specialists don’t perform the tests. “Audiologists, with master’s level training, are the qualified providers,
“I would absolutely encourage audiologists to consider further training in this area; it’s intellectually stimulating and incredibly rewarding."
Dr Celene McNeill Healthy Hearing & Balance Care
yet the current system allows unqualified personnel to bill under a specialist’s number,” she says. “This urgently needs reform.”
In 2020, the Medicare system was reviewed and Melbourne vestibular audiologist Dr Jessica Vitkovic helped describe vestibular items for bulk billing. Her treatment is provided under medical oversight of neuro-otologist Dr John Waterston.
“Medicare allows us to provide those services on his behalf. He doesn’t have to physically see every patient but guidelines stipulate he has input into the patient's care and writes reports,” Dr Vitkovic says. “We’ll see the patient, prepare the draft report, provide management recommendations, and he is like a second pair of eyes and may recommend additional management.”
A vestibular audiologist with 24 years’ experience in the field, Dr Vitkovic says the reason she established her vestibular practice in 2022 was that patients with dizziness, vertigo or imbalance often did not know where to go for help.
Many experienced lengthy delays and costs in getting an accurate diagnosis and she wanted to provide a quicker pathway to diagnosis and treatment. She named her Mount Waverley practice, Dizzology so people with these symptoms could easily find it by googling.
Post graduation, Dr Vitkovic worked at the Royal Victorian Eye and Ear Hospital (Eye and Ear), and later ran the balance unit there. She was also an academic at The University of Melbourne for 19 years, in charge of vestibular research and the audiology masters course.
She enjoys troubleshooting and diagnosis. “There's always something new coming out in this space that helps with diagnosis or understanding pathologies,” she says. “A lot of it involves empowering the patient. Patients want to know what they can do about their symptoms and we get to address that in a two-hour session where we build rapport, trust, and educate them on what will be beneficial across their journey.”
The top three conditions she sees are BPPV, vestibular migraine and PPPD.
“In BPPV, otoconia migrate from one part of the balance organ into the wrong part and in a series of manoeuvres we perform, gravity migrates the crystals out of the wrong part,” she says. “It's very treatable, and the patients love you because you can fix them with one or two manoeuvres. It’s really satisfying. Other pathologies are more complex.”
If treatment is required outside her expertise she refers to physiotherapists, neurologists or ENTs who specialise in the conditions. Anxiety is a common comorbidity Dr Vitkovic can assist with due to cognitive behavioural therapy and acceptance commitment therapy training. “Sometimes people worry, ‘Will I have this forever?’ and ‘I’m dizzy, I'm not going to be able to do this’. There's such a big, dizzy-anxious cycle,” she says. Having vestibular migraine herself is reassuring for patients. “Some arrive in
Neurologist and neuro-otologist
Associate Professor David Szmulewicz.
tears, feeling alone, but leave feeling understood, hopeful, and equipped with tools from someone who truly gets what they're going through,” she says.
Knowledge of protocols and billing systems from her previous roles assisted in setting up her practice, and she chose a geographic area without a similar service.
While still working, she eased herself into her new business, initially renting a room part time in a busy vestibular physiotherapy practice. Once she was working there four days, she moved to her own premises. Business has flourished and she has taken on two vestibular audiologists.
Outlay for equipment was substantial so she initially bought the basics and has bought more as the business has grown. She says vestibular equipment and assessment keeps advancing especially with lighter VNG cameras facilitating the development of the video head impulse test. Testing is becoming more automated and even portable now, she adds.
As an Audiology Australia director, Dr Vitkovic has helped arrange popular vestibular boot camps at its Sound Exchange events as vestibular testing has grown from a caloric test, ABR and a hearing test, to include CVEMP, OVEMP and VHIT.
Dr Vitkovic’s teaching at university inspired her student Jessica Blakeley to specialise in vestibular audiology. Blakely set up her own Melbourne clinic, Ears in Balance Dizziness and Vertigo Clinic in Chelsea, ten years ago.
“She’s the reason I love vestibular audiology; she was a real mentor to me starting out and setting up,” Blakely says. “We collaborate quite a lot, have meetings with our sta members, and share resources – even a vestibular audiologist!”
After graduating, Blakely got a job doing vestibular function testing at The University of Melbourne hearing clinic along with research. She loved it but long distances to work took its toll.
“My mum had done careers coaching and we worked out I wanted to work in a vestibular clinic. Since there wasn’t one close to home, she joked, ‘Why don’t you start one?’” she says. “We created a spreadsheet of what we’d have to do to achieve it and started ticking things o . I set my goal, and it happened.”
Blakely started working two days a week in her practice as she was still working part time at the university and for a neurologist. “I had three jobs but as the business grew, I got to focus solely on it," she says.
“Now I have vestibular audiologist employees and we’ve just refurbished the clinic. We’ve got three clinical rooms with equipment which allows us to see multiple patients in a day because we're so busy.”
Like Dr Vitkovic, Blakely initially rented a room part-time in a physiotherapy
practice, and later in an audiology clinic where the audiologist concentrated on hearing aids and she focused on vestibular issues. That relationship continues today as she refers to both and they refer patients to her.
She says equipment is a big cost in setting up and it's important to pick a manufacturer with support behind it, training modules and who you can reach out to about equipment. Before setup, she used a computer-based 3D room designer to create where equipment would go and how it would fit
Neuro otologist Dr Luke Chen who specialises in vestibular disorders has medical oversight.
“I wanted the service to be accessible to everyone so we bulk bill for everything,” Blakely says. “Luke looks at every report, he’s on call if we have any questions, and he’ll see our urgent patients, such as those with acute vestibular dysfunction, red flags or sudden onset symptoms for the first time, which is great.”
BPPV is the most common condition she sees. “I'm hoping we are creating more awareness,” she adds.
“Our local doctors are getting more switched on and some are sending patients straight to us which I hope cuts down that bouncing around to practitioners that many patients experience.
“Doctors are also sending a lot to physios which is good – they get the more complex ones – but we see a lot too. We also get people who’ve been to a hospital ED and are often misdiagnosed with vertigo.”
Her patients come from a wide catchment from Mornington Peninsula to Brighton and she has even had interstate clients. “Usually, they only have to see us once as if it’s BPPV, we're ideally treating them in one session, but I'll always recommend they follow up with a physio.
“If symptoms recur, they may need another go to reposition all calcium carbonate crystals.”
Accurate diagnosis for other conditions means treatment or referral to other specialists and addressing contributing lifestyle factors.
“Some patients are very frustrated. They've spent a lot of money and had blood tests and sometimes, it’s a process of elimination, so validating that and helping them through the process is important,” she says.
“One of my favourite things is that look of relief – ‘Oh, I'm not going crazy’ –because they’re often invisible symptoms that don't show up on blood tests or scans. To give them that validation that what they're feeling is real, and then how we can work towards feeling better is vital.”
With more awareness, comes more demand for these tests and clinics, she says. “We do need more vestibular audiologists and the more, the merrier,” Blakely says.
Melbourne vestibular audiologist
At the forefront of treating and researching complex balance disorders in Australia is Associate Professor David Szmulewicz, a neurologist and neuro-otologist at the Eye and Ear and head of the NeuroMovement Laboratory at The Bionics Institute.
The hospital’s balance disorders and ataxia service includes a vestibular clinic, complex balance disorders clinic, injecting clinic for vestibular migraine, and a vestibular audiology service.
At the heart of his work is the Complex Balance Disorders and Ataxia Service (COMBDAS), a unique, multidisciplinary clinic set up in response to an increasing need for treatment.
