equilibrium- vestibular assessment infants

JanFeb2012

2 012 B oa r d o f d i r e c t o r s N o m i N at i o N s—pag e 6 9

The magazine of, by, and for audiologists

Published by the American Academy of Audiology | www.audiology.org

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coNteNts

JanFeb2012Volume 24 No.1

24 equilibrium-Vestibular assessment for infants An understanding of the vestibular

system’s role in postural and motor coordination performance can serve as an

invaluable contribution for early identification and intervention.

By Richard Gans

32 the independent Hearing aid fitting forum: a 20-Year retrospective It became

clear very early on in the process that we needed to deal with more than

amplification parameter adjustment if we were going to develop something that

would address the full scope of our collective concerns.

By Dennis Van Vliet

36 Lessons Learned…from an audiologist and mom of a Hearing-impaired child Even

a doctorate of audiology doesn’t prepare you for raising a hearing-impaired child.

By Lisa V. Christensen

44 a Hearing report from Hong Kong In May 2011, AuD students from Northern

Illinois University participated in a two-week Heart of Hearing research and

humanitarian trip to Hong Kong. During their stay, the students toured clinics,

observed surgeries, and conducted hearing tests for individuals with disabilities.

By King Chung, Anna Kam, Jenny Chan, and Lena Wong

departmeNts

editoriaL missioNThe American Academy of Audiology publishes Audiology Today (AT) as a means of communicating information among its members about all aspects of audiology and related topics.

AT provides comprehensive reporting on topics relevant to audiology, including clinical activities and hearing research, current events, news items, professional issues, individual-institutional-organizational announcements, and other areas within the scope of practice of audiology.

Send article ideas, submissions, questions, and concerns to [email protected].

Information and statements published in Audiology Today are not official policy of the American Academy of Audiology unless so indicated.

copYrigHt aNd permissioNsMaterials may not be reproduced or translated without written permission. To order reprints or e-prints, or for permission to copy or republish Audiology Today material, go to www.audiology.org/resources/permissions/pages/default.aspx.

© Copyright 2012 by the American Academy of Audiology. All rights reserved.

8 presideNt’s message Occupy Audiology By Therese Walden

10 executiVe update Meet the JFLACers By Cheryl Kreider Carey

12 from tHe editor Dr. Jerger and JAAA: A Tribute By David Fabry

14 Letter to tHe editor CAA and Clinical Audiology Education

18 KNow-How Pardon the Wait By Brenna Carroll

20 caLeNdar Academy and Other Audiology-Related Deadlines

22 audioLogY.org What's New on the Academy's Web Site

52 case studY CSI: Audiology By Paul Pessis

55 momeNt of scieNce What It Means to “Pay Attention” and How Much It Costs By William J. Bologna and Judy R. Dubno

58 saa cHapter spotLigHt Community Outreach: A Priority for Arizona State University SAA By Alaina Richarz and Natalie Saba

60 codiNg aNd reimBursemeNt New 2012 CPT Code and Code Descriptions: Otoacoustic Emissions

64 aBa Improving Your Practice with PASC By John Coverstone

67 acae corNer Top 10 Benefits of ACAE Accreditation By Maureen Valente

Academy News

69 2012 Board NomiNatioNs Review the 2012 Board of Directors Nominations

75 wasHiNgtoN watcH New Year, New Opportunities to Advance Direct Access By Melissa Sinden

77 Just JoiNed Welcome New Members of the Academy and Student Academy

79 fouNdatioN update Foundation’s AudiologyNOW! Lecture Announced | MAP Applications Due | Support the Auction 4 Audiology

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Board of directors

presideNtTherese Walden, AuD Walter Reed National Military Medical Center Audiology and Speech [email protected]

presideNt-eLectDeborah L. Carlson, PhDUniv. of TX - Medical BranchCtr. for Audiology & Sp. [email protected]

past presideNtPatricia (Patti) Kricos, PhDUniversity of [email protected]

memBers-at-LargeE Kimberly Barry, AuDDept. Veterans [email protected]

Bettie Borton, AuDDoctors Hearing [email protected]

Rebekah F. Cunningham, PhDA.T. Still [email protected]

Brian Fligor, ScDChildren’s Hospital Boston and Harvard Medical [email protected]

Thomas Littman, PhDFactoria Hearing Center [email protected]

Devin McCaslin, PhDVanderbilt Bill Wilkerson [email protected] Erin L. Miller, AuDUniversity of [email protected] Eilene Rall, AuDChildren’s Hospital of [email protected]

David Zapala, PhDAudiology Section-Mayo [email protected]

ex officiosCheryl Kreider Carey, CAEExecutive Director, American Academy of [email protected]

Kari MorgensteinPresident, Student Academy of [email protected]

Audiology Today (ISSN 1535-2609) is published bimonthly by the American Academy of Audiology, 11730 Plaza America Drive, Suite 300, Reston, VA 20190; Phone: 703-790-8466. Periodicals postage paid at Herndon, VA, and additional mailing offices.

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To the extent permissible under applicable laws, no responsibil-ity is assumed by the American Academy of Audiology and its officers, directors, employees, or agents for any injury and/or damage to persons or property arising from any use or opera-tion of any products, services, ideas, instructions, procedures, or methods contained within this publication.

The American Academy of Audiology promotes quality hearing and balance care by advancing the profession of audiology through leadership, advocacy, education, public awareness, and support of research.

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editorial advisors

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8 Audiology Today | JanFeb2012

presideNt’s message

occupy audiology

in the history books. If you are like me, when you look back over the year, you marvel at what happened in only 365 days and then take stock of how you dealt with the issues, changes, and situations that impacted you both personally and professionally. Worldwide, we continued to struggle through the economic downturn and all the “side effects” we experi-enced personally or read about (the European sovereign debt crisis, the U.S. debt ceiling debate, unemploy-ment, etc.). Because of the challenges we faced on the economic front, many of us had to re-assess our per-sonal and business financial “health” and determine best next steps. In 2011, we started the ramp-up for the 2012 presidential elections and all that entails (political commercials, debates, exhaustive/exhausting media coverage, off-year elections, etc.). The Arab spring took hold in 2011 with numerous protests and demonstrations fueled by massive discontent for the status quo in many countries, and although most dem-onstrators participated in accordance with the rules governing civil disobe-dience, there were casualties as the sides collided. In the United States, the “Occupy Wall Street” movement set off civil resistance across the nation. Agree with the demonstra-tors or not, these individuals in the United States and in the Arab world banded together to make a mark, to initiate change and to try to make leadership accountable to the masses. Additionally, because of the global

reach of social media, these move-ments galvanized at a rapid pace, almost too fast as goals had to be made up along the way as opposed to at the outset of the movement.

Where does audiology fit in all of this? How do we position our-selves for the onslaught of continued global chaos? Well, ensure that the Academy leadership (board, com-mittees, task forces) is responsive to the needs of the members. We did this in 2011, as the Academy leader-ship banded together to develop a contemporary strategic plan (our Preferred Future: www.audiology.org, search keywords “preferred future”) based on members’ well-articulated needs and goals. All Academy programs, initiatives, and resources are focused to support our Preferred Futures—our collec-tive roadmap. Also in 2011, Academy committee leadership and members banded together to support our legislative agenda with the introduc-tion of H.R. 2140 (direct access bill). This initiative has garnered wide-spread support, and legislators have a deeper understanding of what this bill, when passed, will mean to their constituents. Additionally, through dedicated relationship building with the AMA by Academy committee leadership and our members, we obtained a “seat at the table” for the CPT-HCPAC.

Then, in October 2011, we banded together Academy leadership, members, allied organizations, and consumers to fight the misdirected

attempt by a large health insurance carrier to provide online hearing tests and hearing aids to subscrib-ers. We worked together to educate each other on the issues and then responded with a collective and non-stop voice to the insurance company that a sustainable, cost-effective service delivery model starts with the individual patient and his or her needs, not the device.

There were many other positive outcomes, lessons learned, mistakes, controversies, etc., in 2011. All of these actions, issues, and initiatives were addressed head-on by a large group of people who share a common goal for the profession of audiology. Your board of directors, committee chairs, committee members, task force members, and fellow Academy members (to include our dynamic Student Academy members) are working together to realize our Preferred Futures for the profession. It takes all of us—past, present, and

As you read this, the year 2011 is now

JanFeb2012 | Audiology Today 9

presideNt’s message

future—to get the work done, sup-port each other, and focus on the globalization of audiology.

What 2012 will bring is yet unknown; however, I am compelled to act together for the profession to accomplish more than we can as indi-viduals. How? Well…in this issue of AT the slate for the 2012 board of direc-tors is presented—you can review the information about these amazing professionals and then vote; you can register for AN! 2012 in Boston—the single greatest gathering of audiology minds; you can take two minutes to contact your elected congressional representative to ask for his or her support of direct access (http://capwiz.com/audiology/home); and you can take a moment to sign up to volunteer

for your Academy (www.audiology.org, search keyword “volunteer”).

We cannot fall prey to ecologist Garrett Hardin’s “tragedy of the com-mons” dilemma, whereby we act alone on professional issues as individu-als—with all good intentions—only to deplete our shared (and limited) resources. Even Aristotle warned against this: “For that which is com-mon to the greatest number has the least care bestowed upon it. Everyone thinks chiefly of his own, hardly at all of the common interest; and only when he is himself concerned as an individual. For besides other consid-erations, everybody is more inclined to neglect the duty which he expects another to fulfill….” I’m all for proving Aristotle wrong.

Therese Walden, AuD President American Academy of Audiology

Editor’s Note: Due to the overwhelming response to the recent Walter Reed article in the Nov/Dec issue of AT—look for Part 2 of the Walter Reed legacy that will describe the expanded role and exciting initiatives in military audiology and speech pathology at the new Walter Reed National Military Medical Center, Bethesda!

Audiology Today | JanFeb201210

executiVe update

James Jerger, PhD, shared these thoughts on leadership

meet the JfLacers

at AudiologyNOW!® 2011 during the ceremony in which the “Future Leaders of Audiology Conference (FLAC)” was renamed the “Jerger Future Leaders of Audiology Conference (JFLAC)” in his honor:

Ralph Waldo Emerson once said, “Do not follow where the path may lead. Go instead where there is no path and leave a trail.” That is the essence of leadership, and it is the goal to which these fine young people aspire. They are learning to take themselves, and others, in the direction they want their lives to go – in a posi-tive, effective way as they unlock their latent potential for leadership.

The future of our profession lies in the hands of these nascent leaders. No one is born a leader. It is a set of skills that must be learned. And learning is the goal of our leadership program. John Quincy Adams gave what I think is the best definition of a trained leader: “If your actions inspire others to dream more, learn more, do more, and become more, you are a leader.”

I am very proud, indeed, that my name is asso-ciated with this important leadership mission.

Dr. Jerger exemplified visionary leadership as the Academy’s founder and first president, and throughout his 22-year tenure as editor-in-chief of the Journal of the American Academy of Audiology (JAAA). That his legacy be carried on through this Academy leadership development program is instilled in the participants, now known as

“JFLACers.” Taking this charge to heart, these mid-career audi-

ologists are demonstrating their passion for audiology through a renewed commitment to service, an increased loyalty to the Academy, and the A4. Here’s a sampling of national leadership roles JFLACers currently hold.

� Shanna Allen—Government Relations Committee and State Leaders Network Regional Captain/Region 7 (AAA)

� Samuel Atcherson—Marketing Committee (ABA)

� Marlo Bailey—Ethical Practices Committee (AAA)

� Shilpi Banerjee—Research Committee (AAA)

� Mindy Brudereck—AT Editorial Advisor (AAA) and Board of Governors (ABA)

� Brenna Carroll—BEST Committee Cochair (AAA)

� Lisa Christensen—State Leaders Network Regional Captain/Region 8 (AAA)

� Sarah Draplin—Membership Committee (AAA) and Secretary (AVAA)

� Drew Dundas—Publications Committee (AAA)

� Brian Fligor—Board of Directors, Secretary/Treasurer (AAA)

� Sumit Dhar—Education Committee Chair (AAA)Dr. Jerger flanked by JFLACers at the renaming ceremony.


executiVe update

� Tish Gaffney—Public Relations Committee Chair and AN!13 Program Committee Chair (AAA)

� Melissa Heche—BEST Committee and PAC Advisory Board (AAA)

� Tiina Huckabay—SAA Advisory Committee Chair/SAA National Advisor (AAA/SAA)

� Craig Kasper—PAC Advisory Board and Publications Committee (AAA)

� Curtis Kwame—International Committee (AAA)

� Samantha Lewis—JAAA Assistant Editor (AAA) and Conference Program Committee Cochair (SAA)

� Shannon Luongo—DiscovEARy Zone Committee and Public Relations Committee (AAA)

� Joscelyn Martin—Board of Trustees (AAA Foundation)

� Hilary Rosenstrauch—Professional Standards & Practices Committee (AAA) and Board of Trustees (AAA Foundation)

� Christine Ulinski—Student Mentor Committee (ADA)

� Brian Urban—Board of Directors, Treasurer (ADA)

We are grateful to the AAA Foundation for their fund-ing of both the 2008 and 2010 conferences. The Foundation contributions to this initiative were made possible thanks to “leadership-level” funding from The Oticon Foundation, members of the Academy and JFLACers who have “paid it forward” by making gifts to future JFLAC meetings.

The American Academy of Audiology’s 24-year history is underpinned by visionary leadership. In celebration of Founders’ Day on January 30, express your gratitude to an Academy leader who has or is inspiring you to dream more, learn more, do more, and become more.

Cheryl Kreider Carey, CAE Executive Director American Academy of Audiology

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J anuary 1, 2012, represents an important milestone for the American Academy of

Audiology, in that it represents the first day that James Jerger, PhD, has not served as editor-in-chief of the Journal of the American Academy of Audiology (JAAA). As the found-ing member and first president of the Academy, as well as a prolific researcher with over 300 publications, Dr. Jerger recognized the importance of establishing our own archival jour-nal and took on the role when JAAA was established in 1990.

JAAA’s first article, “Perceptual and Production Abilities in

Profoundly Deaf Children with Multichannel Implants” (1:1–3), was authored by Steve Staller and repre-sented the written record of a paper presented during a special session on cochlear implants in children during the Academy’s inaugural convention at Kiawah Island on April 21–24, 1989. Also in that first issue were papers authored or coauthored by three Academy founders: John Jacobson, Fred Bess, and Gus Mueller. The next issue featured manuscripts by other notable Academy found-ers (James Jerger, Susan Jerger, Jay Hall, and Brad Stach), and a total of 11 Academy founders published

articles in the first volume, with over two-thirds of Academy founders pub-lishing in JAAA during its tenure.

The commitment to supporting the archival record of the fledgling organization was instrumental in establishing JAAA as the peer-reviewed, archival publication of the profession. Initially, JAAA was published quarterly until 1992 (Volume 3), when it was increased to six times annually. Only seven years later, JAAA expanded to 10 issues per volume, where it stands today. As of December 2011, 1,406 articles, letters, clinical reports, and letters to the editor have been published in JAAA—all under the careful stewardship of Dr. Jerger and his editorial team. This is a staggering number and almost unheard of in the modern academic publishing era. Simply put, editing an archival journal is a demanding and often thankless process. Authors (and reviewers) occasionally have unrealistic expectations, and it takes a deft hand to steer clear of politics and conflicts of interest. The fact that Dr. Jerger was willing to continue to serve for 22 consecutive years is nothing short of remarkable.

Through it all, Dr. Jerger has provided a steady hand and has now earned his right to “pass the baton” to the next generation. Beginning January 1, 2012, Gary Jacobson, PhD, will capa-bly take the reins as editor-in-chief, and Devin McCaslin, PhD, will serve as deputy editor-in-chief of JAAA.

dr. Jerger and JAAA: a tributeBy David Fabry

from tHe editor

Dr. Jacobson (left) takes the reigns from Dr. Jerger.


On Founders’ Day (January 30), take a moment to think about the impact that JAAA has made on you. Whether it was a cutting-edge research paper, clinical case history, or one of Dr. Jerger’s many thought-provoking editorials, keep in mind that evidence-based research serves as the hallmark of an exemplary profession. We owe a debt of gratitude to Dr. Jerger and the other founding members who had the vision to see where the Academy was headed during the first meetings in 1988 and 1989.

David Fabry, PhD, is the content editor for Audiology Today.

from tHe editor

Dr. Jerger reviews the JAAA submission system process with Dr. Jacobson.


Letter to tHe editor

November 1, 2011Dr. David A. FabryContent EditorAudiology TodayAmerican Academy of Audiology11730 Plaza America Drive, Suite 300Reston, VA 20190

dear dr. fabry,The Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) would like to correct a few errors made in the article “Clinical Education in Audiology: A Case of the Emperor’s New Clothes” by Virginia Ramachandran, published in the September/October 2011 issue of Audiology Today.

First, the CAA is the only accredit-ing agency that is recognized by the U.S. Secretary of Education for the accreditation of clinical doctoral pro-grams in audiology. This recognition has been maintained continuously since 1967. Also, the Council for Higher Education Accreditation (CHEA) has recognized the CAA (and its predecessors) since 1964, as the only accrediting agency for the profession of audiology. Further, accrediting organizations do not obtain their authority to accredit programs from these two recogni-tion bodies, as stated in the article. Rather, recognition often is sought to obtain an external assessment and validation that the standards and processes of the accrediting orga-nization are consistent with quality,

improvement, and accountability expectations and that they are meet-ing nationally accepted best practices for accreditation programs. In addi-tion, federal recognition ensures that accreditors are, for the purposes of the Higher Education Act of 1965, as amended (HEA), or for other federal purposes, reliable authorities regard-ing the quality of education offered by the programs they accredit.

