Audacity Issue 3

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Audacity ...a British Society of Audiology Publication issue 3 april 2014 ................................

14 Plasticity following short-term unilateral hearing loss

24 If all you have is a hammer...’

46 DEAFinitely Inclusive Sport

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audacity@thebsa.org.uk

British Society of Audiology

www.thebsa.org.uk

KNOWLEDGE | LEARNING | PRACTICE | IMPACT


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Editorial

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lasticity of the auditory system is central to everything we do in audiology. Whether it is in the rehabilitation of an adult with an acquired hearing loss or the habilitation of a child with a congenital hearing loss, the role of central adaptation of the auditory pathway is crucial to the success of a hearing aid or implantable device. Within this third edition of Audacity, we focus on plasticity of the auditory pathway with articles from Mike Maslin and Jessica Merrit who investigate psychoacoustic, radiological and acoustic reflex changes in the auditory system in response to unilateral changes to an auditory input. Meanwhile, Andrea Pittman looks at the unique and sophisticated strategies that children with hearing loss create to tackle their listening and learning environment. Andrea gives us examples of how children as young as 8 years old can make good choices when using sophisticated hearing aid technology. Within EarReach we look at both the work of Deaf Sport in the UK and the benefits of charitable work in Kenya; whilst EarGlobe transports us to Singapore where we discover something about the history and practice of audiology there. Research Roundup gives an opportunity for academic and research institutions to highlight and promote their specialist areas of work. In this edition Helen Pryce and colleagues review and celebrate the achievements of the Centre for Hearing and Balance studies at the University of Bristol which, after nine successful years, is due to close in September 2014.

In his Chairman's message, Kevin Munro calls for a greater 'buy in ' from all sectors of the audiology and hearing science community to the BSA. We have a similar plea from Audacity. We aim to represent the diverse groups working within the field of Audiology but we can only do that if we have a commitment from those groups to contribute towards the publication. So, please get writing and aim to educate, inform and excite us in future editions!

Martin O’Driscoll Editor-in-Chief On behalf of the editorial team E: martin.odriscoll@cmft.nhs.uk

In the meantime, the editors would like to thank all who have contributed to this third edition. Please look out for the interactive pdf which will be available soon.

We welcome feedback and suggestions for articles or sections that you would like to see included. If you would like to be a guest editor for a particular section or be involved in the editorial team then please let us know.

from the editor


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Contents 3

meet the editorial team...

Editorial Martin O’Driscoll

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Chairman’s Message Kevin Munro

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SIG Segment information and updates from BSA Special Interest Groups

Martin O’Driscoll E: martin.odriscoll@cmft.nhs.uk

Section Editor: Martin O’Driscoll / E: martin.odriscoll@cmft.nhs.uk

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Knowledge Learning Practice Impact information and updates from the BSA Professional Practice Committee (PPC) and the Learning and Events Group (LEG) Section Editor: Rachel Booth / E: rachel.booth@cmft.nhs.uk

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Featured Articles expert writing about topical areas in audiology Section Editors: Martin O’Driscoll / E: martin.odriscoll@cmft.nhs.uk Rachel Booth / E: rachel.booth@cmft.nhs.uk

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Rachel Booth E: rachel.booth@cmft.nhs.uk

Research Round-up a spotlight on major ongoing research projects in the Audiology community worldwide. Section Editor: Rachel Hopkins / E: rachel.hopkins@cmft.nhs.uk

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Lunch & Learn a summary of the latest bite size online seminars for you to get your teeth into! Section Editor: Shahad Howe / E: shahad.howe@cmft.nhs.uk

Dion Jones E: dion.jones@cmft.nhs.uk

35 Ear to the Ground a guide to all things Ear-related in the media… Section Editor: Dion Jones / E: dion.jones@cmft.nhs.uk

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

Jenny Griffin E: jenny.griffin@cmft.nhs.uk

W: www.thebsa.org.uk


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welcome to

Audacity ....a British Society of Audiology Publication

meet the editorial team...

40 Ear Globe an opportunity to learn more about audiology around the world. Explore a different country in every issue! Section Editor: Julie Reading / E: Julie.reading@cmft.nhs.uk

44 Ear Reach find out about the latest charity and humanitarian work going on within audiology, both in the UK and abroad, with some opportunities for you to get involved. Section Editor: Jenny Griffin / E: jenny.griffin@cmft.nhs.uk

Rachel Hopkins E: rachel.hopkins@cmft.nhs.uk

48 Clinical Catch-up Short articles on relevant clinical topics Section Editor: Rachel Hopkins / E: rachel.hopkins@cmft.nhs.uk

53 Hearsay News from Regional Groups and BSA Members Section Editor: Danny Kearney / E: danny.kearney@cmft.nhs.uk Shahad Howe E: shahad.howe@cmft.nhs.uk

56 Company Corner Short articles on relevant clinical topics Section Editor: Danny Kearney / E: danny.kearney@cmft.nhs.uk

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Essentials Key information for the membership Section Editor: Danny Kearney / E: danny.kearney@cmft.nhs.uk

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

W: www.thebsa.org.uk

E: audacity@thebsa.org.uk

Julie Reading E: julie.reading@cmft.nhs.uk


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chairman’s message

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Chairman’s Message UK and BSA: what has held each of them together On 18 September 2014, a relatively small proportion of the population of the United Kingdom of Great Britain and Northern Ireland (British citizens over the age of 16 years who are resident in Scotland) can vote in the Scottish referendum on the question: ‘Should Scotland be an independent country?’ A minority of the people of Scotland (less than 33%) are in favour of independence. Perhaps the Scottish government is relying on a combination of the 700th anniversary of the Battle of Bannockburn (where Robert the Bruce routed a larger English army), along with hosting the Commonwealth Games and the Ryder Cup golf tournament, to generate a Kevin J Munro surge of nationalism and self-efficacy into the Chairman Scots. As Linda Colley points out in her recent essays on the United Kingdom, ‘All countries are synthetic and imperfect creations and subject to change’ (Colley, 2014). The BSA is a composite organisation and also subject to change. Unlike the UK, (a state composed of four nations), the constituent parts of BSA are not ethnic, political, religious or geographical, but there are real differences nevertheless. Compare, for example, the characteristics and culture of members who: (i) function within an educational, health or research setting; (ii) operate within the NHS or independent sector; (iii) are based within the UK or overseas.Therefore, what binds the BSA together? When the BSA was established in 1967, the founders were keen to provide an opportunity for the diverse groups working within the field of Audiology (scientific, technical, medical, educational etc.) to meet, mix and unite around a common purpose- the furtherance of Audiology. Somewhere along the way, the term Audiology has become synonymous with Clinical Audiology and this is unfortunate. No one doubts the importance of Clinical Audiology but we are not the British Society of Clinical Audiology and it would be a weakness to restrict our activities and publications to members who function solely within a clinical setting. There is much work to be done to secure ‘buyin’ from all sectors of the audiology and hearing science community, but we are fortunate that some of our most recent Trustees are committed to ‘Bringing Science to Audiology’ (BSA). In his report, ‘Wither the BSA?’ Ted Evans (Chairman,

chairman’s message

2000-2002) said, ‘our diversity is our strength’ (Allen, 2011). Quite so. Common interests and a common purpose Membership of BSA, like the people of the UK, is united by common interests but this does not automatically translate into a sense of common purpose. Members have autonomy based loosely around professional affiliations. But, in order for BSA to provide ‘added value’, there must be a commitment to the whole as well as recognition of the component parts. How, then, should BSA create and sustain a sense of belonging and allegiance? Special Interest Groups (SIGs) bring together individuals from a wide range of professional backgrounds by providing a common (special) purpose. In this regard, the recently formed Cognition in Hearing SIG has got off to a flying start with its discussion paper (and associated commentaries) on the topic of listening effort and fatigue (McGarrigle et al, 2014). As a coauthor on this publication, I know from first-hand experience that the final manuscript accepted by the International Journal of Audiology was strengthened and improved from input by BSA members within a variety of research and clinical backgrounds.

Currently, there are discussions about the formation of a new SIG on the topic of auditory electrophysiology. Anyone interested in supporting this latest proposal should email Sally Wood at sally.wood3@nhs.net. This is an opportunity to bring together people with common interests and provide a common purpose e.g., identification of research priorities; provision of position papers on electrophysiological assessment of hearing and vestibular function e.g. calibration and specification of equipment for clinical use; provision of guidance on the intro-


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chairman’s message

7 duction of new or novel techniques into clinical practice etcetera. While the formation of an auditory electrophysiology SIG has still to be discussed at Council, it is clear that each SIG unites around a common purpose and provide a forum that is not available elsewhere. This is a distinguishing feature of BSA.

Another opportunity for individuals to unite around a common purpose is public engagement.This is a new BSA activity (identified in our 2013-14 Action Plan), led by Tracey Twomey who is one of our new Trustees. Tracey has secured sponsorship to run a focus group with the aim of establishing how best BSA can engage with the public. It is Tracey’s hope that we may be able to attract a media company with an interest in making a documentary that focuses on hearing impairment. In addition, BSA North is making progress towards a public engagement event under the direction of Tracey Adams. It is our expectation that public engagement activities will also become a distinguishing feature of BSA. The Learning Events Group (LEG), coordinated by Dr Mel Ferguson, includes members from NHS, independent sector and research settings (important because of our membership diversity). The overall aim of LEG is to develop and co-ordinate events that facilitate inter-professional and inter-disciplinary learning. This is illustrated in the composition of the organising committee for our 2014 annual conference: Michael Akeroyd, Stefan Bleeck, Chris Cartwight, Mel Ferguson and David Furness. LEG is working towards a calendar of events that include Journal Clubs (Adult Hearing Screening, Nottingham, 14 May 2014),Twilight Meetings (New Perspectives on Implantable devices, Manchester,Thursday 26 June 2014), eSeminars (monthly Lunch and Learn and also Lightning Updates) and, presumably, research-active members of LEG will also wish to suggest appropriate events for their constituents. An important development is our positive discussions on joint events with the British Academy of Audiology and the British Society of Hearing Aid Audiologists. This range of inter-professional events is another distinguishing feature of BSA. One of our most active groups, the Professional Practice Committee, is working towards National Institute for Health and Clinical Excellence (NICE) accreditation of BSA recommended procedures and clinical guidance documents. Again, this is an opportunity for members with different backgrounds to unite around a common cause. Anyone interested in finding out more about the work of PPC should contact p.james1@nhs.net. NICE accreditation will enhance the quality,

status, and consistency across all of our documents. It will also raise the profile of BSA and Audiology with links from NICE/NHS Evidence websites.These documents are useful reminders of the real impact of BSA and are one of our most significant distinguishing features. Operations Manager: preparing BSA for the future Only the most myopic of individuals could fail to observe that BSA needs to strengthen and professionalise its operational activities, enhance its profile and maximise opportunities for growth. Otherwise, Council is in real danger of continuing to ‘miss the boat’ and preside over a Society that is in ‘managed decline’. On a regular basis, we either miss an opportunity or arrive too late to be effective. Take, for example, the idea of a BSA ‘dating agency’ that was suggested by members at the Innovation Forum in September 2013. The ‘pairing scheme’ would bring together individuals from different professions/disciplines. This would have the intention of encouraging a better understanding of each other’s roles and the potential to establish longstanding links between members. But what structures and people do we have in place to capitalise on this suggestion from members? The list of missed, slow or delayed opportunities is endless: what structures do we have in place to actively grow membership; what structures do we have in place to actively encourage charitable donations; what structures do we have in place to actively address our website needs? No amount of vision, drive and commitment can overcome the current operational vacuum that, adapting the words of Peter Drucker, is eating up our strategy for breakfast. Clearly, a strategic priority must be to address this urgent operational need.

‘Be in no doubt, the creation of such a post (and the appointment of the right individual) will transform BSA and prepare us for the future.’ The BSA lacks an Operations Manager. I could achieve much more as Chairman with such a person in post. BSA could continue, as it has done in recent years, but is this good enough? Should Trustees be expected to lead strategy and undertake operational activities, while working as unpaid volunteers and relying on the goodwill of employers and families? No matter how far reaching our vision, or how brilliant our strategy, neither can proceed with speed while we ‘drive with the breaks on’. An Operations Manager would be responsible for the sorts of activities I mentioned above. But the appointment of the right person will do much more. The right person will develop the national and international profile of the Society, implement our annual Action Plan, meet annual targets for growth in membership and engage our stakeholders. I am delighted to report that Council has agreed, in principal, to the appointment of an Operations Manager. This will require a significant investment so

chairman’s message


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chairman’s message

8 we will need safeguards related to Key Performance Indicators and piloting (0.5 WTE for 2 years).The result will be to increase the capacity of Trustees to better direct strategy and to be more responsive to challenges and opportunities. The role comes at an exciting time in delivering our Action Plan and the implementation of our many new developments. Assuming Trustees are satisfied that the post is financially viable, we will be looking to appoint someone with passion, energy, drive and the ability to motivate and inspire others. Be in no doubt, the creation of such a post (and the appointment of the right individual) will transform BSA and prepare us for the future. Some say charity begins at home: why not begin at BSA? In the past we have been fortunate to receive funds that now support the TS Littler prize and the George Harris Fund, amongst others. Since 1970, BSA has been registered with the Charity Commission.This provides BSA with an opportunity to receive charitable donations from individuals and companies. Did you know that, as an individual, you can make a donation and have a prize or lecture named after you? Did you know that, as a company, you could make a donation and, for example, have a research fund named after you, or your organisation? Both types of donation have associated tax benefits/relief good for you and for BSA. Giving a company donation to BSA means that you can receive tax relief by deducting the amount donated from pre-tax profits at the end of the financial year. Some very useful information is available at: www.hmrc.gov.uk/businesses/giving/companies.htm I would be delighted to discuss this further with anyone considering making a donation to BSA.

‘Did you know that you could make a donation and, for example, have a research fund named after you, or your organisation?’ A sneak preview of the new BSA website… To capture the dynamic and forward-thinking work of the current BSA Council, we have decided that the time has come to have a leading website that is the first port of call for Audiology. To achieve this, the Council formed their own version of “Dragons’ Den” that drew up a demanding specification and shortlist of potential professional website designers. Interviews took place in December 2013 and Key Multimedia was identified as the most suitable and cost-effective supplier. There is great excitement about the new website. A sneak preview of some of the key elements includes: •

Online access to electronic versions of BSA publications such as Audacity and the International Journal of Audiology Easy and free access to BSA Policies and Procedures, out-

chairman’s message

• •

lining best practice based on current evidence Easy access to our very popular recorded Lunch & Learn and Lightning Updates, keeping you informed of latest developments from the comfort of your own desk Direct access and updates on the work of the BSA Special Interest Groups and news of their publications and international collaboration Information about conferences and events, with easy online registration for BSA events Information and updates about research grants, prizes and awards

You will be able to Facebook or Tweet us – or reach us in more traditional ways. We will be there for you – on your ipad, notebook or computer, in a format that is quick and easy to access. Watch this space. And finally… I think it was George Parkin who said, ‘A policy of drift will never result in united strength’. Council is working relentlessly, on your behalf, to make a real difference. The progress and numerous changes made in recent years should reassure you that BSA is far from adrift. We are emerging from a period of transformation and the next stage is development and growth i.e., closing the gap between what we do and where we want to go. The appointment of an Operations Manager will accelerate this process and assist us in the challenges that lie ahead. Finally, I recently invited our Trustees and Council Advisors to write a 150 word summary about their role within BSA. Having forgotten that there are around 26 individuals in total, this means the summaries are much too long to include in my Chairman’s message. However, they will shortly appear on our new website. As always, I welcome your views: contact me at kevin.munro@manchester.ac.uk My best wishes,

Kevin J Munro Manchester February 2014 References 1. Allen A. (2011). The history of the British Society of Audiology. Reading: Ann Allen. 2. Colley L. (2014). Acts of union and disunion: what has held the UK together- and what is dividing it? London: Profile Books. 3. McGarrigle R. Munro KJ, Dawes P, Stewart A, Moore DR, Barry JG, Amitay S. (2014). Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in hearing Special Interest group ‘white paper’. International Journal of Audiology (In Press).


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SIG segment

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SIG Segment Information and updates from BSA Special Interest Groups

BSA Special Interest Group

BSA Balance Interest Group Debbie Cane, Chair of Balance Interest Group (BIG) SIG

The Balance Interest Group (BIG) steering committee is pleased to announce its biennial conference ‘Balance testing and rehabilitation: Past, present and future’, which will be on 7th November 2013 at the UCL Ear institute, London.This will consist of an excellent mix of presentations in the morning and a choice of workshops with hands on experience in the afternoon, all given by experts in their field. As in previous conferences, there will be opportunities to share practise and experience and learn new or perfect existing skills. We hope that clinicians from all professions who work with patients with inner ear balance disorders will be able to join us. Further details will be published soon. Research-wise, BIG hopes to extend work by a member of the group on norms for spontaneous and gaze evoked nystagmus. We also hope to circulate a questionnaire to eval-

SIG segment

uate both balance function testing and rehabilitation service provision throughout the country. A similar questionnaire was circulated in 2009, and it will be interesting to see how services have changed over this time. A large part of BIGs work is to publish protocols to give guidance on how best to perform the large variety of tests we have available to us to aid in diagnosis. The ‘Vestibular assessment: Eye movement recordings’ protocol is currently on the BSA website for consultation and we welcome comments on this. An extended version of the old Dix Hallpike protocol, the ‘BPPV positioning test protocol’ containing guidance on the tests available for the diagnosis of BPPV of all three canals is nearing completion, as is a guidance document on how to perform ’ocular vestibular evoked myogenic potentials’.