A/Prof Szmulewicz says it’s the only clinic of its type in Australia dedicated to patients with complex balance disorders such as combinations of peripheral and central vestibular disorders, peripheral sensory and other impairments.
“Patients seen in this clinic often don’t fit neatly into a single diagnosis. Their presentations are complex, so assessments must be equally comprehensive,” he adds.
COMBDAS opened two years ago after earlier operation elsewhere. Its status as a US National Ataxia Foundation Centre of Excellence reflects its national and international recognition.
It conducts extended vestibular and ocular motor objective assessment, detailed MRI brain and full spine scans, an ataxia protocol neurophysiology panel including large and small fibre nerve conduction studies, autonomic nervous system assessment, and central sensory evoked potentials.
“The clinic’s been a great success; it has seen more than 400 patients and continues to receive referrals weekly nationwide from audiologists, ENT specialists, neurologists, GPs, and physiotherapists,” A/Prof Szmulewicz says.
Audiologist referrals
Audiologist referrals to the standard vestibular clinic are via GPs to satisfy Medicare hospital referral requirements and are for patients with vestibular disorders.
If vestibular function testing raises suspicion of central vestibular pathology, they can refer patients to the complex balance disorders clinic.
“In many cases, audiologists play a central role, not only in identifying peripheral vestibular deficits but also in referring onward when central pathologies are suspected,” he says.
“Treatment depends on the patient’s condition but is multidisciplinary and involves specialised balance physiotherapy, speech and swallow therapy, occupational therapy, and medications. Additionally, optometrist management – for example, prisms – may be useful where there is double vision in a squint.”
The COMBDAS clinic is also a research hub and his team was involved in a rehabilitation trial for central and combined central and peripheral vestibular disorders. It also discovered the two most common inherited complex balance disorders including spinocerebellar ataxia type 27b (SCA27b), the most common inherited central vestibular disease.
A/Prof Szmulewicz says more recent testing in the vestibular space includes routine 6-canal VHIT to assess superior and inferior branches of the vestibular nerve; expanded VEMP protocols for better detection of superior semicircular canal dehiscence (SSCD); and VHIT-caloric dissociation to di erentiate between vestibular migraine and Menière’s disease.
Treatment of nystagmus and its e ect on destabilising vision, in particular downbeat nystagmus, is with 4-aminopyridine. This partly relates to the discovery of SCA27b.
Other innovations include the Epley Omniax Positioning System to assess and treat BPPV in patients with physical limitations or complex presentations, some of whom need neurosurgery. This major piece of
Melbourne vestibular audiologist Jessica Blakeley using specialised goggles to assess the vestibulo-ocular reflex.
Image: Ears in Balance.
equipment was funded by a Gandel Foundation Major Grant.
and management manoeuvres where required,” A/Prof Szmulewicz says. “It is my view that any audiologist can be readily trained to do this and enjoy the satisfaction of curing this condition on the spot.”
The clinic has instrumented wearable devices to assess ataxia and imbalance including the Ataxia Instrumented Measurement System (AIMS). There are 150 inherited cerebellar or central vestibular diseases and Machado-Joseph Disease (MJD/SCA3) is one.
The world’s highest prevalence of MJD occurs in the Northern Territory and through collaboration with the MJD Foundation, A/Prof Szmulewicz and his team conduct outreach clinics four times a year. “Before we began, fewer than 10% had seen a neurologist. That’s now 97%,” he says.
He also discovered the second most common inherited ataxia – cerebellar ataxia, neuropathy and vestibular areflexia syndrome (CANVAS) – and with collaborators at the Murdoch Children's Research Institute and Walter and Eliza Hall Institute of Medical Research, its genetic cause, RFC1.
“Audiologists and ENT surgeons see this condition, particularly for the presence of bilateral vestibular hypofunction,” he says. “Hearing for this condition is una ected. We also developed diagnostic guidelines.”
Additionally, the clinic pioneered a “VHIT on arrival” protocol, ensuring all new patients undergo video head impulse testing before their first medical consultation which streamlines diagnosis and improves clinical e ciency. With Dr Hamish MacDougall from the Bionics Institute, the team also developed the video VVOR test, a sensitive ocular motor assessment for detecting combined central and peripheral vestibular dysfunction.
With its pioneering research, patient-focused innovation, and interdisciplinary approach, COMBDAS o ers a glimpse into the future of vestibular care, one where audiologists are key partners in diagnosis, referral, and treatment. More audiologists going down the vestibular path in future will also help improve access and outcomes for the dizzy patient.
Vestibular physiotherapist LEIA BARNES and audiologist TRONG NGUYEN say more awareness about dizziness is needed among health and hearing care practitioners and the public – with recent advances offering effective treatment outcomes.
Physiotherapist Ms Leia Barnes has turned a good idea into a great program that has helped many patients with vestibular symptoms and improved hospital flow in Queensland, freeing up beds.
She pioneered the Dial a Dizzy vertigo hotline in 2021, which provides immediate clinical advice for patients with acute dizziness in Queensland hospitals. The telehealth program serves 26 hospitals and community health centres by o ering specialist advice to medical, nursing and physiotherapy sta about patients presenting to emergency departments and other acute hospital services with dizziness, vertigo or imbalance.
“We’ve conducted more than 400 consults, and the initiative has had some excellent outcomes,” Barnes says. “For referrals directly from emergency departments, 80% of patients referred have been safely discharged home with the other 20% being admitted or transferred for more investigations.
“Before Dial a Dizzy, we were noticing a state-wide average of about 50% transferring to wards and only 50% discharging home directly from ED, so it’s helped in timely discharge and decision-making and reduced pressure on the acute hospital system.”
Rural and remote ED sta phone in Barnes is a vestibular and neurological physiotherapist at Logan Hospital between Brisbane and the Gold Coast where she runs Queensland’s Complex Vestibular Service. The hospital has clinics for acute and chronic dizziness.
“About 2019 we came up with the idea of sta from rural or remote EDs phoning in and we would provide advice via telehealth. We o er recommendations about what's going on typically based on the findings of the HINTS Plus protocol, which is international best practice standard for acute continuous vertigo,” she says.
The protocol is a bedside test to di erentiate between peripheral and central causes of acute vestibular syndrome (AVS), which includes sudden vertigo and nystagmus. It builds on the HINTS (Head Impulse, Nystagmus, Test of Skew) protocol by adding a hearing test to detect hearing loss, which can be associated with strokes causing vertigo.
“The first test patient presented to Cooktown Hospital with vertigo, and on the video link we talked the doctor through testing, and how to treat them. "The patient was successfully discharged home, and didn't need medical evacuation,” Barnes recalls.
The video link enables vestibular physiotherapy specialists to observe and live coach referrers in the ED and acute wards. Referrers are typically rural doctors, physios or nurses. If there are red flags, the service can advise escalation or evacuation.
The initiative has potential for expansion, with interest from interstate health services and a Queensland-wide virtual hospital.
“Dizziness is common with about 28,000 ED presentations in Queensland in 2020. A recent review led by Queensland physiotherapists found 50% of fallers have underlying vestibular dysfunction,” Barnes says. “Vestibular presentations to EDs in Queensland are also growing by 8% per year.”
Nearly 30% of Australians over 65 have at least one fall a year, and new Australian falls guidelines show these cost more than $2.8 billion annually.
Barnes, who has a 20-year career in vestibular physiotherapy, sees a need for more vestibular training for audiologists and physiotherapists. At Logan Hospital she assists people with a range of vestibular and balance disorders. These include benign paroxysmal positional vertigo (BPPV), Menière's disease, superior semicircular canal dehiscence, chronic dizziness or persistent postural-perceptual dizziness (PPPD), vestibular migraines and related disorders.