Second, contrary to what the author states, there are many certifi-cation programs that do not require additional experience or postgradu-ate study following the attainment of a degree. As is widely known, the audiology profession determined that acquisition of the required knowl-edge and skills across the scope of practice could no longer be accom-plished in a master’s level program. This determination was made based on the results of a comprehensive and scientific research study (prac-tice analysis), conducted in 1994 and then revalidated most recently in 2007. The results also indicated that the knowledge and skills across the depth and breadth of the scope of practice should be learned as part

of the graduate program. Therefore, the clinical experiences, which were gained previously as part of the audiology clinical fellowship following attainment of the master’s degree, were incorporated into the clinical doctoral program so that, upon graduation, individuals would be prepared for independent profes-sional practice.

Third, and most importantly, the author’s interpretation is not accu-rate regarding the CAA’s standard related to national credentials. The purpose of CAA’s accreditation is to prepare individuals to enter indepen-dent professional practice. In order to enter practice, specific creden-tials are required in many cases, either by the state or by employers. Further, in recent years, the U.S. Department of Education (USDE), and analogous private sector bodies, have elevated “learning outcomes assessment” to one of the most important components in evaluat-ing the effectiveness of an academic program. Performance of graduates on a standardized, national certifi-cation examination is seen as one of the most objective “outcomes” of



a program (Balasa, D., Interfaces Between Professional Certification and Academic Accreditation: A Non-Technical Legal Perspective, Institute for Credentialing Excellence, November 2008). As a demonstration of this, when under review for USDE recognition, accreditors are typically expected to provide data on their accredited programs regarding the performance of their graduates on the profession’s national certification exam, if such exists.

The specific CAA standard to which the author refers is 3.1A, which indicates that programs must ensure that students have sufficient opportunities to acquire the knowledge and skills needed for entry into inde-pendent professional practice and to qualify for those state and national credentials for independent profes-sional practice that are relevant to the

program’s purpose and goals. In addi-tion, the program must demonstrate that it provides supervised clinical experiences, and the breadth and depth of opportunities, for students to obtain a variety of clinical experi-ences with different populations sufficient to enter independent pro-fessional practice. Therefore, if the program’s goal is to prepare gradu-ates for ASHA certification, then the program would need to ensure that they have provided the opportuni-ties for their graduates to be eligible for such a credential. However, if the program’s goal is to prepare students only for state licensure, then the program may need to provide other opportunities, depending on the state. Many states currently include requirements similar to those for ASHA certification, such as hours of supervised clinical experience,

etc. So the program would need to demonstrate to the CAA that it is not only aware of the requirements to obtain relevant credentials, depend-ing on its stated purpose and goals, but that it also has mechanisms in place to track whether the students have had sufficient opportunities to maintain eligibility for such credentials.

On behalf of the CAA, we respect-fully request that you publish this letter in order to inform your readers of the errors that were made in the article. Please feel free to contact me if you have any questions.

Sincerely,Dan C. Halling, PhD, ChairCouncil on Academic Accreditation in Audiology and Speech-Language Pathology

Author’s Response

dear dr. Halling,I would like to thank the author and the Council on Academic Accreditation in Audiology and Speech-Language Pathology (CAA) for taking the time and effort to comment on my article on clinical education in audiology.

First, I would like to rectify an error. It is true that the CAA is the only accrediting agency that is recognized by the U.S. Secretary of Education for the accreditation of clinical doctoral programs in audiology at this time. I stand cor-rected. Thank you for providing this information. Furthermore, it is more correct to state, as you have, that this recognition is voluntary. While

recognition has potential advantages, it is not a necessary credential for accrediting bodies.

It is noted that my interpreta-tion regarding the CAA’s standard related to “national credentials” was inaccurate. This assertion actually supports the point that I was mak-ing in the article, which is that the current standards provide no clear direction as to what is meant by this term. The standards and subsequent

“clarifications” (see later), while cer-tainly sounding authoritative, simply support the obfuscation.

My “misinterpretation” of the standard was not for lack of trying to understand its actual meaning. In

February 2011, I attempted to clarify this issue by asking the CAA what is meant by “national credentials.” I received the following response,

“...The CAA feels that it is impor-tant that academic programs are preparing students to qualify for any professional credentialing that they choose; this certainly includes state licensure (if any), state teacher certification, and also national certifications for which, in the case of audiology, there are two options. This is an indicator of the qual-ity of educational preparation and, as an accreditor, the CAA doesn’t believe that a program’s student outcomes would be met appropriately


if graduates of a program are not sufficiently prepared to qualify for professional credentialing. So, accredited programs must prepare students to be eligible for creden-tialing, whether or not the student actually seeks credentials.... However, the CAA believes strongly that if a program chooses not to provide the opportunities for graduates to qualify for specific credentials that are widely accepted among employers, then the program has a respon-sibility to appropriately inform the students of the potential risk involved.... So, to reiterate your basic question, accredited programs must sufficiently prepare students so as to have the opportunity to seek state and national credentials.”

The response of the CAA was still unclear but does appear to suggest that audiology students should be prepared for certification upon grad-uation. The specific reference to the profession of audiology having “two options,” presumably referencing the Certificate of Clinical Competence in Audiology from ASHA or certification by the American Board of Audiology®, would also appear to indicate this. Interestingly, however, in this let-ter to the editor, a “standardized national certification examination” appears to be the “national creden-tial” to which the CAA is referring. In reading these various “clarifications,” the meaning of “national credentials” appears to be a moving target.

Being in the position of ensur-ing that the clinical education of my students met the CAA standards, I felt compelled to clarify this issue further. I did not want to be in the position of placing my program in jeopardy by misunderstanding the standards. In April 2011, I specifically

asked to have explained in clear and understandable language what our program could do to ensure that we were meeting this clinical education standard. In October 2011, following publication of my article, I received the following response,

“...There is not a definite yes or no answer to your specific question whether the program must provide a minimum of 1,820 hours of supervi-sion by an ASHA-certified audiologist. It could be yes or no, depending on the program’s stated purpose and goals. If the program’s goal is to pre-pare graduates to be eligible for ASHA certification, then the answer would be yes, because that is an ASHA certi-fication requirement. However, if the program’s goal is to prepare students only for state licensure, the answer would be that it really depends on the state. Many states reflect, either completely or in part, the ASHA requirements. So the program would need to demonstrate to the CAA that it is aware of the requirements to obtain relevant credentials, depend-ing on its stated purpose and goals, and that it has mechanisms in place to track whether the students have had sufficient opportunities to main-tain eligibility for such credentials.”

While I appreciated finally receiv-ing clarification from the CAA, I found this statement, consistent with what was written in your letter, to be alarming. I would like to address this, first from a theoretical and then from a practical perspective.

I believe that understanding the purpose of academic accreditation is of paramount importance in this discussion. Various stakeholders, including academic programs and certifying bodies, have conflicts of interest when it comes to creating

standards for clinical education because they have the potential to create self-serving standards. For example, academic programs could have a vested interest in setting standards low, because it is easier to graduate students from such a program and certifying bodies could have a vested interest in creating standards that require the purchase of a product that they sell, such as a certificate. As a profession, we must provide the public with assurance of the quality of academic preparation, and, frankly put, we cannot expect that academic programs, certifying bodies, or state licensure boards will create standards free of self-interest.

The role of an accrediting body is essentially a regulatory one. The task is to independently create standards for education and ensure that pro-grams meet these standards. As an accreditor of so many audiology pro-grams, the CAA carries an enormous responsibility to create appropri-ate clinical standards for audiology education.

However, the CAA has stated that it considers preparation of students for state and national credentials to be “an indicator of the quality of educational preparation,” and that students must graduate prepared for state and national credentialing. On the surface, this sounds ideal because students are then able to become licensed or certified practi-tioners by virtue of graduation. The danger lies in the abandonment of the CAA’s regulatory function. It allows those stakeholders with potential conflicts of interest to dic-tate the educational preparation of students and to do so without regard for whether these standards contrib-ute to student outcomes.




Consider for a moment the case of speech-language pathology (SLP). Academic programs, in fact, have no ability whatsoever to prepare SLP students for either state or national credentialing. In either case gradu-ates must complete a postgraduate clinical fellowship training year in order to qualify for credentialing, and this is done outside the purview of the academic program. Just because entry-level clinical education has been encompassed within audiol-ogy doctoral programs, it does not follow that students must graduate prepared for credentialing. If a state licensing board or a certification body requires additional training or preparation beyond that deemed appropriate for professional prepara-tion by the accrediting agency, that is their business. And if the graduate chooses to pursue such credentials, that is their decision. Academic programs that wish to attract students might find it in their own self-interest to create a curriculum that provides assurance to students that they would qualify for such credentials upon graduation, but it is certainly not the role of the CAA to require or encourage them to do so. It is the role of the CAA to set the standard for student outcomes.

In my opinion, the entire concept of “preparation for state and national credentials” has no place in profes-sional accreditation standards. There is no reason to fear the removal of this concept, as long as the accredit-ing agency does its job of creating its own standards that ensure appro-priate preparation of students for professional practice.

In addition to interfering with the underlying role of regulatory

oversight, the inclusion of the requirement for preparation of students for state and national credentials also creates a number of practical problems.

The most recent clarification of the CAA appears to indicate that the national standards for clinical education of audiology students can vary depending on the “stated goals of the program” and individual state licensure laws. National standards for education could then vary from program to program and state to state. Why would the national stan-dard for clinical education outcomes be different for different students? Would having different standards not virtually guarantee that some students are less qualified?

In some cases the standards become circular with accreditation, guaranteeing no actual standard. As an example: in the state of Michigan, in order to demonstrate my competency to practice, I must provide evidence that I have passed the national examination in audiol-ogy, and I must provide evidence of graduation from an accredited educational program. (Note that in this case, as with almost every other state, certification is not a require-ment for licensure.) In this case, the standard for state licensure is that I graduated from an accredited program. But the CAA is depending on the standards of state licensure as my standard for clinical preparation. Where is the actual standard?

Forcing any programs to utilize clinical educators who have the credential of the CCC-A, and the CAA has now clarified that this is the requirement for at least cer-tain programs, has the potential to

interfere with, rather than to support, clinical education. I have addressed these concerns more fully in my article, but to briefly restate the problem, requiring this credential of clinical educators has the poten-tial to limit the number of qualified clinical educators and does so with no evidence or even reasonable argu-ment that requiring this credential improves clinical education. It may even be misleading or mask the need for clinical educator credentials that might be more appropriate.

Requiring some programs to utilize the credential of CCC-A for clinical educators also creates the appearance of a conflict of interest. This is problematic from the point of view of the CAA as a regulatory agent that the public relies on for assur-ance of educational quality.

I ask the members of the CAA to reconsider their position on the issue of preparation for state and national credentialing for the profession of audiology. I also call upon those who are impacted by this issue, students, academic educators, clinical edu-cators, and all audiologists whose professional preparation will be judged by the public based upon the CAA standards, to voice their opinion to the CAA. As a current accreditor of every audiology program in the country, the CAA necessarily repre-sents all of us, and we need to ensure that we are working together for the benefit of the profession.

Thank you, Virginia Ramachandran, AuD


KNow-How

pardon the wait: Tips to Enhance the Patient Waiting Room ExperienceBy Brenna Carroll

e ven the most smoothly run-ning practice will occasionally encounter events that result

in a patient waiting a length of time before being seen by the audiolo-gist. Waiting area design and patient reactions have been examined by Wendy Leebov in her book, Physician Entrepreneurs: The Quality Patient Experience: Improve Outcomes, Boost Quality Scores, and Increase Revenue (2008) and by Abraham Wandersman and Robert Hess in their publication, Beyond the Individual: Environmental Approaches and Prevention (1985). For those occurrences when a patient spends a significant length of time in the waiting room, teaching audiology

staff to respond to patient reactions and carefully considering the setup of your practice’s waiting area can enhance the patient experience. Front desk staff plays an integral role in your patient’s hearing health-care experience. Training audiology sup-port staff to both identify and diffuse patient frustration while waiting can be invaluable for patient satisfac-tion, retention, and referral growth (Leebov, 2008).

Waiting to be seen by the audi-ologist can sometimes feel like an interminable length of time for the patient who is feeling excited about obtaining the latest amplification technology or nervous about the

potential results of an audiogram. Patients may begin to experience anxiety, irritation, frustration, and anger while waiting to be seen by the provider. Patient satisfaction research indicates that patients become frustrated not only by actual wait time but also by perceived wait time (Wandersman and Hess, 1985; Leebov, 2008). If your patient arrives early, the front desk can immedi-ately diffuse potential anxiety about wait length by warmly greeting the patient with a friendly acknowl-edgment. An early arrival might be greeted with, “Good morning, Mr. Jones. I see that you are about 20 minutes early for your 10:30


KNow-How

appointment. Thanks for being so prompt! The audiologist is currently with another patient but will be with you at your scheduled appoint-ment time.” Train your front desk staff to invite your patients to enjoy the magazines, use the restroom, or have a beverage upon being seated. Inviting language alleviates patient anxiety (Leebov, 2008).

Provide entertaining materials in the greeting area to occupy the patient’s attention while waiting (Leebov, 2008). Subscribe to a variety of current magazines appealing to a wide range of interests. Consider publications popular with your patient demographic. If your prac-tice caters to pediatric patients and young families, include publications that appeal to both children and adults. Provide Sudoku and word search puzzle books, interesting facts and anecdotes about staff, brochures, and hearing and balance wellness tips in your waiting area. Consider providing wireless Internet access. Provide safe and easy-to-clean toys to occupy young children who may visit your practice. A television with an assistive listening device, tuned to a local news station, can be a great opportunity to market advances in technology while passing the time. Self-serve coffee and tea service is appreciated. A densely packed waiting area can lead to the illusion of a longer perceived wait length (Wandersman and Hess, 1985). Keep the waiting area free of clutter with large seating and space between seating when possible.

At times even the most punctual audiologist will encounter unfore-seen events resulting in a clinic running behind schedule. Train your front desk staff to acknowledge the patient by name within five min-utes of the scheduled appointment time, and inform him or her that

the audiologist is aware that they are waiting, “Thank you for your patience, Mr. Jones. The audiologist is aware that you are here and will be with you as quickly as possible. I apologize for the delay.” Patients may have difficulty tolerating a wait of an undetermined length of time (Wandersman and Hess, 1985; Leebov, 2008). If the front desk is aware that the audiologist is running 15 or 20 minutes behind schedule, notifying the patient of the expected delay is appreciated. If the patient relies on others for transportation, invite the patient to borrow a phone to contact a driver for notification. When possi-ble and not in violation of the privacy of your other patients, providing a reason for the delay is appreci-ated (Leebov, 2008). An explanation such as, “I apologize for the delay. The computer system has required some maintenance today,” can foster understanding and patience.

Patients often have more toler-ance for waiting when they feel they are “in process” (Leebov, 2008). Provide patients scheduled for an audiogram with a hearing history form to be collected when finished. Hearing aid consultations can complete a questionnaire to assess areas of listening difficulty and amplification goals. Those scheduled for hearing aid checks can complete forms to indicate the problem with the device. If space permits, have the patient roomed in an appoint-ment area rather than the lobby. If a patient is roomed, instruct support staff to periodically check on the patient to ensure that the patient does not feel “forgotten.”

Apologize! Regardless of fault for the wait, always apologize to patients for the delay and thank them for their patience. Patients are less distressed by the inconvenience when they feel you genuinely care and respect their

time (Leebov, 2008). If possible, vali-date parking or provide coffee cards or hearing aid batteries as tokens of acknowledgement for the inconve-nience. Looking the patient in the eye and providing a sincere apology is always appreciated.

Brenna Carroll, AuD, is a clinical audiologist at Swedish Medical Center in Issaquah, WA. She also participated in the Academy’s 2010 Jerger Future Leaders of Audiology Conference ( JFLAC) and is currently the cochair of the Academy’s BEST Committee.

Illustration by Johanna van der Sterre.

References

Leebov W. (2008) Physician Entrepreneurs: The Quality Patient Experience: Improve Outcomes, Boost Quality Scores, and Increase Revenue. Marblehead: HCPro.

Wandersman A, Hess R. (1985) Beyond the Individual: Environmental Approaches and Prevention. New York: Haworth Press.


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a udiologists have a unique opportunity in the early identification and evaluation of equilib-rium function in infants and young children.

Especially for those with known congenital sensorineural (SNHL) hearing loss. The global acceptance and success of early neonatal hearing testing has also significantly improved our ability to identify infants at risk for equi-librium dysfunction, due to the comorbidities of hearing loss and vestibular dysfunction. It is estimated that over 500 syndromes and nonsyndromes are known to have an audiovestibular expressivity. Recent investigators have reported as high as 90 percent abnormal vestibular-evoked myogenic potential (VEMP) responses in children with congenital SNHL hearing loss. The emerging use of neonate and infant VEMP data suggests a much higher incidence of vestibular dysfunction than the 30–50 percent previously estimated (Kelsch et al, 2006; Picciotti et al, 2007; Sheykholesami et al, 2005; Zhou et al 2009). Several recent studies are presented in TABLE 1. We recog-nize the importance of normal hearing for acquisition of

speech and language. Intact vestibular function is just as critical to the infant’s physical and motor development as is normal hearing for speech and language acquisition.

A child has an audiovestibular system, not just an auditory system. Congenital or acquired deficits can affect all or part of this system. The peripheral end organ of the vestibular system is actually the first sensory system to develop; it precedes cochlear development (the phylogenic development of the cochlea follows that of the saccule) and is developed by 49 days’ gestation. The neural connections with the central pathways continue to develop through the eighth month of gestation (Wiener-Vacher, 2008).

The majority of equilibrium problems in infants and children manifest as balance problems not as vertigo or dizziness. Delayed maturational motor milestones typically evidence the equilibrium dysfunction. It is important to ask the parents about the child’s motor development timeline as well as to make your own observations. Possible indicators of peripheral-central vestibular dysfunction may include the infant’s ability to hold his or her head upright, crawl, stand, and then walk. Benign paroxysmal vertigo of infancy (not to be confused with BPPV), a classification of migraine, is the condition

An understanding of the vestibular system’s role in postural and motor coordination performance can serve as an invaluable contribution for early identification and intervention.