We continue our work to fulfil one of the aims of BIG, namely ‘to raise awareness of peripheral and central balance disorders’, with a number of the group lecturing and teaching on a variety of balance courses country-wide.


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SIG segment

11 BSA Auditory Processing Disorder (APD) Special Interest Group Pauline Grant, Chair of Auditory Processing Disorder (APD) SIG

In January I took over the chairmanship of the APD SIG from Nicci Campbell and I would like to take this opportunity to thank her for her hard work and dedication to the SIG and, in particular, the advice and support she has given to me. She will be a very hard act to follow……… At our January meeting, we reflected on the success of the APD Satellite Day we hosted last September at Keele University. The feedback was very positive and we are delighted that the BSA plans further satellite days on different topics every year. The APD SIG is made up of representatives from a range of disciplines – medical, audiology and communication sciences, education, psychology, speech & language therapy and hearing therapy. We believe this approach is a real strength, enabling us to offer targeted advice and support to adults and children who have diagnosed or suspected APD, their families, teachers and employers. Our aim for the next two years is to ensure an overview of APD provision nationally, to develop links with other agencies and to broaden knowledge and awareness about the condition – raising the profile in schools, GP surgeries and clinics. The coming year will be a busy one! • The APD Position Statement and the Practice Guidance documents we produced in 2011 will be reviewed and updated, with Dave Moore and Nicci Campbell overseeing this as lead authors. • New APD leaflets are being prepared. Roshini Alles (adults) and Dilys Treharne (children) will lead on this. The leaflets will be available in print and also to download via the BSA website. • Building on the success of the first Parent Awareness Day in June 2013, arranged by Doris-Eva Bamiou and Tony Sirimanna, a second APD Information Day is planned for November. As well as guest speakers, we will offer practical ‘hands on’ opportunities to experi-

ence FM technology and try activities and programmes designed to develop listening skills. There will be separate workshops for adults and children. We are delighted that Mr. Andrew Strivens has agreed to be the Parent Advisor to the SIG and that he will be involved in planning the day. • We’ll raise our profile via the BSA Facebook page and if I can make myself understand it, Twitter! Finally, we are pleased to announce that a further global conference - ‘Clinical Populations with Central Auditory Processing Disorder: What We Know and What Lies Ahead’ - will take place on Saturday March 29th 2014 in Orlando, Florida. This follows on from our collaboration with the American Academy of Audiology (AAA) to present a very successful APD day as part of the AAA conference, held in Boston in March 2012. Please visit: http://www.audiologynow.org/progr am/capdconference.htm

BSA Cognition in Hearing Special Interest Group Piers Dawes, Chair of Cognition in Hearing SIG

A 'white paper' discussion of listening effort and fatigue has been accepted for publication in the International Journal of Audiology. The paper follows the format of the APD special interest group's 2013 APD white paper. It comprises a critical discussion of the theory and measurement of listening effort and fatigue, with expert commentaries by international experts Jerger Ronnberg and Art Wingfield. Look out for this paper, appearing soon! "Listening effort and fatigue: what exactly are we measuring? A British Society of Audiology Cognition in Hearing Special Interest Group 'white paper'".

SIG segment


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knowledge learning practice impact

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Knowledge Learning Practice Impact BSA Professional Practice Committee (PPC) Paul James MSc Chief Audiologist NHS Clinical Leadership Fellow Chair PPC E: Paul.James@uclh.nhs.uk or p.james1@nhs.net or ppcadmin@thebsa.org.uk

Work has been continuing well on our application for BSA to be accredited as a provider of documents by NICE and we are on target to make a formal application this spring. Once successful, we will then need to put a couple of documents through the process before accreditation is finally awarded (note the optimism). Several documents have been put on hold while we complete this process, so there are busy times ahead for us as we work on these and complete the adoption of the NHSP protocols. These are very exciting times to be a member of the PPC, and as luck would have it, we have vacancies for 2 new members. Working with the PPC is very rewarding and it has a high impact. Amanda Casey, Chair of the RCCP, has also confirmed that developing guidelines is a good example of CPD, so there are many incentives. Look out for the advertisement soon, and apply early to avoid disappointment. Alternatively, if you wish you can register an expression of interest before the advertisement is released, please contact us directly on ppcadmin@thebsa.org.uk. Applications are welcome from all, but we would be particularly excited by people with an interest in training and education for our short courses sub-committee, or in paediatrics. The VRA document is now in its final stages and should be ready for publication soon. Sorry for the delay with this

- I know it is eagerly awaited.

knowledge learning practice impact

Look out for the advertisement soon CALL FOR NEW MEMBERS

if you wish to register an expression of interest before the advertisement

â—?

please contact contact

ppcadmin@thebsa.org.uk


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knowledge learning practice impact

13 BSA Learning and Events Group Update Mel Ferguson Learning and Events Group Lead E: melanie.ferguson@nottingham.ac.uk

The Learning Events Group (LEG) has recently overhauled and revised the aims and objectives inherited from the previous Programmes Committee and identified a series of short and medium term targets through to 2015. The overall aim of the group is to develop and co-ordinate a programme of learning events relevant to the BSA membership and to facilitate interprofessional learning. In particular, we are keen to include input from individuals and organisations involving healthcare professions, research organisations, the commercial sector, the third sector, policymakers, commissioners and patients. So for example, the Journal Club on Hearing Screening will include contributors from clinical audiology (John Day) and the third sector (Lorraine Gailey, Hearing Link), and the next Twilight meeting on New Perspectives on Implantable Devices includes input from surgery (Kevin Green), basic science (Bob Carlyon) and audiology (Catherine Killan). Furthermore, to encourage dissemination opportunities, we are offering 10 free places for this Twilight meeting to those who would like to present either their clinical or research findings (or both) in a poster presentation. In particular, we are keen to encourage input from those in the early stages of their career. After discussions with both presidents of BSHAA and BAA, an interactive session to introduce the research principles behind evidence-based practice is to be run at the next BSHAA Professional Development Day (myself and Helen Henshaw). If this goes well (and we like to think it will!), something similar will be arranged for the BAA conference. The organisation of the longstanding BSA Annual Conference (Keele University) and PAIG (Birmingham) meetings are well underway, with Todd Ricketts and Corne Kros giving keynote lectures at the Annual Conference. More details on the Annual Conference, including a draft programme, will be released over the next month. One

new development LEG are working on is an e-conference drawing on the expertise and experience of Chris Cartwright, which we envisage would involve most, if not all, of those mentioned in the opening paragraph. The beauty of an e-conference is that it is easier to cast the net outside of the UK and bring in international contributors to bring a global perspective. This is nicely highlighted with the mix of UK and international presenters for the Lunch and Learn e-seminars organised by Shahad Howe, which have so far included several from Austraila (Andrea Caposecco from HEARing Cooperative Research Centre, Melbourne and Nerina Scarcini from The University of Queensland, Brisbane), which is about as far away as one can get from the UK, with at least one other in the pipeline for the Summer Special. Finally, although there is a healthy audience tuning into the Lunch and Learn e-seminars (as many as 700 for the Christmas Special) we are keen to get some more detailed feedback on how useful these e-seminars are. Similarly, we would like feedback on the Lightning Updates, which are specific to BSA activities. This will be just two short questions asking for a rating after the presentation, so please take the time to fill these in – shouldn’t take more than the time than it takes Usain Bolt to cross the 100m finish line (that’s less than 9.58s to be precise), and requiring significantly less effort!

Upcoming events: May 14th Journal Club - Hearing Screening in Adults, Nottingham June 26th

Twilight Evening Meeting New Perspectives on Implantable Devices, Manchester

July 3-4th

PAIG Annual Meeting, Birmingham

September 1-3rd

BSA Annual Conference, Keele University

See BSA website for more details.

knowledge learning practice impact


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featured articles

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Plasticity following short-term unilateral hearing loss – a step towards translating theory into clinical application.

CD

Author and Correspondence Michael RD Maslin School of Psychological Sciences University of Manchester Manchester, UK

Kevin J Munro School of Psychological Sciences, University of Manchester, Manchester, UK Vanessa K Lim School of Psychology, University of Auckland, Auckland, New Zealand Suzanne C Purdy School of Psychology, University of Auckland, Auckland, New Zealand Deborah A Hall Nottingham Hearing Biomedical Research Unit, Ropewalk House, Nottingham, UK This work was funded by grants from the BSA Stuart Gatehouse Applied Research Fund, and the University of Manchester Translational Imaging Unit.

It is increasingly clear that the mammalian central nervous system (CNS) remains plastic, at least to some extent, throughout adulthood. It is this plasticity, or ability of the CNS to alter its structure and function to external stimuli, that seems to underlie normal learning and memory [1]. However, it is also thought to underlie adaptive and maladaptive changes following a sensory deprivation like deafness. The primary goal of researchers interested in plasticity is therefore to advance the translation of our basic understanding of plasticity towards tangible clinical applications that reduce disability, for example by minimising maladaptive changes (such as occurs with some forms of tinnitus) while maximising adaptive changes (such as with hearing aid acclimatization) [2]. In the central auditory system, a useful model for studying plasticity in adult humans involves measuring the responses of

featured articles

binaurally sensitive neurons following a prolonged interaural asymmetry due to unilateral hearing loss. One reason is that the effects are thought to be widespread throughout the auditory system, from the brainstem to the cortex, and are therefore relatively easy to measure using the types of non-invasive, far field techniques that are available in human studies (for example Auditory Brainstem Responses, Acoustic Reflex Thresholds, Cortical Auditory Evoked Potentials or functional Magnetic Resonance Imaging). Another reason is that certain clinical populations, such as those undergoing unilateral acoustic neuroma removal, or corrective surgery for otosclerosis, offer the opportunity for before-andafter measures of the long-term effects of unilateral hearing loss within the same individual. A final reason is that short-term effects can be easily studied by simulating unilateral losses in otherwise normally hearing individuals by the simple introduction of an earplug. This article provides an overview of our study, supported by the BSA Stuart Gatehouse Applied Research fund, which explored the topic of plasticity after simulated unilateral losses through ear plugging [3]. Based on evidence from animal models with either sensorineural or conductive unilateral loss, stimulation of the intact ear produces increased central auditory system activation and reduced hemispheric asymmetries compared with controls [4]. Normal hemispheric asymmetry following monaural stimulation can be explained by the majority of afferent nerve fibres from each ear crossing the midline, initially at the level of the lower brainstem, and innervating the contralateral hemisphere of the brain more strongly than the ipsilateral hemisphere. An overall increase in activation after unilateral hearing loss can be explained by the recruitment of binaural neurons that were previously most sensitive to stimulation of the now deafened ear, and the reduced hemispheric asymmetries can be explained by the majority of these newly recruited neurons being located in the hemisphere ipsilateral to the ear of stimulation [for a review see 5]. An increasing body of evidence, including several recent studies from our own lab [5,6], demonstrates similar patterns of plasticity within the human central auditory system following unilateral sensorineural hearing loss. However, for reasons that are as yet unclear, plasticity has not been seen in individuals with long-standing unilateral conductive losses [7-9].


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15 One possibility is that these studies suffered from high variability due to their comparisons between different groups, and with the relatively few participants in each study (n=2 to 6) exhibiting varying degrees and durations of deafness due to various aetiologies. We therefore decided to investigate this discrepancy further by studying the effects of a short-term unilateral conductive loss on cortical activity in a larger group of adult humans. We studied the same individuals before-and-after plugging, which allowed us to control for much of the variability in the earlier studies.The hypothesis was for increased cortical activation and reduced hemispheric asymmetries upon stimulation of the unplugged ear.

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In addition to cortical plasticity, we were also Figure 1: fMRI activation maps from a single participant before and after plugging in response to interested in whether sub-cortical plasticity could 0.5 kHz band-limited noise. Voxels that are significantly active at P<0.05 are shown overlaid onto also be observed over the same period of time. the participants anatomical slice. C = Contralateral hemisphere; I = Ipsilateral hemisphere relative It is already known that significant brainstem plasto ear of stimulation. ticity occurs in adults following short-term unilateral plugging [10], and this can be demonstrated this hemispheric asymmetry occurs after plugging because relavia changes in acoustic reflex thresholds. Specifically, thresholds tive strengths of activity between hemispheres do not change. in the plugged ear tend to decrease whilst a small increase also occurs in the unplugged ear. We therefore also hypothesised Group data is shown in Figure 2. The data reveal a normal reduced acoustic reflex thresholds in the plugged ear and pattern of hemispheric asymmetry at baseline in response to increased thresholds in the unplugged ear of our participants. both the low and high frequency stimuli, with a significantly greater response from the contralateral hemisphere compared Eleven normally hearing adults were recruited to the study.They with the ipsilateral hemisphere in each case. were each asked to wear a custom-made silicone ear-plug in their left ear continuously for seven days (except for daily abluHowever, after seven days of continuous ear-plugging, there tions). The ear plugs provided a conductive hearing loss which were no clear changes in either the overall level of activation was similar to a mild, high frequency loss with a mean attenuaor hemispheric asymmetries. Further analyses, which focused tion of around 10 dB at 0.25 kHz and around 30 dB at 4 kHz. separately on the primary and non primary cortex showed a similar pattern [3]. Cortical activity was measured via functional magnetic resonance imaging (fMRI) in each participant at baseline (immediTable 1 summarises the acoustic reflex data.They show a mean ately after insertion of the ear-plug) and again seven days later reduction of 3-7dB in the thresholds measured in the plugged (immediately prior to removal of the plug).Two types of stimuli ear after seven days, compared with baseline.This occurred for were used; the first was a low frequency band-limited noise both the low and high frequency stimuli. A small but significant centred at 0.5 kHz and the second a higher frequency bandincrease in thresholds was also observed in the unplugged ear limited noise centred at 4 kHz. Stimuli were presented at 90 after seven days (not shown). dB SPL via an MR compatible circum-aural headphone. Further details of the fMRI recording and analysis procedures can be found in [3]. Ipsilateral acoustic reflex thresholds were also measured from both ears at baseline and again after seven days, immediately before the respective scanning procedures. Pure tone stimuli at 0.5 kHz and 4 kHz were initially presented at 70 dB HL. The level was then increased in 2 dB step-sizes until a reflex was obtained. Again, details of the procedure can be found in [3]. The fMRI results from one participant at one frequency are shown in Figure 1, as an example. The activity in the contralateral hemisphere appears greater than that of the ipsilateral hemisphere at baseline, as expected. However, no reduction in

Plugged ear

0.5 kHz 4kHz

Before 92 (10) 93 (8)

After 89 (8) 86 (8)

Table 1: Mean acoustic reflex thresholds, in dB HL with 1s.d. in parentheses (n=11).

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16 either plasticity effects observed in the brainstem are not frequency specific, or more prosaically, the low frequency stimuli were evoking a reflex response via high frequency neurons as a result of basal ward extension of excitation on the basilar membrane.

mean activity (arbitrary units)

0.9 0.7 0.5 0.3 0.1 -0.1 -0.3

Contralateral Hemisphere

Ipsilateral Hemisphere

-0.5

mean activity (arbitrary units)

0.9 0.7 0.5 0.3 0.1 -0.1 -0.3 -0.5

Contralateral Hemisphere

Ipsilateral Hemisphere

Figure 2: Mean fMRI activity at baseline (filled columns) and after 7 days unilateral ear plugging (open columns). Error bars Âą 1s.d. (n=10).

Overall, these findings confirm that sub-cortical plasticity can be measured in adult humans after relatively short periods of partial unilateral hearing loss. However, the same conditions did not result in cortical plasticity in the same individuals, at least as measured using our fMRI paradigm. We believe that we are the first to investigate the effect of short-term unilateral conductive hearing loss on neurophysiological activity from the human auditory cortex.The findings are consistent with previous reports investigating long-term conductive losses affecting one ear, showing that cortical responses do not appear to be substantially affected [7-9]. There are several possible explanations for this result. One is that the changes we noted at the level of the brainstem act to normalise neural activity, negating further changes at subsequent levels of the auditory pathway such as the cortex. Alternatively, our study design may simply not have been sufficiently sensitive to reveal subtle changes in suprathreshold binaural interactions in the cortex after partial and short-term deafness in the face of ongoing spontaneous and low-level evoked neural activity that presumably still arises from the plugged ear. Hence, future studies may care to either provide binaural, dichotomous stimuli in order to maximise sensitivity to binaural interactions, or assess the cortical responses to monaural stimulation of the plugged ear (where the greatest changes in the acoustic reflexes were observed). The acoustic reflex findings confirm previous data [10] but they also extend these findings by demonstrating that changes occur similarly for both low and high frequency stimuli. This finding is intriguing since the level of attenuation provided by the earplug was much greater for higher frequencies.This suggests that

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Overall these findings may provide an important stepping-stone informing the design of future studies that are sensitive to detecting the plasticity of binaural interactions previously reported in animal models of conductive hearing loss. Understanding what, if any, plasticity occurs in the central auditory system, their physiological mechanisms and perceptual consequences following even minor perturbations in input from each ear could have implications both for clinical populations with deafness and their rehabilitation via hearing aids or other means. References 1. Kleim JA, Jones TA. Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research 2008; 51: S225-239. 2. Cramer SC, Sur M, Dobkin BH, O'Brien C, Sanger TD, Trojanowski JQ et al. Harnessing neuroplasticity for clinical applications. Brain 2011; 134: 1591-1609. 3. Maslin M, Munro K, Lim V, Purdy S, Hall D. Investigation of cortical and subcortical plasticity followingshort-term unilateral auditory deprivation in normal hearing adults. NeuroReport 2013. in press. 4. Moore DR, King AJ. Plasticity of Binaural Systems. In: Parks TN, Rubel EW, Fay RR, Popper AN editors. Springer Handbook of Auditory Research. New York: Springer-Verlag; 2004. pp. 96 - 172. 5. Maslin MR, Munro KJ, El-Deredy W. Source analysis reveals plasticity in the auditory cortex: Evidence for reduced hemispheric asymmetries following unilateral deafness. Clin Neurophysiol 2013; 124: 391-399. 6. Maslin M, El-Deredy W, Munro K. Evidence for multiple mechanisms of cortical plasticity: a study of humans with late-onsetprofound unilateral deafness. Clin Neurophysiol 2013. in press. 7. Vasama JP, Makela JP, Parkkonen L, Hari R. Auditory cortical responses in humans with congenital unilateral conductive hearing loss. Hear Res 1994; 78: 91-97. 8. Moore DR, Devlin JT, Raley J,Tunbridge E, Lanary K, FloyerLea A et al. Effects of Long Term Unilateral Hearing Loss on the Lateralization of fMRI Measured Activation in Human Auditory Cortex. New York: Springer; 2005. 9. Hall D, Wild D. Fundamental principles underlying MRI and functional MRI. In: Tremblay K, Burkard R editors. Translational Perspectives in Auditory Neuroscience: Hearing Across the Lifespan - Assessment and Disorders. San Diego: Plural Publishing Inc; 2012. pp. 283-315. 10. Munro KJ, Blount J. Adaptive plasticity in brainstem of adult listeners following earplug-induced deprivation. J Acoust Soc Am 2009; 126: 568-571.