Testing has advanced to assess multiple sensory organs within the vestibular system, she says, and equipment such as oVEMPs, cVEMPs, the video head impulse test, and rotary chairs are becoming more common. Virtual reality (VR) is also increasingly used for vestibular rehabilitation, especially for patients with visual motion sensitivity. Logan Hospital uses a computerised dynamic posturography immersive VR system. After about eight VR sessions, patients show significant symptom reduction, she adds. VR therapy is exposure-based, and many patients become symptom-free.
“It also helps with increasing head movement. People are more engaged with virtual reality, they're looking around at their environment, and they might feel less scared than being in the real environment," Barnes says. “It builds their confidence and builds up the vestibular system through increased movements.”
More first-point-of-contact models are also appearing, where people on ENT and neurology waitlists are assessed by physios and audiologists for vestibular schwannoma and other vestibular and balance disorders.
“Vestibular testing is in a very exciting space. When it was just calorics, there wasn't a lot we could learn from the vestibular system with diagnostic assessment, but now we can more rapidly assess vestibular function at bedside in a variety of ways,” Barnes says. “We can test five di erent sensory organs using oVEMPs and cVEMPs – which are home grown from Australia and adopted worldwide – for the otolith organs, and the video head impulse test for the semicircular canals.” Barnes runs Vestibular Education Australia with her colleagues, which is a private education provider predominately for physiotherapists, with some courses sponsored by Interacoustics.
Mr Trong Nguyen, Interacoustics Australia's general manager, stresses the importance of a multidisciplinary approach to improve vestibular care and better educate professionals.
“In audiology, hearing health often overshadows balance issues, leading to inadequate care of the dizzy patient,” he says. “Audiologists often lack recent training in vestibular assessment and receive limited hands-on experience in the educational space and in the field.
“We don’t do enough in this space as audiologists. Although we are working in a multidisciplinary way, we need to establish a wider network and further educate health professionals to be able to support the dizzy patient.”
Nguyen says people need to understand more about dizziness, and the sector must create pathways so patients know where to go with their dizziness. In particular, GPs need more education on dizziness and balance issues and how a patient may present to them.
“Typically, the first point of call for the dizzy patient is a GP or the hospital emergency department. Through education and awareness for the public and health professionals, we can improve access to care and diagnosis and treat vestibular disorders in an e cient way,” he adds.
“With more physiotherapists being trained and specialising in vestibular rehabilitation, audiologists have more opportunities to refer their dizzy patient and achieve best outcomes.”
Nguyen says audiologists are often hesitant to do vestibular assessment, but through education and understanding of the fundamentals, there can be e ciencies in the overall test battery.
“There is often a sense of fear that the gold standard vestibular assessment takes two-to-three hours,” he says. “If you can perform a detailed vestibular history, use the Dizziness Handicap Inventory and have a sense of what you are looking for, you can narrow down your vestibular assessment and home in on specific conditions.’
He recommends routinely asking about dizziness or balance issues on patient intake forms in all audiology clinics. “I would strongly push that this becomes standard for audiologists to inquire about in history taking and know what questions to expand on regarding nystagmus,” Nguyen says.
He highlights Interacoustics’ role in further developing its videonystagmography (VNG) solutions to include saccadometry, ocular counter roll, cervical gaze and self-paced saccades, as well as working with Virtualis on rehab
Trong Nguyen with Interacoustics equipment, (from left) VisualEyes525, Touch Keyboard Audiometer and EyeSeeCam vHIT.
technologies including VR goggles and dynamic force plates. These tools help diagnose and treat vestibular conditions by stimulating the balance system in targeted ways, he adds.
Interacoustics also manufactures the TRV (Thomas Richard Vitton) chair, to diagnose and treat BPPV, and other positional vertigo. Several sessions may be required, particularly if the condition recurs.
Founded in Denmark in 1967, Interacoustics originally specialised in diagnostic audiometers, impedance and hearing aid fitting devices. By the early 2000s, it expanded its equipment portfolio to balance equipment and will continue in rehabilitative devices. “Research and development engineers, product managers and clinicians including audiologists and physiotherapists are involved in developing these systems,” Nguyen says.
VR systems from Virtualis coming to Australia
He says Virtualis’ VR systems will soon be available in Australia through Interacoustics. These help understand diagnostic issues and apply exercises in VR environments to rehabilitate patients with vestibular issues.
Nguyen is seeing trends in audiologists wanting to expand their clinics and start doing balance assessment, an area where Interacoustics can help.
“We love to be involved from the early stages of planning and budgeting for equipment as well as knowing where it’s best to set up a vestibular clinic,” he says.
“It's also important to know your medical network and who you’ll refer to.” Further, he says having more vestibular clinics will allow patients to be seen at the acute phase of their dizziness.
"We should make more services available, whether it's in independent hearing aid clinics, or within the chains, as well as have emergency departments equipped to do vestibular bedside assessment,” Nguyen says.
The Interacoustics Academy provides global training and in 2025 launched the Clinical Diploma in VNG covering anatomy and physiology, pathology and assessment including mentoring.
The company also runs seminars and workshops at audiology conferences to help professionals stay current with evidence-based practice.
“Patient satisfaction is incredibly rewarding as long as we can treat these patients successfully,” Nguyen says. “If we can raise vestibular awareness to the public and health professions even more, we'll start to see better outcomes for all. You may have those patients for life, especially if they return for hearing aids, and their word of mouth is valuable advertising."
Award-winning small business accountant KATIE BRYAN’S firm Propeller Advisory offers audiology practices nationwide a unique approach to handling their finances and growing their business.
Mrs Katie Bryan is not your usual accountant. Instead of just focusing on tax, her business o ers a subscription-based service that zeroes in on the financial health of a business and o ers strategic advice to help practice owners get the fundamentals right.
Propeller Advisory is a remote service whose monthly subscription options provide year-round service including meetings and masterclasses to ensure the practice is on top of their financial goals and obligations. There’s also benchmarking to see how an audiology practice might be performing against industry norms.
As a working mum, Bryan is proud that rather than just helping practitioners run a business and get their numbers right, “we’re also helping them build a business that gives them the flexibility to be able to do what they want with their time".
"So many go into business to be business owners but end up stuck doing the clinical work and everything else: admin, finances, reporting, you name it," she says.
“But with the right advisor and the right advice, especially early on, they can step fully into the business owner seat. We help them build the right team, put the right systems in place, and create the business they actually set out to build… not one that keeps them stuck after hours catching up on paperwork."
Bryan's motto is accounting can be done di erently. “It’s one thing to tick, flick and lodge a tax return, but it's another thing to get the right help to build and grow the business that you're looking for,” she says.
“I think a lot of audiologists don't realise that it's available, that they can have help in other ways, and they don't need to do it all themselves.”
Propeller Advisory, led by Bryan, has a team of 14 accountants, bookkeepers and virtual admin assistants. It o ers three tiers of subscription – Keeping You Compliant, Best Practice Biz Owner, and Strategic Go Getter.
The first package o ers basic Australian Tax O ce (ATO) compliance, Bryan says.
“If you just want to tick the boxes, and that's totally fine and normal, then this one is for you.," she says. “Lots of business owners just want their tax done, and if that’s the case then that's your package. It gives you everything the ATO needs you to have from the bare minimum standpoint.”
The second package includes basic compliance but is the next level up.
“It’s a better service and includes regular catchups with your accountant, and a monthly masterclass and reports,” Bryan says.
“The top level is for businesses that want high growth; they want more, a virtual chief financial o cer. This one’s very popular with our audiologists as they want a 12-month budget.