Equilibrium-Vestibular Assessment

— for —Infants

By RiChARD GAns

TABLE 1. Review of Pediatric VEMP Studies

investigators study

Zhou et al, 2009 21/23 (91 percent) SNHL had abnormal amplitudes

Picciotti et al, 2007 3–15 years old

Kelsch et al, 2006 3–11 years old

Sheykholesami et al, 2005

Neonates


Equilibr ium-Vestibular Assessment for infants

most likely to produce symptoms of vertigo in children (Gans, 2002).

Although numerous investigators and authors have reported vestibular evaluation techniques and norms for children, these studies have primarily focused on the application and adaptation of adult tests, that is, VNG, computerized dynamic posturography, and rotary chair (O’Reilly et al, 2011; Valente, 2007; Weiss and Phillips, 2006). Typically children in these studies have been five years of age or older, with the exception of the new normative VEMP data with age ranges from three months through the teen years. The purpose of this article is to provide the reader with an overview of the most common causes of pediatric vestibular dysfunction, a review of common causes, and a discussion of clinical and behav-ioral assessment tools that have both good sensitivity to underlying vestibular deficits and can be easily per-formed without the obstacles of technology or cost.

causes of pediatric equilibrium—Vestibular dysfunction

congenital and acquiredFIGURE 1 outlines common causes of vestibular dysfunc-tion in the pediatric population, both congenital and acquired. It is important to remember that the majority of causes result in overall equilibrium dysfunction second-ary to bilateral loss or dysfunction rather than acquired unilateral dysfunction resulting in vertigo or dizziness as is the case with adult-onset vestibular disorders.

Congenital disorders by far are the leading cause of pediatric vestibular dysfunction (Pikus, 2002). Syndromes with known and unspecified expressivity can be found in

FIGURE 1. Common causes of pediatric vestibular dysfunction.

migraine congenital trauma

otitis media syndromes Non-syndromal

> Guatemalan children with hearing loss are

screened for vestibular problems.

> Dr. Patricia Castellanos

Munoz conducts a balance screening.

< Ronald McDonald helps Dr. Munoz make the screening fun.



TABLE 2. A brief description of each syndrome is presented in TABLE 3 to better familiarize the reader with common expressivities associated with the conditions. It has been well established that audiovestibular anomalies are the most frequently found defect across all known mitochon-drial diseases. In addition, there are nearly 70 identified different nonsyndromic loci for hereditary audioves-tibular impairment. Of these, at least 30 are dominantly inherited, which means that hearing loss may not be consistently seen. So, if there were no failure of a high-risk hearing screening at birth but only the vestibular symptoms, the vestibular loss would probably be missed. Autosomal recessive disorders in the nonsyndromic cat-egory account for over two dozen loci.

Acquired conditions may include benign paroxys-mal vertigo of childhood, which is the leading cause of pediatric dizziness. It could be argued that since this is a migraine variant that it is actually genetic. As its onset usually occurs between ages one and four, it affects the infant by the age he or she is independently ambulating, and there are no prior developmental delays to forewarn of future occurrences. Head trauma can cause the same form of BPPV as seen in adults. This is usually seen, however, in older children who are involved in sports or activities where they are susceptible to even minor head bumps playing soccer or contact sports. Of great concern, particularly in emerging economies, is overdosing with aminoglycosides for treatment of bacterial infections in infants and young children (Koyuncu et al, 1999). This has become a growing problem and is presently being addressed by a joint effort between the World Health Organization (WHO) and the AAO-HNS Foundation.

Dr. Paty Castellanos Munoz, a well-known audiolo-gist in Guatemala, has added a vestibular screening

TABLE 3. Description of Syndromes Affecting Audiovestibular System

Usher Type I—Congenital-bilateral profound SNHL, retinitis pig-mentosa. Type II—Mild-severe progressive high-frequency SNHL.

Branchiootorenal Preauricular pits or tags, bran-chial cysts, hearing loss, and /or abnormal development of the kidneys.

Pendred Congenital, severe-profound SNHL, abnormality of bony labyrinth. Abnormal thyroid development with goiter in early puberty or adulthood.

Neurofibromatosis Type 2 (NF2)

Bilateral vestibular schwano-mas, tinnitus, hearing loss and balance dysfunction. Schwanomas of other periph-eral nerves, meningiomas, and juvenile cataract.

Waardenburg Congenital SNHL, pigmentary disturbances of iris, hair, skin. Vestibular disturbances without hearing loss.

Von Hippel-Lindau Hemangioblastomas of brain, spinal cord, and retina. Renal cysts and renal cell carcinoma (40 percent). Dizziness/imbal-ance and hearing loss may be initial symptoms, may mimic Ménière’s.

CHARGE Coloboma-heart-atresia-retarded-genital-ear. Vestibular symptoms prevalent.

Marshall Saddle nose, myopia, early-onset cataracts and short stature. Vestibular symptoms prevalent.

Spinocerebellar ataxia

Complex and progressive. Twenty-three distinct genetic disorders. May also include hearing loss.

TABLE 2. Syndromes with Vestibular Expressivity

Known unspecified

Usher Waardenburg

Branchiootorenal Von Hippel-Lindau

Pendred

Neurofibromatosis Type 2 (NF2)

CHARGE

Marshall

Spinocerebellar ataxia



component, in collaboration with myself, to her ongoing humanitarian audiological care in the testing and fitting of hearing aids to children. The project is conducted at

McDonald’s restaurants throughout Guatemala (pictured in the photos on page 24). Balance function testing has now been collected on over 1,000 children with sensori-neural hearing loss. This represents the largest study of this type to be conducted and the data will soon be avail-able for publication.

Behavioral assessment techniquesJust as with auditory testing, there is an array of clini-cal–behavioral tests available. These are age specific

with normative data in the form of maturational motor milestones as shown in TABLE 4 (Viholainen et al, 2006). A good case history is essential in speak-ing with the parents and asking about when these milestones were achieved. Likewise spending some informal time observing the infant, on a mat, play-ing can provide a great deal of valuable information. Just as we do with hearing testing, much of the evaluation is child directed. Evaluations can be accurately conducted as early as three months of age with neonates who are suspected of

congenital hearing loss. Three months of age is prefer-able because time is needed for the neck musculature to mature enough that the child can begin to hold his or her own head upright. Ideally, as there are three distinct ves-tibular reflexes, one or more or preferably all three may be evaluated even with behavioral techniques: vestibuloc-ular (VOR), vestibulospinal (VSR), and vestibulocolic (VCR).

TABLE 4. Summary of Maturational Motor Milestones

3 months 7 months 9 months 12 months 24 months

� Raises head and chest when lying on stomach

� Starts to use eyes and hands in coordination

� Begins to support head

� Pushes down with legs when feet placed on floor

� Moves eyes in all directions

� Sits with and then without support of hands

� Supports weight on legs

� Ability to track moving objects improves

� Rolls over

� Supports head when sitting

� Crawling on hands and knees

� Walking with assistance

� Upper body—turns from sitting to crawling position

� Sits without assistance

� Crawls forward on belly by pulling with arms and pushing with legs

� Creeps on hands and knees and supports trunk

� Pulls self up to standing position

� Walks holding on to furniture

� Stands momen-tarily without support

� Walks alone by 18 months

� Begins to run

� Can push a wheeled toy

The majority of equilibrium problems in infants and children manifest as balance problems not as vertigo or dizziness.



The best test of the VCR is arguably the VEMP, which is an electrophysiological assessment tool.

physiology of equilibrium—Vestibular reflexes

Vestibular signals interact in a complex manner with other systems to produce a number of pos-tural reflexes. The cerebellum appears to play a key role in these interactions which can involve limb and neck proprioception, touch, vision and descending cortical influences relayed to the vestibular complex primarily via the reticular formation. The various sensory modalities inter-act to provide information to the posture control system from three frames of reference. These are: (1) proprioception, the sense of position and movement of one part of the body relative to another, via muscle, joint, tactile and visual receptors; (2) exteroception, the relationship of objects in the environment to each other, via primarily visual and tactile inputs; (3) expro-prioception, or information about the body parts relative to the external environment, from all types of sensory receptors. Because the vestibu-lar system subserves a purely exproprioceptive sense that reports velocity and acceleration of the head relative to gravity and inertia, it is especially useful in correcting erroneous infor-mation from the other sensory inputs. [Clark, 1985]

Descending pathways responsible for postural reflexes include the vestibulospinal and reticulospinal tracts. Both receive signals from the vestibular end organ, and both are strongly influenced by cerebellar efferents. Descending motor control of the neck musculature is more closely linked to the vestibular end organ and to the semicircular canals. Limb muscle reflexes are more closely linked to input from several sensory systems.

Lifting the child in space or changing the child’s position while on a variety of movable surfaces can test righting reflexes and equilibrium responses. An example of this can be seen in FIGURE 2. The three-month-old is placed on a physioball, a dynamic surface. The infant’s head and torso remain stable and centered even when he is pertubated in any direction. Lateral tilt, for example, activates utricular receptors, which in turn excite ves-tibulospinal neurons and influence the activity of limb muscles. Age guidelines for head righting, equilibrium

FIGURE 2. Placing infant on physioball creates a vestibular response.

FIGURE 3. Righting response places the infant toward the ground.

FIGURE 4. Infant produces an upward head turn as part of the intact vestibular righting reflex.



responses, and other postural reactions, which are depen-dent, at least in part, on vestibular processing, have been documented by many developmental researchers, and are well known to therapists who work in pediatrics.

Another clinical observation relates to the presence of tonic neck postures. Problems in integration of tonic neck reflexes may implicate related vestibular dysfunc-tion because labyrinthine receptors indicate body position only in conjunction with neck receptors. FIGURE 3 and FIGURE 4 show a righting response. This four-month-old is comfortably and safely placed on his mother’s lap. The infant is then gently pointed downward. As can be seen in FIGURE 4, there is a clear upturn of the head away from the floor. Muscle tone is another important aspect within the evaluation, as it is closely associated with the integrity of the vestibular system. Loss of vestibular input may result in prolonged muscular debility that may even extend to the visceral muscles.

The visual observation of optokinetic nystagmus (OKN) utilizing a rotating drum, which fills the infant’s visual field (at least 80 percent) is also an excellent method of assessing the VOR. It has been demonstrated that its appearance is as early as one month, and it is nicely developed at three months of age. Conditions where there is a bilateral vestibular dysfunction (BVD) will not produce a binocular bidirectional response. In those cases where there may be a noncompensated unilateral vestibular dysfunction, it will be asymmetrical with no or reduced response with the moving stimuli in the direc-tion of the involved labyrinth. It is my experience that it is rare to see infants or young children with noncompen-sated BVD secondary to an acquired otologic lesion.

triageInfants with vestibular, equilibrium, and delayed matu-rational motor control disorders can now be identified at an earlier age, thanks to the success of newborn hearing screening. Unlike older children or adults with acquired unilateral vestibular deficits, these infants with BVD will not benefit from traditional vestibular rehabilitation strat-egies. They will benefit, however, from ongoing sensory integration, substitution, and conditioning therapy with trained pediatric physical and occupational therapists. The knowledge of the status of vestibular modality will provide the therapists with valuable information about therapy protocols and ultimately the child’s prognosis over time. Although it does require at least two intact sen-sory modalities to produce normal equilibrium function, this early therapy jump-start will be critical in providing

them with a more normal and active lifestyle during their formative years.

conclusionIt is well documented that the audiovestibular system in infants is just as susceptible to vestibular as to hear-ing deficits. Audiologists can play an important role in the early identification of infants, especially those with hearing loss, who may be at risk for balance problems as well. Young infants, with the exception of VEMP test-ing, are not candidates for VNG, posturography, or rotary chair examinations, even if the technology were available. Therefore, an understanding of the vestibular system’s role in postural and motor coordination performance can serve as an invaluable contribution for early identification and intervention.

Richard Gans, PhD, is the executive director at The American Institute of Balance, in Largo, FL.

References

Clark DL. (1985) The vestibular system: an overview of structure and function. Ottenbacher KJ, Short MA, eds. Vestibular Processing Dysfunction in Children. New York: Haworth.

Gans RE. (2002) Classification of audiovestibular symptoms related to migraine, part 3: benign paroxysmal vertigo of childhood (BPVC). Hear Rev 36:38.

Kelsch TA, Schaefer LA, Esquivel CR. (2006) Vestibular evoked myogenic potentials in young children: test parameters and normative data. Laryngoscope 116(6):895–900.

Koyuncu M, Saka MM, Tanyeri Y, Sesen T, Ünal R, Tekat A, Yilmaz F. (1999) Effects of otitis media with effusion on the vestibular system in children. Otolaryngol Head Neck Surg 120(1):117–121.

ALSO OF INTEREST“Vestibular Learning Manual: Interview with Bre Lynn Myers, AuD.” Scan the QR code to view this interview on your mobile device.



O’Reilly RC, Greywoode J, Morlet T, Miller F, Henley J, Church C, Campbell J, Beaman J, Cox AM, Zwicky E, Bean C, Falcheck S. (2011) Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surg 144(2):142–148.

Picciotti PM, Fiorita A, DiNardo W, Calò L, Scarano E, Paludetti G. (2007) Vestibular evoked myogenic potentials in children. Int J Pediatr Otorhinolaryngol 71:29–33.

Pikus A. (2002) Heritable vestibular disorders. In: Gans RE, ed. Vestibular Diagnosis and Rehabilitation: Science and Clinical Applications. Semin Hear 23(2):129–142.

Sheykholesami K, Kaga K, Megerian, CA. Arnold JE. (2005) Vestibular-evoked myogenic potentials in infancy and early childhood. Laryngoscope 115:1440–1444.

Valente M. (2007) Maturational effects of the vestibular system: a study of rotary chair, computerized dynamic posturography, and vestibular evoked myogenic potentials with children. J Am Acad Audiol 18(6):461–481.

Viholainen H, Ahonen T, Cantell M, Tolvanen A, Lyytinen H. (2006) The early motor milestones in infancy and later motor skills in toddlers: a structural equation model of motor development. Phys Occup Ther Pediatr 26(1/2):91–108.

Weiss AH, Phillips JO. (2006) Congenital and compensated vestibular dysfunction in childhood: an overlooked entity. J Child Neurol 21(7):572–579.

Wiener-Vacher SR. (2008) Vestibular disorders in children. Int J Audiol 47(9):578–583.

Zhou G, Kenna MA, Stevens K, Licameli G. (2009) Assessment of saccular function in children with sensorineural hearing loss. Otolaryngol Head Neck Surg 135(1):40–44.

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The IndependenT hearIng aId

FITTIng F rum:

a 20-Year retrospectiveBy DEnnis VAn VliET

It became clear very early on in the process that we needed to address more than amplification parameter adjustment if we were going to develop something that would address the full scope of our collective concerns.


Hearing aid manufacturing processes and the products available in the market were changing. Component miniaturization and digital control of analog circuits had evolved to the point that digitally programmable hearing aids were commonplace, and digital processing hear-ing aids were on the near horizon. The flexibility offered by the digital controls allowed manufacturers to bring hearing aids to market with a much wider array of ampli-fication parameter controls than ever before. Audiologists were offered proprietary protocols for fitting hearing aids by the manufacturers, but little independent guidance on fitting hearing aids with the expanded control capabilities was available for the everyday clinician.

This situation was frustrating for clinicians interested in taking full advantage of the programming features in the hearing aids. As I discussed my personal frustra-tion on this topic with colleagues, it was clear that others shared my concerns. Michael Marion and I had experience in professional meeting organization and decided that we might be able to bring together a representative group of experts who could discuss and better define the issue, and develop a strategy to resolve some of the concerns.

I started contacting professional acquaintances with expertise in hearing aids and asking for volunteer partici-pation in an independent group to study the problem. The

“I” stands for independent in Independent Hearing Aid Fitting Forum (IHAFF), and true to that spirit, most of the costs for travel and associated expenses were absorbed by the members. However, some additional support was necessary to underwrite the effort. Michael Marion was able to obtain funding from a variety of hearing aid and related manufacturers to cover additional costs. Not knowing what, if any, outcome or product would come of the efforts, he could only describe what our concerns were and that we would develop a plan of action in the process of our proceedings, and he was able to get enough commitments to balance our small budget.

The initial meeting was to establish agreement on concerns, determine expertise and topical interests of the participants, and discuss what additions to participants might be needed. Subsequent periodic meetings of the

he hearing aid industry was changing in 1992. The u.S. economy was climbing out of a two-year economic downturn, and we didn’t know it at the time, but hearing aid sales were heading into a two-year decline, likely the result of the preceding financial turmoil and press coverage of the Fda’s crackdown on alleged misleading claims about hearing aid performance by hearing aid manufacturers in the spring of 1993.


The independent hear ing Aid Fitt ing Forum: A 20-year Retrospective

group looked at a broad array of topics related not only to fitting parameters but also to the full scope of rehabilita-tive treatment for hearing loss that included pre-fitting assessment requirements as well as postfitting verifica-tion and validation.

It became clear very early on in the process that we needed to address more than amplification parameter adjustment if we were going to develop something that would address the full scope of our collective concerns. Trying to chair meetings of enthusiastic and passionate professionals was not easy, but eventually we were able to establish a sense of where each of us could offer clinical, research, academic, or rehabilitative perspectives, and we proceeded to discuss our common concerns and what, if anything, might be done about it.

The early 1990s was a time that e-mail was in a growth curve but by no means ubiquitous. We called each other, sent faxes to members who had fax machines, and sent out documents and floppy disks by mail. We had trouble merging documents because several of us used different and incompatible word processing programs. When we held face-to-face meetings, we left a wake of coffee stains and input-output curves sketched on napkins and table-cloths, and carried home our assignments scratched out on hotel-provided notepaper.

Meetings were serious, sometimes contentious, and taxing. We learned that some of us simply stopped think-ing at 5:00 pm, and others couldn’t turn it off and would continue discussing thorny problems for hours. We would often end a weekend meeting feeling disorganized and wondering how we would even write up a summary, only to have someone such as Robyn Cox come to the next meeting with an elegant solution to the biggest problem we had faced at the prior meeting. We all learned a tre-mendous amount from each other.