Spring 2014 Ad_Layout 1 05/03/2014 09:57 Page 1

Phonak Insight Noisy environments The development of directional microphones has been the hearing aid technology most instrumental in improving speech understanding in noisy environments. A review of the evidence for directional microphones, by Bentler (2005), supports the technology available at that stage and further progress has been made in the eight years since her review was published. Although the benefits of directional microphones may be reduced in the case of an open fitting, studies show that it is still more beneficial than using omnidirectional microphones (Kemp & Dhar, 2008; Magnusson et al., 2013). The ability to stream a full audio signal between two hearing aids allows an even greater benefit of directionality, as it incorporates not two microphones per ear, but a network of four microphones across two hearing aids. This creates more advanced beamformer polar responses that were previously unavailable with directional microphones in hearing aids that were either not linked or merely synchronised.

In the car Among the various everyday listening situations, listening while driving a car may be one of the most challenging. Several studies have shown that the car is a common, complex and loud sound environment for patients (Jensen & Nielsen, 2005; Wagener et al., 2008; Wu & Bentler, 2012). A number of hearing aid features have been developed to deal with this, such as using asymmetrical directional settings or asymmetrical gain settings in a pair of hearing aids. These tactics can help make the listening situation more comfortable, but may not enhance speech understanding. Phonak auto ZoomControl harnesses the streaming ability of Binaural VoiceStream TechnologyTM to improve speech understanding when the signal that the listener wants to hear may not be in front of them, such as when driving a car. When comparing different hearing aid technologies in a car listening situation, (Stangl et al., 2012) showed that only the pair of hearing aids that streamed the full audio signal from one hearing aid to the other was able to improve speech perception both when the speaker was seated either next to the listener and behind them. Bentler, R. A. (2005). Effectiveness of directional microphones and noise reduction schemes in hearing aids: a systematic review of the evidence. Journal of the American Academy of Audiology, 16(7), 473-484. Klemp, E. J., & Dhar, S. (2008). Speech Perception in Noise Using Directional Microphones in Open-Canal Hearing Aids. Journal of the American Academy of Audiology, 19, 571578. Magnusson, L., Claesson, A., Persson, M., & Tengstrand, T. (2013). Speech recognition in noise using bilateral open-fit hearing aids: The limited benefit of directional microphones and noise reduction. International Journal of Audiology, 52, 29-36. Jensen, N. S., & Nielsen, C. (2005). Auditory ecology in a group of experienced hearing-aid users: Can knowledge about hearing-aid users’ auditory ecology improve their rehabilitation? Paper presented at the Danavox Symposium, Kolding, Denmark. Wagener, K. C., Hansen, M., & Ludvigsen, C. (2008). Recording and classification of the acoustic environment of hearing aid users. Journal of the American Academy of Audiology, 19(4), 348-370. Wu, Y.-H., & Bentler, R. A. (2012). Do Older Adults Have Social Lifestyles That Place Fewer Demands on Hearing? Journal of the American Academy of Audiology, 23, 697-711.


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Turn Up the Volume: Auditory Plasticity and Short-Term Hearing Aid Use.

CD

Author and Correspondence Jessica F Merrett Pre-Registered Clinical Scientist Audiology BRI Bradford Teaching Hopsitals NHS Foundation Trust

Kevin J Munro School of Psychological Sciences University of Manchester Manchester, UK

The auditory system is a dynamically connected map of ipsilateral and contralateral pathways that retain a great deal of plasticity throughout adulthood. ‘Auditory plasticity’ is a term used to describe changes in the anatomical and physiological properties of neurons in the brain, following a change in auditory input or experience.[1] Such experience-related physiological reorganisation is often accompanied by perceptual changes which may, or may not, be helpful to the individual. Auditory plasticity can result from long-term auditory deprivation caused by a sensorineural or conductive hearing loss. Reintroducing auditory input through hearing aid use or cochlear implantation has been shown to induce secondary plasticity.[2] The implications of long term deprivation and stimulation have been found to affect a range of physiological and perceptual measures including loudness perception, intensity discrimination, the auditory brainstem response and the acoustic reflex threshold (ART).[3] Auditory plasticity can also result from shortterm auditory deprivation and stimulation. Formby and colleagues reported on 10 normal-hearing listeners who wore bilateral earplugs (deprivation) or noise generators (stimulation) for 2-4 weeks.[4] After earplug experience, listeners required a decrease in level of around 6-8 dB to match pre-treatment loudness for moderate and high stimulus presentation levels. Conversely, listeners required an increase in level of around 68 dB after noise generator experience. Perceptual and physiological changes have been found to occur following short-term auditory deprivation. Munro and Blount

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fitted 11 normal hearing adults with monaural ear plugs.[5] They found that after seven days of regular use the level required to elicit the acoustic reflex in the treatment ear (i.e. the ear with the earplug) decreased by 5-7 dB, relative to pre-treatment levels. Measurements made seven days post-treatment showed that the ART had returned to baseline values. These changes are consistent with a ‘central gain mechanism’. The central gain mechanism can be likened to an internal volume control. It was hypothesised that because the plugged ear is deprived of input, neural processes increase the gain in order to restore average neural activity and this is revealed by a lower sound level required to elicit an acoustic reflex. When the earplug is removed, gain reverts back to pre-treatment levels and this is accompanied by an increase in the level required to elicit an acoustic reflex. Recent neurophysiological research has proposed that high levels of neural gain are implicated in the disorders of tinnitus and hyperacusis.[6,7] It has been suggested that a central homeostatic mechanism causes an abnormal increase in central gain in response to auditory deprivation or trauma.[8] Consequently, a possible solution is to find ways to manipulate central gain. In summary, previous work suggests that it is possible to manipulate central gain. Short-term auditory deprivation results in an increase in central gain and, thus, a decrease in the ART and an increase in loudness of sounds. These findings were the motivation for our recent study; is it possible to induce plasticity in response to short-term auditory stimulation in adults? The main aim of the study was to investigate the effect of shortterm use of low-gain hearing aids on ARTs and loudness. We recruited 21 normal hearing adults for the study. The participants were fitted monaurally with a Starkey S series, nonoccluding, receiver in the canal (RIC) hearing instrument. The hearing aid settings were adjusted so that real-ear insertion gain i.e., the difference in response between the aided and unaided conditions, was 0 dB at 0.5 kHz and 15-20 dB at 2-4 kHz (Figure 1.). Amplification was given at 2-4 kHz only, so that we could assess whether the treatment could induce frequency specific changes.The participants were asked to wear the device continuously for five days, except whilst in bed. ARTs and loudness ratings for the fitted and the control ear were made on three occasions over a five day period: immediately before hearing aid fitting (day zero), after three days of hearing aid use and after five days of hearing aid use (Figure 2.). Ipsilateral ARTs were measured using a 0.5 kHz, 2 kHz and broadband noise (BBN) stimulus. Loudness judgements were


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19 obtained with a 0.5 kHz and 3 kHz tone using the Contour Test of Loudness Perception.[9] Listeners used a response pad to assign one of seven loudness categories to a train of pulsed warble tones. The loudness categories ranged from ‘very soft’ to ‘uncomfortably loud’.

Real Ear Insertion Gain (dB)

30 25 20 15 10 5 0 -5 100

Frequency (Hz) 1000

1000

Figure 1. Mean frequency-dependent real-ear insertion gain provided by the hearing instrument. Error bars show ± one standard deviation

The data presented in this article compares the change at day five only (Figure 3.). However, all the findings have been reported in Munro and Merrett.[10] For the 0.5 kHz tone, the change was less than 1 dB in the fitted ear. For the 2 kHz tone, the change was greatest at day five, where the mean difference between ears was around 3 dB, primarily due to an increase in ART in the fitted ear. For BBN, there was a mean difference between ears of around 3-4 dB at day five. For the fitted ear, listeners generally needed more intense stimuli (+3 to +5 dB) after wearing the hearing aid in order to give the same loudness judgements. In contrast, changes for the control ear were small and generally <1 dB.

Figure 2: Timeline of test sessions. Blue boxes represent the test sessions for the fitted and the control ear. Baseline measurements were made on Day 0.

The effect of amplification-induced stimulation is opposite to the effect of earplug-induced deprivation. Our results show an increase in the ART and an increase in loudness tolerance in the fitted ear following short term amplification. The change in ARTs provides support for a gain control mechanism. Because the fitted ear is provided with an ‘enhanced’ input, the gain is reduced and this is revealed by a higher sound level required to elicit the acoustic reflex. In comparison to the loudness judgement changes, the changes in the ARTs appear to be relatively frequency specific. This may reflect different characteristics of the gain mechanism at different levels within the auditory system. The findings in the present study may have implications for patients with tinnitus and/or sound tolerance problems. It is possible that ear plug use increases neural gain and leads to the phantom sensation of sound (tinnitus) and the aberrant perception of hyperacusis. The results are consistent with the changes in gain noted on auditory brainstem response testing in adults with tinnitus and also in animal models of hearing loss.[11-13]

Figure 3. Mean change in acoustic reflex threshold for fitted ear (green symbols) and control ear (blue symbols). Error bars show ± standard error. Modified from Figure 2. in Munro and Merrett.[10]

However, it would be important to replicate the study with a larger sample size, a longer treatment period and to make a comparison between solely high and low frequency stimulation.

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20 4.

Formby, C., Sherlock, L. P., and Gold, S. L. (2003). “Adaptive plasticity of loudness induced by chronic attenuation and enhancement of the acoustic background (L),” J. Acoust. Soc. Am. 114, 55-58. 5. Munro, K. J., Blount, J. (2009). “Adaptive plasticity in brainstem of adult listeners following earplug-induced deprivation (L),” J. Acoust. Soc. Am. 126, 568-571. 6. Jastreboff, P.J. &Hazell, J.W.P. (1993). A neurophysiological approach to tinnitus: clinical implications. British Journal of Audiology, 27, 7-17. 7. Melcher, J.R., Levine, R.A., Bergevin, C. & Norris, B. (2009). The auditory midbrain of people with tinnitus: Abnormal soundevoked activity revisited. Hearing Research, 113, 165-172. 8. Norena, A., J., and Cherry-Croze, S. (2007). “Enriched acoustic environment rescales auditory sensitivity,” NeuroReport. 18, 12511255. 9. Cox, R. M., Alexander, G., C., Taylor, I. M., and Gray, C. A. (1997). “The contour test of loudness perception,” Ear. Hear. 18, 338400. 10. Munro, K.J. and Merrett, J.F. (2013). Brainstem plasticity and modified loudness following short-term use of hearing aids. J Acoust Soc Am, 113(1), 343-349. 11. Schaette, R., Turtle, C., Munro K. J. (2012). Figure 4. Mean change in loudness at day five for fitted ear (green symbols) and control ear (blue Reversible induction of phantom auditory symbols). Error bars show ± standard error. Modified from Figure 3.in Munro and Merrett.[10] sensations through simulated unilateral hearing loss. PLos ONE 7, e35238. Doi: References 10.1371/journal.pone.0035238 1. Tremblay, K.L. & Kraus, N. (2002). Beyond the ear: central 12. Gu, J.W., Levine, R.A. and Melcher, J.R. (2012). Brainstem auditory plasticity. Otorinolaringol, 52, 93-100. auditory evoked potentials suggest a role for the ventral 2. Willott, J.F. (1996). Physiological plasticity in the auditory cochlear nucleus in tinnitus. J Assoc Res Otolaryngol, 13(6), system and its possible relevance to hearing aid use, depri819-833. vation effects, and acclimatisation.Ear.Hear.,17(3), 66-77. 13. Cai, S., Ma, W. And Young, E.D. (2009) Encoding intensity in 3. Munro, K.J. (2008). Reorganisation of the adult auditory ventral cochlear nucleus following acoustic trauma: Implisystem: perceptual and physiological evidence from monaucations for loudness recruitment. J Assoc Res Otolaryngol, ral fitting of hearing aids. Trends in Amplification, 12(2), 1-18. 10(1), 5-22.

Audacity

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30 Tinnitus in Children

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39 Research Round-up: Goodbye to Brian Moore and the Auditory Perception Group

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Hearing Loss, Hearing Aids, and the Business of Childhood

CD

Author and Correspondence Andrea Pittman, PhD CCC-A Associate Professor Arizona State University Speech and Hearing Science Department Tempe, AZ 85287-0102 E: andrea.pittman@asu.edu

Take Home Message: Children with hearing loss face the challenges of communication in unique and effective ways Website: http://pedamp.asu.edu/

Research over the last two decades has shown us that hearing loss creates unique challenges for children. One would expect that these challenges are similar to those experienced by adults with hearing loss but they rarely are. In fact, it is not possible to predict the performance of children with hearing loss based on the performance of adults with hearing loss. That makes sense when we realize that most adults enjoyed normal hearing, typical speech and language development, and effective communication for decades before the gradual onset of hearing loss interfered with their communication. The impact of childhood hearing loss, on the other hand, begins immediately regardless of the age of the child or the degree of the loss. The development of speech, language, and communication is slowed and can impact their academic, social, and vocational success. Thus, when most adults seek help for hearing loss, usually in the form of personal hearing aids, their goal is to restore their communication to levels that they have been accustomed to. Children, on the other hand, rarely recall or have any reference to normal hearing and thus the goal for their intervention, also in the form of personal hearing aids, is to facilitate the development of communication. Put simply, hearing aids help adults continue to communicate while hearing aids help children learn to communicate. The goal of the research conducted in the Pediatric Amplification Laboratory at Arizona State University is to understand the impact of hearing loss on the business of childhood and to determine which amplification features are most likely to optimize their success. A fundamental part of the business of childhood is the process of building a broad and deep vocabulary. Such a vocabulary is essential as they learn to speak intelligibly, read comprehensively, and write cogently. We have

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known for some time that children with mild to moderate hearing losses have significantly smaller vocabularies than children with normal hearing (Blamey et al., 2001; Pittman, Lewis, Hoover, & Stelmachowicz, 2005). Although early identification and intervention have improved children’s early language development, grade-school children continue to lag behind their normally hearing classmates. Over the last few years, we’ve discovered several situations that appear to slow the learning process for these children. For example, we now know that children with hearing loss need to hear a new word several more times than children with normal hearing to learn the word well (Pittman, 2008). But that’s only if they are learning a new word in a quiet environment. Their learning rate slows to a crawl when trying to learn new words in a noisy environment while the learning rate of children with normal hearing is unaffected (Pittman, 2011a). The problem is made more difficult when we realize that the environment where children are expected to learn, i.e. school, is the noisiest (Crukley, Scollie, & Parsa, 2011). So, how can we help children with hearing loss learn in a school environment? One option is to provide personal amplification that includes noise management features like digital noise reduction or directional microphone technology. The only concern is that these features are thought to require a sophisticated user to operate properly. For example, directional microphones have been shown to be quite effective in noise if the hearing aid user can position himself between what he wants to hear (in front) and what he doesn’t want to hear (in back). For that reason, these features are not routinely activated in children’s hearing aids for fear that they might use them ineffectively and impede rather than enhance their academic progress at school. But this may be one of those cases where we are trying to predict the performance of children from that of adults. The fact that children can manipulate technical devices better than adults suggests that they may be able to make good choices with advanced hearing aid technology. To find out, we compared children’s ability to perceive speech with their ability to choose the most optimal hearing aid setting in noisy listening environments (Pittman & Hiipakka, 2013). We fit children with high-end hearing aids having four orthogonally programmed memories containing digital noise reduction (on/off) and directional microphones (on/off). The children were first asked to cycle through the four memories while listening to a story presented in noise and indicate which memory they liked the most. Then children repeated speech stimuli presented from a loudspeaker in front or in back of them while noise played continuously. Finally, the children were asked again to indicate which memory they liked the most while listening to the story in noise.The results revealed that in the most difficult listening conditions, the children preferred noise management features that would max-