“They want an active cash flow system, to do business planning and work on their goals and strategy. Our audiology clients come to us for
“We can let them know whether they’re pricing themselves correctly, are spending too much money on wages or administration, if their hearing aid costs are too low, or they're not doing enough private consultations."
that package, which also comes with a quarterly meeting with me. They add on bookkeeping and tax later.”
Propeller Advisory has many allied health clients, but Bryan says the audiology profession is di erent due to quirks such as the Hearing Services Program (HSP) which must be considered when doing financials.
To ensure she is tuned into the profession’s needs, she attends the Hearing Business Alliance’s main seminar annually to keep updated on what’s changing in the industry, including HSP updates.
“It's a unique industry, and from an accounting and finance standpoint, it has little quirks that need specialist accountant knowledge” she says.
“Having an accountant who understands the di erent systems, how CounselEar works and integrates with Xero, and the flow of information is invaluable for our clients.”
After graduating in commerce and as a chartered accountant, Bryan worked for others in various areas of accounting.
“That’s one of my points of di erence – I haven't just worked in tax, I've worked in business advisory, insolvency, and mergers and acquisitions,” she says. “In Melbourne I met lots of accounting firm
owners and noticed the same thing everywhere – older men with piles of paperwork on their desks.
“I thought, ‘I could do this di erently. I could start my own firm, run by a woman, we could go straight to the cloud and do everything remotely’ – rather than just a tax perspective, let's go at it from a business health perspective, and help people get the fundamentals of business right.”
Bryan was inspired by the book, The Perfect Firm, which advised setting up with fixed fee, subscription-based services to avoid bill shocks for clients. She has done just that and everything is upfront on the website.
The subscription service was a pivotal part of the business from the moment she founded it nine years ago. “People thought it was cool because they’d say, ‘I just got this big bill from my accountant, I wasn't expecting it, I don't even know what they do for that money!’
“I’d say, ‘we have the perfect solution because I'll tell you upfront exactly what I'm going to do, how much it’ll cost, and we'll break it up over 12 monthly payments.”
Benchmarking benefits
Bryan says her team has worked with every o ce management system platform for audiology so understands proper set up and integration with other systems.
“The biggest benefit is we can help our audiology clients benchmark themselves against other players within the industry,” she says. “We can let them know whether they’re pricing themselves correctly, are spending too much money on wages or administration, if their hearing aid costs are too low, or they're not doing enough private consultations.
“We look at their profits and losses and can give that sort of information freely.”
Another tool, the Finance Launch Pad, has also been popular, particularly with audiology clients. “It teaches them the fundamentals of finance – how to read their profit and loss and balance sheets, build a budget and so on. It also involves group coaching,” Bryan says.
Propeller Advisory has won multiple awards and is a Xero Platinum Partner, signifying a high level of expertise and experience in using Xero's cloud-based accounting software. Bryan was three times named one of the Top 50 Women in Accounting Worldwide by Ignition billing automation platform and won the Women in Finance Principal of the Year award in 2021.
“Propeller means to drive forward and that was always the goal, to help businesses drive themselves forward and grow,” Bryan says.
For more information, visit: propelleradvisory.com.au.
One of the most valuable aspects of working with Propeller Advisory is its monthly subscription model, according to Ms Helen Campbell, CEO of Knox Audiology in Melbourne.
She says it helped transform the audiology business in just two years, assisting it to gain clarity and focus action to elevate it from a solid business to a purpose-led enterprise that is constantly learning, adapting, and thriving.
“Rather than seeing an accountant once a year at tax time, we receive ongoing, hands-on support,” Campbell says.
“This includes monthly feedback on how we’re tracking against our budget, advice on sta ng and expansion, and help integrating new software and systems that suit our specific operations.
“Katie liaises with our bookkeeper to ensure everything entered is accurate and purposeful, allowing her to give us the most relevant and strategic advice.”
Campbell discovered Propeller Advisory at a HBA conference and was inspired by Bryan’s “unique ability to make sense of the numbers that underpin every business decision”.
“Her presentation wasn’t just about accounting, it was about empowerment through understanding,” Campbell says. “That’s what led us to start working with her and her team two years ago, and it’s been one of the most transformative decisions for our business.
“The Propeller team demonstrated not just technical expertise but a rare insight into the workings of audiology businesses like ours. They helped us pinpoint where money was slipping through the cracks, guided us in goal setting, and supported us in implementing systems that keep our business profitable and purpose-driven.”
Campbell says Propeller’s knowledge of audiology practices including understanding programs like HSP set it apart. “They’re not trying to apply a generic accounting model to a specialised business; they truly ‘get’ our field and the challenges and opportunities we face.
“Monthly education sessions run by Katie help the business understand key financial concepts such as profit versus tax and what a balance sheet really tells us. These sessions have not only lifted the financial literacy of our leadership team but have helped foster a culture of ownership and transparency.”
Campbell says that, as a visionary CEO, she needed someone who could help translate vision into action, and Propeller provided that bridge through strategic planning and actionable targets. “Katie has helped us break our goals down into monthly milestones and made sure we stay aligned with our ‘why’ – keeping people connected to themselves, their families, and the world.
“That mission is more than words for us. For every patient we see, we donate through B1G1 to causes around the globe. Katie helped our leadership team to champion our impact work, helping us create and manage the strategy to support projects like my 2024 trip to Ethiopia with the Hamelin Fistula Foundation.”
Propeller helped structure Knox Audiology’s $6,000 fundraising target over the year and integrated it into its business goals so giving remained central, not additional.
“Katie’s leadership and mentorship go beyond accounting. Her monthly inspirational messages and personal reflections help our team stay grounded and motivated, especially as leaders navigating the complexities and solitude that can come with business growth,” Campbell says.
“Katie and her team are, in many ways, the glue that holds the strategic side of our business together, o ering structure and inspiration. With their guidance, we’ve moved from good intentions to confident, data-backed action. The result is a more e cient, connected, and impactful business.”
2025: The
and
of Otolaryngology Head and Neck Surgery (OHNS) is heading to Hobart in November and features an exceptional line-up of 21 speakers.
Ear, nose and throat (ENT) surgeons will have unbridled access to clinical and academic leaders in the field in the inclusive environment of Frontiers 2025 conference in Tasmania.
The biennial conference, presented by the Passe & Williams Foundation, will be at Hobart’s Hotel Grand Chancellor from 13-15 November. The gathering of practitioners and scientists to explore the latest research and address emerging clinical needs in the field aims to foster meaningful collaboration across the ENT community, challenging and inspiring specialists in Australia and New Zealand to connect and drive future direction of the medical specialty.
A poster session, with short pitches on stage, conference dinner and welcome function also o er valuable networking opportunities.
Frontiers started in 1998 and welcomes delegates from all over the world including surgeons, scientists, engineers, nurses, students, audiologists and other allied health professionals committed to advancing otolaryngology head and neck surgery (OHNS).
Sparking ideas and a single session format
Dr Jeanette Pritchard, the foundation’s CEO, says Frontiers was born from the bold idea that “by bringing clinicians and scientists together in the right environment, we could unlock new possibilities for ENT”.
“It’s never been about simply presenting research; it’s about sparking ideas, challenging assumptions, and shaping the future of our specialty,” she adds.
“Over time, that’s evolved into a meeting of minds, driven by curiosity, fuelled by collaboration, and deeply committed to improving lives.”
The single-session format creates a focused, inclusive environment where everyone shares the same experience, she says. “We find this accelerates important conversations.