What eventually emerged from the group was the idea that a comprehensive protocol for fitting nonlin-ear hearing aids would have value, and we set about to assemble the essential components. A key, but untested, assumption was that an optimal hearing aid fitting would result from amplification that restored normal loudness relationships. This would require suprathreshold mea-sures of loudness in the pre-fitting assessment. There was much discussion about compression parameters and how to determine what compression ratios, kneepoints, and output limiting would be appropriate for an individual patient. From ongoing research in her lab, Robyn Cox con-tributed the visual input output locator algorithm (VIOLA), which automated the loudness judgment procedure and provided a visual display that facilitated the clinician’s

First Meeting and Participants

Our first meeting was in the spring of 1993 at an airport hotel in Denver, Colorado. At that meeting, or soon after, the IHAFF members participating in the initial effort were:

Lu Beck

Ruth Bentler

Robyn Cox

David Fabry

Gail Gudmundsen

David Hawkins

Mead Killion

Michael Marion

Gus Mueller

Larry Revit

Michael Valente

Dennis Van Vliet

(Margo Skinner and Richard Seewald served as unofficial consultants to the effort.)

Following four subsequent face-to-face meetings in 1993 and 1994, the protocol was presented at the 1994 Jackson Hole Rendezvous in August 1994. Following the 1994 Jackson Hole conference, additional meetings were convened to discuss additional topics of concern. One outcome of those meetings was a special edition of the Journal of the American Academy of Auidology (JAAA) on evidence-based practice. Alison Grimes, Catherine Palmer, and Robert Sweetow joined the IHAFF participants in that effort.


The independent hear ing Aid Fitt ing Forum: A 20-year Retrospective

selection of appropriate com-pression and output limiting parameters.

The IHAFF protocol adopted existing technology and pro-cedures for verification of the fitting parameters including probe microphone measures and aided loudness judgments that have become the standard of care.

A formalized method for vali-dation of benefit was also judged to be an important part of the protocol. Input from the IHAFF group discussions led to the APHAB, an abbrevi-ated version of the profile of hearing aid benefit (PHAB) also from Robyn Cox’s research lab.

The final product introduced at the 1994 Jackson Hole Rendezvous included a software suite including the APHAB and VIOLA programs and a document explain-ing the rationale and basic elements of the protocol. A fundamental goal of the protocol was that amplifica-tion parameters should be set in as wide a bandwidth as possible so that soft sounds would be perceived as soft; loud sounds as loud, but not uncomfortable; and normal conversational sounds as comfortable. Protocol packets were distributed upon request by mail initially. Eventually, the information was made available for download on the Hearing Aid Research Lab Web site.

I’d like to say that the protocol was widely accepted and made an impact on the profession and the fitting of nonlinear hearing aids. That didn’t happen. What did happen was the adoption of the APHAB as a clinical and research tool, and it was accepted that amplification should be adjusted so that it not only meets audibility and loudness comfort criteria but that normal conversational speech should be perceived at a comfortable level.

Following the 1994 Jackson Hole meeting, the group periodically reassembled to renew friendships and to discuss other professional issues of concern. One topic that emerged from those meetings involved evidence-based practice. That effort led to another Jackson Hole Rendezvous meeting in 2004 and a special edition of JAAA in 2005.

Working so closely and collaboratively led to close friendships and a fellowship that we didn’t expect but learned to embrace as time elapsed. From a personal standpoint, I found that I learned and grew personally and professionally beyond any experience I have had in my career, and ended up with lifetime friends that I likely would not have otherwise had the opportunity to make.

Readers who think that the IHAFF effort was simply a hearing aid nerd-fest are invited to check out earTunes for some of the lighter outcomes of the project at www.eartunes.com/ur/audiology-song-104.shtml.

Dennis Van Vliet is senior director of professional relations with Starkey Laboratories in Eden Prairie, MN.

The University of Texas at Dallas’ Callier Center for Communication Dis-orders is accepting nominations for the 2013 Callier Prize in Communica-tion Disorders. The biennial award recognizes individuals whose leader-ship and research contributions have promoted scientific advances and significant developments in the diagnosis and treatment of communica-tion disorders.

The award, which rotates between the fields of audiology and speech-language pathology, includes a $10,000 prize. Nominees for the 2013 Callier Prize should represent researchers in hearing/audiology.

The winner will be announced in March 2012 and will receive the award at a conference in Dallas in spring 2013. The deadline for nomina-tions is Feb. 15, 2012.

To nominate an individual, send a curriculum vita (or personal website) and a written statement (not to exceed one page) summarizing the nomi-nee’s contributions in the areas of hearing/audiology to Dr. Susan Jerger at [email protected].

Honor Will Recognize Research Contributions in Hearing

NomiNaTioNs soughT For The

2013 Callier Prize:

We needed to address more than amplification parameter adjustment

if we were going to develop something that would address the

full scope of our collective concerns.

Lessons Learned…Audiologist and Mom of a Hearing-Impaired

ChildBy lisA V. ChRisTEnsEn



f or the past nine years, I have practiced only as a pediatric audiologist. I could most likely quote much of the pediatric research involving amplification.

However, what happened nearly five years ago would change everything I knew about pediatric audiology and hearing-impaired children.

During a typical work day in the summer of 2006, I tested a 20-month-old female with a family history of hearing loss. She had been placed in foster care at 12 months of age and had never had an audiological evalua-tion outside of her failed newborn hearing screening. As I had imagined, she was indeed hearing impaired. Earmold impressions were taken, and hearing aids were ordered. I do not remember thinking much about this child that day, only knowing from speaking to the foster mother that the child’s sibling would be in to see me the next week for what I was sure would have a similar outcome.

As with most new identifications of hearing loss, the evaluation and identification are the easiest parts. Now there were two children with limited speech and lan-guage skills and two foster families that must be helped through a process that most scared and intimidated most

So as we settled into

our daily routines

many things became

clear to me—even a

doctorate of audiology

doesn’t prepare you

for raising a hearing-

impaired child.


lessons learned…Audiologist and Mom of a hear ing-impaired Child

biological families. My continual thoughts and feelings through the first few months were of pure frustration. These children had such potential, and I had to figure out a way to make sure their potential was met.

Somewhere along the way I got very attached to this little girl, Ella. It didn’t happen all at once, but I remember going home to my husband and talking to him about this sweet foster child, I had on my caseload at work. Luckily, adoption wasn’t a foreign concept to my husband. My father-in-law was adopted when he was three years old. So when we began to tell our family of our intention to adopt a child it was met with mostly enthusiasm. Even our son, Michael, who was four years old at the time, seemed to enjoy the idea of adopting a sister.

Seems like a great plan, right? A pediatric audiologist decides to adopt one of her patients. Unfortunately, the U.S. Department of Human Services (DHS) didn’t share our enthusiasm. Apparently one of their pet peeves is people “picking out their children.” To make a very long story as short as possible, it was a long 18 months before we found out that Ella would become a part of our family. I now refer to the time lapsed as the very long labor and delivery of my second child.

Two years and two months almost to the day I met Ella, she was delivered to our house for the first time. After all this time waiting, the DHS worker basically just called and asked what time we would be home from work because she will be dropping off Ella on Friday. You would think with such a long time to prepare I would have been organized and well prepared for her arrival, but I wasn’t prepared at all. I remember being in panic mode the entire first month. We had technically lost our sibling preference for the daycare located at my workplace because during the long labor and delivery process my son had started kindergarten. I know I must have looked like a crazy woman when I showed up at the daycare on Monday morning. Luckily her spot was still available. Next, we had to set up services for her; fortunately for us, I happen to know a few speech pathologists.

So as we settled into our daily routines many things became clear to me—even a doctorate of audiology doesn’t prepare you for raising a hearing-impaired child. First of all, hearing aids are so easy to lose! I never had much empathy families who lost multiple sets of hearing aids, but I do now. We lost three hearing aids and two FM receivers in the first six months that Ella lived with us! I wish I could say they were lost in pairs, as if the behind-the-ear (BTE) and receiver were lost together but no, they were each lost separately. So while Oprah might say the



iPad is the best invention of the century, I am going to say integrated FM receivers is on the top of my list.

Another thing that I noticed early on with Ella was that each evening she was ready to take off her hearing aids several hours before I would let her. It made me wonder what had been her typical evening routine prior to living with us. I began to speculate that when families were told they needed to achieve “full-time hearing aid use,” they took that to mean a 40 hour work week. Because she removed the hearing aids each evening, there were hours spent without amplification.

Now when I counsel families about hearing aid usage, I borrow the phrase “during all waking hours except when engaged in water activities” from some of my favorite auditory verbal therapists. I also learned that with “full-time usage” comes huge battery drain, especially when you have the FM receiver integrated. Although integrated receivers reduce the parts that can go missing, I quickly became a huge fan of FM receivers that have the capabil-ity of being slipped on and off easily so one can save a little battery life in the evenings and weekends.

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Now when I counsel families about hearing aid usage, I borrow the phrase “during all waking hours except when engaged in water activities” from some of my favorite auditory verbal therapists.



My husband and I love technology. So you can only imagine when a man with a computer degree is married to a woman with an AuD, the hearing-impaired child is well-equipped. Ella has a streamer and all the other gadgets that we can possibly connect to her hearing aids. However, talking on the phone is still hard for her, and her television is always at top volume when we do not use her streamer. I honestly thought these wouldn’t be

issues for a six-year-old child with a moderate-to-severe hearing loss, but I quickly discovered these situations are still difficult for her without all the extra technol-ogy. I once believed we should make things as simple as possible for families, but now I know that we have to push for all families to embrace the technology we have available to us.

One of the most eye-opening things for me is being able to talk to other parents of hearing-impaired children. Many of these parents do open up to each other, as well as my family, when we are in small groups together. The question they most often ask me is “Do you really make Ella wear her hearing aids?” Being in my unique situa-tion, I know what happens when children do not wear their hearing aids. I am always honest with those families and explain the consequences of unaided hearing loss to them. At this point, the first thing Ella does when she wakes up in the morning is put on her hearing aids. It is

our last task at night to take them out and put them away. I am not naïve enough to think that we will never have a problem during our preteen and teenage years, but for now she realizes the importance of wearing them even if it’s only because she cannot hear her Nintendo DSi or her television without her aids.

Another question families ask me is “Do you use sign language with Ella?” During my undergraduate degree, I minored in sign language studies and have many cul-turally Deaf friends. However, we do not sign with Ella. Several months ago, Ella asked how people who couldn’t talk communicated with each other. I told her about sign-ing, and she asks me every once in a while what the sign is for some random word. I really have no oppositions to teaching her sign language, it is just not a priority for us right now. I often wonder if maybe it should be as she gets older and classes become more of a lecture format. Like every parent, we want everything possible to help her succeed in life. But for now, her language skills are age-appropriate, and her articulation skills are improving every day.

Raising a hearing-impaired child takes a village. I found myself in audiology because my grandfather was hard of hearing due to an accident in his 20s. He always wore hearing aids, and I was always fascinated by them as a child. But even with this extended family experience with hearing loss, I still had to explain hearing loss to all of our extended family. Everyone that had some sort of possibility of staying with Ella without my husband or I had to be capable of putting hearing aids on her and changing batteries in the beginning. This is also true of Ella’s daycare. Educating Ella’s other caregivers is easy for me because I am an audiologist, but I can only imagine how overwhelming this would be for a grieving nonaudi-ologist parent.

Since I mentioned overwhelming, let me tell you some newfound dislikes: water parks, swimming pools, bath time, bedtime, and those huge warehouses filled with inflatables, just to name just a few. I guess you can all see a theme here: water activities and time without hearing

ALSO OF INTEREST“Pediatric Audiology: Interview with Anne Marie Tharpe, PhD.” Scan the QR code to view this interview on you mobile device.

Most older adults with

hearing aids strike up

a conversation with

Ella and then they

show off their hearing

aids to each other.



aids. Ella just turned seven years old and wants to take showers instead of baths because she thinks showers are a seven-year-old thing to do. If you have seen the movie Christmas Vacation you are familiar with Aunt Bethany and Uncle Lewis; every shower I play the part of Uncle Lewis shouting “The Blessing!” and she is Aunt Bethany, attempting to understand. The experience is extremely frustrating for both of us, just like trying to talk to her from across the swimming pool during the summer.

The worst situation is when we are separated by a distance in water parks, but that experience is closely followed by speaking at a distance in a crowd or in poor acoustics. Even with a loudspeaker calling out her name in the carpool line at school, her brother still has to go tap her on the shoulder to get her attention each day. I will say some of her inattention in the carpool line might have to do with her chatting with friends; last year in kindergarten she knew where every child’s parent in her class worked.

People are so curious when they see a young child wearing hearing aids. Most older adults with hearing aids

The Department of Hearing and Speech Sciences in the Vanderbilt Bill Wilkerson Center at the Vanderbilt University Medical Center in Nashville, Tennessee is seeking an experienced candidate for a faculty position with emphasis in the area of psychoacoustics. Applicants should have a Ph.D. in hearing science, psychology, or related disciplines (e.g., audiology, neuroscience).

Responsibilities with this open rank position focus on maintaining an active research program in one or more areas of psychoacoustics and working with graduate (primarily PhD) students. The successful candidate should have an established record of extramurally-funded basic/applied research and peer-reviewed publications, accompanied by a record of experience in teaching and supervising graduate student research. Numerous opportunities for collaboration are available within Vanderbilt University as well as within the university’s highly-ranked Department of Otolaryngology, the Vanderbilt Brain Institute, Neuroscience Program, Vanderbilt University Institute for Imaging Sciences, and the Vanderbilt Kennedy Center.

Vanderbilt’s Department of Hearing and Speech Sciences is CAA accredited, with the Audiology and Speech-Language

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Applicants should submit a letter of interest (including area of expertise and research focus) and curriculum vitae to: Linda J. Hood, PhD, Professor and Search Committee Chair, Vanderbilt Bill Wilkerson Center, Department of Hearing and Speech Sciences, 1215 21st Avenue South, Nashville, TN 37232. This position will remain open until the appropriate candidate is identified. For more information contact Dr. Hood at [email protected] or visit the website below.

www.vanderbiltbillwilkersoncenter.com

Vanderbilt is an equal opportunity, affirmative action employer.



strike up a conversation with Ella and then they show off their hearing aids to each other. This is way too much fun for me seeing random strangers actually being a little excited about wearing hearing aids! Ella loves to talk to adults with hearing aids. She has a hard time under-standing why they didn’t choose a prettier color for their hearing aids like pink or red. Ella loves having colorful BTEs and earmolds. I once counseled parents to get the beige BTE and then change the colors on the earmolds, but now I second guess that recommendation because of Ella’s love of the colors. I really do think if she couldn’t pick that out, it would be harder to get her motivated to wear them.

The negative side of random strangers noticing her hearing aids is the occasional look of pity, that Southern

“Bless her heart” look followed by a hand over the heart. Some people we encounter give her things or let us move in front of them in line and all sorts of other crazy

things, which I hate. Ella, being the princess of our family, loves it. At her previous school, people ran to our car in the morning to help her up on the curb. It took several months of telling people it’s her ears and not her feet that have the problem.

Ella also loves to find other children wearing hear-ing aids. She really wanted to see Spy Kids 4D because the boy wore blue hearing aids. She loved the movie but then later saw the boy actor in an interview on television and noticed he wasn’t wearing his hearing aids. She was disappointed to learn he didn’t actually wear hearing aids. Another time she noticed a boy wearing hearing aids dur-ing a parade in Disney World two years ago, and of course we spoke to him. Have I mentioned that Ella has never met anyone she considers to be a stranger? That might be a foster care side-effect, but now that we have established some safety rules for it, I think it has helped her be much more assertive and at the end of the day I want her to become her own best advocate.

If you ask my husband the biggest thing he’s learned, he will say he was astonished that on a daily basis at Ella’s former school no one even knew how to change a battery, let alone troubleshoot any other hearing aid problem. This experience was probably one of the biggest reasons I can now say “former” school. We moved to a new house for this school year in a district with a full-time educational audiologist. This is a rarity in our state, and the differences have been astonishing from the first day. A very wise speech pathologist told me that I needed to teach Ella how to put on her own hearing aids prior to kindergarten. That might have been the best advice we were given, and I actually took it a step further and taught my son how to put her hearing aids on her and how to change her batteries, so that at least one person in the building would be able to do these things. This year in first grade, Ella is also responsible for changing her own batteries, and even though we have an educational audiologist now, I think it makes Ella proud that she can handle it.

So now that we are on track with normal language, progressing articulation, and an excellent educational placement, what’s left? Well, there are things that still keep me up at night. I have mentioned my dislike of the pity we receive from strangers. Even though this is rare for us, it still makes me wonder what her future will be like. Have we progressed from the idea that hearing aid users are less intelligent, less personable, less attractive, and less likely to achieve over individuals not wearing hearing aids that Blood et al, described in 1977?

A picture drawn of Ella drawn by a

classmate, maybe a future audiologist.


I hope so, and here is some hope from an unpublished doctoral project from Ward et al: A survey was designed and given to 101 University of Southern Mississippi col-lege students to rate photographs of an individual in four conditions: No device; behind-the-ear hearing aid; iPod; and Bluetooth device. Subjects ranked each photograph on a 1–5 scale based on six factors: (1) attractiveness, (2) intelligence, (3) appearance, (4) awareness, (5) sociability, and (6) employability. The primary purpose of this study was to determine if perceptions have changed.

Although the “No Device” condition did not lose to any other device, there is strong evidence that perceptions have changed regarding individuals who wear hearing aids. The hearing aid condition won seven times and tied six times with other devices. This research gives me hope that people will look at my child with all the hope and possibility they see in everyone else.