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imize their performance. However, in the easier listening conditions where their performance was not at risk, they preferred noise management that maximized their listening comfort, particularly after a short period of use. So, it appears that children as young as 8 years old can make good choices when using high-end hearing aid technology. Not only might this technology provide children with more options in noisy environments, it may improve their communication and learning at school. Without these features, children may choose to remove their hearing aids altogether when they are unable to tolerate the noise at school. Another job of childhood is to manage the complexities of the classroom. When learning new information, for example, children must listen to their teacher, write information on their worksheet, monitor their neighbor’s conversation, and ignore the traffic noise outside. That raises another interesting question: how do children with hearing loss manage these complex environments? To answer that question, we measured gradeschool children’s performance in noise while they attempted to do two tasks at the same time (Pittman, 2011b). One of the tasks was a simple pattern completion game that most children learn to do before they enter kindergarten. The second task was also simple and required the children to listen to words and indicate which of three categories the words belonged to. Although these tasks are easy to do by themselves, they become more difficult when put together. Research at that time suggested that when adults with hearing loss were asked to do two tasks like these (not the same tasks but similar ones), they tended to put more effort into the auditory task because it was more difficult for them. That meant that their performance for the visual task went down; however, this turned out to be another situation where the performance of children couldn’t be predicted from the performance of adults. Rather than putting more effort into the auditory task, the children with hearing loss in our study put more effort into the visual task allowing their performance on the auditory task to drop:- but, is that a good strategy or a bad strategy? It turns out that children with hearing loss have surprisingly strong listening strategies that may work for and against them. In a recent study we asked children to count the number of nonsense words that we had placed into short sentences

(Pittman & Schuett, 2013). We expected that the children with hearing loss would count more nonsense words than were really there because their hearing losses would distort their perception of real words. As expected, their overall performance was poorer than that of the children with normal hearing but the children with hearing loss counted fewer nonsense words than there really were. That suggests that children with hearing loss may have been repairing the words and that their repair strategies where so strong they were unable to identify words that they didn’t know. Such strategies could have both good and bad consequences. Specifically, strong repair strategy may cause children to miss opportunities to learn new words and could explain, in part, why children with hearing loss have smaller vocabularies than their normally hearing classmates. However, these same repair strategies may serve to increase the probability of successful communication in difficult listening environments. Given the unique and sophisticated strategies that children with hearing loss create to tackle their listening and learning environments, future research and intervention could focus on helping these children form more effective strategies to meet specific communication and learning needs. With any luck, such efforts may help to close the gap between children with hearing loss and their normally hearing friends. References 1. Blamey, P. J., Sarant, J. Z., Paatsch, L. E., Barry, J. G., Bow, C. P., Wales, R. J. et al. (2001). Relationships among speech perception, production, language, hearing loss, and age in children with impaired hearing. J.Speech Lang Hear.Res., 44, 264-285. 2. Crukley, J., Scollie, S., & Parsa, V. (2011). An Exploration of Non-Quiet Listening at School. Journal of Educational Audiology, 17, 23-35. 3. Pittman, A. (2011a). Age-Related Benefits of Digital Noise Reduction for Short-Term Word Learning in Children with Hearing Loss. J.Speech Lang Hear.Res.. 4. Pittman, A. (2011b). Children's Performance in Complex Listening Conditions: Effects of Hearing Loss and Digital Noise Reduction. J.Speech Lang Hear.Res., 54, 1224-1239. 5. Pittman, A. L. (2008). Short-term word-learning rate in children with normal hearing and children with hearing loss in limited and extended high-frequency bandwidths. J.Speech Lang Hear.Res., 51, 785-797. 6. Pittman, A. L. & Hiipakka, M. M. (2013). Hearing impaired children's preference for, and performance with, four combinations of directional microphone and digital noise reduction technology. J.Am.Acad.Audiol., 24, 832-844. 7. Pittman, A. L., Lewis, D. E., Hoover, B. M., & Stelmachowicz, P. G. (2005). Rapid word-learning in normal-hearing and hearing-impaired children: effects of age, receptive vocabulary, and high-frequency amplification. Ear Hear., 26, 619629. 8. Pittman, A. L. & Schuett, B. C. (2013). Effects of semantic and acoustic context on nonword detection in children with hearing loss. Ear Hear., 34, 213-220.

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‘If all you have is a hammer...’ Why we needed the Centre for Hearing and Balance studies at the University of Bristol

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Authors and Correspondence Article by Dr Helen Pryce with Dr Amanda Hall, Dr Lindsay St Claire, Dr Fei Zhao, Claire Blackham, Julie Cummings & Norma Meecham

‘If all you have is a hammer, you tend to see every problem as a nail’ Antony Maslow

The Centre for Hearing and Balance Studies at the University of Bristol will close in September 2014. In this article, we remember the history of the centre and the legacy it leaves.

Back in the early 2000s a small number of part time Hearing Therapists (Beverley Nicholls, Norma Kaufman, Fiona Watts) applied to the Workforce Development Confederation (NHS) for funding to expand the number of Hearing Therapy diploma places in England. They were commissioned to train an additional 70 Hearing Therapists. Their aim was to increase the critical mass of rehabilitative expertise in Audiology.The Hearing Therapy diplomas were organised and taught by Norma Kaufman, Melanie Ward and Helen Pryce at the University of Bristol and the placements and liaison with employers was organised by Marion Hoyle. As the diplomas ran, the world of Audiology was changing rapidly: a new BSc in Audiology was proposed as part of Modernising Hearing Aid Services. Digital hearing aids were being rolled out and a new training route with it.

The new BSc in Audiology was an opportunity to include teaching and learning across the range of academic disciplines that audiologists drew upon in practice. The Hearing Therapy team seized the opportunity and worked to develop draft curricula. There was to be a biomedical training in physiology, neurology and anatomy; scientific training in acoustics, phonetics and diagnostic processes; training in psychology, and counselling skills; training in research and evidence based practice. The first member of the new team was a psychologist, Dr Lindsay St Claire who further developed the curricula and enabled vocational learning elements to be delivered alongside the academic rigour required by University of Bristol. Marion Hoyle undertook the crucial organisation and liaison required to go through the approvals process with the University. Helen Pryce began the first of the new centre’s research activities and teaching.

‘Our students would have more than the ‘hammer’ of tests and hearing aids’ Our key aims were to bring an evidence-based approach to audiology, to equip students to present complex information to patients, to listen to patient experiences and to strive for shared informed decision making in their practice, in the context of a top class and relevant academic program. We prided

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25 The new BSc in Audiology was an opportunity to include teaching and learning across the range of academic disciplines that audiologists drew upon in practice.

Fei Zhao, Lucy Handscomb and Helen Pryce celebrate Lucy’s MSc. Lucy investigated the use of sound enrichment devices in coping with tinnitus.

ourselves in thinking beyond a reductionist notion of hearing loss as impairment and were committed to training audiologists who could engage fully with patients and bring evidence based choices together with a respect for patient preferences. Our students would have more than the ‘hammer’ of tests and hearing aids. They would have a tool box of skills in informing patients of choices, creating opportunities for them to make choices, providing a range of diagnostic and rehabilitative activities, supporting those with tinnitus and chronic medically unexplained hearing difficulties. Above all they would have a sense of respect for the complexity of the experience and the diverse factors that influence it.

The Centre was formed as part of a new School of Applied Health and Community Studies within the faculty of Social Sciences and Law. There was close collaboration with researchers and teachers interested in adaptation and change, health behaviours, learning, social constructions of disability and Deafness. The academic staff was drawn from the fields of Audiological Medicine, Audiological Science, Counselling, Epidemiology and public health, Health Psychology, Rehabilitative Audiology, Child Health and Education and Social Psychology which enabled a multi-disciplinary approach to high quality research. As the reputation for excellence in rehabilitation grew we recruited to the first UK MSc in Audiological Rehabilitation and this was followed by a partner MSc in Advanced Clinical Audiology.These programmes enabled practising clinicians to develop their academic expertise alongside their careers. Programmes were to be accessible to those in full time work and we celebrated a large number of babies as students found it possible to combine not only work and study but work, study and parenthood! Students were encouraged to develop their own priorities for research, based on their interests and their employer’s needs and we supported a wide range of projects using a broad range of research methodologies from phenomenology to randomised controlled trials and meta-analysis.

Rarely are audiology interventions simple, relying on social and psychological processes and our team and students have contributed a real understanding of the complexity of the applied aspects of audiology.

Claudine Clucas celebrates her PhD with Lindsay St Claire. Claudine studied the role of respect in therapeutic relationships. Amongst other things, she discovered participants report worse tinnitus symptoms if their doctors treat them disrespectfully. She also found evidence of a positive ‘hearing aid effect’ in the attitudes of medical students, especially the females.

To highlight the range of skills our students acquired we have published with them systematic reviews of auditory training, phenomenological investigations into how people cope with hearing loss, theorised what people seek when they seek help with their hearing, identified the mechanisms through which tinnitus groups enable coping to name but a few. The theme that unites these diverse projects is respect for the complexity of the experience. Rarely are audiology interventions simple, relying on social and psychological processes and our team and students have contributed a real understanding of the complexity of the applied aspects of audiology.

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26 Special mention must go to colleagues who contributed to the Centre but are no longer part of it.The original team in the form of Mel Ward, Norma Kauffman, Bev Nicholls, Fiona Watts and Marion Hoyle made major contributions to the development of the centre and the BSc in particular. Dr Rachel Humphriss led the vestibular and diagnostics teaching, Lucy Handscomb covered Helen’s maternity leave on the MSc, convening and organising units as well as teaching on them, Polly Robertson gave undergraduates an insight into the wider field of Deafness and disability studies through her People and Deafness unit and supported many MSc students through difficult transitions in learning. In particular we are indebted to Dr Amr El Refaie who managed the BSc combining a high teaching load with directing the programme and our seminar series. He was a touchstone for the students, a great teacher, friend and colleague. We were also supported by a fantastic group of visiting staff including Professor David Bagueley, Dr Laurence McKenna, Professor David MacAlpine, Professor Dafydd Stephens, Professor Adrian Davis, Dr Chris Metcalfe, Dr Adam Beckman, Barry Downes and staff at the Children’s Hearing Centre in Bristol, Dr. Kathy Dunkerley, John Barrett, Dr. Kyra Neubauer, Dr. Priscilla Heard.

Publications from our students include: 1.

2.

3.

Joint with School of Social and Community Medicine: 1.

2.

Clinical teaching and learning was supported by Caroline O’Sullivan and we are indebted to audiology departments and clinicians in the South West. 3. What is most pleasing is that despite a commissioning climate that is tempted to reduce audiological rehabilitation to a cheap tariffed set of activities, our alumni are actively creating new opportunities for those interested in aural rehabilitation. Sheila Fidler and Lucy Handscomb are two of our Masters graduates creating their own rehabilitation programmes at other universities. Others are actively using their research skills to improve the lives of those with tinnitus and hearing loss. Wherever you see academic interest, questions being asked and challenges being raised you will find a ‘Bristol student’ not far away. Our current students and alumni are the greatest compliment we could have about the Centre and about what has been achieved here over the last nine years. They succeed academically despite all the challenges that life throws at them. In recent times their dedication to the discipline despite the changing career path has been steadfast. They have a range of skills to cope with the current climate of healthcare provision and research not least because they have an understanding of the complexity of their work.

4.

5.

6.

7.

8.

We are very proud of them. We wish them well in their quest to explore human hearing and balance.

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Claesen E. &Pryce CH. (2012) 'An exploration of the perspectives of help-seekers prescribed hearing aids', Primary Healthcare Research and Development, (pp. 1-6). 10.1017/s1463423611000570 El Refaie, A, Brouns K. &Pryce CH.(2011)'Auditory training and adult rehabilitation: a critical review of the evidence', Global Journal of Health Science, 3, (pp. 49-63). 10.5539/gjhs.v3n1p49 Thompson P., Pryce CH& El Refaie, A. (2011)'Group or individual tinnitus therapy: What matters to participants?', Journal Of Audiological Medicine, 9, (pp. 110-116). ISSN: 1651-386X 10.3109/1651386X.2011.604470

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Humphriss, R., Hall, A. J., May, M., Zuccolo, L., & Macleod, J. (2013). Prenatal alcohol exposure and childhood balance ability: findings from a UK birth cohort study. BMJ Open, 3(6). 10.1136/bmjopen-2013-002718 Humphriss, R., Hall, A. J., May, M., & Macleod, J. A. A. (2011). Balance ability of 7 and 10 year old children in the population: Results from a large UK birth cohort study. International Journal of Pediatric Otorhinolaryngology, 75, 106 - 113. 10.1016/j.ijporl.2010.10.019 Humphriss, R., & Hall, A. J. (2011). Dizziness in 10 year old children: an epidemiological study. International Journal of Pediatric Otorhinolaryngology,75, 395 - 400. 10.1016/j.ijporl.2010.12.015 Southam G. 2012. Factors influencing attendance at a balance support group. A pilot study BAA conference, Manchester. St. Claire, L., & Clucas, C. (2012). In sickness and in health: influences of social categorizations on health-related outcomes. In The Social Cure: Identity, Health, and Well-being. Edited by Jolanda Jetten, Catherine Haslam & S. Alexander Haslam. Clucas, C., Karira, J., & St. Claire, L., (2012). Respect for a young male with and without a hearing aid: A reversal of the "hearing aid effect" in medical and non-medical students? International Journal of Audiology, 51(10), 739-45. Clucas, C., & St. Claire, L. (2011). Relationship between communication skills training and doctors’ perceptions of patient similarity. International Journal of Medical Education, (2), 30-35. Clucas, C., & St. Claire, L. (2011). Influence of patients’ selfrespect on their experience of feeling respected in doctorpatient interactions. Psychology, Health and Medicine, 16(2), 166-177. Clucas, C., & St. Claire, L., (2010). The Effect of Feeling Respected and the Patient Role on Patient Outcomes. Applied Psychology: Health and Well-Being, 2(3), 298-322. doi/10.1111/j.17580854.2010.01036


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BSA Applied Research Grant in honour of Stuart Gatehouse Application deadlines for 2014

The BSA, in conjunction with the MRC Institute of Hearing Research (IHR, offers an annual fund of £20,000 for research projects involving BSA members.There are two opportunities per year to apply for grants of up to £5000 for projects to be completed within two years. Applications in applied research areas relevant to hearing, tinnitus and/or balance will be considered. However emphasis will be placed on the following areas:

31 May 2014 30 November 2014

• • • • • •

• Collaborative projects between clinicians and scientists. • Under-researched areas. • Projects aimed at harnessing the clinical experience of members. • The clinical or professional practice associated with assess-

ment, diagnosis and management of hearing, tinnitus and balance disorders. The patient’s experience of services relating to hearing, tinnitus and balance disorders. The policy context for services in the UK. Surveys of services available. Case ascertainment of rare conditions. Multicentre studies of clinical evaluation of new therapies or of management strategies. Linked projects with professionals from disciplines relevant to hearing and balance disorders but who are not necessarily BSA members.

Since 2008 more than £80,000 has been awarded to clinicians and scientists conducting 23 projects.

Lead investigator

Project

Funding

Prof Kevin Munro Manchester

Does functional imagining show evidence of brain plasticity in the adult auditory system after unilateral earplug experience

£3000

Dr Ruth Brooke Leeds

Repeatability of neck and lower limb sound induced vestibular evoked myogenic potentials

£3000

Dr Veronica Kennedy Bolton

Management of paediatric tinnitus: a survey of working practice in the UK

£1903

Dr Louisa Murdin London

Genetics of migrainous vertigo

£3000

Dr Stefan Bleeck Southampton

Tinnitus in cochlear implantees: cognitive behavioural therapy for cochlear implant users

£3000

Dr Christian Fullgrabe Nottingham

Speech segregation in elderly normal-hearing listeners: Effect of cognitive load

£2697

Dr Dilys Treharne Sheffield

Auditory and audio-visual Speech Reception Threshold in Children and Adolescents

£3000

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28 Dr Waheeda Pagarkar London

Study of ocular and cervical vestibular evoked myogenic potentials in healthy school-age children

£3000

Dr Doris Bamiou London

Hearing Evaluation And Rehabilitation after Stroke (HEARS)

£2950

Dr Katie Ireland Reading

Can cortical auditory evoked potentials reliably measure access to speech using frequency compression hearing aids?

£2940

Prof Deb Hall Nottingham

Consensus on hearing-aid fitting candidature for mild hearing loss with and without tinnitus: Delphi review

£1428

Dr Mel Ferguson Nottingham

Development and evaluation of an interactive video tutorial for hearing aid users and their communication partners

£4296

Rachel Knappett Cambridge

Is it possible to improve hearing handicap in patients with single sided deafness

£5032

Hannah Cooper Reading

Imaging Auditory Pathways in children with Auditory Neuropathy Spectrum Disorder

£3263

Dr Nick Thyer Leeds

The influence of advances in hearing aid technology on models of service delivery for hearing impaired adults in the NHS

£4908

Dr Michael Maslin Manchester

Perceptual consequences of plasticity in binaural systems: evidence from adults with unilateral deafness

£4561

Sally Dawson London

Otosclerosis: Evaluating candidate genes identified by whole exome sequencing in a cohort of familial otosclerosis patients

£4967

Dr Derek Hoare Nottingham

Watchful waiting and tinnitus: a systematic review and meta-analysis

£3201

Mat Daniel Nottingham

What is important to parents of children with glue ear?

£4960

Dr Amanda Hall Bristol

Development of a patient decision aid for shared decision making in adult audiology services

£4485

Stephanie Greer Wrexham

Evaluation of live voice auditory training in a randomised controlled trial of existing hearing aid users

£3414

Owen Brimijoin Glasgow

Establishing the preferences of high intelligibility audio mixes of BBC television programmes among hearing impaired individuals

£4337

Jackie Young Winchester

A clinical practice comparison of the amplification dispensed at adult hearing aid fitting using (i) live real ear measures with custom ear moulds vs (ii) real ear to coupler difference (RECD measures with foam inserts

£3252

To submit an application please go to the BSA website to download an application pack, including the application form and guidance. Current members of review panel (numbers shortly to be increased): Dr Heather Fortnum (Chair) Dr Michael Akeroyd (Representing MRC) Dr Ros Davies (BSA member) Prof Dave Furness (BSA member) BSA treasurer If you have any questions, please contact Heather Fortnum or any member of the review panel.