“What makes Frontiers special is how open and welcoming it is. This is the place to introduce yourself to clinical and academic leaders in our field, and they’ll make time for you. The connections you make here and the conversations you have will stay with you for decades.”
Co-convenor and foundation chair, Professor William Coman, says the conference o ers a space where delegates can connect, explore new opportunities, and turn discussions into real progress.
“You will leave genuinely inspired, you’ll hear something that shifts your thinking, meet someone who opens a new door, and walk away feeling part of something bigger. Whatever career stage you’re at, you’ll get more out of this than you expect,” he adds.
Prof Coman says many delegates have attended big meetings like the Australian Society of Otolaryngology Head and Neck Surgery’s annual scientific meeting and others globally, which are appropriately tailored for their surgical membership.
“They then come to Frontiers to connect with scientists, engineers and allied health practitioners working in the field, eager to influence research directions for positive clinical outcomes,” he says.
Co-convenor and board chair, Dr Michael Jay, says the 2025 event marks an exciting chapter, being its first time in Hobart, and with a bold, future-focused program. This includes the inaugural Colin Richards & Peter Freeman Lecture in honour of the foundation’s first Trustees, whose leadership and originality changed the nature of ENT outcomes in Australia and New Zealand. Professor John Funder, the foundation’s longest-serving board director who was instrumental in establishing the conference format, will present the lecture.
“One of the real strengths of Frontiers is the way it brings people together across disciplines,” Dr Jay says. “That mix of expertise creates unexpected connections and often leads to breakthroughs you just wouldn’t get in a more siloed environment.
“All speakers are invitation-only and we carefully curate the single stream program based on the evolving challenges of ENT. We’re always looking to bring in diverse voices and expertise. This year we’ve invited three incredible keynotes from the UK, USA and Canada, who will present across both days.
“Charles Limb’s work uncovers the fascinating ways our brains create and respond to sound and music. He will touch on one theme – quality of life.”
Other themes are voice and transformation. Keynotes are Dr Limb (University of California, San Francisco), Dr Karen Kost (McGill University, Canada), and Professor Mahmood Bhutta (Brighton and Sussex Medical School, UK).
Other sessions include the latest research from early-mid career researchers, and a panel discussion on mentoring and gatekeeping.
There will be presentations on ear health in low-resource settings, the patient perspective, dementia and hearing, tinnitus, leadership in research,
Dr Pritchard says the art of ENT theme will explore ideas around music and the voice, and how these are critical when considering quality of life for those impacted by ENT conditions.
“Charles and Karen will bring their global experience to this discussion, which is sure to be inspirational, and Mahmood will challenge the status quo in pushing for sustainability in healthcare and changing the way we deliver healthcare in rural, remote and developing economies,” she says. “It’s the kind of bold thinking we love at Frontiers.”
The conference is also welcoming sponsor partnerships for the first time.
Prof Bhutta is the inaugural Professor in ENT at Brighton and Sussex Medical School in the United Kingdom. He has a clinical and academic interest in ear and hearing care in low resource settings, particularly models for management of chronic suppurative otitis media. He is an honorary consultant to the World Health Organization program for prevention of deafness and hearing loss, and was the recipient of the 2024 Nikhil J Bhatt International Humanitarian Award by the American Academy of Otolaryngology and Head and Neck Surgery.
INTERNATIONAL KEYNOTE SPEAKER
DR CHARLES LIMB
Dr Limb is the Francis A. Sooy Professor of OHNS and chief of the Division of Otology, Neurotology and Skull Base Surgery at UC San Francisco. He is director of the UCSF Douglas Grant Cochlear Implant Center and past president of the American Auditory Society. Dr Limb was the 2022 NIH Clinical Center Distinguished Clinical Research Scholar and Educator in Residence, one of the Kennedy Center’s Next 50 and received the American Computer and Robotics Museum’s 2024 Stibitz-Wilson Award. His research on the neurobiology of music has received widespread media coverage and featured at the Smithsonian Institute and American Museum of Natural History.
A Sydney ENT surgeon who specialises in otology, neurotology and skull base surgery, Dr Creber is dedicated to advancing care in hearing loss and preservation, hearing implants and cochlear surgery, and skull base tumours. His work is driven by a commitment to improving outcomes for patients with complex ear and hearing disorders. Other research interests include regenerative therapies, and innovative surgical techniques to enhance patient outcomes. A RACS Fellow and ASOHNS member, he has research appointments at the University of Sydney, the University of Melbourne, the Institute of Academic Surgery, and the Royal Prince Alfred Hospital in Sydney.
DR COURTENAY HENRYS
Dr Courtenay Henrys, a Queensland trained ENT surgeon with a special interest in otology, will discuss audiometric follow-up post paediatric bacterial meningitis. After completing her surgical training she moved to Cairns to experience regional medicine and become involved in remote outreach services in the Torres and Cape. Dr Henrys is commencing an otology fellowship at The Royal Victorian Eye and Ear Hospital in mid-2025 to further her knowledge in complex ear disease, hearing implants and cochlear surgery.
OHNS RESEARCH SESSION SPEAKERS: JUNIORMID CAREER RESEARCHERS FUNDED BY THE FOUNDATION PRESENT THEIR WORK
DR BRIANNA ATTO
Dr Atto is a Garnett Passe & Rodney Williams junior fellow based at the University of Tasmania. She was born and raised in Tasmania, and since starting post-doctoral research in 2023, has been dedicated to establishing an independent otitis media research program in her hometown Launceston. Her research focuses on developing novel therapeutic agents that could be used to prevent/treat otitis media in children. Her passion for this work stems from childhood experience with chronic middle ear infections which has had a major impact on her life, as it has for many children worldwide.
DR MEHRNAZ SHOUSHTARIAN
After graduating with a PhD in Biomedical Engineering from Monash University, Dr Shoushtarian’s research has focused on measurement and processing of physiological signals using conventional and novel recording techniques and use of research outcomes for development and commercialisation of medical devices. At the Bionics Institute she uses functional near-infrared spectroscopy and other physiological measures to develop objective measures of tinnitus. At Cortical Dynamics, she was principal scientist in a small team that took a depth of anaesthesia monitor prototype to clinical trials and regulatory approval, and co-led establishment of ISO13485 (Quality Management Systems for Medical Devices) across the company. She volunteers with the Institute of Electrical and Electronics Engineers and was formerly Victorian section chair.
A neuroscientist from the translational hearing research team at the Bionics Institute of Australia, Dr Peng has a background in biomedical engineering from Washington University and computer systems engineering from the University of Auckland, with expertise in signal processing, psychophysics, electrophysiology, and machine learning. In America, he designed and implemented speech-in-noise hearing tests on smartphone and tablet devices to improve accessibility of hearing assessments. His research aims to improve hearing outcomes in cochlear implant users by identifying and addressing recipient-specific neural problems, such as intra-cochlear neural dead regions. He hopes the newly developed diagnostic tests and techniques will become a part of the standard cochlear implant tuning process in clinics.
A University of Melbourne postdoctoral research fellow, with a research focus on fundamental molecular biology in the inner ear, Dr Ogier completed her PhD at the Murdoch Children’s Research Institute, having identified a novel molecular target for preventing aminoglycoside-induced hearing damage. At Sunnybrook Research Institute she optimised human cochlea cultures for single-cell sequencing and completed ototoxicity-based research that earned the University of Toronto Witterick Research Prize. She is using human stem-cell-derived organoids and proteomics to understand how cells in the ear develop, communicate, and die to improve understanding of biological processes such as inflammation, fibrotic tissue responses, and sensory cell death in the ear, while advancing therapeutic approaches to improve outcomes in cochlear implant recipients.