The other thing I spend time thinking about is funding for hearing aids. Right now, because Ella was adopted from foster care and is classified as “special needs” under Arkansas law, she will continue to keep her Arkansas Medicaid until she is 18 years old. Since Arkansas Medicaid provides hearing aids for children, we are set with amplification until she turns 18 years old. But what happens then? Luckily for us, if she stays in Arkansas, we have Act 1179 that mandates private insurance compa-nies offer hearing aid funding for children and adults. Only two other states, Rhode Island and New Hampshire, have similar coverage. There are 16 states that mandate private insurance coverage for children only. I know there are currently bigger concerns and controversies in our profession, but I still have to worry about how she will stay in the best technology into her adult life.

Reading…need I say more? We all know the research involving hearing-impaired children and literacy—or should I say lack of literacy at times? First graders spend a large portion of their year learning to spell, and now my evenings are spent researching methods to teach spelling words. If you would have told me even three months ago that my PubMed searches would include the Theodore Clymer versus the Stephen Stall research on teaching spelling, I would have laughed and continued my bone-anchored implant searches. Once again, I realize the lessons I’ve learned from having Ella in my life have barely begun.

A final concern for me is H.R. 2140, which would pro-vide direct access to audiology. This is such a key piece of legislation right now for all of us. I know Ella is far away from the days of Medicare, but her hearing loss is a

lifetime disability, and I need to do everything I can now to help her for a lifetime.

It’s pretty hard to hide a pair of bright red hearing aids with a red blinking light, not that Ella wants to hide them; she thinks the red light is the most beautiful thing she’s ever seen. The lights are second only to all those hearing aid stickers she found in her drawer and stuck on every-thing in her room except her hearing aids. Since they are so visible, I hope that other people do take notice and see Ella for what she is: a typical seven-year-old full of life, love, and personality.

Lisa V. Christensen, AuD, is a pediatric audiologist with the Arkansas School for the Deaf in Little Rock, AR. She also participated in the Academy’s 2008 Jerger Future Leaders of Audiology Conference ( JFLAC) and is currently the State Leaders Network Region 8 Captain.

Funding Available for Graduate Students

AAA Foundation ScholarshipsApplicAtion deAdline: April 30

STAR (Student Travel Award Reimbursement) Program GrantsApplicAtion deAdline: July 1

to learn more, visit www.audiologyfoundation.org or call 703-226-1048.



H ong Kong, a group of small islands in the South China Sea, is known as the “Pearl of the Orient.” It was a British colony from 1839 to 1997, and it is

now a special administration region of China. High-rise buildings line the coast and every inch of buildable land. Most of the seven million inhabitants are crowded into approximately 25 percent of the total 1,104 km2. Besides the night lights in the beautiful Victoria Harbor, Hong Kong is also well-known for its vibrant economy, active stock market, expensive real estate, and flavorful food from all over the world.

audiological practicesAlthough audiologic services existed in Hong Kong for quite some time, the field of audiology is relatively young. Between the 1970s and the 1990s, the Hong Kong government funded a scholarship program to send postsecondary school students and university graduates

to one- or two-year audiology programs in England and Australia. The one-year programs produced audiology technicians with a diploma. Graduates were obligated to serve in one of the government agencies or the Education Bureau for three to five years. Graduates from the two-year programs earned their master’s degrees and gained the status of audiologists, who were obligated to serve for three years.

In 1996, the University of Hong Kong established the first and the only audiology program in Hong Kong. The two-year master’s program accepts students every alternate year. Students come from Hong Kong, mainland China, Canada, the Philippines, the United States, and other countries around the world. The audiology pro-gram consists of two academic years of course work and practicum throughout the program. As it is one of the few audiology degree programs in Asia, graduates are often

A HeAring report FromHong Kong


In May 2011, Dr. King Chung and a group of AuD students from Northern Illinois University embarked on a two-week Heart of Hearing research and humanitarian trip to Hong Kong. During their stay, the students toured both a public and a private audiology clinic, observed two otological surgeries, and collaborated with students and faculty in the University of Hong Kong’s Division of Speech and Hearing Sciences to conduct hearing tests for nearly 200 individuals with intellectual, physical, emotional, and/or mental disabilities.

employed in Hong Kong, Taiwan, mainland China, and other surrounding countries.

Currently, there is no licensure examination for audiol-ogists in Hong Kong. The status of audiologist or audiology technician is determined by the degree or diploma that the individual earned. There are approximately 100 audiologists and 20 technicians working in the Hong Kong Hospital Authority, Health Department, Education Bureau, university clinics, private practices, and government- subsidized organizations (such as Hong Kong Society for the Deaf). The scope of practice for audiologists includes:

� audiological evaluation

� electrophysiologic evaluation

� dizziness evaluation

� hearing aid evaluation and fitting

� assistive listening device evaluation and fitting

� cochlear implant evaluation and mapping

� hearing protection device evaluation and fitting

� noise monitoring and noise control

� aural habilitation/rehabilitation and public health education

The scope of practice of audiology technicians is mostly limited to hearing evaluation, hearing aid fitting, making earmolds, and, sometimes, hearing aid repair, depending on the work setting.

By KinG ChunG, AnnA KAM, JEnny ChAn, AnD lEnA WonG


A hearing Report from hong Kong

audiological services in Hong KongHong Kong has an extensive government-run health service system for its residents. Each time a patient goes to see a doctor or a health-care professional in a public hospital, he or she only needs to pay HKD 60 (USD 8) for the registration fee. Hearing services can be obtained in public hospitals for free or in private clinics for a fee. The wait time in the public hospitals is usually very long compared to the private clinics. The whole hearing aid fitting process, for example, can take one to two years in public hospitals, but it can be achieved within two weeks in private clinics. The speed of service in public hospitals also differs between adults and children; the latter usu-ally can obtain hearing aid services within three months of hearing loss identification.

adult audiological servicesIf adults suspect that they have a hearing problem, they can choose to see a general practitioner in a private practice or at one of the local public clinics. The general doctor would then refer them to a specialist, an ear, nose, and throat (ENT) doctor. If the person chooses to see an ENT in the public health-care system, the wait is usually six months, although the waiting time for urgent medi-cal issues such as sudden hearing loss is much shorter. A hearing evaluation is usually performed between the first and second ENT appointment. If there is no other medically correctable condition, the person is referred to an audiologist for hearing aid services at the second ENT appointment. The wait for the first hearing aid appoint-ment can be two to twelve months.

Hong Kong’s public hospital adopted a hearing aid ten-dering system. Every other year, distributors of different hearing aid manufacturers enter their bids, with stipula-tions of whether other hearing aid accessories, such as earmolds, are included in their prices. Each tendering cycle, the Hospital Authority chooses one or two brands of hearing aids in the following five categories: (1) in-the-ear hearing aid; (2) behind-the-ear hearing aid with medium power; (3) behind-the-ear hearing aid with high power; (4) body-worn hearing aid with medium power; and (5) body-worn hearing aid with high power. These hearing aids are recommended to patients in public hospitals. The non-body-worn hearing aids are usually entry-level digi-tal hearing aids that cost less than HKD 1500 per hearing aid (<USD 200). The whole public hospital system does not offer open-fit hearing aids.

During the first audiology appointment for hearing aid services, the audiologist rechecks the patient’s hearing thresholds if (1) the last audiogram showed a conductive hearing loss; (2) the hearing evaluation was performed more than six months ago; or (3) the patient reported a change in hearing. Otherwise, the audiologist goes directly to hearing aid evaluation, in which he or she lets the patient try two different brands of hearing aids. The final hearing aid recommendation depends on outcome measures such as aided hearing thresholds, aided speech recognition, and patient preference. In the case of binau-ral hearing loss, the patient can choose whether he or she wants one or two hearing aids. A hearing aid model and settings are recommended to the patient. An earmold impression is taken for the patient before he or she is sent to the hearing aid distributor of the recommended brand to purchase the hearing aid(s).

The patient then returns in one to three months for the second audiology appointment to obtain the

The NIU group toured the famous Victoria Peak and enjoyed the night lights of Victoria Harbor. From left: Alyssa Pursley, Perrine Pham, Dr. King Chung, Brittany Camillo, Joanna Ripstein.

NIU and HKU students teamed up to test the hearing of a wheelchair-bound individual in the residence hall for adults with disabilities. From left: Ms. Ngon Hung Chan (a staff member), a resident (in the wheelchair), Jessie Poon, Loretta Ho, Perrine.



earmold(s) and hearing aid(s). During this appoint-ment, the audiologist fits the earmold, performs real-ear measurement, fine-tunes the hearing aid(s) according to patient feedback, and counsels the patient on hearing aid use and maintenance. A third or a fourth follow-up appointment can be made in the following one to three months if needed, but all repairing issues are taken care of by the distributor from then on.

child audiological servicesHong Kong offers universal newborn hearing screen-ing in all public hospitals. Most private hospitals also screen newborns before they leave the hospital. Babies who missed the newborn screening will be screened in Maternal and Child Health Centres when they come back for immunization or health and developmental checkups within three months of birth.

If a child fails the newborn hearing screening, he or she is referred to ENTs in public hospitals. If a child fails the infant screening in Maternal and Child Health Centres, he or she is referred to Child Assessment Services in the Department of Health. The Child Assessment Services carries out diagnostic hearing evaluation as well as multidisciplinary tests for children with suspected or confirmed intellectual or physical disabilities. All chil-dren with confirmed hearing loss would be referred to the Education Bureau for audiological services. The speed of service is usually very quick, and hearing aids can be fit-ted within one month of identification.

Hong Kong offers 12 years of free education for all resi-dents (i.e., from primary 1/first grade to form 6/twelfth grade). Student Health Services in the Department of Health offers a comprehensive screening program for all first-grade students. The screening areas include physi-cal examination, screening for health problems related to growth, nutrition, blood pressure, vision, hearing, the spine, body development, psychological health, and behavior. Students identified with hearing loss are again referred to the Education Bureau for follow-up and hear-ing aid fitting.

The Speech and Hearing Service Section of the Education Bureau provides comprehensive speech and hearing services to children identified with speech and language delays and/or hearing loss. The Education Bureau has its own tendering system, which selects one hearing aid distributor every two to three years. The cur-rent hearing aid is a middle-level digital hearing aid with six channels, with a list price between HKD 7000 and 9000 (≈USD 1050).

Children with identified hearing loss can receive a pair of behind-the-ear hearing aids for free every three years until they finish their whole period of free educa-tion. If they lose the hearing aids, they can go to a police station to report the loss and receive new hearing aids from the Education Bureau. After the hearing aid fitting, children with speech and language delays are referred to receive free speech language intervention and/or aural habilitation.

cochlear implant servicesThree public hospitals offer cochlear implant services. The Hong Kong government currently offers approxi-mately 70 free cochlear implants to these three hospitals each year. Children identified with profound hearing loss are offered hearing aid trials for two to three months by the Education Bureau. If the results are not satisfactory, cochlear implants would be recommended. Adults are usually referred by their ENTs after at least six weeks of hearing aid trial.

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A multidisciplinary team in each hospital meets every three months to discuss potential cochlear implant cases. Priorities are usually given to children and adults with good prognosis (e.g., postlingually deafened adults), although sometimes prelingually deafened adults or chil-dren with intellectual disability may also be selected. No patient with unilateral deafness would be considered. The surgery and the cochlear implant would be free for patients who are responsible for only two to five days of overnight hospital stay fees (i.e., HKD 100/≈USD 15 per night).

As Hong Kong has excellent medical facilities and well-trained physicians, many people from mainland China and other parts of the world seek medical care from private hospitals in Hong Kong. The total fee for one cochlear implant device, the surgery, and the hospital

stay is approximately HKD 230,000–250,000 in private hos-pitals (≈USD 31,000).

Heart of Hearing research and Humanitarian trip to Hong KongOn May 29, 2011, a group of audiology students and a faculty member (Dr. King Chung) from Northern Illinois University (NIU) arrived at the Hong Kong International Airport and started a two-week research and humani-tarian trip in Hong Kong. The three themes of the trip were humanitarian service, professional exchanges, and cultural immersion. Two doctor of audiology students also finished the data collection for their capstone project: prevalence of hearing loss among individuals with special needs in Hong Kong.

The trip started with a series of professional visits and cultural activities. The NIU group toured a public audiology clinic in Prince of Wales Hospital and a private audiol-ogy clinic, The Hearing Clinic (Asia) Limited, owned by Ms. Meilin Poon, an audiologist who obtained her degrees in the United States. These were valuable opportunities for the students to observe different medical practices between the public and private settings in Hong Kong.

Another professional activity was the observation of two otologic surgeries. Dr. Chang performed the first sur-gery on a patient in an advanced stage of otosclerosis at the Alice Ho Nethersole Hospital. Because of recent tight-ening of regulations for operation observations, the NIU group observed through the television in the observation room and took turns observing in the operating room. Dr. Henry Lam, another experienced ENT doctor, spent the afternoon with the group in the observation room and patiently explained the anatomic landmarks, prosthesis characteristics, and surgical procedures. He also men-tioned that patients usually have to wait several years for a surgery in a public hospital because of high demand and limited manpower and resources. A similar surgery can be scheduled almost immediately in a private hospital but will cost close to HKD 100,000 (≈ USD 15,000), which many people in Hong Kong cannot afford.

The second surgery was performed by the head of the academic division of the Department of Otorhinolaryngology, Head and Neck Surgery of the Chinese University of Hong Kong, Dr. Michael Tong. The two-year-old patient was a twin who had been born with congenital deafness along with his twin brother. His parents opted to have the cochlear implant surgery at a private hospital in Hong Kong (Union Hospital) because of better facilities and Dr. Tong’s reputation. The parents are

Play audiometry was conducted if an individual was found to have abnormal middle ear functions or absent otoacoustic emissions in three of the five test frequencies. From left: Gloria Ng, an individual with disability, Brittany.

The NIU and HKU group is halfway through the climb to a drug rehabilitation center for males in a remote part of Hong Kong. Can you see our destination? From left, back row: Chris Li, Gloria, Ada Lo, Anabelle Wong, Brittany; middle row: Dr. King Chung, Alyssa; front row: Perrine, Joanna, Felix Zheng.



in the process of raising money for the other twin to have a cochlear implant in Hong Kong also.

During the operation, the group took turns observ-ing in the operating room, and a representative from the cochlear implant manufacturer explained patient history and the newest features of the device to the NIU group in the waiting room. It was amazing to see that Dr. Tong and the anesthesiologist have such a deep understanding that the child woke up within two minutes of the completion of the surgical and cleaning-up procedures. The observa-tion of both surgeries provided valuable experiences to learn and appreciate the art and sciences of our medical kin, and to gain understanding of the medical services systems in other parts of the world. Both the students and the faculty learned a lot from these rewarding experiences.

For humanitarian service, the NIU group joined forces with students and faculty in the Division of Speech and Hearing Sciences from the University of Hong Kong (HKU) and conducted hearing tests for nearly 200 individuals with intellectual, physical, emotional, and/or mental dis-abilities. One of the locations was a subsidized primary school for students with disabilities, Po Leung Kuk Yu Lee Mo Fan Memorial School at North Point. Hong Kong has approximately 60 schools that enroll students with differ-ent degrees of disabilities. The Education Bureau provides hearing services to students who are identified with hear-ing loss, or hearing screening to students whose parents refer them to Student Health Services in the Department of Health.

In Hong Kong, adults with disabilities are normally taken care of by domestic helpers at home, sent to day activity centers that offer training in self-care and simple work skills, or enrolled in residential halls for individuals with disabilities. No regular hearing service is offered to these individuals by the government, government-subsi-dized organizations, or private organizations. The HKU and NIU group provided hearing tests to adults with disabilities in two day activity centers, Hong Chi Tai Po Centre and Hong Chi Tai Ping Centre, and a residence hall in the New Territories, Hong Chi Fanling Integrative Rehabilitation Complex. During hearing tests, students performed otoscopy (Welch Allyn MacroView), distor-tion product otoacoustic emissions, and tympanometry (EroScan Pro). If no otoacoustic emissions were detected in three of the five test frequencies (i.e., 1000, 2000, 3000, 4000, and 5000 Hz) or the tympanometry revealed middle ear dysfunctions, the individual was lead to another room where play or behavioral observation audiometry was conducted.

The portable audiometers (EarScan 3) were calibrated every three to four days during the trip. The results showed that 62.7 percent of the adults in the day activ-ity centers and the residence hall failed one or more of the following tests: (1) otoscopy (e.g., excessive wax), (2) tympanometry (e.g., Type B tympanograms in two consecutive trials), (3) otoacoustic emissions absent in at least three of the five frequencies tested, and/or (4) play audiometry having thresholds higher than 30 dB HL or behavioral observation audiometry higher than 35 dB HL. Individuals who failed otoacoustic emissions but had thresholds below 30 dB HL or minimal responses below 35 dB HL were counted as “pass.” Among the 35.9 percent of the individuals who passed all tests, about 3.5 percent had Type C tympanograms, which were classi-fied as “monitor” in FIGURE 1. About 21.1 percent of adults had excessive or occluding wax in one or both of their ear canals. Individuals with excessive/occluding ear wax and those with Type B tympanograms were referred to medi-cal follow-up. Referrals were also made to audiologists

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Per

cent

(%)

1009080706050403020100

Pass

MonitorWax PlusWax Only

Adults in Day Centers/Residence

HallN = 142

Special Ed SchoolN = 46

Drug Rehabilitation

CentersN = 54

Fail Pass FailCNT DNT

Pass Fail CNT DNT

if the individual failed play or behavior observation audiometry.

The test results for students enrolled in the special education school gave a very different picture: 59.2 per-cent passed the hearing test, and only 18.4 percent failed. Surprisingly, no student was found to have wax in his or her ear canal sufficient to warrant medical attention (note that cerumen removal is not in the scope of practice of audiologists in Hong Kong). In this school, about 22.4 percent of the students could not be tested; these are typically students with a severe degree of disability, very young students, or students who could not tolerate the probe tips or foam tips in their ear canals.

Besides hearing services, Ms. Jenny Chan gave a seminar on basic hearing health in one of the day activity centers. It was well received by nearly 50 staff members, parents, guardians, and/or family members of adults with disabilities. As the need for hearing services was so great, students and faculty from the University of Hong Kong also went back to one of the day activity centers to provide an extra day of service near the end of summer.