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The New Unity 3. Available April 2014

Unity™ 3. Maximum efficiency – Minimum size. For precise diagnostics and effortless fitting. www.siemens.co.uk/hearing

The all new Unity 3 is a PC controlled diagnostic fitting system which combines small size and light weight with ease of use.

The new Unity 3 test box operates stand alone and independently from the fitting module, saving you money and space.

Building on the success of Unity 2, the new Unity 3 remains a powerful, robust, reliable and flexible fitting system. Unity 3 introduces new innovations and is extremely portable, making it suitable for hearing instrument fittings in the clinic, in the home or for remote clinic use.

For more information or for quotations please contact your Siemens Account Manager. For all general enquiries please call 01293 423700 and quote reference JN6950.

Unity 3 features include new binaural measurements which reduces testing times. New smart headsets which have their own calibration data stored on-board means calibration and maintenance is made easy. In fact, just opt into the Siemens replacement headset scheme and you will never be without your equipment. The result – no service downtime.

6950 BSA Unity 3 ad_April.indd 1

Life sounds brilliant.

07/03/2014 14:07


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Lunch and Learn CD

Facilitators and Correspondence Shahad Howe Clinical Scientist, Manchester Royal Infirmary

Christopher Cartwright Professional Marketing Manager, Phonak

E: Shahad.howe@cmft.nhs.uk

E: Chris.cartwright@phonak.com

If you would like to contribute a seminar, have any queries or would like regular email updates, please email one of the facilitators above.

BSA Lunch and Learn eSeminars An exciting series of online presentations covering current topics of interest and clinically relevant research findings in Audiology and related professions, free of charge to all BSA members and non-members.

Recent bites

Coming up on the menu

These and other earlier seminars are available to access at www.thebsa.org.uk and http://www.phonaknhs.co.uk/news/newsarchive/. You may need to request connection through Firewalls with your local IT department for your first eLearning experience.

To go live on the first Monday of every month for access by the emailed link, via the BAA or Audiology Northwest England Facebook pages, or archived at www.thebsa.org.uk and http://www.phonaknhs.co.uk/news/news-archive/. You may need to request connection through Firewalls with your local IT department for your first eLearning experience.

January 2014

April 2014

New technology in Audiology: matching patient needs to technology › Josephine Marriage,

Using a family-centred care approach in hearing rehabilitation for older adults and their significant others › Dr Nerina Scarini,

Chear

School of Health and Rehabilitation Sciences, The University of Queensland

February 2014 Health Literacy, User Guides, and Hearing Aid Management › Andrea Caposecco, Prof Louise Hickson, Dr Carly Meyer HEARing Cooperative Research Centre, Melbourne, Australia; School of Health and Rehabilitation Sciences, The University of Queensland

March 2014 Interventions to improve hearing aid use › Fiona Barker, Princess Margaret Hospital, Windsor

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May 2014 Theory of mind and importance of overhearing › Lyndsey Allen, The Ear Foundation

June 2014 Clinical feasibility and acceptability of recording infant obligatory cortical auitory evoked potentials in the sound field: results from the first 55 infants › Kevin J Munro1,2, Ruth Nassar2, Suzanne C Purdy3, Martin O’Driscoll1,2, Rachel Booth2, Iain Bruce1,2, Kai Uus1. School of Psychological Sciences, University of Manchester, UK. 2Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, 3School of Psychology, University of Auckland. 1


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How adults with hearing impairment perceive the role of aging and cognition in help-seeking and rehabilitation This short communication is based on the on-line BSA Lunch and Learn seminar by Ariane Laplante-Lévesque, PhD, 7th October 2013. The recording is available at www.thebsa.org.uk This study was conducted by Jill Preminger, PhD, and Ariane Laplante-Lévesque, PhD.

Researchers and audiologists acknowledge the important role of aging and cognition in hearing help-seeking and rehabilitation. The impact of a person’s chronological age and cognitive functioning on making an appointment at an audiology clinic and on taking up hearing aids or other forms of rehabilitation (e.g. group audiological rehabilitation) is well known. But what about the clinical population, audiology patients, people with hearing impairment, how do they view aging and cognition? Hearing impairment and hearing aid stigma has been studied previously, for example by researchers in Canada and the USA (Hétu 1996; Southall et al 2010; Wallhagen 2010). But beyond stigma, how do adults with hearing impairment perceive the role of aging and cognition in their help-seeking and rehabilitation? Do they think about it in the same way as researchers and audiologists?

This study used a qualitative approach to explore the perspectives of adults with hearing impairment on hearing helpseeking and rehabilitation (see Laplante-Lévesque et al 2010 for more information). In-depth semi-structured interviews were completed in four countries (Australia, Denmark, UK, and USA) with 34 adults with hearing impairment. Participants included individuals with different levels of experiences in hearing help-seeking and rehabilitation: from participants who had never sought help to participants who described

Adults with hearing impairment think of their age and their cognition as contributing to their hearing help-seeking and rehabilitation themselves as satisfied hearing aid users. Participants were aged 26 to 96 years and had various degrees of hearing impairment (mild to severe-to-profound). Interviewers asked participants to “tell the story of their hearing”, and followed with similarly open questions. The interviews lasted approximately one hour on average. The interviews were audio-recorded and transcribed. The interview transcripts were analysed qualitatively. The themes of Age and Cognition emerged from

Figure 1. Results of the qualitative analysis: How 34 adults with hearing impairment perceive the role of aging and cognition on their hearing help-seeking and rehabilitation.

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32 the data. These themes were analysed further using interpretative phenomenology to investigate how they related to hearing help-seeking and rehabilitation. The NVivo software was used as a platform for analysis. When reporting their expectations and experience of hearing help-seeking and rehabilitation, the participants saw aging and cognition as both barriers and facilitators. Aging and cognition were also very much inter-related. For example, participants mentioned age-related cognitive changes, either changes they expected or they had themselves experienced. The participants discussed the theme of aging according to three sub-themes: Expectations, Coping, and Self-Image. Participants described expectations of help-seeking and rehabilitation and linked those with their expectations of aging. Participants had different methods for coping with an aging body and mind, for example when adapting to reduced body functions. Self-image, which participants linked to identity and self-confidence, was discussed in relation to help-seeking and rehabilitation. Some participants felt discriminated against because of their age (ageism) when seeking help. The participants discussed the theme of cognition according to three sub-themes: Plasticity, Operations, and Effort. Neuroplasticity, the ability of the brain to change, was very prominent in the participants’ discourse. Participants described for example their expectations or experiences regarding learning to use new hearing aids. Participants described cognitive operations: many had a sophisticated understanding of how hearing and cognitive operations interact in people with hearing impairment. Participants also described what happened when these cognitive operations were taxed, or overloaded,

resulting in effort and, ultimately, fatigue. For participants, this could be alleviated with rehabilitation, for example hearing aids. Adults with hearing impairment think of their age and their cognition as contributing to their hearing help-seeking and rehabilitation. Audiologists can discuss with their patients the interplay between aging, cognition, and hearing impairment and, most importantly, the consequences of these on their daily functioning. Audiologists can also describe how rehabilitation plays a role in this picture. Audiologists can instill coping mechanisms and problem-solving skills to support people with hearing impairment in their help-seeking and rehabilitation. To find out more about this study, please see the article by Preminger and Laplante-Lévesque (available early online). References 1. Hétu R. (1996). The stigma attached to hearing impairment. Scandinavian Audiolology, 43 (Supplement), 12–24. 2. Laplante-Lévesque A, Knudsen LV, Preminger JE, Jones L, Nielsen C, Öberg M, Lunner T, Hickson L, Naylor G, Kramer SE. (2012). Hearing help-seeking and rehabilitation: Perspectives of adults with hearing impairment. International Journal of Audiology, 51, 93–102. 3. Preminger JE, Laplante-Lévesque A. (available early online). Perceptions of age and brain in relation to hearing helpseeking and rehabilitation. Ear and Hearing. 4. Southall K, Gagné J-P, Jennings MB. (2010). Stigma: A negative and a positive influence on help-seeking for adults with acquired hearing loss. International Journal of Audiology, 49, 804–814. 5. Wallhagen MI. (2010).The stigma of hearing loss. Gerontology, 50, 66–75.

Music and cochlear implants: opening the lid to look at signal processing strategies This short communication is based on the on-line BSA Lunch and Learn seminar by Colette McKay, PhD, 2nd December 2013. The recording is available on www.thebsa.org.uk

After speech perception, the appreciation of music is often nominated by deaf patients as the most important aspect of hearing that they wish to have restored. Unfortunately restoring

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music perception has been one of the hardest challenges facing developers of cochlear implants (CIs). Although aspects of music such as rhythm, timbre and lyrics are relatively well transmitted by current CIs, musical pitch (hence melody) is not well transmitted and patients cannot appreciate the different musical instruments and harmonies that comprise music played by groups or orchestras. This seminar addressed the challenge of signal processing for musical pitch, explaining how normallyhearing listeners hear pitch and looking at the different signal processing ideas that have been tried to improve pitch perception in CI users. There are basically two different ways that normally-hearing listeners can derive pitch (or fundamental frequency – F0) from a musical sound: we can hear the temporal fluctuations at F0;


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Figure 1: Results cited in McDermott (2004) for ability of CI users to correctly rank the pitch of pairs of sung vowels. The results show that, on average, subjects are doing not significantly better than guessing (the red horizontal line) except for the very lowest F0 range (where F0 modulations are strongest) and the very highest F0 range (where there are no modulation cues but where the whole spectrum shifts upwards when F0 changes).

or we can ‘hear out’ the different harmonics (multiple of F0) and use central auditory processing to derive F0. For normallyhearing listeners, the second way provides a much stronger pitch percept but is unfortunately very difficult or impossible for CI users. To hear harmonics out of a complex sound and derive F0 from them, CI users would have to firstly resolve the different harmonics and secondly be able to accurately determine the harmonic frequencies. Signal processing strategies that use current focussing (e.g. tripolar or multipolar modes) may help to get better spectral resolution, and current steering may help to represent small changes in harmonic

strategies include using a higher stimulation rate to better represent modulations: this would theoretically help if the update rate is initially less than 4 times F0. Alternatively, efforts have been made to improve the representation of F0 modulations in the processor output: for example by lining up the F0 modulations in time across electrodes (to limit smearing from electrode interactions) or making the F0 modulations bigger in amplitude or sharper in shape. However, studies aiming to show benefit from these strategies show little or no improvement in musical pitch perception, possibly because the pitch provided by F0 modulations is weak to start with.

Appreciation of music is often nominated by deaf patients as the most important aspect of hearing that they wish to have restored

Overall, the challenge of improving the perception of musical pitch remains to be satisfactorily addressed. Possibly it will require patients to have a lot more surviving auditory nerve cells, and for us to be able to activate them more independently. We also need to better understand how the central pitch mechanism works. In the meantime, the best way of improving pitch perception for a CI user is to encourage them to use a hearing aid if they have any residual hearing in the low frequencies…and to encourage them to listen to rap music or familiar songs rather than classical music!

frequencies. However, neither of these strategies help to derive the actual harmonic frequencies, since the place of activation in the cochlear is not related in CI users to the place the harmonics would excite in normal hearing. Accordingly no study has shown improved musical pitch perception with current focussing or current steering strategies. Other strategies have aimed to improve the perception of temporal fluctuations at the fundamental frequency. Such

References 1. A good review of music with cochlear implants is provided by McDermott (2004) “Music perception with cochlear implants: a review” Trends in Amplification 2. See the seminar recording for specific references to particular studies

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Ear to the ground for all things ear-related in the media

This edition of Ear to the Ground includes another excellent installment of #twitterarty by Amanda Hall. In this issue, she focusses on the #mynameis campaign initiated by Doctor Kate Granger, detailing how the campaign has used Twitter to gather incredible momentum. The Bits and Pieces section in this issue has plenty of tidbits from within the media, including some interesting responses to a tinnitus awareness questionnaire, potentially exciting breakthroughs in research and some mind boggling auditory illusions!

Mandela mishap One of the major Audiology related stories to grace the news recently was that of Thamsanqa Jantjie, who stood on stage during Nelson Mandela's memorial service providing fake sign language interpretation to speeches from world leaders including President Obama. It has been reported that Mr Jantjie was later hospitalised as he claimed he had experienced a schizophrenic episode while on stage. Googling "Thamsanqa Jantjie" or "Nelson Mandela sign language" offers several news sites covering the story from several angles.

Hearing through the darkness The BBC News website recently reported on an interesting new perspective on neuroplasticity. The article introduces a study published in the journal Neuron in which the hearing of mice was improved by depriving them of light for a week or longer. The hearing improvement was seen for several weeks following the reintroduction of light. What is interesting in this study is that improvements were not attributed to reprogramming of vision centres in the brain, but rather a "beefing-up" of the auditory cortex. This study adds to a growing body of knowledge of how sensory systems interact, though it will be some time before audiologists are confining their patients to darkened rooms for weeks on end! This article can be read at http://www.bbc.co.uk/news/health-26046229.

What is tinnitus? The BBC also reported recently on a poll by the charity Action on Hearing Loss on tinnitus and noise exposure. The article, which can be read at http://www.bbc.co.uk/news/health-25980275, quotes some alarming figures from the 1000 people that were polled. These include that 1 in 3 would ignore the safe level of their music players, 2 in 3 experiences ringing in their ears following a night out, and 3% of those polled believed that tinnitus meant "big ears". The article also highlights Action on Hearing Loss' website, in particular, directing readers to the audio version of "what tinnitus sounds like" that the charity have produced to raise awareness. This recording can be found at http://www.actiononhearingloss.org.uk/your-hearing/tinnitus/what-is-tinnitus.aspx

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36 Cognitive decline and hearing The final dip into BBC News' treasure trove of audiology snippets is a piece reporting on a study into the impact of hearing loss on cognitive decline and dementia. The study followed around 2000 subjects for 6 years following baseline cognitive and hearing tests. The study found that cognition declined 40% quicker in those with a hearing loss. The article offered two hypotheses for these results, one based on social isolation and the other based on cognitive load. Read the article at http://www.bbc.co.uk/news/health-21120024.

Jacqueline Stokes obituary There was sad news recently, as the profession mourned the passing of Jacqueline Stokes, who was the first practising auditory verbal therapist in the UK. Posy Marriage wrote a thoughtful obituary in the Guardian, summarising Jacqueline’s work in helping parents develop the skills to encourage their children in listening and talking. Posy captures Jacqueline's enthusiasm and determination, and the vision which pushed the boundaries of her field in the UK. Read the obituary at http://www.theguardian.com/society/2014/jan/29/jacqueline-stokes.

Altruistic intentions On an international note, USA Today published an interview with Starkey owner Bill Austin from a Starkey Hearing Foundation mission to Uganda. He discusses how he came into the hearing aid business, as well as his role within the business and the company’s charity foundation. It is nice to see the charitable work of a company in our profession highlighted in the media; read the full interview at http://yourlife.usatoday.com/health/sk-hearing-loss-5/index.

Stem cell development Next is a piece that anybody who commutes to work on public transport may have spotted. The free Metro newspaper reported on a study published in Stem Cell Reports that found hair cells in the mouse cochlea that could spontaneously regenerate. The study demonstrated that inhibition of the notch signalling pathway increased the formation of new hair cells from Lgr5-expressing support cells. If that sounds like a lot of science to cram into one sentence, read the article in the Metro’s free online edition at http://eedition.metro.co.uk/2014/02/21/. The article can be found on page 16 of the paper.

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Wax on, wax off Staying across the Pond is a piece in Canada Journal which reports on an organic chemical analysis of human earwax. The analysis determined significantly different ratios of the chemical compounds in the earwax of the Caucasian population, when compared to East Asians. This leads to the assertion that “Earwax can determine a person’s ethnic origin”. Read the full report at http://canadajournal.net/health/earwax-can-determine-persons-ethnic-origin-study-report-3899-2014/.

SYBIL!! An interesting article was published in January in the ‘Femail’ section of the Daily Mail newspaper. Writer Liz Jones gives a witty insight into the difficulties facing those with a hearing loss. She discusses the complexities of navigating corporate phone calls, the shortcomings of certain subtitle services, and the frustration she feels at being treated as a ‘cloth eared bint’, borrowing one of Basil Fawlty’s famous lines. This could be a great piece to show patients who may feel that nobody understands what they are going through, as it eloquently highlights several of the more common emotions experienced by our patients. Read the full article at http://www.dailymail.co.uk/femail/article-2044159/Im-deaf-thatsreason-Apple-store-treat-like-cloth-eared-bint.html.

Prepare to be dazzled... The final offering in this issue’s Bits & Pieces section comes courtesy of the Daily Mail. As a member of the Audiology community, do you find yourself experiencing sensory envy as people are amazed and confounded by optical illusions? Well, never fear, because in this article hearing is believing, with a focus on auditory illusions including the Shephard tone, the scale illusion, and the Wessel illusion. Admittedly, on playing the clips, I was less flabbergasted than the time I looked at what I thought was patterned wallpaper and a shark jumped out at me, but perhaps they may provide some light amusement at your next fondue party. The article, which has links to clips of all the illusions, can be found at http://www.dailymail.co.uk /sciencetech/article-2547978/Hearing-believing-These-incredibleaudio-illusions-make-head-spin.html.

Don’t forget that any piece that appears on a news website can be commented on or shared via social media, allowing the reader to add their voice to a debate and pass the story to friends and colleagues.