Psychologist Ms KIRSTEN MCKENNA spoke at the Australian Society of Otolaryngology Head and Neck Surgery’s 75th annual scientific meeting in Sydney in March 2025. She summarises her talk ahead of R U OK? Day on 11 September.
“STUDIES
REVEAL THAT MORE THAN HALF OF SURGEONS EXPERIENCE BURNOUT SYMPTOMS, WITH ENT SURGEONS RANKING AMONG THOSE AT HIGHER RISK.”
As ear, nose and throat (ENT)
surgeons you navigate an intricate world, one where precision and endurance define success, and where patient outcomes routinely rest upon your shoulders. But there’s another side to this narrative, there’s a hidden cost to caring. Not just the exhaustion you push through after long surgical days, but the deeper, systemic issues that impact your health, well-being, quality of life, and ultimately, patient care.
Burnout is an insidious threat that poses far-reaching consequences both personally and professionally. Within the surgical community is a stigma, a stigma associated with seeking help, resulting in an underlying pressure to struggle in silence.
Studies reveal that more than half of surgeons experience burnout symptoms, with ENT surgeons ranking among those at higher risk. Furthermore, burnout extends beyond occupational stressors, impacting individuals outside of the workforce. Burnout occurs when individuals exhaust their resources due to long-term exposure to demanding circumstances.
A skilled and accurate diagnosis considers a holistic approach by employing clinical reasoning underpinned by a pattern analytic approach.
BURNOUT
UNSW Scienta Professor and psychiatrist, Dr Gordon Parker, highlights that burnout is a collection
of symptoms that extend beyond the traditional domains of emotional exhaustion, depersonalisation and feelings of reduced professional e cacy. The aetiopathogenesis of burnout is multifactorial, stemming from personal, environmental and social aspects of life. In the workplace, there are common culprits that both lead to burnout and continue to perpetuate it.
As a complex condition, with a complex aetiopathogenesis, the recommended approach for preventing burnout in surgical practice is four-fold:
1. Educate yourselves on what burnout is, what predisposes us to it and what perpetuates it.
2. Increase your self-awareness.
3. Discuss challenge and struggle openly to help eliminate the stigma.
4. Take action. Have the conversation. Get involved. Become an advocate or mentor.
Research also emphasises a pluralistic approach from both a systems and an individual level.
From a systems perspective, it would be beneficial to audit the following:
a) What type of social support is available within your unit/team?
b) How often are you providing feedback? Do you make it a priority to provide praise and recognition?
c) How are you ensuring others possess a degree of autonomy, have input into decision making, are included in communications and have the support they need?
d) How are your leaders inspiring, strengthening and connecting their teams?
From an individual level, there are practices you can employ to protect you from burnout and positively influence the environments you work in:
1. Adopt a reflective practice – reflection is a deliberate metacognitive process involving unbiased and unattached selfobservation, in an e ort to gain insight and to increase personal e ectiveness. Adopting regular reflective practice either daily, weekly or both need not take more than five
to 10 minutes. It’s also beneficial to reflect on where stress shows up for you; in your body, thoughts and behaviours. Think of these signals as an alarm and call-to-action.
2. Set healthy boundaries –acknowledging that our energy and our attention need them. Minimising cognitive overload through filtering what we take in, delegation, streamlined workflows, and digital tools can significantly reduce stress. Without clear boundaries, you risk operating in a near-constant state of work, leaving little room for recovery or personal time.
3. Make wellbeing a priority – personal wellbeing provides you with an ability to manage the inevitable stressors you face each day. Wellbeing can be achieved when there is balance between your psychological, social and physical resources and the psychological, social and physical challenges encountered. American psychology professor and author Martin Seligman identified five elements that contribute to our wellbeing, with a sixth of ‘health’ added subsequently. According to the research, people who are flourishing:
i. Are intentional about experiencing positive emotions.
ii. Find states of flow throughout their day.
iii. Have positive relationships.
iv. Have a sense of meaning.
v. Possess a sense of accomplishment.
vi. Make their health a priority –focussing on the three pillars of movement, nourishment and rest/ recovery.
Advocate for systemic changes and foster a culture where well-being is valued as a crucial element of clinical excellence. Burnout is not inevitable. Sustainable success is possible. But it starts with a conversation, one we need to have openly and often.
ABOUT THE AUTHOR: Clinical psychologist
Ms Kirsten McKenna is a performance and leadership consultant and principal consultant at Cortex Consulting. She is also a mindfulness meditation teacher and has a Bachelor of Physical and Health Education.
Members and non-members are both welcome!
Step beyond the basics and sharpen your hearing aid fitting skills in our Friday afternoon Connect & Learn events in Melbourne, Sydney, and Brisbane.
Enjoy:
useful insights that bridge research and real-world application
practical guidance on fitting with NAL-NL3
an in-depth look at noise reduction systems
2 CPD points for Audiology Australia members
Australasian College of Audiometry (AuCA) staff discuss career paths, specialised areas, and benefits of regional work in Australia.
“AUDIOMETRY
IS SEEING EXCITING GROWTH IN SPECIALISED AREAS PARTICULARLY CERUMEN MICROSUCTION AND OCCUPATIONAL NOISE ASSESSMENT CLINICS.”
College of Audiometry (AuCA) lecturer, Ms Katie Lian, says
“Clientele there are in need of hearing themselves seeing a di erent clinician back to metropolitan areas,” she says.
“Many of our audiometry students are already serving these communities daily and are eager to take on the role of permanent clinicians.
“For those wanting to enter the industry as audiometrists, there are more opportunities in the retail (hearing device) industry that need to be filled.”
AuCA CEO Mr Chedy Kalach agrees and says some regional practices find it easier to upskill a sta member from the area through the diploma o ered by AuCA rather than trying to find someone already qualified.
“This is a win-win for the practice, sta members and the community. Many of our students are career changers entering the industry,” he says.
Some clinics o er traineeships to potential new employees to become an audiometrist, says Ms Heather Joseph, AuCA’s general manager. “This can form part of the wages package o ered, or reimbursement of fees on completion of their diploma in combination with supervision,” she says.
“It may be coupled with an agreement for the newly trained audiometrist to stay with the clinic or for a predetermined time after their Qualified Practitioner (QP) number is gained.
"This can be an especially attractive
option for regional clinics, however some metro clinics also o er similar programs.”
Lian says clinicians in metropolitan and regional areas encounter a diverse range of populations and ear conditions, enriching their experience and expertise.
“While metropolitan roles can be competitive due to audiologists and audiometrists being eligible, regional areas may o er stronger interdisciplinary networks, providing clinicians with more networking opportunities and reassurance about client care,” she says.
“Regional settings may also have more opportunities for autonomous clinical work, though this can vary by clinic.”
Audiometry is seeing exciting growth in specialised areas, Lian adds, particularly cerumen microsuction and occupational noise assessment clinics. “For clinicians seeking fulfilling roles beyond the traditional retail setting, these niches o er the opportunity to provide highly sought-after services to a diverse clientele,” she says.
Joseph says the college is seeing increased interest from health screeners in occupational noise assessment who want to upskill and gain knowledge in audiometry.
“I believe this trend will continue as noisy industries are held accountable for protecting their workers from the risk of hearing loss,” she says. “This will in turn create greater community awareness around noise, risks of hearing loss and hopefully relieve some of the associated stigma.”
Lian says despite a significant need for clinicians to address widespread ear health issues among First Nations people in remote areas, meeting this demand necessitates a sensitive understanding of community cultures.
“AuCA is supporting this critical need for improved hearing healthcare access for First Nations people through regular delivery of the HLT47415 Certificate IV in Audiometry,” she says.