Another underserved population tested consisted of residents in three residential drug rehabilitation centers. Recreational drugs present a tremendous problem in Hong Kong. Many students or young adults are introduced to drugs at very young ages because their friends offer them drugs to try for free the first few times. Once they become addicted, they are slaves to the drugs and often get involved in gang or criminal activities in order to feed their addiction.

Drug rehabilitation centers in Hong Kong often are run by religious or nonprofit organizations that are subsidized by government funds. One of the three centers where HKU and NIU students provided hearing tests was located in a remote part of the New Territories close to the China border. The group needed to travel to a restricted area, take a boat, and then walk a mile and a half uphill to reach the facility. It was surprising to see that some residents were as young as 15 or 16 years old. The centers forbid residents to have any communication with the out-side world for the duration of the stay (approximately 9–12 months). The goal is to help them cut the ties with gangs and other undesirable acquaintances.

In a sharing session with the residents in a drug reha-bilitation center for females, a young lady who was less than 30 years old told her story: She came from a loving family in which her mom and dad took good care of her. She was first introduced to drugs by a friend. After she was addicted, she alienated all of her friends. Gang mem-bers visited her home and threatened to burn her family’s flat (an apartment in a high rise building) because she owed them money. Her family did not trust her to handle any money as they knew she would spend it on drugs. After 14 years of addiction, she was very glad to check into the rehabilitation center and has been drug free since. She hoped to stay away from the gangs and to keep out of drugs when she graduated from the program. Because of her experiences, she wanted to serve people with drug addiction and help them fight their addictions.

A total of 54 residents and approximately 20 staff members were tested in three drug rehabilitation centers. None of the residents had their hearing tested before, and most of them were very interested in knowing whether recreational drugs had affected their hearing. Residents were tested with otoscopy and otoacoustic emissions first. Those who failed two out of five frequencies tested were sent for pure tone audiometry. Fortunately, only two older residents (aged 55 and 60 years) and one younger adult (aged 35 years) were found to have some degree of hearing loss. All other residents had hearing sensitivity within normal limits (FIGURE 1). The prevalence of hearing loss among this group did not exceed that among the general public. As recreational drugs are known to affect brain chemistry and bodily functions, one of the NIU under-graduate students, Alyssa Pursley, will pursue a research study to examine whether recreational drugs would have any long-term effects on speech understanding ability using the U.S. population.

For cultural immersion activities, NIU students and faculty visited local landmarks such as the Victoria Peak,

FIGURE 1. Hearing test results of individuals evaluated during the trip. CNT = could not test; DNT = did not test.


A Hearing Report from Hong Kong

Ocean Park, Repulse Bay, Stanley Market, Hong Kong Science Museum, and a fishing village on Lantau Island. In addition, the NIU group attended one of the most celebrated Chinese festivals, Dragon Boat Festival, at the beautiful Stanley Beach. To understand more about the colonial life, the group also spent one day in Macau, a neighboring city that was previously a Portuguese colony and was subsequently returned to China in 1999.

All the above activities provided precious learning opportunities for all participants. As the NIU students did not have a good command of the Chinese language, they were challenged to think creatively and to collabo-rate with HKU students and audiologists to accomplish the tasks. The HKU students also refined their skills on testing children and adults with disabilities. Through these activities, students widened their scope of clini-cal practices and built connections with professionals from a different part of the world. Listening to the stories, students also gained more understanding of people with different backgrounds and appreciated how fortunate they were. This trip also supported the long-term goals for our summer missions, to eliminate health-care inequality and to facilitate the provision of more frequent and better quality hearing health-care services to underserved popu-lations and individuals with disability around the world.

More information about audiology services can be found at the Hong Kong Audiology Society Web site: www.audiology.org.hk/eng/default.asp.

More information about the Heart of Hearing trip to Hong Kong can be found on www.blurb.com/books/2874903.

King Chung, PhD, is an associate professor of audiology at Northern Illinois University. She leads students on research and humanitarian trips to different countries every summer. Her long-term vision is to facilitate health-care equality and to improve hearing health care for the underserved popula-tions around the world. Dr. Chung’s other research interests and areas of expertise include wind noise reduction strategies and enhancement of hearing aid, cochlear implant, and hearing protector performance.

Anna C.S. Kam, AuD, is an assistant professor in the Department of Otorhinolaryngology, Head and Neck Surgery at the Chinese University of Hong Kong. She is the chairperson of the Continuing Professional Development Board of the Hong Kong Society of Audiology (2011–2014). Her research interests include aural rehabilitation, auditory processing, and tinnitus management.

Jenny Chan, MS, is a clinical supervisor in the Division of Speech and Hearing Sciences in the University of Hong Kong. She has well-rounded clinical and research experiences in differ-ent countries including the United States, Singapore, and Hong Kong. Her research interest is mainly in auditory processing abilities in different age groups and the development of outcome measures in Chinese.

Lena L.N. Wong, PhD, is an associate professor at the University of Hong Kong. Her research interests are outcome measurement and second-language speech perception. For the past 17 years, she has been teaching continuing educa-tion courses for teachers and hearing health-care personnel in Mainland China. Acknowledgments: We would like to thank Drs. Michael Tong and John Woo, who made the observation of the surgeries pos-sible, and Etymotic Research, Oticon Inc. (USA), and members of the NIU Audiology Advisory Board for their generous sup-port of the trip.

Proceeds support programs in audiology research and education.

Lighthouse at the Seaport Hotel Wednesday, March 28

5:30–7:30 pm

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AudiologyNOW! 2012 | Boston, MA

csi: audiology— You Be the detective!By Paul Pessis

w elcome back to an ongoing article series that challenges the audiologist to identify a diagnosis for a case study based on a listing

and explanation of the nonaudiology and audiology test battery. It is important to recognize that a hearing loss or a vestibular issue may be a manifestation of a systemic illness. Being part of the diagnostic and treatment “team” is a crucial role of the audiologist. Securing the definitive diagnosis is not only rewarding for the audiologist but enhances patient hearing and balance health care.

case HistoryA six-year-old female was referred with a complaint of a progressive hearing loss. She was first identified with hearing loss at age three at another facility and was

amplified binaurally. The child was speech and language delayed. The speech pathologist wanted a current hearing evaluation and wanted the child seen by otolaryngology (ENT) due to the child’s speech sounding nasal.

medication and past HistoryThe child was conceived by in-vitro fertilization. She was born at 36 weeks with no complications. She was identi-fied with a bicuspid aortic valve during the first year. The child is short for her age and had “fallen off” the growth chart at age two and was started on a growth hormone regimen. She was in good health otherwise.

physical examinationThe child was essentially normal appearing except for being short for her age. Her outer ears, canals, tympanic membranes, and middle ears were normal. She had a mildly webbed neck. ENT stated that she had rhinosinus-itis; tonsils were normal.

Hearing evaluationSee FIGURE 1 for the child’s puretone audiogram. Speech SRTs were 40 dB for the right ear and 45 dB for the left. Word recognition scores were 76 and 72 percent, right and left ear respectively.

� Tympanograms: normal bilaterally � Acoustic reflexes: no response bilaterally

medical workupThe child was seen by ENT, and the following tests were ordered.

Labs � CBC with differential � Rheumatoid factor (RF) � Antinuclear antibody (ANA) � Sedimentation (Sed) rate � Fasting glucose

case studY



case studY

� T4/thyroid stimulating hormone (TSH) � Lyme antibody screen � Cholesterol/triglycerides � BUN/creatinine � FTA � Urinalysis

Lab and evaluation � Genetic evaluation for hearing loss and small stature

tests � EKG � CT (computerized tomography) scan of middle and

inner ears � Retinal exam by an ophthalmologist

findings1. Thyroid tests: elevated TSH, low T42. All other labs were normal3. CT scan of the ears: Mild cochlear malformations bilat-

erally with lack of formation of the apical turns. The modioli were mildly malformed, too. The vestibular aqueducts were normal in size (i.e., not enlarged).

4. EKG: normal5. Ophthalmologic exam: normal6. Genetic evaluation: 46,X,i(X)(q10[21]/45,X[9])

ENT had diagnosed the child with rhinosinusitis. After a 21 day course of the antibiotic therapy (Augmentin), the infection resolved, and the nasality of her speech was no longer present!

You Be the detectivePossible diagnoses could be:

a. Mondini malformationB. Pendred’s syndromec. Turner’s syndromed. A and Be. All of the above

And the answer is … E, all three diagnoses.

discussionThe cochlear malformation is a type of Mondini’s apla-sia. The abnormal thyroid function tests in the presence of sensorineural hearing loss (SNHL) are suspicious for Pendred’s syndrome. The abnormal genetic pattern sup-ported Turner’s syndrome with mosaicism.

cochlear malformationOsseous and membranous labyrinth abnormalities account for 20 percent of all patients with congeni-tal SNHL, although it is not uncommon to just have a membranous labyrinth without the osseous component. Cochlear malformation results from arrested or aberrant development between the fourth and eighth weeks of gestation. It may be genetically predetermined.

mondini’s malformationMondini’s describes incomplete or abnormal partitions between the turns of the cochlea. The normal cochlea has 2.5 turns. With Mondini’s, there may be a variable number of turns, for example, only 1.5 or a “common cavity.” In some cases, only the basal coil can be clearly identified. Mondini’s is reported as bilateral 65 percent of the time and is unilateral in 35 percent of reported cases

Hearing loss is more apt to be progressive if there is an absence of the bony divisions between the coils of the cochlea.

For this young child, she was fortunate not to have enlarged vestibular aqueduct syndrome (VAS). It is not uncommon for someone to present with both Mondini’s and VAS. When VAS is present, the anomaly involves the membranous divisions, resulting in a greater chance for progressive hearing loss. Furthermore, when the malformation is not solely related to the bony partitions, potential head trauma and contact sports should be avoided. Head injury could result in total loss of hearing.

FIGURE 1. The child’s audiogram.


case studY

pendred’s syndromePendred’s syndrome is autosomal recessive: the child inherits one copy of a gene from each parent. Both par-ents must be carriers or have the disease to give birth to an affected child. It is caused by mutation in the PDS gene with abnormal iodine metabolism. It can be present from birth, or it may develop in childhood. Normal IQ is common. It usually is associated with enlarged vestibular aqueducts (although this was not the case for this child). It may be asymmetric. Thyroid dysfunction is common and generally occurs later in childhood. Without a thor-ough lab workup, this diagnosis is often unknown; this is unfortunate in view of the progressive SNHL and the fact that for many of these patients, head trauma must be avoided.

turner’s syndromeThe incidence of Turner’s syndrome is one per 3,000 live births. It is caused by a chromosomal abnormality (usu-ally absence of the second sex chromosome). Instead of

46 chromosomes in each cell, Turner’s patients have only 45, or a mosaic of 45,XO, and 46,XX. For this patient, some cells are 45,XO and others are 46,X,i(X): one normal paired with an abnormal X.

Typical features include short stature; the average female is four feet, eight inches. It is usually associ-ated with renal and cardiovascular anomalies. There is a webbing of the neck, infertility is common, and there is a delay or lack of sexual development. Hearing loss is common. There is typically normal IQ, but visual-spatial learning disabilities are often reported.

treatmentSerial hearing diagnostics are needed to document potential progressive hearing loss. Due to the diagnosis of Pendred’s, oral thyroid hormone therapy (Synthroid) is needed to maintain normal thyroid levels. Routine blood testing is indicated to monitor the hormone treat-ment. With Turner’s, growth hormone therapy is needed to stimulate height. Estrogen replacement therapy is also required to compensate for the ovarian dysfunction. Careful monitoring of her blood pressure is indicated due to increased risk of hypertension.

In the case of this child, binaural amplification is indi-cated. New hearing aids have been worn over the past six months that have frequency transposition. The patient, parents, teachers, and speech pathologist all report dramatic improvement in hearing. The educational audi-ologists have played a crucial role in her success at school. They have added an FM system, and with their advocacy there is excellent compliance of the FM device not only by the child but by the teachers as well.

This once again underscores the importance of per-forming the right diagnostic test battery. This is a child with multiple diagnoses that can affect her hearing, let alone her general health status and safety. The informa-tion learned from a comprehensive diagnostic workup strongly benefits the audiologist in selecting the correct amplification and knowing the importance of performing serial audiograms due to the progressive nature of her conditions. In the end, the patient is the beneficiary of quality care.

“Case” closed until the next AT issue!

Paul Pessis, AuD, is president of North Shore Audio-Vestibular Lab in Highland Park, IL.

The Department of Hearing and Speech Sciences at Vanderbilt University is seeking applicants for admission to its Specialty Track Programs beginning in the fall semester 2012.

Vanderbilt offers interested students in Audiology the opportunity to pursue a specialty in their chosen field. These specialty tracks provide students with curriculum designed to augment their base training. Audiology specialty tracks are Childhood Hearing Loss, Vestibular Sciences, and Auditory Neuroscience.

For more information about the Vanderbilt program in Hearing and Speech Sciences and the application process, visit www.mc.vanderbilt.edu/graduatestudies.

Vanderbilt Hearing and Speech Sciences Specialty Track Programs


momeNt of scieNce

what it means to “pay attention” and How much it costs

By William J. Bologna and Judy R. Dubno

a ttention is a complex concept, but almost everyone agrees that attention affects com-

munication. When someone tells you, “I’m sorry, I wasn’t paying attention,” the expectation is that you repeat what you said. As audiologists we are aware of the problems that inat-tention can cause when measuring

pure-tone thresholds or speech recognition. We include objec-tive measures such as otoacoustic emissions and auditory brainstem responses because they are pre-sumed to be unaffected by attention. Traditional diagnostic auditory tests focus primarily on measuring thresholds for pure tones and speech to determine audibility and predict real-world communication abilities. However, if our goal is to evaluate and aid communication, changes in maintaining or sustaining attention should be considered an additional source of communication difficulties.

Attention can be broadly defined as the brain’s ability to priori-

tize different mental processes for use

of cognitive resources (e.g., Knudsen, 2007). Perception represents

one of the main resource

competitors. The use of “attentional resources” shortens reaction time and improves performance

on psychoacoustic tasks. A reduction or absence of these

resources leads to a breakdown in certain elements of informa-

tion processing (Fritz et al, 2007). While the attentional demands of

face-to-face communication in quiet

environments are typically low, the use of attentional resources may increase in noisy environments with multiple talkers and competing con-versations. In these “cocktail party” situations, listeners must prioritize several sources of speech from different locations so attentional resources can be selectively applied to the talker of interest (the “target talker”). The perceptual separation of different sound sources is called auditory stream segregation, and the role of attention in this process has been debated in the literature for more than 10 years (Sussman et al, 1999; Carlyon et al, 2001; Macken et al, 2003).

Stream segregation has been studied extensively using repeti-tive sequences of two alternating pure tones, typically referred to as A and B. A sequence of alternating A and B tones (ABABAB) can take two perceptual forms, a single sequence of alternating tones (ABABAB) or two separate sequences of the same repeating tone (AAA and BBB), the latter indicating stream segregation. Listeners are more likely to report the perception of stream segregation after several seconds of listening to a repetitive tonal sequence. This is referred to as the “build up” of stream segregation and is dependent on the listener’s attention (Carlyon et al, 2001). When the experimen-tal task requires listeners to ignore the tonal sequence and focus on


momeNt of scieNce

a different auditory task, percep-tion resets to a single stream, and the build up function begins again when attention is redirected to the tonal sequence. These and other results raise the question of whether attention is necessary for stream seg-regation and if stream segregation occurs in “ignored” stimulus condi-tions (Sussman et al, 1999; Macken et al, 2003). It is still unclear to what extent “ignored” stimuli are deprived of attentional resources and the importance of attentional resources when stream segregation cues are very strong.

To disentangle the effects of attention on the perception of tonal sequences, neurophysiological meth-ods have been used to search for the neural basis of stream segregation. Recent work with magnetoencepha-lography (MEG), a neuroimaging technique with high temporal resolution, has demonstrated the importance of temporal coherence, or the synchronicity of neural activ-ity across time (Elhilali et al, 2009; Shamma et al, 2011). In a simultane-ous behavioral-neurophysiological study of stream segregation, partici-pants listened for a steady repeating tone in a background of random distracter tones. MEG data revealed a steady-state neural signal that pulsed at the same rate as the target tone (4 Hz). The magnitude of this response was correlated with per-formance on the stream segregation task. When participants attended to the target tones, the temporal coherence of the neural response increased over a period of seconds, consistent with the presumed build up of stream segregation. In contrast, when participants attended to the background tones, the 4 Hz response was suppressed. These results suggest the role of attention is to sharpen temporal coherence and

facilitate stream segregation over several seconds of listening.

Stream segregation is critical for listening in background noise, and these challenging stream segrega-tion environments draw heavily on attentional resources. When speech is presented in complex backgrounds with multiple talkers, listeners must first segregate the target talker from the background voices and then sustain this segre-gated perception over the course of the conversation. If stream segrega-tion deteriorates, the target voice will blend into the background and the listener will be unable to listen selectively to the target while sup-pressing the irrelevant background speech. The listener must spend even more attentional resources to resegregate the target talker before continuing to listen selectively. This process is inefficient and forces listeners to pay close attention to the target talker to avoid losing it amidst other voices. Maintaining good speech understanding in com-plex environments comes at the cost of increased vigilance and effortful listening, even for younger adults with normal hearing. When mental demands on attention are too great, it is likely that stream segregation cannot be maintained efficiently and performance will decline.

Difficulty understanding speech in noisy or complex environments is a common complaint, and this problem may be rooted in attention-related systems as much as in the auditory system. Selective atten-tion begins to decline in middle age (Commordari and Guarnera, 2008), with some listeners notic-ing difficulty or greater effort in noisy environments before report-ing a decline in hearing. As these individuals age, stream segregation cues such as spatial location, onsets,

and fundamental frequency (F0) may be degraded by reductions in audibility, and spectral and tempo-ral resolution (Grimault et al, 2001; Shinn-Cunningham and Best, 2008). This places greater demands on attentional gain mechanisms (Kerlin et al, 2010), which may improve the salience of these cues and help older listeners compensate for perceptual declines. While some older adults compensate well by increasing attention to the stimulus, others are unable to achieve the same benefit (Alain et al, 2004; Harris et al, 2010). As more is learned about stream segregation and new test paradigms are developed, evaluation of stream segregation may become clinically feasible. Discoveries about the contri-butions of higher level functions in communication should prompt audiologists to become more aware of stream segregation and attention and their involvement in everyday communication.