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Twitterarty @HallAmandJ introduces you to the audiology Twitter community

Twitter to measure patient experience The reach of twitter has led many hospitals and healthcare providers to use twitter to capture feedback on the quality of care provided. The reach of twitter has led many hospitals The reach of twitter has led many hospitals and healthcare providers to use twitter to capture feedback on the quality of care provided. and healthcare providers to use twitter to capture feedback on the quality of care provided.

Twitter is increasingly being used by patients and healthcare providers as a method of giving and capturing feedback on healthcare provision. This edition therefore moves away from #Audiology into the wider twittersphere of patient care and #patientexperience.

Kate is happy for us to tell her story

During one of her stays in hospital, Kate became increasingly frustrated with the lack of introductions from staff and noted the importance of personal communication‌. Equally patients are able to tweet about their healthcare experiences, both positive and negative. @patientopinion is an organisation which allows patients to tweet and comment on any aspect of their healthcare, positive or negative; comments are kept in a searchable database. @patientopinion passes all comments on to the healthcare provider mentioned who are able to respond. A positive example‌.

Twitter and patient stories Kate Granger, @GrangerKate, is a Doctor and also a patient with terminal cancer. She has been undergoing palliative chemotherapy and tweeting during her illness including her stays in hospital. Her experience as an in-patient last year led to a highly successful twitter campaign, #hellomynameis

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‌.and the value of compassionate care


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39 ----changes in lanyards,

These experiences led to the start of a twitter campaign based on the hashtag #hellomyname is to highlight the importance of good communication between healthcare professionals and patients

….and backed by the Chief Executive of the NHS She challenged all healthcare professionals to introduce themselves to every patient they meet and to support the pledge using the hashtag #hellomynameis. She wrote on her blog: Here is mine to get us started: “Hello. May name is Dr Kate Granger. I’m one of the senior doctors who will be looking after you on the ward while you’re with us. How are you feeling today?”

So far there have been 12 million impressions (or readers of) #hellomynameis tweets

Kate now has 20,000 followers on twitter and the campaign has resonated widely….

....led to changes in policy,

Read more If you’re interested in finding out more about Kate’s story, her blog can be found at: http://theothersidestory.co.uk/ or follow Kate on twitter @GrangerKate

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40

Audiology in Singapore

FACTFILE... Population: 5.3 million Total area: 710km2 Capital: Singapore Prevalence of hearing impairment: 20% of people aged 50-59yrs / 33% of people aged 60-69yrs Average life expectancy: 80.6yrs, third best in Asia

CD

Author and Correspondence Shijitha Chenicheri

Alexandra Hospital 378 Alexandra Road Singapore E: shijitha.c@gmail.com

Biography Shijitha qualified as an Audiologist in 2009 after completing a Bachelor’s degree in Speech Language Pathology and Audiology at All India Institute of Speech and Hearing, Mysore, India. She later obtained an MSc in Audiology at the University of Manchester in 2010. She then returned to India, working with Widex India as a clinical Audiologist before moving to Singapore in April 2013. She is currently working as an Audiologist for Jurong Health at the Alexandra Hospital, and will soon move to Ng Teng Fong General Hospital which is due to open towards the end of this year.

About Singapore Singapore is a small island country and city-state in Southeast Asia. It is well known for its highly urbanized landscape, high standard of living and the diverse cultural heritage. Singapore is a multi-racial and multi-lingual nation as reflected by its four official languages: English, Malay, Mandarin and Tamil. Healthcare

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in Singapore is delivered via seven public hospitals, twelve private hospitals, six national specialty centres and numerous primary care and rehabilitation centres. The 2010 Singapore Ministry of Health survey found that one in five of those aged between 50-59 years and one in three aged between 60-69 years have some degree of hearing impairment. History of Audiology in Singapore I am fortunate enough to be working with one of the first Audiologists to practice in Singapore, Mr Yiap Kim Hong, who has been kind enough to share some of his early experiences of working in the field. In the 1960s and 70s, Mr Yiap Kim Hong recalls audiology services being provided by nurses or attendants in the ENT department at Singapore General Hospital (SGH). There were very few audiologists in the country at this time and they were all from overseas, mostly originating from India. By the late 1970s, a high-quality facility had been established at SGH with three audiometry booths, one large paediatric room with free field and Evoked Response Audiometry (ERA) testing facilities and the latest available instruments.

Singapore is a vibrant and bustling city in which to live and work with a wide diversity of activities and places to explore


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41 Paediatric audiology services began in collaboration with the Canossian convent school with the development of a national aural habilitation programme. The cochlear implant programme was established in the mid-1980s when a small number of post-lingual adults were fitted with the single-channel 3M cochlear implant at SGH. Despite these developments, the low numbers of qualified Audiologists was still an issue. Services gradually improved in the 1990s with more manpower available and more hospitals offering audiological services, as well as the introduction of new services such as cochlear implants for children and Auditory Brainstem Response (ABR) and Otoacoustic Emission (OAE) testing. At present there are seven public hospitals all well-equipped with advanced audiological equipment and well-staffed with audiologists/audiometricians. Service structure Audiological services in Singapore can be broadly divided into diagnostic and rehabilitation services. Most of the public hospitals are equipped with specialist diagnostic testing facilities including evoked potentials, videonystagmography and speech audiometry (with standardised word lists available in each of the official languages). Patients obtain referrals from their GP to access diagnostic services at the nearest available public hospital. Hearing aid services are available in both public hospitals and private clinics. Most modern digital hearing aids and accessories supplied by the major hearing aid companies are available in the public hospitals. Patients are given a ‘trial’ of a minimum of two hearing aids to help them decide on their preferred model.

They are either required to purchase the hearing aid themselves or are referred to social services for subsidy. In the past, there were no specific funds available from the Singapore Government for hearing aids. Patients with lower incomes received assistance from the Medical Social Services department to apply for grants from various funding agencies. The waiting period was anywhere between several weeks to several months. However in July 2013, Singapore's Senior Mobility Fund was increased five-fold.This translated into elderly patients aged 60 years and above with no income having to contribute only 0-10% of the total hearing aid price when obtaining hearing aids from public hospital services. Under this scheme, these patients can now obtain hearing aids priced up to $3000 SGD whilst paying a maximum of a few hundred dollars. This is a great first step from the government in recognising hearing aids as an essential device for the elderly. It is a relief for the elderly patients as they can acquire high-quality hearing aids for this price given that most of the midrange aids fall under the $3000 SGD limit. Unfortunately they can use this scheme only once in their lifetime as it stands. Singaporean citizens from lower-income households can apply for a CHAS (Community Health Assist Scheme) card which entitles them to subsidised treatment, including hearing aid provision.These patients may also receive help through Medifund; an endowment fund set up by the Government for those who cannot afford the subsidised treatment charges. The process is quite fast and most patients are able to obtain hearing aids within 2-3 weeks. Audiologists work with the Medical Social Worker in such cases.

The gardens surrounding Alexandra hospital contain over 100 butterfly species

Paediatric services Paediatric services are delivered at a number of

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42 sites, including the KK Women’s and Children's Hospital, National University Hospital, Singapore General Hospital, and various rehabilitation centres and specialist schools. Routine tests are used for paediatric assessment including Visual Reinforcement Audiometry (VRA), play audiometry, pure tone audiometry, tympanometry, OAEs and diagnostic ABR. Central Auditory Processing Disorder (APD) testing is also available for children aged 7- 12 years old. (Re-) habilitation services are delivered through the use of modern digital hearing aids as well as BAHA, CROS aids, cochlear implants, middle ear implants, and FM systems. A holistic approach is employed where the Audiologist works closely with the child’s parents, speech therapist, auditory-verbal therapist and the teachers in specialist schools.

Visiting Merlion park set against the city's Central Business District

Newborn hearing screening in Singapore began in 2002. Singapore follows the Universal Newborn Hearing Screening (UNHS) standard of detecting hearing loss in newborns by 3 months, fitting hearing aids by 6 months and cochlear implantation by 12 months if indicated. Screening is performed by screeners/nurses at the neonatal units within 24 hours of birth using the Automated ABR (AABR). In the case of a fail, a second screen is performed again with AABR. A second fail prompts a more detailed assessment using diagnostic ABR.

common platform for audiologists working in Singapore. The SAPS conducts workshops and programmes with the aim to provide continuing professional education and development for its members.

Audiology career structure The Ministry of Health in Singapore has the following career structure for all allied health professionals, including Audiologists:

Historically Singapore has not hosted its own Audiology degree course and audiologists working in the country have obtained their qualifications and training from various institutions overseas. Hence in 2013,The National University of Singapore’s Yong Loo Lin School of Medicine (YLLSoM) launched the first ever MSc Audiology degree course in Singapore to build up local manpower. Currently the course is running with 18 students and the first batch of Audiologists trained in Singapore will be qualified by 2015. The course has been adapted from one of the top audiology programmes offered by the University of Melbourne.

Audiologist

Senior Audiologist

Principal Audiologist

Senior Principal Audiologist Currently there is no mandatory professional registration for audiologists or hearing aid dispensers in Singapore and most employers accept a 4 year Bachelors degree or Masters degree from any recognized institution as proof of competence. Professional bodies and education The audiology community in Singapore is quite small with approximately 60 audiologists, mostly from overseas, and less than half of this number working in the public sector. The main professional association for Audiologists in Singapore is the Society of Audiology Professionals Singapore or the SAPS. The SAPS was established in 2000 with the aim of forming a

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the first batch of Audiologists trained in Singapore will be qualified by 2015.

As an Audiologist in Singapore Singapore is a vibrant and bustling city in which to live and work with a wide diversity of activities and places to explore in one's free time. Working as an Audiologist in Singapore has been a great learning experience for me. Patients are very friendly and appreciate even the smallest things you do for them. Occasionally the variability in languages spoken by my patients can offer some challenges. Fortunately most patients or carers can communicate effectively in English. However, I occasionally require the help of my colleagues with interpretation, particularly for patients who speak Mandarin which is challenging to learn due to it being a tonal language.The quality of audiological services delivered in the country is generally high, although a focus on bringing uniformity in training and services should help to improve the overall quality of services delivered. Mandatory professional registration and regulation by the professional body may go somewhere towards achieving this goal, particularly in the private sector.


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Serendipity and Seven Trips to Kenya CD

Author and Correspondence Frances Tweedy BSc, MSc (retired audiologist) E: frances.tweedy@talktalk.net W: www. audmed.org.uk

Take-home message The importance of knowledge of local epidemiology and culture in developing audiology services. In audiology we do like a challenge, and these trips have been a challenge to develop my skills in a different context which has been a bonus to my career. Indeed, I consider that I have had the good fortune to experience and follow-up the development of audiology education in Kenya. Thanks to colleagues such as Professor Valerie Newton, I was first introduced to audiology for the public sector in Kenya through a British Council Link between the Universities of Manchester and Nairobi. Initially, in the 1990s we and other colleagues, including Professor John Bamford, worked with Kenyan Clinical Officers in ENT on short courses in audiology at the Kenyatta Hospital, Nairobi. I think this was the raising of their awareness that ears are for hearing and not just sites of infection to be mopped out....and my realisation of the importance of epidemiology and cultural context in developing services. Childhood deafness in sub-Saharan Africa is mainly associated with untreated middle ear disease and with acquired childhood diseases such as malaria and meningitis and the medication thereof. Indeed, one of our colleagues in Zanzibar (Naufal Kassim) has shown that absence of weighing scales for babies at the clinics and hospitals can result in unintentional overdoses of ototoxic drugs and consequent deafness (Freeland et al, 2010). My experience of the results of late diagnosis of hearing loss prior to the introduction of new-born hearing screening in the UK is highly relevant to much of the developing world, where no such screening programme exists.The causes of adult deafness, however, are more similar to those in the West: often a combination of noise exposure and ageing, with cases of middle-ear disease and systemic disease in addition to these. Overall though, the prevalence of deafness in the developing world is higher than that in the developed world: WHO estimated (in 2012) that there were around 360 million people worldwide

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(5.3% of the population) who had disabling hearing loss1. The prevalence of disabling hearing loss amongst children was estimated to be 1.9% in Sub-Saharan Africa compared to 0.5% in ‘high-income’ countries. I suppose we are taking the approach of “ teaching a man to fish” and therefore funding was sought to bring students to Manchester to do post-graduate training in audiology, Thankfully, this resulted in a couple of MSc graduates working in the Kenyatta Hospital and with the WHO in Kenya. Subsequently, one of the graduates, Serah Ndegwa, was key in the development of a Diploma in Audiology and Public Health Otology in 2001 at the University of Nairobi. Other students had chosen to stay in the UK after graduating, so a local (Kenyan) course seemed more appropriate. Indeed, the content of the course could be tailored to be appropriate to the context of sub-Saharan Africa. Meanwhile, the other Manchester graduate from Kenya, Zackary Wanjohi worked on the WHO project “Ear drop” whereby key trained children in school classes became “ear-monitors” to keep an eye on their peers discharging ears so that they can be seen as quickly as possible; a bit more responsibility than my own duty as “window monitor” in my school-days! Currently, Zackary is developing hearing aid management in the rural communities of Kenya, when not teaching on the Diploma Programme. Furthermore, the Public Health Otology part of the course is seen to address the importance of discharging ears by audiologists. In supporting the development of the Diploma in Audiology and Public Health Otology, funds from the British Council were granted. Following these, funding from the charity Aud-M-Ed (Audiology, Medicine and Education) has been key in the maintenance of this course, the first audiology course in Africa outside South Africa. We are particularly grateful to a cyclist from Saudi Arabia who, in 2009, donated his generous sponsorship money from a 109 mile race in the Italian Alps which has allowed the charity to sponsor several African students onto the course through the “Gran Fondo Scholarship”. In addition, the British Council and Aud-M-Ed have given me and other Manchester audiologists (Penny Feltham and Martin O'Driscoll) the good fortune to observe audiology and teach on the Diploma course in Nairobi. On my last visit in 2013, there were 10 audiology students, each leaving their families for 12 months, from 8 different African countries, so I really felt that awareness of the discipline of audiology is growing in Africa. Furthermore, Aud-M-Ed The WHO have defined a disabling hearing loss as greater than 40dB in the better hearing ear in adults (15 years or older) and greater than 30dB in the better hearing ear in children (0-14 years).

1


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45 First hearing aid fitting

Stetoclip practise

is currently sponsoring a student undertaking a new MSc course in Audiology at the University of Accra, Ghana, which I believe is appealing to BSA for guidance in its development. As audiology is a technology-dependent discipline the quest for appropriate technology is one of the contextual challenges we face. Distraction testing rather than VRA, and live voice rather than warblers, were among the first obvious choices though not without the teaching and development of more cuttingedge techniques. Discussion with students did reveal some interesting cultural factors. For instance, paediatric speech tests might not easily use toys as playing with toys is not common to all cultures. When I suggested to a student from a rural tribe who are renowned for carving that they might use carved miniature animals (lions, giraffes etc) for a speech-identification test, I learned that rural African children would NOT recognise them as they don’t live near them (for obvious reasons!) and have no books or toys to familiarise themselves with them either. It makes me feel our children are so materially loaded with toys; even my spoilt cocker spaniel fetches “badger”! Similarly, use of hearing aid related technology is context-dependent. In the days of analogue hearing aids, hearing aid fitting was less technology-dependent but required a good understanding of acoustics and sound perception. Africa was an obvious place for the use of obsolete analogue aids as the programme for the Modernisation of Hearing Aid Services ensued in England, beginning in 2000/2001. For the African students the use of hearing aid test boxes is more important than real-ear measures. Similarly, training in the listening to hearing aids through an attenuated stetoclip is instrumental to the use and understanding of spec' sheets, and manipulation of trim pots on analogue aids was and still is pertinent. In addition, the manual calculation of prescription formulae, with theoretical corrections for ear-coupler differences is part of the student's normal competence. However, globalisation has meant that computers and the internet are common to most African cities and with them, the expectation that digital technology should be applicable to their clinical population. Nevertheless, the specialised requirements

of probe-tube measures are yet to reach most of African audiology settings. Initially obsolete digital hearing aids were re-programmed at Manchester Royal Infirmary, thanks to a group of altruistic audiologists there who spent their spare time at “Hearing-Aid Parties” (!) The aids were programmed to be as versatile as possible (eg different gain in the different programme slots of an aid) and generally with high gain to cater for the severity of the losses the patients have by the time they arrive at the Audiology Clinics in Africa. And after programming we enjoyed pizza and cake to justify the labelling the evenings as “parties”. Experience in Kenya also revealed that the clinic population usually expect the audiologist to tell them what they believe is the appropriate rehabilitation rather the options to be explained and the patient to make an informed choice. Clearly, the African audiologists knew more about this kind of thing than we did and the western questionnaires such as GHABP and COSI are not culturally appropriate. Nevertheless, the student audiologists are now primed to develop questionnaires which are suitable for their own context. As hearing-aid software has developed, and computers have become more widespread, some African audiologists can now practice individual digital aid programming though real-ear measures are unlikely to be realised in the public-sector clinics we encountered. Aud-M-Ed endeavours to provide equipment for the successful scholarship recipients and Sound Seekers do the same. Smart audiometers powered by a laptop are a welcome addition to the raft of technology geared to this context. Unfortunately, often the public sector health services do not see audiology as a priority in the allocation of resources but I can only sympathise when I consider the importance of clean water and basic nutrition in Africa. However, I believe one has to instigate change as soon as possible: to wait until more basic needs are fulfilled would be potentially an ever-changing goal. After all we didn't wait in Manchester for NHS funding to start multi-channel cochlear implantation but relied on charitable funding.Thankfully, the success was soon convincing enough for public funding to be justified in terms of economic costs of deafness. The efforts of charities aim to give a positive contribution both to the development of audiology in the developing world and the appreciation of appropriate clinical skills by Western audiologists with the good fortune to experience a taste of Africa. References 1. Freeland, A., Jones, A., and Mohammed, N.K. (2010). Sensorineural deafness in Tanzanian children—Is ototoxicity a significant cause? A pilot study. INT J PED OTORHINOLARYNGOL, 74, 516-519. 2. WHO (2010). WHO global estimates on prevalence of hearing loss: mortality and burden of diseases and prevention of blindness and deafness.