“This program specifically supports First Nations individuals who are already delivering essential health services within their communities. Training
is expertly guided by experienced audiologists and trainers, Janette and Eliza Brazel, whose deep community knowledge is invaluable to this initiative.”
Kalach says the ageing population, skills shortage of audiologists and demand for audiometrists will naturally increase, particularly in regional areas.
“The audiology landscape is undergoing rapid transformation, fuelled by increasing public awareness campaigns focused on social inclusion and accessibility for individuals with hearing loss,” Lian adds. “It’s likely that clinicians who embrace and readily adopt these technological innovations will flourish in this evolving field."
Lian says exciting innovations such as Auracast, 3D imaging, the growing popularity of hearables, and the integration of AI in hearing devices promise a future with greater accessibility, more streamlined clinical appointments, and potentially improved client outcomes.
"Despite the transformative potential of these technologies, I believe the crucial role of hearing care professionals in triaging and educating a broader population remains indispensable,” she adds.
Kalach says that while Jobs and Skills Australia doesn’t report on audiometrists separately, it’s safe to say there’s a shortage across Australia that corresponds with a skills shortage for audiologists.
“As the hearing aid industry expands so will the need for qualified professionals,” Joseph adds. “This, I believe, will be a mix of audiologists and audiometrists.
"According to Grand View Research, in 2024, Australia's audiology devices market was valued at $346 million and is expected to reach $496 million by 2030, growing at a compound annual growth rate of 6.2% from 2025 to 2030. Hearing aids are the largest and fastest-growing segment in this market."
ABOUT THE AUTHORS: Ms Katie Lian is a Melbourne audiologist who also works as a trainer/educator with the Australasian College of Audiometry (AuCA). Mr Chedy Kalach is AuCA's managing director and Ms Heather Joseph is AuCA's general manager.
GREG JENNINGS discusses Beyond Blue’s NewAccess for Small Business Owners service, a free mental health coaching program to help small business owners get back on track.
Many hearing practitioners face a uniquely demanding dual role.
Not only are they entrusted with delivering high-quality healthcare to their clients, but many also shoulder the responsibility of running the day-to-day operations of their own practice.
“THE SERVICE IS DESIGNED TO PROVIDE EARLY SUPPORT AND COACH THEM BACK TO GOOD MENTAL HEALTH.”
GREG JENNINGS
This means they're having to navigate the complexities of small business ownership, manage sta , finances, compliance, and marketing, all while tending to others' health and wellbeing. Amid the pressure to remain constantly available and compassionate, there's also the essential need to safeguard their own mental health – yet time, resources, and other pressures can make that a di cult priority to uphold.
When this delicate balance between delivering personalised hearing care and managing the operational demands of running a clinic tips too far in either direction, it can contribute to burnout, fatigue, and put strain on your personal and professional life. The sense of responsibility and pressure to do it all, without adequate support or systems, can leave you feeling overwhelmed and disconnected from the very purpose that drew you to this work.
These types of symptoms are felt by many small business owners in all sectors across Australia. While many small business owners find fulfilment through autonomy, purpose-driven work, flexible schedules, and stronger ties to their community – all of which enhance job satisfaction and wellbeing – the pursuit of balance can still prove elusive.
In 2023, Beyond Blue partner, Xero,
conducted a survey of small business owners, finding that financial stress and cashflow issues over the preceding 12 months resulted in feelings of stress (57%), anxiety (50%) and trouble sleeping (48%). Left unchecked, this presents a real risk to the long-term mental health of small business owners.
Recognising the widespread impact of these stressors on small business owners’ mental health means targeted support programs are more crucial than ever.
And that’s where Beyond Blue’s NewAccess for Small Business Owners (NASBO) service comes in.
In the four years since NASBO was launched, the service has supported more than 8,500 small business owners across Australia with practical mental health coaching. It’s a completely free service and no GP referral is needed. The service is designed to provide early support and coach them back to good mental health via phone or video coaching.
NASBO is tailored to the realities of small business life, pairing each participant with a trained mental health coach who understands the pressures of entrepreneurship firsthand because they each have a background in small business. Whether it’s managing rising costs, navigating uncertainty, or simply trying to maintain a healthy work-life balance, this successful service helps people cope more e ectively and feel more in control.
Others, initially unsure they could spare the time, expressed gratitude for making space to engage, and reported clearer thinking and a renewed sense of productivity as a result.
NASBO is based on Beyond Blue’s highly e ective NewAccess program and is grounded in evidence-based cognitive behavioural therapy, o ering six free coaching sessions with two follow-up appointments. It’s flexible too, operating outside standard business hours and linking participants with other support services such as financial counselling when needed.
Importantly, NASBO helps fill a gap in the mental health system, easing pressure on traditional services and addressing the unique needs of the small business community. For many owners feeling overwhelmed, isolated, or stuck, this can be a turning point.
NASBO serves as a vital reminder that support is within reach, without judgement, without cost, and with support from mental health coaches who understand what small business owners are going through. I encourage small business owners to reach out for support early, before things get beyond them.
NASBO is available to sole traders and small businesses with 20 or fewer employees and is funded by the Commonwealth Government Treasury. For more information, call 1300 945 301 or visit beyondblue.org.au/nasbo.
Since its beginnings, NASBO has repeatedly received outstanding results with positive feedback from participants who continue to report powerful outcomes. Nearly 90% of participants have reported they feel better equipped to handle stress after the coaching sessions and service data shows that almost seven in ten participants recovered from a mental health condition.
Many participants have praised the service for the value of being heard by someone who truly understands the pressures of small business ownership. They’ve shared how the coaching helped them identify personal roadblocks and regain clarity.
“Since completing the NASBO program, I’ve been able to return to my business with a clearer head and put simple, practical strategies in place to boost lead generation and cash flow. It wasn’t business coaching – it was the program helping me think straight. CBT’s simplicity and impact are seriously underrated!”
“The program has had a big impact on helping me gain clarity and make real progress during a critical growth stage of my small business. It gave me the headspace and focus I needed to move forward with confidence and make decisions that support long-term success.”
ABOUT THE AUTHOR: Mr Greg Jennings is Beyond Blue’s small business and workplace mental health expert. Beyond Blue is an Australian mental health organisation that provides information, resources, and support to improve mental health and make it easier for people to feel better earlier, get well and stay well.
AirPods Pro 2 are more than earbuds; they are a step towards better hearing, says Dr Nicky Chong-White.
Those popular white earbuds with the stubby stems you see so many people wearing – did you know they can now work as hearing aids too? With Apple’s update in March this year, AirPods Pro 2 became TGA-approved Class IIa medical devices in Australia, functioning as over-the-counter (OTC) hearing aids. This is paired with a validated hearing test built into the iPhone’s iOS. It’s a development bringing excitement, curiosity, and some apprehension across the hearing profession.
As a hearing researcher and technology innovation lead, I’m optimistic. AirPods Pro 2 won’t suit everyone, but for those they do, they could make a real di erence. They’re not about replacing hearing aids but can be a gateway – a low-risk step towards better hearing.
Apple’s updates turn AirPods Pro 2 into OTC hearing aids, providing tailored amplification for mild-to-moderate hearing loss. The hearing test feature o ers a quick, easy way to measure hearing thresholds at home, with results configuring the AirPods Pro 2 for personalised gain – no clinic visit needed. For many, AirPods Pro 2 are devices they already own - used daily for calls, music, or podcasts. Now, they’re also hearing devices. No extra cost. No appointments needed. Many people don’t even know these features exist, yet for those quietly struggling with hearing in certain situations, they o er a discreet
way to try amplification - without stigma or anyone even knowing.