William J. Bologna is an AuD extern in the Department of Otolaryngology-Head and Neck Surgery at the Medical University of South Carolina (MUSC) in Charleston, SC, and a student in the doctoral program in clinical audiol-ogy at the Department of Hearing and Speech Sciences, University of Maryland in College Park, MD. Judy R. Dubno, PhD, is a professor in the department of Otolaryngology-Head and Neck Surgery at MUSC.

References

Alain C, McDonald KL, Ostroff JM, Schneider B. (2004) Aging: a switch from automatic to controlled processing of sounds? Psychol Aging 19:125–133.


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Carlyon R, Cusack R, Foxton J, Robertson I. (2001) Effects of attention and unilateral neglect on auditory stream segregation. J Exp Psychol Hum Percept Perform 27:115–127.

Commordari E, Guarnera M. (2008) Attention and aging. Aging Clin Exp Res 20:578–584.

Elhilali M, Xiang J, Shamma S, Simon J. (2009) Interactions between attention and bottom-up saliency mediates the representations of foreground and background in an auditory scene. PLoS Biol 7:e1000129.

Fritz JB, Elhlali M, David SV, Shamma SA. (2007) Auditory attention—focusing the searchlight on sound. Curr Opin Neurobiol 17:437–455.

Grimault N, Micheyl C, Carlyon RP, Arthaud P, Collet L. (2001) Perceptual auditory stream segregation of sequences of complex sounds in subjects with normal and impaired hearing. Br J Audiol 35:173–182.

Harris KC, Eckert MA, Ahlstrom JB, Dubno JR. (2010) Age-related differences in gap detection: Effects of task difficulty and cognitive ability. Hear Res 264:21–29.

Kerlin JR, Shahin AJ, Lee MM. (2010) Attentional gain control of ongoing cortical speech representations in a “cocktail party.” J Neurosci 30:620–628.

Knudsen EI. (2007) Fundamental components of attention. Annu Rev Neurosci 30:57–78.

Macken WJ, Tremblay S, Houghton RJ, Nicholls AP, Jones DM. (2003) Does auditory streaming require attention? Evidence from attentional selectivity in short-term memory. J Exp Psychol Hum Percept Perform 29:43–51.

Shamma SA, Elhilali M, Micheyl C. (2011) Temporal coherence and attention in auditory scene analysis. Trends Neurosci 34:114–123.

Shinn-Cunningham BG, Best V. (2008) Selective attention in normal and impaired hearing. Trends Amplif 12:283–299.

Sussman E, Ritter W, Vaughan JR. (1999) An investigation of the auditory streaming effect using event-related brain potentials. Psychophysiology 36:22–34.

The PAC is one of the most powerful tools to help audiology gain influence on Capitol Hill.

NOW IS A GREAT TIME TO MAKE YOUR 2012 CONTRIBUTION!Visit www.audiology.org, search keywords “PUSH the PAC,” and contribute to the Political Action Committee (PAC).


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community outreach a priority for arizona state university saaBy Alaina Richarz and natalie saba

d uring the last few years, community outreach has been at the forefront of chapter involvement for the Arizona State University (ASU) chap-ter of the Student Academy of Audiology (SAA). In the spring of 2010,

a community outreach chair was added to the chapter board of directors to organize events within the Phoenix area aimed at promoting the profession of audiology, the awareness of hearing and balance disorders, and hearing protection.

The duties of the community outreach chair, as developed by the ASU SAA chapter, consist of the following:

� Consult with the chapter board of directors each semester to determine where outreach efforts should be focused.

� Form committees when appropriate to foster smooth operations of events within the community.

� Plan and execute outreach events.

� Maintain professional contact with all organizations affiliated with out-reach efforts.

� Organize the chapter’s involvement in the local Special Olympics Healthy Hearing Program.

� Communicate with the chapter board of directors on a monthly basis to report progress of outreach efforts.

Following the inception of this position, the ASU SAA chapter advisor, Dr. Gail Belus, learned of an educational partnership between the ASU nursing department and the Phoenix Children’s Museum. After hearing about their educational events, the idea of educating both children and parents about hearing conservation and audiology through interactive games and activities at the museum evolved. Once permission was received from the museum to stage an event, many members of the ASU SAA chapter became involved in the development of this project by brainstorming, planning, designing, and building games.

The first ASU SAA Hearing Conservation and Education Program was held at the Phoenix Children’s Museum on the afternoon of March 4, 2011, and was

Natalie Saba and Alaina Richarz, 2010–2011 ASU SAA Community

Outreach cochairs, showing how to use the sound-level meter game.


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open to children from birth to five years and their parents. Four different sta-tions were set up with games and activities including:

� Sound-Level Meter: Children selected and placed pictures of objects pro-ducing varying noise levels into the categories of soft, medium, loud, and too loud.

� What Should You Do?: Children were given options of what to do in a noisy situation—wear ear plugs, do nothing, turn the volume down, or walk away.

� How to Use Earplugs: An informative display explaining what earplugs are, when to use them, and how to insert them. A chapter member dem-onstrated proper usage and helped children and parents practice proper earplug insertion. Classic foam earplugs were given away along with infor-mation on custom earplugs.

� Ear Anatomy: Coloring supplies and pictures of the ear were available for children to color and label.

Other activities included the opportunity to use a type three sound level meter, and an information table with handouts about hearing loss and the importance of hearing conservation.

The event was a tremendous success with more than 70 children and parents in attendance. The ASU SAA chapter is looking forward to future continuation of the Hearing Conservation and Education Program at the Phoenix Children’s Museum. In addition to educating children and parents, the chapter hopes to continue to fine-tune this program and encourage other SAA chapters to expand their community involvement efforts by creating similar outreach programs.

Alaina Richarz and Natalie Saba are third-year AuD students at Arizona State University (ASU) in Tempe, AZ. They were the community outreach co-chairs during the 2010–2011 academic year for the ASU chapter of the Student Academy of Audiology.

Arizona State University SAA members who participated in the Hearing Conservation and Education Program at the Phoenix Children’s Museum. Pictured from left (back row): Nicole Corbin, Laurie Satz, Josh Miller, Madalyn Rash, Sara Larman, Greta Eikenberry, Dr. Gail Belus, and Jennifer Imboden. Front row: Natalie Saba, Alaina Richarz, and Kayla Mann.

Other ASU SAA Community Involvement

On-Campus Hearing Protection Awareness Concert

ASU Homecoming Hearing Awareness and Protection Campaign

Arizona Special Olympics Healthy Hearing Program

Arizona Coalition for Tomorrow (ACT) Fair Head Start Hearing Screenings

Custom Musician Earplugs

Audiology Education Events for Kids: Girls Scouts, homeschool groups, etc.


New 2012 cpt code and code descriptions for audiologists: otoacoustic emissions

e ffective January 1, 2012, there will be a new Otoacoustic Emissions (OAE) Current

Procedural Terminology (CPT®1) code—92558—to describe OAE screening, as well as new code descriptors for two existing OAE codes—92587 and 92588—to clarify the OAE evaluations. The new code descriptors will guide the audiolo-gist in how to correctly select the appropriate OAE code and file an OAE claim.

BackgroundThe Centers for Medicare and Medicaid Services (CMS) had pre-viously identified CPT code 92587 for review due to rapidly growing utilization. In calendar year 2011, this service was surveyed by the audiology specialty societies. After reviewing the survey data, the spe-cialties concluded that more than one service was being represented under this code. As a result, three codes were created. CPT 92558 was created to describe automated OAE screening; CPT 92587 was clarified to describe the procedure commonly used to determine the presence or absence of auditory disorder as a follow-up to screening or as an objective verifica-tion of disorder; and CPT 92588 was clarified to describe the procedure used for “cochlear mapping” com-monly aimed at fine-resolution monitoring of cochlear function. Services billed on or after January 1,

2012, must be coded with one of these three codes as described below.

cpt code descriptions and guidance

cpt 92558 descriptionEvoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), auto-mated analysis.

GuidanceCPT 92558 should be used when an automated pass/fail screening is performed, via a fixed number of frequencies at a single intensity level, when administered by support per-sonnel, an audiologist, or a physician. This procedure has been designated by CMS to be a non-covered service under the Medicare program.

It is important that audiologists consult the specific guidance that will be provided by regional and federal payers such as Medicare Administrative Contractors (MACs) and Medicaid, as well as guidance from their private third-party payers. Some third-party payers may dictate the use of specific codes, modifiers, and coverage determinations specific to the state or location where the service is performed.

cpt 92587 descriptionDistortion product-evoked otoacous-tic emissions, limited evaluation

(to confirm the presence or absence of hearing disorder, three to six frequencies), or transient-evoked otoacoustic emissions, with interpre-tation and report.

GuidanceCPT 92587 is to be used when three to six frequencies are tested bilaterally and includes the interpretation of the test, with a reporting of the results in the patient’s medical record. If you perform both distortion product and transient evoked otoacoustic emissions, you may seek additional reimbursement using the –22 modi-fier in conjunction with CPT 92587. Again, audiologists should be aware that third-party payors may dictate the use of specific codes, modifiers, and coverage determinations specific to the state or location where the service is performed.

CPT 92587 is a global procedure code comprised of both a technical component (TC) and professional component (PC). If the audiologist is performing the procedure, provid-ing the interpretation of the results and making a report of the results in the patient’s medical record, this code should be reported without a modifier.

Under the Medicare program, OAE testing may be performed by a technician, who is working under the direct supervision of a physician. Testing performed by a technician should be reported using the TC

codiNg aNd reimBursemeNt


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modifier. Audiologists should be aware that services performed by a technician that are billed under the National Provider Identifier (NPI) of an audiologist are not covered under the Medicare program.

cpt 92588 descriptionComprehensive diagnostic evalua-tion (quantitative analysis of outer hair cell function by cochlear map-ping, minimum of 12 frequencies), with interpretation and report.

Guidance CPT 92588 is to be used when a minimum of 12 frequencies is tested bilaterally and includes the interpre-tation of the test, with a reporting of the results in the patient’s medical record. If fewer than 12 frequencies

were performed, file the claim with CPT 92587.

CPT 92588 is a global proce-dure comprised of both a technical component (TC) and professional component (PC). If the audiologist is performing the procedure, provid-ing the interpretation of the results, and making a report of the results in the patient’s medical record, this code should be reported without a modifier.

Under the Medicare program, OAE testing may be performed by a technician who is working under the direct supervision of a physician. Testing performed by a technician should be reported using the TC modifier. Audiologists should be aware that services performed by a technician that are billed under the

NPI of an audiologist are not covered under the Medicare program.

Note

1. This guidance is for informational purposes only and was developed by the Academy with input from the Academy of Doctors of Audiology and the American Speech-Language-Hearing Association. CPT® codes and descriptions are copyright 2011 American Medical Association. CPT is a registered trademark of the American Medical Association.

Serve on an Academy committee or task force. Getting involved is a great way to contribute ideas, solutions and strategies that move the profession forward.

What does it take to be a good committee member?

� A good spirited individual with interest in teamwork

� Commitment to completing tasks

How do I show my interest in future committee work?

� Complete the committee volunteer form.

� Select your interest areas and submit the form via fax or mail.

When will I hear something?

� Committee member appointments are made in May/June timeframe or as task forces are initiated.

� The committee year starts on July 1 and ends on June 30 of the following year.

� Three positions per committee normally open up annually.

� Because there are limited positions, not all will be selected. If you are not selected, submit your form next year!

To download the volunteer form, visit www.audiology.org search keyword “volunteer.”

2012 CAll for VolunteerS

RegisteR foR on-demand Web seminaRs at youR convenience.

title descRiption ceus

Medical Errors to Avoid: Guidelines for Audiologistspresented by James W. Hall iii, phd

avoid medical errors by identifying those that occur in audiology and develop preventive steps for reducing them in the future.

.2

“Can I Wear Hearing Aids While I Sleep?”—Audiologic Counseling, or When NOT to Answer a Questionpresented by Kris english, phd

learn counseling strategies designed to support patients through the help-seeking process.

.1

Could You Use an Assistant?presented by teri Hamill, phd, and gyl Kasewurm, aud

learn the advantages of using assistants in an audiology practice, the legal limits on their scope of practice, and the academy’s position on appropriate tasks.

.1

Global Humanitarian Audiology: The Next Steppresented by tomi browne, aud, and Jackie l. clark, phd

develop the building blocks so you can plan a sustainable and successful humanitarian program in international or domestic venues.

.1

a m e R i c a n a c a d e m y o f a u d i o l o g y

title descRiption ceus

Rules of the Engagement: Compliance, Legalities, and Ethics in Audiology Today presented by Kim cavitt, aud ABA Certificants: Ethics

discover the practical aspects of federal and state rules and regulations, state licensure acts, and professional ethics guidance and their role in the daily lives of audiologists.

.1

Aural Rehabilitation in a Busy Clinic—What to Do for Starters and Howpresented by John greer clark, phd

discover how to overcome the impediments to aural rehabilitation encountered by both audiologists and their patients and learn about a suggested protocol for the busy practitioner.

.1

Monitoring Technology in Kids: Are They Hearing Well Enough?presented by Jane madell, phd

Discover the advantages of real ear and behavioral verification. .2

Relationship Between Auditory-Evoked Potentials and Behavioral Tests of Auditory Processing in ChildrenRebekah f. cunningham, phdABA Certificants: Tier 1

learn about literature, theory, and practice using both behavioral and electrophysiological measures to evaluate pediatric patients with suspected auditory processing disorder.

.3

Going Solo......or Not? Practice Networks and the Private Practitionerpresented by lawrence eng, aud, and georgine Ray, aud

learn the pros and cons of working with the various audiology networks.

.1

Real World Ethics for Audiologists presented by gail m. Whitelaw, phdABA Certificants: Tier 1 & Ethics

identify practical aspects of ethics while attempting to address the age old question of “Why do i need to know about ethics?”

.3

Visit www.eAudiology.org to see the full on-demand library and all upcoming live seminars.

coding & ReimbuRsement seRies eacH seminaR offeRs .1 ceus

upcoming live seminaRsJanuaRy 10, 2012—coding changes for 2012maRcH 13, 2012—insurance 101may 8, 2012—preparing for the icd-10 code transition

available on-demandunbundling and itemizing Hearing aid services (recorded september 13, 2011)medicare enrollment and Regulations (recorded november 8, 2011)


americaN Board of audioLogY (aBa)

Board of Governors

Gail M. Whitelaw, PhD, Chair

Angela S. Pond, AuD, First Chair

Mindy Brudereck, AuD

John A. Coverstone, AuD

Barbara L. Kurman, AuD

Kerry Ormson, EdD, AuD

Yvonne S. Sininger, PhD

Past Chair ex officio Member

Antony Joseph, AuD, PhD

Public representativePatty A. Keffer, MBA

american academy of audiology Board of

directors LiaisonDavid Zapala, PhD

Managing director ex officio Member

Torryn P. Brazell, CMP, CAE

for aBa information, contact:American Board of Audiology

11730 Plaza America Drive

Suite 300

Reston, VA 20190

800-881-5410

[email protected]

improving Your practice with pediatric audiology specialty certificationBy John Coverstone

a ny pediatric audiologist is acutely aware that it requires specialized knowledge and

skills to diagnose and treat hearing and balance disorders in a pediatric population. This population requires

special needs that differ from older populations. It requires a specific knowledge and skill set to obtain information from the child who does not want or know how to give it. Practical application and pediatric

aBa Board profile

Barbara L. Kurman, aud

Hails from: Upper Saddle River, NJ

Year Certified: 1999

Degree: AuD

What I Do for the ABA: As a newly elected member of the Board of Governors, I enjoyed my first board meeting in November 2011 and was able to participate at all levels. In addition, I believe that those of us who are certified by the ABA should act as ABA ambassadors to encourage everyone to become ABA certified.

In My Free Time: I sing with my temple choir, I am vice president of the Board of Governors of Hillel at Syracuse University, Sisterhood Board of my temple, and spend as much time with my husband and adult children as possible.

Quote to Live by: “Action may not always bring happiness; but there is no happiness without action.” Benjamin Disraeli



audiology knowledge are required to successfully work with children and be able to disseminate appropriate infor-mation to parents, physicians, and educational personnel regarding the overall needs of the child.

By obtaining specialty certification in pediatric audiology, it makes a state-ment that the audiologist demonstrates a significant level of knowledge and expertise that sets him or her apart from others in the profession. While a certification is not a guarantee of a particular skill or competency, an audiologist holding this certification has demonstrated the ability to pass a rigorous examination in pediatric audiology and has a minimum of two years of audiologi-cal practice.

To date, 13 audiologists have passed the early exami-nations and achieved pediatric audiology specialty certification (PASC). It is anticipated that a large number of audiologists will sit for the examination following AudiologyNOW! 2012 in Boston. These audiologists, as pediatric specialists, recognize the benefit of this creden-tial and wish to promote themselves and their facilities as centers of excellence in this area. The American Board of Audiology (ABA) has been contacted by directors of audiology settings announcing their intentions to have their audiologists achieve PASC. In addition, the ABA has already received inquiries from prospective employers looking to hire audiologists holding pediatric certification. A need for pediatric audiologists has been identified in our profession, and prospective employers are increas-ingly recognizing that a credential such as PASC will help them to identify higher level qualified candidates for posi-tions needing to be filled.

In speaking with those who have sought pediatric audiology specialty certification, and many subject mat-ter experts involved with creating the exam, a number of benefits have been expressed for the PASC.

� Many audiologists have sought the recognition asso-ciated with achieving certification that includes a rigorous examination.