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DEAFinitely Inclusive Sport CD

Audiologists have a key role to play in getting deaf people active. People who are deaf or hard of hearing are highly unlikely to play sport (Sport England Active People Survey).The current levels of inactivity suggest that deaf people are at a higher risk of obesity due to poor lifestyles, poor health awareness and low self-esteem.This in turn leads to a higher risk of the associated co-morbidities such as Coronary Heart Disease, diabetes and some forms of cancer.

Author and Correspondence

Clive Breedon Participation Officer for the UK Deaf Sport W: www.ukdeafsport.org.uk www.facebook.com/ukdeafsport @deafsport

To get involved and become part of the Deaf Sport Family just: E: participation@ukds.org.uk so you can be contacted.

Often a deaf person’s first point of contact and advice is their audiologist. By working together we can encourage more people from the deaf community to participate in sport. It has been shown that this can improve not only physical health but also key elements of mental health such as building confidence, the development of a social network, and improved positive self image. It has also been proven that physical activity can impact positively on mild depression. The biggest challenge that deaf people face when trying to access sport and phys-

ical activity opportunities is that of communication: both the ability to communicate with sports activity organisers and the organisers’ ability to communicate with them. Significant amounts of funding have been made available for grass roots disability sport via the Inclusive Sports Fund. Deaf Sport has benefitted from the overall direction of Sport England to increase the number of disabled (and deaf) people to participate in sport. If the Deaf community embraces this opportunity to play more sport, then there is every chance that we will be able to make the case for more funding for deaf sport and continue to improve the opportunities and the quality of the experience for deaf people. As the strategic lead for Deaf Sport in the UK, the organisation has been working hard to develop opportunities for people who are deaf to play sports. UK Deaf Sport wants to get Deaf and hard of Hearing people: • Playing more sport

Figure 1 Figure 3

Figure 2 Figure 1. Lauren Peffers kissing her medal, athletics women's 400m race Figure 2. Meeting Wayne Rooney at Manchester United Football Club Figure 3. Deaf Squash Championship group Figure 4. Ben Stephens being Coached

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Figure 4


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47 in the next 5 months.

• Becoming coaches in sport • Volunteering in sport

We also want to significantly increase the number of Deaf coaches in sport. We really do need to identify deaf people who would like to become coaches. Audiologists can have a role in making deaf people aware of the opportunities to coach or volunteer in sport. By being aware of the support available audiologists will be able to signpost people to opportunities to develop skills to support the deaf community and improve life chances.

To do this we have focussed on working with community organisations, sports organisations and clubs as well as health organisations in specific regions. DEAFinitely Inclusive Sports Networks UK Deaf Sport is developing regional DEAFinitely Inclusive Sports Networks. The aim of these networks is to bring together local partners to promote and improve the opportunities for deaf and hard of hearing people to play sport and develop a healthy lifestyle. All organisations that are involved are committed to being trained to be deaf aware and to provide welcoming, fun and supportive environments. We need audiologists to be linked into this network. Networks are being developed in the North West, East Midlands, North East, West Midlands, London and the South West Network Example: Birmingham Institute for the Deaf (BID) So far, BID have developed men’s and women’s Deaf Football and have just launched a Deaf Badminton Club that has over 40 people attending every Thursday evening. BID are now looking at developing a Deaf Run England programme and at supporting people from the deaf community to become coaches, which 10 people already have. Networks are beginning to run a variety of sports activities and each will be running DEAFinitely Inclusive Sports days through the summer. Sport National Governing Bodies National Governing Bodies (NGBs) are responsible for the governance and development of their individual sports and lead on new sports ideas. For example the Football Association lead on Deaf Football delivery and development. UK Deaf Sport has worked with 14 NGBs to create the Deaf Sport Family. The sports are athletics, badminton, basketball, cricket, cycling, football, golf, netball, rugby, rowing squash, swimming, sailing, shooting and tennis. All these sports are committed to providing more opportunities for deaf children and adults to play, coach and volunteer in sport.

Martin Anderson, England Deaf World Golf Team

NGBs are providing resources and training for accredited clubs to improve their deaf awareness and provide more deaf inclusive activities. They are also committed to providing communication support for deaf people who want to become coaches. National Governing Bodies example: England Golf England Golf is working with focus golf clubs in 7 priority counties to make each club deaf aware. This includes a training programme for PGA professionals and Club volunteers and officials. England Golf is also working with England Deaf Golf to deliver deaf inclusive Get Into Golf sessions. Deaf Specific Sport Development There is a network of over 40 Deaf Sports Organisations. It is the role of UKDS to support these sports to develop their governance and infrastructure to increase numbers participating in deaf sport and develop those with talent. Coach Development UKDS supports sports coaches to improve their ability to communicate with the deaf community. We work with partners to provide Deaf Awareness and British Sign Language training and have developed a specific “Effective Communication – Coaching Deaf People in Sport” Workshop with Sports Coach UK. Over 15 courses are being run across England

Giving Deaf people the best chance to achieve their potential UKDS works with Deaf Sport Organisations and Sport NGBs to develop clear pathways for Deaf sports people to develop their skills and progress through to reach their full potential. We are working to significantly improve the quantity and quality of support.This includes support in gaining access to good quality coaches, nutritional support and advice in finding financial support for athletes that have the potential to become National and International performers. Audiologists can provide a crucial first point of contact into what is often an almost invisible network. Support for Audiologists UK Deaf Sport is committed to supporting a network of professionals to support Deaf and Hard of hearing people to participate in sport. Audiologists will be supported to make contacts with key locality based sports and physical activity organisations such as County Sports Partnerships which already have responsibilities with regards to health and Wellbeing. We will provide information on sporting and physical activity opportunities in your local area as well as points of contact for professionals to signpost individuals into activity programmes. To get involved and become part of the Deaf Sport Family just e mail participation@ukds.org.uk so you can be contacted. Key Contacts UK Deaf Sport National Participation Officer : participation@UKDS.org.UK UK Deaf Sport Talent Officer : Talent@UKDS.org.uk

ear reach


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48

Setting up a Peer review VRA group: scaling the heights and avoiding the pitfalls

CD

Author and Correspondence Dr Josephine Marriage Clinical Scientist, Director of Chear

by email or via "cloud"-based software thus avoiding costly attendance by the reviewer and enabling a reasonable proportion of cases to be peer reviewed.

E: josephine@chears.co.uk

Key points for peer review from ABR experience are:

Dr Rosamund Aylett Specialty Doctor Community Paediatrics Epsom and St. Helier University Hospitals NHS Trust. E: rosamund.aylett@esth.nhs.uk

Background The aim of the peer-review group was to provide a forum for developing skills for accuracy and consistency in visual reinforcement audiometry (VRA) practice for experienced clinicians working in paediatric audiology, whether in community or hospital settings. The need for peer-review groups is in response to some high profile cases of misdiagnosis with VRA, but also in recognising that all professions need continuing professional development, not least for the VRA technique which has no formalised training scheme and which has been introduced to replace the now obsolete distraction test (ref HTA 1996). Peer review groups for auditory brainstem response (ABR) testing are now well established as an efficient method for improving standards developed by Guy Lightfoot and others. In this article we describe the setting up and running of a VRA peer review group in South London. Comparison with ABR Peer Review We wanted to build on the lessons learned from ABR peer review in order to make the process effective and efficient: Guy Lightfoot notes that there is an obvious difference between ABR & VRA in that with ABR there is a detailed technical record on which to base peer review of procedure, strategy and interpretation; that cases can be sent from tester to reviewer

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1. The reviewer should have received some form of training (in the review process) and accreditation as a reviewer - or be a recognised expert. 2. The reviewer should be external / independent. 3. Cases for review should be selected in a predefined way, not chosen by the centre or testers being reviewed and should include both "likely normal" and "known abnormal" cases.There should be enough of them to represent departmental practice. 4.The review should be based on recognised national procedures and should show valid, scientific interpretation of responses and non-responses using an established protocol.

Beginnings of VRA peer-review Following the introduction of the UK new born hearing screening programme in 2006, the National Quality assurance process noted variability in the calibre of post screening hearing assessments in South West London audiology clinics. The lead clinician Geeta Ubhayakar was supported by public health commissioners in setting up a group to review and develop key topics in clinical practice.The preliminary group had six to eight members and aimed to develop clinical skills through selfreflection and mutual support. Eventually the group expanded to accommodate clinicians from adjoining areas in SW London to ensure consistency in practice and interpretation of responses. In August 2012 Josephine Marriage was asked to act as trainer and facilitator for the South London group, having developed and run VRA hands-on training days around the UK prior to this.


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49 clinician. This helped to identify the areas of practice needing to be the focus of peer-review. Terms of Reference of the group We developed some terms of reference (TOR) for the group so that there was a clear purpose and an aim that could be evaluated over time to assess benefit from the evolution of good practice within departments.

Organisation Our meetings have occurred every 2 months or so, over the past 2 years, for an afternoon, with about 20 delegates and the trainer typically attending. Clinics are cancelled so that clinicians can attend therefore it is clearly important that the time is used as effectively as possible and the focus is on the aspects of learning for which people need to be in a group setting. How to organise the group structure? The group is made up of representatives from about 12 different audiology teams. Initially different people from each audiology team attended the meetings, but this caused confusion in the level of understanding of the process across different people and learning was not disseminated effectively. It was agreed that each team would nominate a ‘local coordinator’ whose role included passing on information and arranging for peer-review sessions of staff members within their own departments. One of the local coordinators now chairs the group and another takes the minutes. Geeta Ubhayakar arranged administration support from her team.The administrator keeps a record of attendees, circulates meeting details, agenda and minutes and also keeps track of which team has the video cameras and gorilla pods which are used for recording VRA sessions.The chairperson draws up the agenda and forwards the minutes of the previous meeting to the administrator Where are the meetings held? When the group started the venue for each meeting was chosen so that teams could look at the host clinic VRA set up. Later meetings have usually taken place in a conference room at one of the team’s sites. The room requires adequate seating with tables, computer and projector with correct software for using a USB or other storage device. A good quality audible sound system is essential. Development of an Audit tool of VRA result sheets In order to evaluate current practice an audit tool was developed which was an audit of actual VRA result sheets and which was completed by delegates on results from another

Who comes along? All attendance is voluntary, but if people chose to attend they are expected to be active participants. Anyone involved in VRA in the member organisations is invited.This includes audiologists, paediatricians and audiology assistants. The inclusion of the assistants has proved to be crucial as they provide invaluable insights into the difficulties of engaging some babies and children who are particularly challenging to test. The number of people attending from each team is decided by each local co-ordinator and is dependent on managerial consent as the meetings contribute towards professional development.

As with any new clinical procedure, it is very difficult to change the actual practice of testing that happens in a clinic. Real change is likely also to need the support of a manager for new toys or equipment, or positioning in the test room and, crucially, scope to review practice for more senior staff or people who have worked with set practice over decades (which we all find extremely challenging as we get older!). Even the best motivated and innovative clinician will default to previous practice when pressurised by a difficult case or insufficient clinical time. What do we cover at the meeting? Early meetings had a larger theory component, reviewing the evidence-base and literature for VRA and guest speakers were invited to talk on related subjects e.g. Cochlear implants. Now the format is more focussed on the review of VRA clinical practice by the delegates and audit of clinical practice. Each group is requested, in turn, to bring a video recording of a recent VRA assessment from their department, so that it can be watched and reviewed by the group. Initially there were concerns that families would be reluctant to agree to their assessment being videoed. However this has not proved to be an issue once it is explained that it is for training. Parents or carers sign a form giving permission for the video recording for training purposes and stating that the video is deleted following use.

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50 Some organisations were reported not to allow video, but in practice this has largely been addressed by explaining that it is part of quality assurance and training of staff, along with storage on an encrypted memory stick or disc, and deletion following use at the peer-review meeting.

Reviewing the video recording and test record This has been facilitated by a trainer [Dr Josephine Marriage]. Establishing Validity The purpose of the group is to improve standards and the essence of high standards is a valid test. Validity can be considered under a number of headings • Test Set up There is a wide range of test facilities within the group from single sound treated rooms to sound proof rooms with observation room and two way communication. Various seating arrangements for the child and parent and toys for engagement have been observed. These are discussed and changes are considered, many of which are quite minor and would involve little or no cost. The variety of toys that are appropriate across the age range from 6 months to 2 years is much wider than was typically found in departments. • Test procedure At the beginning of each meeting we recap the crucial differences in practice required for VRA in engaging consistently with the child, which is not the same as the phasing and releasing of attention used in distraction testing. We also review the importance of sticking to the test protocol, around either 10 dB down, 5 dB up, or if preferred 20 dB down, 10 up once, but not repeating a signal presentation at the same level when a child has not made a response For the purposes of the VRA peer

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When it comes to reviewing the practice with the rest of the group, clearly there need to be rules about what people say and that it is a safe and supportive environment, but as everyone is going to go through this, there is a sense of being reflective without being critical.

review group we restricted signals to warble tones, as these are calibrated to national standards, both for sound field and earspecific testing.There are many other signals that can and should be used, but the purpose of the group was to establish reliable, consistent and effective practice with an evidence-base, as described by Graham Sutton in BSA Audacity December 2013. We have often discussed the option of a screening protocol for VRA and the decision has been that there is no safe use of screening by presenting at a set level for VRA testing for the peer-review process, or indeed in any clinical venue, as VRA is not a screening test, but is a hearing assessment technique. We developed some observation checklists for people to evaluate different aspects of testing either on the video clips, or for trainees within their own clinics, including for example, ‘Are there any false positive head turns, if so, how many?’ At the end of observing a video of a VRA assessment, there is discussion around how the testing could be modified for the individual case presented and how this would be implemented within the home clinic.


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51 • Child response In order for the result sheets to be meaningful, we also needed to define what is an acceptable response for the peer-review. One tester’s eye widening is another person’s non-response, so this needs to be agreed and clearly stated.Thus we specified that the only response that we accept is a head turn to the visual reward, and which is time locked to the onset of the auditory signal. One also needs a reasonably consistent duration of signal for the case being tested, to control for the warble tone being left on longer when the child doesn’t immediately respond, which would introduce uncontrolled variability into the test procedure. • Recording of test results With an ABR assessment there is a record of results on the computer, as long as the clinician has not deleted traces that were considered not to show a wave V. The deletion of nonresponses in ABR is now recognised to be incompetent practice, as the result record needs to include all the valid recordings, including non-responses, in order for an independent assessor to evaluate the results, without bias from the tester. When using a behavioural technique like VRA, we also need a full record, including all signal presentations and non-responses, for it to have validity for someone reviewing the assessment procedure and results. Thus the response sheet needs to be a

complete record, with responses manually recorded following each signal presentation, with either a tick (child responded) or a cross (child did not respond). We use the published VRA protocol on the NHSP newborn hearing screening website (www.hearing.screening.nhs.uk) as our protocol for reference. We developed a couple of different response sheets to trial including the one that is included on NHSP so that departments can modify their own, as long as all relevant data is recorded. This includes the part of testing when the child learns the association of sound with visual reward (classical conditioning phase), followed by the test phase comprising the responses and non-responses to sounds, the number of false positive responses and at least a couple of absent responses at sound levels below threshold. Observations about implementing change and new practice As any trainer will tell you, doing training sessions with people who feel that their current practice is optimal, is irrelevant, wasteful and frankly, dis-spiriting.Thus it is important to identify delegates who are motivated to learn, engaged in the process and reflective in their personal practice, particularly for the first few meetings. Those who are uninterested, guarded about professional sensitivity or snoozing, are probably better to attend later groups, once procedures are established. It is also necessary to have managers who support evolution in clinical practice regardless of the grade of practitioner who is implementing it.

Many of the group have expressed that the VRA peer-review process has been helpful in developing their understanding of the VRA technique, and the perceptual world of infants and toddlers, despite initial trepidation about sharing videoed practice. Transparency in testing is an important component of continual professional development which is core when aspiring to conscious competence in paediatric audiology.

Look out for our next issue with a focus on psychoacoustics

clinical catch-up


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Tinnitus Awareness Week 2014 Manchester Tinnitus Awareness Event This year the British Tinnitus Association (BTA) Tinnitus Awareness Week took place from 3rd to 9th February.The aim of the week is to raise awareness about tinnitus amongst the general public and healthcare professionals. As part of Tinnitus Awareness Week the Manchester Royal Infirmary Audiology Department in partnership with the Manchester Tinnitus Support Group held an information event at the Manchester Deaf Centre on Wednesday 5th February. Within the main hall the British Tinnitus Association, GNResound, Puretone, Action on Hearing Loss,The Tinnitus Clinic

and Manchester Tinnitus Support Group had stands to demonstrate equipment and provide information. Throughout the day members of the public dropped in to view the stands and speak to the exhibitors. In the morning alongside the exhibition there was a Northwest Complex Hearing Needs Network meeting focusing on tinnitus. This was attended by Audiology professionals and students from around the North West. The meeting was kindly sponsored by GN Resound and Heather Dowber from GNResound presented information about the company’s current range of tinnitus devices and other new technology.