Only about one in five people who could benefit from hearing aids actually use them. AirPods Pro 2 could change that. At $399, they’re far more a ordable than traditional hearing aids, and because they’re so common, wearing them doesn’t signal “I’ve got hearing loss,” which can help reduce stigma.
For people with situational di culties, mild loss, or who are unsure about traditional aids, AirPods Pro 2 o er a way to experience amplified sound in daily life. In noisy cafes, meetings, watching TV, or on calls, they can help improve enjoyment, connection, and confidence.
At the National Acoustic Laboratories (NAL), we’ve been evaluating each new hearing feature of AirPods Pro as it has been released over the past five years, assessing their acoustic performance, and how well they help improve speech understanding.
We’ve found that AirPods Pro 2 provide e ective amplification for typical sloping mild to moderate losses and can improve listening in noisy places. Right now, we’re digging deeper into how people actually use them as hearing aids in daily life - insights that will be crucial for both clinicians and those wondering if these features might help them.
AirPods Pro 2 as hearing aids aren’t for everyone. Their snug fit can become uncomfortable over long periods, and their five to seven hour battery life isn’t enough for all-day wear. Their assistive capabilities are impressive for consumer earbuds, but they don’t match the performance of advanced features in dedicated hearing aids, especially in noisy or complex listening environments. They also lack the fine-tuning, expertise, and personalised support of a professional fitting. But for many people who aren’t ready to take that step, they o er a practical way to try amplification and see what better hearing could feel like.
AirPods Pro 2 mark a shift, moving from being audio earbuds to also serving as hearing devices. For younger or tech-savvy users, they may feel more acceptable than traditional hearing aids, especially for those already used to wearing earbuds. As more earbuds start o ering hearing assistance features, I think social perceptions will change to recognise these devices as tools for hearing support, not just for music or calls.
AirPods Pro 2 as hearing devices present both a challenge and an opportunity. Some see them as a threat to traditional hearing aids and service delivery models.
My view? Because of Apple’s very large consumer reach and the popularity of AirPods, they have a unique ability to raise awareness of hearing health and give people an easy first step to experiencing hearing support. If these devices get people thinking about their hearing and taking action sooner, that’s a win.
Name: Dr Nicky Chong-White, PhD
Qualifications: Bachelor of Engineering, (Electrical and Electronics) (Hons), Doctor of Philosophy in Speech signal processing.
A liations: Principal Engineer at National Acoustic Laboratories, the research division of Hearing Australia
Location: Sydney Years in industry: 21
* Dr Chong-White is principal investigator in several studies evaluating Apple AirPods Pro 2 as hearing devices.
“WE’RE DIGGING DEEPER INTO HOW PEOPLE ACTUALLY USE THEM AS HEARING AIDS IN DAILY LIFE.”
Mr Peter Justesen has taken over from Scott Davis as leader of GN’s hearing business. Davis stepped down from daily management but will continue to support GN in an advisory role. CEO Mr Peter Karlstromer said Davis was instrumental in securing GN’s strong position in the hearing aid market and thanked him for his strong, customer-centric leadership of GN’s hearing business. “Peter Justesen comes with 13 years of background in GN, most recently heading up hearing international sales,” Karlstromer said. “We have great momentum in our hearing business and together with our competent teams and leaders around the world, I’m sure we can keep building on that.”
In May 2025, driven by a passion to assist individuals with their hearing needs, Ms Pooja Bontu established her own independent audiology clinic, Candid Hearing. The Canberra- based clinic serves the ACT and surrounding NSW regions. Bontu completed a Master's degree in audiology and speech pathology in India in 2009 and worked in ENT clinics for two years before moving to Australia in 2011. Since then, she has been a full member of ACAud inc HAASA. She was previously employed by Amplifon until 2024.
manager for Starkey Hearing Technologies Australia and New Zealand. Her qualifications include an Associated Diploma of Business Administration and a Bachelor of Business with Certificates in Leadership Development. Kelly is an established HR professional with a demonstrated history of working in fast-paced and dynamic environments to deliver high-end solutions in all facets of HR. Her background includes mergers and acquisitions, organisational transformation and turn-arounds, systems integration and implementation, employee engagement, talent coaching and management, remuneration awards and recognition, employee relations, enterprise bargaining agreement negotiations and award interpretation.
Mr Sayedali ‘Ali’ Mohseni has joined the Australian Hearing Hub at Macquarie University as a research assistant. In this role, he works on a project led by Dr Heivet Hernandez-Perez (primary chief investigator), Dr Joerg Encke (chief investigator), and Professor Jorg Buchholz (associate investigator), exploring how reverberant environments affect speech understanding and spatial hearing through data analysis, signal processing, and behavioural experiments with human listeners. Mohseni has a Bachelor’s degree in polymer engineering and a Master’s in data science. He previously worked at the Kolling Institute, Chris O’Brien Lifehouse, and AI Point, contributing to projects in genome sequencing, AI, and medical imaging.
Mr Tobias Fischer has been appointed president of EURO-CIU, the European Association of Cochlear Implant Users, representing cochlear implant users across 23 countries. He also serves as president of ÖCIG, the Austrian Cochlear Implant Association. Fischer was one of the first children in Germany and Europe to receive a cochlear implant in 1988. His lifelong experience as a cochlear implant user has shaped his deep commitment to advocacy, accessibility, and inclusion in hearing health. Through his roles, he aims to strengthen the voice of cochlear implant users and promote positive change in policy, innovation, and support across Europe and beyond.
To list an event in our calendar please email helen.carter@primecreative.com.au
EVALUATING AND OPTIMISING HEARING IN ASYMMETRICAL & UNILATERAL HL
Online webinar 20 August independentaudiologists.net.au
HEARING AIDS: UNDERSTANDING THE TECH BEHIND THE FIT
Sydney, Brisbane 22 & 29 August respectively audiology.eventsair.com/connectlearn
DEAF ECOSYSTEM SUMMIT
Sydney, Australia 28-29 August convo.io/au/summit
2025
ENT EMERGENCY SURGERY REFRESHER COURSE Sydney, Australia 6 September asohns.org.au
SMARTER DATA: BUSINESS INTELLIGENCE LIKE A BOSS Online webinar 24 September (IAA members only) independentaudiologists.net.au
OTL 2025: 78TH NZSOHNS ASM 7-9 October Hawke's Bay, New Zealand asohns.org.au
CI ADVOCACY IN ACTION 2025 16-17 October Brussels, Belgium ciicanet.org
ACADEMY RESEARCH CONFERENCE 2025: DIAGNOSIS AND MANAGEMENT OF TINNITUS Virtual 17 October audiology.org/event
AUDIOLOGY UNCHAINED 2025 17-18 October Mooloolaba, Queensland independentaudiologists.net.au
VICTORIAN TEMPORAL BONE SURGICAL COURSE Melbourne, Australia 23-24 October asohns.org.au
ITINERANT TEACHER OF THE DEAF CONFERENCE 2025 Sydney, Australia 31 October nextsense.org.au
FRONTIERS 2025 13-15 November Hobart, Australia thefrontiersconference.org
Quality you can count on
Your patients depend on the technology you fit. Your reputation does too. That’s why, at Starkey, we put our hearing aids through the industry’s most comprehensive quality control process – so that every pair you fit performs as reliably on Day 1,000 as it does on Day One.
We push endurance and durability to the max – so our technology can be fit and worn with confidence.
• 500+ hours of high-stress testing
• Pro8 HydraShield® waterproof system is rated beyond IP68
• Significant investments made in quality innovations