Kathryn Fackrell Nottingham Hearing Biomedical Research Unit presented information about the array of tinnitus research taking place within the unit.This included information about her PhD project validating the Tinnitus Functional Index. There was also a talk by Teresa Czajka from the Manchester Mental Health service which discussed the relationship between mental health and tinnitus and highlighted the resources available for patients and clinicians. In the afternoon the Manchester Tinnitus Support Group had their monthly meeting. The meeting included presentations by Karen Smith, Hearing Therapist at Manchester Royal Infirmary and David Stockdale, Chief Executive of the BTA. Overall the event was a great success with attendees learning more about tinnitus and the support that is available for those experiencing it. Lianne Riley, Manchester Tinnitus Support Group Secretary and third year BSc Audiology placement student at Manchester Royal Infirmary

hearsay


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Report from the BAA Trent Regional Meeting 12th March 2014 – Nottingham by BAA Trent Region Representatives Darren Cordon E: Darren.j.cordon@uhl-tr.nhs.uk Jennifer Thwaites E: Jennifer.thwaites@ulh-tr.nhs.uk

This meeting of the BAA Trent Region; kindly sponsored by Oticon, and well-attended by over 50 clinicians, covered the management of non-routine patients by audiology services. During the course of the meeting the audience was invited to consider the needs and service challenges of patients with both medically complex hearing loss and/or various co-existing impairments (e.g. dementia, deaf/blind patients).

Society) provided practical tips for working with patients with dementia in the clinical environment and the importance of the role of their carer in overall management; Martin O’Driscoll (Central Manchester University Hospitals) discussed his department’s work on designing a complex hearing needs service and the subsequent adoption of this by the local CCG for non-routine AQP patients. Finally, Alison Stone (Oticon) offered practical examples and tips on managing patients with medically complex hearing loss. At the end of the meeting Michelle Booth gave the audience feedback on the BAA conference in November 2013 and plans for 2014. In summary this was an excellent and thought-provoking meeting highlighting the various challenges of defining non-routine complex needs, as well as practical considerations to ensure effective and holistic management by Audiology Services.

In her opening presentation, BAA Board Member Michelle Booth, outlined the BAA’s ongoing work in defining ‘complex needs’ in terms of the breadth of impairments, conditions and types of hearing loss in order to provide guidance on the nonroutine patient pathway. Practical considerations for clinicians were then covered in a series of excellent presentations. Donna Corrigan (Sense) and Suzanne Harrigan (Ear Foundation) discussed their preliminary findings of a study into deaf-blind Audiology service users’ experiences; Chris Cartwright (Phonak) outlined how best to assess the hearing of patients with multi-sensory impairments, profound learning disability, and/or brain injury; Jennifer Oates (Alzheimer’s

The next BAA Trent Regional Meeting is scheduled for the afternoon of Wednesday 24th September at NBRUH, Nottingham, with the proposed topic of Paediatric Transition. For more details or to book a place please contact Darren.j.cordon@uhl-tr.nhs.uk or Jennifer.thwaites@ulh-tr.nhs.uk

Digital versions of Audacity are available at: Audacity

Audacity

...a British Society of Audiology Publication issue 1 august 2013 .............................

issue 2 december 2013 ..................................

10 Update on the BSA Annual Conference

38

68 ................................. www.thebsa.org.uk

hearsay

23

14

Infant sucking Response

Plasticity following shortterm unilateral hearing loss a step towards translating theory into clinical application

24

46

Research Round-up: Goodbye to Brian Moore and the Auditory Perception Group

British Society of Audiology KNOWLEDGE | LEARNING | PRACTICE | IMPACT

.................................

http://is.gd/Audacity_Issue_3

If all you have is a hammer...’

39

Essay Competition deadline 31st October 2013

http://is.gd/Audacity_Issue_2

issue 3 april 2014 ................................

Tinnitus in Children

DEAFinitely Inclusive Sport

audacity@thebsa.org.uk

British Society of Audiology

www.thebsa.org.uk

KNOWLEDGE | LEARNING | PRACTICE | IMPACT

http://is.gd/Audacity_Issue_1

...a British Society of Audiology Publication

30

Research Round-up Who are the ‘EAR Team’?

audacity@thebsa.org.uk

Audacity

...a British Society of Audiology Publication

.................................

audacity@thebsa.org.uk

British Society of Audiology

www.thebsa.org.uk

KNOWLEDGE | LEARNING | PRACTICE | IMPACT


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04/02/2014 10:02:21


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company corner

56 News from companies working in the field of Audiology PRE S RELE S ASE

Healthcare Sector Hearing Instruments Division

Siemens Hearing Instruments introduce new diagnostic and fitting system designed for efficient workflow: Unity™3 Siemens Hearing Instruments are proud to introduce the latest innovation in diagnosis and fitting - Unity™3. The system provides fast measurements and excellent fitting results to simplify and speed up daily audiology work processes. The portable, lightweight technology is USB powered, enabling audiologists to easily fit at a patient’s home or bed side and will be available in April 2014.

Siemens Hearing Instruments unveil the Unity™3 diagnosis and fitting system to simplify and speed up audiology work processes.

The Unity 3 system includes an innovative plug and play function; once headphones are plugged into the station, the instrument adjusts automatically, allowing for a fast and proficient set up. Workflow is also optimised with a portable and easy to use design, featuring user-friendly controls and large graphics for easy measurements. The system also minimises downtime for calibration and service, maximising cost-effectiveness. Siemens also offer a transducer calibration exchange service meaning that audiology clinics need never be without their Unity 3. The system is PC-controlled with modular hardware and software components to ensure it remains flexible to fit audiology needs. The Unity 3 is also compatible with various software systems including Connexx™ and can be combined with NOAH 3 and NOAH 4 along with support for Connexx AutoFit™. The solution includes a 2 channel diagnostic audiometer, a binaural REM module and a speech mapping module which includes percentile analysis. The system’s transducers possess their own calibration data, also the calibration for sound field testing can be set up with automatic process using the REM probe microphones. The Unity 3 was originally unveiled at the BAA Annual Conference in 2013. The conference “was a successful event at which Siemens Hearing Instruments were able to showcase the latest innovations in hearing technology. The Unity 3 system provides faster measurements and better fitting results, benefitting audiologists and patients alike,” states Mark Laben, Product and Marketing Manager at Siemens Hearing Instruments. “The compact solution makes it practical for

company corner

mounting on the wall of your office or sound-proof booth, or simply sat on your desk. It also offers a small footprint and lightweight housing which can be detached from the test box making it ideally suited for use in a home environment during external visits.” Contact for journalists: Siemens Hearing Instruments •Francesca Knee-Wright Marketing Administrator T: 01293 423789 E: francesca.knee-wright@siemens.com •Mark Laben Product & Marketing Manager T: 01293 423725 E: mark.laben@siemens.com For further information visit www.siemens.co.uk/hearing.

Siemens Hearing Instruments Ltd (Crawley, West Sussex) provides a comprehensive range of digital hearing instruments and software, patient management systems and audiology equipment to the National Health Service, independent retail dispensers and national chains in the UK. It is the UK operation of Siemens Audiology Solutions, a business unit of the Siemens Healthcare Sector; Siemens Audiology Solutions has been at the forefront of audiological innovation for over 130 years and is the world’s market leader in the design and manufacture of audiological products.


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Essentials Council Members / Meeting Dates Officers

Prof Kevin Munro – Chairman Dr Huw Cooper – Vice Chairman Dr David Baguley – Immediate Past Chairman Prof David Furness – Secretary (ESP) Mr Andrew Reid – Treasurer Elected Trustees

Dr Michael Akeroyd Mr Peter Byrom Mr Chris Cartwright Mr John Day Dr Heather Fortnum (RFSCo) Dr Sebastian Hendricks (PAIG) Dr Martin O’Driscoll (Audacity)

Ms Helen Pryce Dr Nick Thyer Ms Tracey Twomey Council Advisors

Dr Nicci Campbell (BSA New Website) Miss Debbie Cane (Chair, Balance Interest Group) Professor Adrian Davis (IJA Council Representative) Dr Piers Dawes (Interim Chair, Cognition and Hearing) Ms Mel Ferguson (Coordinator Learning & Events Group) Ms Pauline Grant (Chair, Auditory Processing Disorders) Ms Lucy Handscomb (Chair, Adult Rehabilitation Interest Group) Mr Paul James (Chair, Professional Practice Committee) Mr Jason Smalley (Webmaster) Miss Charlotte Turtle (New Members Representative) Dr Peter West (IJA Council Representative)

Council Meeting Dates for 2014 Tuesday 18th March - University of Manchester Tuesday 10th June - University of Manchester Wednesday 3rd September - Annual Conference, Keele Tuesday 9th December - University of Manchester (TBC) Council from 11.00am to 4.30pm

Housekeeping Meetings Dates Tuesday 25th February - Southampton Tuesday 20th May Tuesday 12th August Thursday 23rd October The above meetings will be held at the BSA Admin Office

Professional Practice Committee Meeting Dates Monday 3rd March Monday 2nd June Monday 22nd September Monday 24th November Hearing and Balance UK Meeting Dates Wednesday 26th February Wednesday 4th June Wednesday 16th October

For further information, please contact BSA Admin Office Tel: 0118 966 0622 Fax: 0118 935 1915 Email: bsa@thebsa.org.uk Web: www.thebsa.org.uk

Meeting dates and venues may be liable to change.... essentials


BSA Flyer - 2014_Layout 1 13/03/2014 14:13 Page 1

Advancing Knowledge

Improving Lives

BRITISH SOCIETY OF AUDIOLOGY YOUR OPPORTUNITY TO HONOUR AN OUTSTANDING MEMBER OF THE SOCIETY • Thomas Simm Littler Lectureship • George Harris Award • Denzil Brooks Trophy • Thomas Simm Littler Prize • Ruth Spencer Prize

tion a n i Nom dline Dea y 2014 a st 31 M

• Jos Millar Shield

See reverse for details about the awards and the nomination process


BSA Flyer - 2014_Layout 1 13/03/2014 14:13 Page 2

AWARDS THAT ARE NOMINATED BY TRUSTEES OF THE SOCIETY Thomas Simm Littler Lectureship The Thomas Simm Littler lectureship was established in 1970 to honour Dr Thomas Simm Littler, a pioneer of British audiology. The lectureship is awarded in recognition of a sustained academic contribution to the discipline of audiology. It is awarded biennially and consists of a certificate and honorarium. The lecture is normally delivered at the Society始s annual conference. The first recipient of the lectureship was Sir Alexander Ewing. Recent recipients include Professor Dai Stephens, Professor Richard Ramsden and Professor Stuart Rosen. George Harris Award The George Harris award was established in 2006 using an endowment from the late George Harris who was a hearing aid audiologist working in the independent sector. The award is made in recognition of a notable contribution to hearing aid audiology in any one year. It consists of a certificate and discretionary honorarium. Previous recipients of the award include Dr Denzil Brooks, Graham Frost, Judith Bird and Dr Josephine Marriage. Denzil Brooks Trophy The Denzil Brooks trophy was established in 2007 in memory of the late Denzil Brooks who was a pioneer of adult hearing aid provision within the UK. The award is made to a member in recognition of promoting excellence in audiological practice. It is awarded annually and consists of a certificate and trophy. Previous recipients of the trophy include Pauline Smith, Dr Sarita Fonseca and Sally Wood. AWARDS THAT ARE NOMINATED BY MEMBERS OF THE SOCIETY Thomas Simm Littler Prize The Thomas Simm Littler prize was established in 1970 to honour Dr Thomas Simm Littler, a pioneer of British audiology. The prize is awarded in recognition of an academic contribution to the discipline of audiology. It is awarded annually and consists of a certificate and honorarium. The first recipient of the award was Dr John Bench. Recent recipients of the prize include Dr Kevin J Munro, Professor Brian Moore, Dr Robert Marchbanks, Professor John Bamford, Professor Colette McKay, Dr Robert Carlyon and Professor Deb Hall. Ruth Spencer Prize The Ruth Spencer prize was established in 1976 to honour the memory of Ruth Spencer. It is made in recognition of a contribution to clinical services by a registered practitioner. It is awarded annually and consists of a certificate and honorarium. The original recipient was Hilary Ballam. Recent recipients include Karen Finch, Helen Pryce, Fiona Barker and Rachel Knappett. AWARDS THAT ARE NOMINATED BY THE EDITORIAL TEAM OF BSA NEWS Jos Millar Shield The Jos Millar shield was established in 2000 by the winner of the 1997 Ruth Spencer prize. It is awarded annually for the best article published in BSA News and consists of a certificate and shield. Recipients of the award include Hashir Aazh, Debbie Fife, Douglas Beck and Ravi Sockalingham. THE NOMINATION PROCESS Members can make nominations for prizes and awards throughout the year. The final date for nominations to be considered in a given calendar year is 31 May 2014 (except for the TS Littler lectureship which is 31 December of the previous year). In order to nominate a member, you should submit a letter of support (250 word limit) including a citation for the award and a CV or brief biography (100 word limit).** The winner of each award and prize is determined by the Trustees of the Society, usually at the June Council meeting of each year. The awards and prizes are made at the Annual Conference in September. Nominations should be sent to BSA, 80 Brighton Road, Reading, RG6 1PS. Email: bsa@thebsa.org.uk. **In the case of the Jos Millar shield, the editorial team should submit the article along with a letter of support instead of a CV or biography.


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

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (Audio-Training) Bahati Nyundo Lynn Hiskey Mark McDowell Danielle Coleman Jackie Creese Diane Hicks Louise Corfe Ricky Dummer Aaron Trowbridge Juliet Morley Barry Mitchell

Mark Clare Richard Clothier Andrew Coughlan Michael Domican Max Flövik Jon Harper Greg Dwyer Mark Clare Simon Morley Samantha Barker Negin Behnam

Claire Russell Laura Matkin Nyree Petitjean Michael Agyei Paul Jobin Richard Rice Helen Lundberg Julie Rose William Naylor Emma O’Rourke Graham Lister

BSA Certificate in Industrial Audiometry (Audio-Training) Erica Gillard Dee Davies Cian Daly Emma Corcoran

Catherine Ingram Stephen Ross Karen Crampin Georgina Mackie

Lee Davison Rosemary Sharples Penelope Lane

BSA Certificate in Industrial Audiometry (Albacare) Michelle Moore Mirelle McHendrie Alan Cathcart

Gillian McKeeman Annmarie Robb Cathy Douglas

Graeme Walker

BSA Certificate in Industrial Audiometry (Insight Health Screening) Julie Ling Warren O’Neil

Simon Clarke

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

essentials

Maria Pomirska


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

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

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

AMPLIVOX LIMITED Amplivox provides a range of audiological products and services that combine innovation and reliability E: n.court@amplivox.ltd.uk W: www.amplivox.ltd.uk

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

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

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

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

STARKEY LABORATORIES LIMITED Provides information throughout the world about hearing loss, hearing aids and different types of hearing professionals. E: sales@starkey.co.uk W: www.starkey.co.uk

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

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

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

ECKEL INDUSTRIES OF EUROPE LIMITED Eckel supply, design and install hemi (semi) and anechoic chambers. Further applications offered include Audiology Rooms and Suites. E: general@eckeleurope.co.uk W: www.eckeleurope.co.uk

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

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

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

GN RESOUND LIMITED ReSound is part of GN ReSound Group, one of the world’s largest providers of hearing instruments and diagnostic audiological instrumentation E: iinfo@gnresound.co.uk W: www.gnresound.co.uk

THANK YOU FOR THE VALUABLE SUPPORTS

www.thebsa.org.uk

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Essentials Audacity Advertising rates ADVERTISING RATES : 2014 - 2015 Sponsors Non-Sponsors Half A4 colour Full A4 colour

£325 £545

£495 £845

Special Positions Full A4 Colour Outside Back Cover Full A4 Colour Inside Front Cover Inside/Outside Cover Sponsors ONLY Technology Update per issue

£915 £845 £215 £230

Flyer insert in Audacity Single A4 (flyer provided) Single A4 (B/W printed by BSA)

£645 £895

For further details, please contact the BSA Admin Office by email: bsa@thebsa.org.uk or Tel: 0118 966 0622

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Combined Career Opportunity Full A4 in Audacity + Web listing + Bulk Email (commercial) Half A4 in Audacity + Web listing + Bulk Email (commercial) Full A4 colour in Audacity (unlimited words) + web listing Half A4 colour in Audacity (unlimited words) + web listing Quarter A4 colour (200 words) + web listing Advertisements

Audacity

(copy date deadline)

(dispatch date)

10th March 2014 23rd June 2014 20th October 2014

25th April 2014 8th August 2014 5th December 2014

£1375 £995 £1195 £775 £590


AREER WITH SPE C A CSA INK H VE T RS E W IS HY A W N A Y AUD OR IOL ICE F O OG H C IST D N OR U O S G AID DISPENS N I ER AR E H

AK TO M E.

AUDIOLOGISTS & HEARING AID DISPENSERS Opportunities Nationwide If there’s a better place than Specsavers to develop your career, we’ve yet to hear about it. Our network of over 450 stores offer customers, whether private or NHS, the best, most professional care. And to ensure we can continue to expand our hearing services and meet increasing demand, we’re looking for more talented people to join our teams across the UK. We want you to bring your expertise and customer service skills to Specsavers, a company with an impressive track record for developing talent. Join us and we’ll give you freedom to do things your way, support when you need it, and offer you the chance to continue your professional development through our Clinical Excellence Programme. Please get in touch. We think you’ll be pleasantly surprised by what we can do for your career. For more information about these roles or to register your interest in working for us, please contact our in-house recruitment team, Specsavers Recruitment Services on 0808 102 0275 or e-mail uk.recruitment@specsavers.com

For details visit: http://jobs.specsavers.co.uk


Spirit Synergy

Building a Better Future

INIUM WIRELESS

For further information contact your Oticon NHS Regional Manager or visit our NEW website: oticonnhs.co.uk

Customer Services 01698 283363 Technical Support 01698 208200 info@oticon.co.uk


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