� Many audiologists have also expressed a desire to demonstrate their commitment to this area of our pro-fession and their dedication to maintaining a current knowledge set in pediatrics.

� Some audiologists are looking or hoping to improve salaries.

� Some audiologists have recognized the increased marketability of a certified audiologist when seeking employment in a facility that attracts children.

Audiologists have also recognized the benefits of pro-moting pediatric audiology specialty certification to those outside our profession.

The ABA has already received inquiries from prospective employers

looking to hire audiologists holding pediatric certification.



� Physicians and other audiolo-gists may be more likely to refer patients to an audiologist holding specialty certification.

� A clinical facility can promote itself as a “center of excellence” with greater confidence.

� Promoting an audiologist holding pediatric specialty certification is likely to gain increased trust from families, other audiolo-gists (primary care audiologists, for instance), and referring physicians.

� Those audiologists who have earned specialty certification are also listed on the ABA Web site, which will increasingly serve as a central resource for those orga-nizations seeking an audiologist who is a pediatric specialist.

Reviewing the preparatory mate-rials located on the ABA Web site—all of which were carefully chosen to cover the domains of knowledge created from an in-depth analysis of a pediatric audiologist—has been reported as a valuable tool itself to improve knowledge of pediatric practitioners. The published domains of knowledge and the reference mate-rials available on the ABA Web site may also help direct study efforts for audiologists wanting to move into pediatrics. This should also serve to assist the individual in determining whether pediatric audiology is the right specialty area for him or her to consider. Likewise, students may use this information to see whether they have knowledge gaps that should be filled before entering professional practice. Educators may use the same materials to guide curriculum and ensure that complete pediatric instruction is provided to students.

General audiologists may also use the PASC to identify preferred pedi-atric facilities and providers to which their own patients may be referred. By referring to pediatric audiolo-gists holding PASC, we can ensure that we are referring to practitioners who have proven their knowledge in pediatrics through a rigorous exami-nation and have the necessary years of experience.

Audiologists wishing to achieve pediatric audiology specialty certifi-cation must hold a graduate degree in audiology and a valid license to practice audiology. They must dem-onstrate a minimum of two years of full-time paid professional experi-ence as an audiologist, with 550 hours in direct contact with pediatric patients and 50 hours in case man-agement of pediatric cases in two of the past five years. Applicants must forward two letters of recommenda-tion citing experience in pediatric audiology along with the application and the application and examination fee. Full details and the application form may be obtained by visiting www.americanboardofaudiology.org or contacting ABA at 800-881-5410 or [email protected].

The next PASC examination will be given in Boston, April 1, 2012, immediately following AudiologyNOW! If you practice pediatric audiology, now is the time to submit your application and join those who have demonstrated a high level of knowledge in pediatrics!

John Coverstone, AuD, is a member of the ABA Board of Governors.

Virginia M. Corley, PhD south Carolina

Susan G. Dreith, AuDColorado

Melissa A. Garafalo, AuD Colorado

Deborah Hayes, PhDColorado

Sheetal S. Vyas, AuDFlorida

Jamie C. Zerr, AuD Colorado

Join us in extending our congratulations to the most recent class of Pediatric Audiology Specialty Certification certificants!

PEDIATRIC AUDIOLOGYSPECIALTY CERTIFICATION


top 10 Benefits of acae accreditation

By Maureen Valente

i n an effort to convey information in a novel way and complemen-tary to the format of any previous

article, I have decided to compose a “top 10” list of the numerous positive aspects of experiencing the ACAE accreditation process. Many endeavors touched upon are “works in progress,” and ACAE is continually undergoing self-assessment so that additional benefits may be enjoyed by its programs.

10unique web-Based technology

When I was hired in 2005 as the director of audiology studies within Washington University in the St. Louis School of Medicine’s Program in Audiology and Communication Sciences, our program had already agreed to serve as an ACAE beta site. I appreciated that much program data had already been uploaded into the unique Web site format, through Phase I of the process. At the time, I found this technology and concept to be quite impressive, and the many highly skilled professionals involved with ACAE have invested much time and effort in further advancing its development.

9 capability for Virtual site Visit

Phase II of the beta site process involved the assignment of a three–five person site visit team (SVT), members of whom dedicated count-less hours toward synthesizing the many tables, forms, and data provided during Phase I. Our Phase II process took place during an entire summer, and I enjoyed receiving correspon-dences from SVT members, asking for clarification and additional informa-tion. Phone calls and conference calls took place, as needed, with adminis-trative personnel and team members readily available. In no way meant to replace the personal touch, Phase II organized materials and prepared all parties for the actual site visit.

8No Last-minute cramming for site Visits

How many of us have felt pangs of angst when a site visit is looming and seven–eight years of data must be collected within a short time? With ACAE’s unique Web site in place, many forms of program data may be stored, retrieved, and updated from year to year. There are future plans for additionally reaping benefits of computer technology, such as cre-ation of professional databases and sharing of materials among profes-sionals and programs.

7 site Visit is supportive

During Phase III (the final phase) members of the SVT visited our program for two and half days. The ACAE was very well organized in thoroughly communicating with us regarding all aspects of planning and preparation. We knew well in advance what to expect and what the SVT expected of us. Most of all, everyone involved in this process approached this visit with positivity and enthusiasm. Although we knew standards were rigorous—as well they should be—the lenses through which Phase III was viewed were of support and constructive improvement through facilitation of self-assessment. There was an aura of collaboration and collegiality created.

6thorough assessment of aud education

Many of these important areas are interwoven. ACAE Accreditation processes were created as a result of much careful thought and planning,

acae corNer


acae corNer

such that they are structured of, by, and for audiologists and our doctoral profession of audiology. Standards and competencies are not “cookie cutter” replicas of those developed by previous accreditation bodies; rather, they thoroughly address our entire Scope of Practice, the lifespan of hearing-impaired patients we serve, and evidence-based practice. The SVT met with all involved in the educational process, including the dean, program director, faculty, pre-ceptors, alumni, and students. The visit reflected team spirit and profes-sionalism leading to shared goals: provision of the highest possible quality of education to future leaders of the profession.

5 focus on outcomes

This area and the self-assessment facet that I have listed in #4 go hand-in-hand. Much professional emphasis has been placed upon “learning outcomes,” and ACAE effectively incorporates these concepts in a qualitative way. As only one small example, does it really matter if a student gains X number of hours in adult hearing aid selection, veri-fication, and fitting? Or is the key that the student efficiently demon-strates skill and knowledge related to this area upon progression to the subsequent year of study and upon graduation? As educators, we are motivated toward instilling pride in life-long learning, graduating the most competent and compassionate audiologists possible.

4 focus on self-assessment

Of all aspects of our ACAE accredi-tation process, discussion of self-assessment is perhaps the most vivid and one that provided a great deal of benefit for me on profes-sional and personal levels. Simply, AuD programs are complex, and it is imperative that we routinely engage in ongoing assessment of all pieces. We should use aggregate principles whereby we approach any one area (research project, course-work, practicum experience, or other area) from a variety of measurable means. Measures should be valid and reliable, and it is critical to initiate constructive improvement as a result of any feedback that is collected.

3ongoing assessment of standards

In the spirit of practicing what one is preaching, the ACAE board has continued to guarantee continual updating of its processes, standards, requirements, Web site, and other crucial aspects. As a natural outcome of serving as a beta site, we were in a position (and were encouraged) to provide feedback so that the process would be more streamlined and of the highest quality. We consistently found ACAE to be willing to listen to our feedback and to be open to suggested changes, verifying the collaborative nature previously described.

2 of, By, and for audiology

This phrase speaks for itself. It is imperative for the sake of our profes-sion’s autonomy and further growth that we hold in high regard and sup-port our own governing bodies and

accrediting organization. ACAE was founded as such a body, formed of, by, and for members of the profession of audiology. On a more concrete and realistic level, it is very refreshing to communicate with an ACAE adminis-trator or SVT member. We speak the same language, and team members thoroughly understand even the smallest detail related to profes-sional concepts we are discussing and implementing within our program. It’s not only refreshing; however, it’s a necessity.

1present and future Views of the profession

Relatively speaking, our profession is still quite new and our clinical doctoral degree is in the process of further development. ACAE’s founders, administrators, and board members demonstrate passion, caring, and dedication toward their mission of achieving success. As this new entity takes greater hold and as transition occurs, it is important to view the current state of the profes-sion and also to look to the future.

conclusionAudiology has made great strides in transitioning to a doctoral-level entry profession and the profession is now undergoing exciting additional transformations. Further accredita-tion advances and support are vital as audiologists continue to look toward an autonomous future, educate future leaders, and ensure the highest qual-ity of practitioners and patient care.

Maureen Valente, PhD, is the director of audiology studies within Washington University in the St. Louis School of Medicine’s Program in Audiology and Communication Sciences (PACS).


Academy News2012 Board of directors Nominations

the members presented in this issue of Audiology Today are nominees for the president-elect and three member-at-large positions on the academy’s Board of directors.One of the nominees for president-elect will be elected by the general membership to serve a three-year term (one year as president-elect, one year as president, and one year as past president) beginning July 2012 and ending June 2015.

Three of the candidates for the member-at-large positions will be elected by the general membership to serve a three-year term, beginning in July 2012 and ending June 2015.

The 2012 American Academy of Audiology election of new board members will be held from January 30, 2012, through February 24, 2012. All members with an electronic address in the database will be sent an e-mail linking them to our election Web site. Please note the election Web site is separate from the Academy Web site. The link you receive in the e-mail is individually unique and can only be used by the member receiving the e-mail. Once used, the unique link is disabled.

It is anticipated that the new board members and the new president-elect will be announced in early March 2012.

The biographical information and position statements presented here will also be available on the election Web site. Voting for the leadership of the Academy is an important privilege of membership for Fellows of the American Academy of Audiology.

You are encouraged to vote.


Academy News

president-elect

Bettie B. Borton, audCEO, Doctors Hearing Clinic, Montgomery, AL

EducationBS: Education of the Deaf with CED Certification, University of Texas, 1974 MCD: Audiology, LSU Medical Center, 1976AuD: Audiology, University of Florida, 2000

Position Statement I am honored to be considered for president of the American Academy of Audiology. Together, we now face new political and economic realities that will challenge our ability to achieve professional autonomy. Becoming truly independent practitioners will require legitimizing audiolo-gists as the providers of choice for hearing and balance health care, and accepting the risks inherent to success-fully resolving divergent perspectives in that regard.

Successfully achieving our goal is contingent upon owning every sector of our discipline including member-ship, certification, accreditation, and audiology support personnel, as well as developing a preferred future for each of those sectors. This effort will require leaders with courage, whose focus on the future will assist Academy staff and members alike in the discovery of innovative solutions to the challenges before us through profes-sionally relevant, carefully prioritized, and skillfully implemented objectives. It will also demand our collec-tive commitment and firm resolve. In today’s health-care arena, only a professional organization that embodies excellence and promotes accountability will succeed in achieving its goals. It would be a privilege to serve as president of the Academy, and if elected, I will work diligently to promote its priorities, strengthen its founda-tions, and advocate for the professionals it represents.

Lawrence m. eng, audOwner-Partner, Golden Gate Hearing Services,

San Francisco, CA, and Senior Audiologist, David S. Crow,

MD, PhD, LCC, Maui, HI

EducationBS: Communication Disorders, San Francisco State University, 1984MS: Audiology, San Francisco State University, 1987AuD: Audiology, Salus University, 2001

Position StatementAs president-elect in these difficult economic times, as well as changes in the health-care system, it is impera-tive to continue the work of the Academy by focusing on growth of its membership to advance the goals and initia-tives set by the Academy board and its members. As president-elect, I will focus on the following areas: Continue the fight for direct access by educating our legislators and members; promote audiology specialty certification and a new national exam; support accredi-tation of audiology programs for and by audiologists; promote research in hearing and balance; create more global outreach and collaboration; promote colleagues in private practices by providing the tools needed for increased consumer knowledge of the profession; and promote evidence-based practice and the collection of outcomes data to verify effectiveness of treatments when provided by an audiologist.

Not only do we need to grow the membership, but we also need to expand the number of audiologists in the profession as the demands for hearing and balance ser-vices increase with the increase in population. We need to particularly promote audiology practices.

2012 Board of directors Nominations


Academy News

members at Large

shilpi Banerjee, phdSenior Research Audiologist, Starkey Laboratories, Inc.,

Eden Prairie, MN

EducationBSc: Audiology and Speech Therapy, Bombay University (India), 1992MA: Audiology and Hearing Science, Northwestern University, 1994 PhD: Communication Sciences and Disorders, Northwestern University, 2003

Position StatementWe are scientists, educators, entrepreneurs, and, above all, healthcare professionals. When asked, most audiolo-gists say that they chose this profession as a vehicle to help people. Let’s not lose that spirit by sliding down the slippery slope of complacency. Like all great journeys, it starts with a small step—a commitment to monitor and evaluate the outcomes of our clinical decisions. Evidence-based audiology is not some esoteric pursuit reserved for ivory towers. It is a means for demonstrating our pro-fessional value in a cluttered marketplace. Advances in science and technology make available newer and better solutions to hearing and balance problems; they also mandate the evolution of our profession. With reimburse-ment rates lagging well behind the pace of costs, there is an urgent need for efficiency. Audiology could borrow solutions from other doctoring professions—automated test procedures, use of assistants, tele-audiology, and even re-evaluating our approach to education—or develop unique methods better suited to our profession. And, direct access to audiologists for hearing and balance care would certainly make for a leaner and more efficient healthcare system. While these challenges are not eas-ily or quickly addressed, I will give them my thoughtful attention. Thank you for supporting my candidacy.

carol geltman cokely, phdClinical Associate Professor, Coordinator of Clinical

Teaching; University of Texas at Dallas

EducationBA: Communicative Disorders, Queens College, 1980MA: Audiology and Hearing Impairment, Northwestern University, 1982PhD: Audiology, Indiana University, 1994

Position StatementAudiology is rightfully recognized as one of the top professions in the country because of career opportuni-ties, job satisfaction, and the importance of the services we provide to local and global communities. Excellence and autonomy in audiology is attainable and sustainable only with clarity of vision, wisdom in leadership, and the commitment of hundreds of volunteers. The priorities of the Academy should address perception, position, and performance and include:

� Increased recognition and high regard for how audi-ologists are perceived by the public, other doctoring, health-care professions, and higher education;

� Coordinated efforts for various economic and health-care goals with colleagues across health care, such as physical/occupational therapy, pharmacy, engineering, vocational rehabilitation, and speech/language pathol-ogy. Isolation should not be confused with autonomy.

� Demand for the highest level of service provision and education. An accreditation process that can provide an accounting of an institution’s audiology health is paramount. Likewise, our ability to maintain an admirable level of skill and state-of-the-art service provision of existing practitioners must be addressed.

� Aggressive support for research because it directly impacts the field from service provision to reimbursement.



Academy News

members at Large

patricia a. gaffney, audAssistant Professor of Audiology and Director of United

Kingdom AuD Program, Nova Southeastern University, Ft

Lauderdale, FL

EducationBA: Speech and Hearing Science, George Washington University, 2001AuD: Audiology, University of Pittsburgh, 2005

Position StatementIt has been an honor to serve my profession through vari-ous committees and I hope to continue my service on the Academy board of directors. Over the past several years, as the chair of the public relations committee, audiology awareness has been my priority. Public awareness and education is key to the success of this field. Opportunities such as direct access can only be moderately success-ful unless patients know that they have to come to an audiologist for their services. As an organization, we must be vigilant in keeping pressure on Congress for continued momentum towards the goal of direct access.

Reimbursement is an ever present and constantly changing priority for the membership. Payment just to keep the doors open and to serve our community patient population is a concern of the membership and the board must maintain this is as a key priority for our field.

Education is an important mission for the Academy and the field of audiology in general. Strengthening our educational core values and giving a clear and consistent message of what is essential for competent AuD gradu-ates, as well as fulfilling the need for PhD researchers in the field, fundamentally starts with recruiting highly motivated and diverse students into our programs.

carolyn H. gaiero, audPrivate Practice Owner and Clinical Audiologist, Hearing

Solutions, Belfast, ME

EducationBA: Speech Communication, Penn State University, 1990MA: Audiology and Hearing Sciences, Northwestern University, 1993AuD: Audiology, AT Still University, Arizona School of Health Sciences, 2002

Position StatementI am passionate, hard working, driven to achieve, and every single day, I advocate for our profession. I truly believe every person can make a difference.

To ensure audiologists are the preferred health-care providers for hearing and balance care, it is imperative we create a culture of volunteerism and develop success-ful mentoring programs. We need to mentor individuals in the classroom, the clinic, research, the political arena, and abroad.

To achieve autonomy, we need to re-examine the road map. Have you ever gone to MapQuest for directions and thought “no one that knows how to get there would go that way”? We need a new map. We need to attract quality students that have a clear understanding of who we are, what we do, and where we do it before they graduate from high school. Science fairs and summer internships offer opportunities.

Perhaps nothing in recent years has created a greater sense of outcry than the latest United Healthcare announcement. This punctuates the need for proactive action in the legislative arena. Policy changes are made by the people that show up. Every one of us needs to show up to educate the policy makers.

Ultimately the power to make positive changes in our profession lies with each of us. If elected, I promise to work tirelessly to promote audiology. I will use my voice to reflect the 11,000 plus that stand behind me to achieve autonomy through mentoring. More importantly I hope you are inspired to do the same.



Academy News

members at Large

richard a. roberts, phdOwner/Director of Vestibular Services, Alabama Hearing

and Balance Associates, Inc., Foley, AL

EducationBS: Speech and Hearing Sciences, University of South Alabama, 1992MS: Speech and Hearing Sciences (Audiology), University of South Alabama, 1994PhD: Communication Sciences and Disorders (Audiology), University of South Alabama, 1997

Position StatementAudiology is facing certain challenges—confusion regard-ing hearing care entry point, declining reimbursement, manufacturer consolidation, and lack of direct access for Medicare patients. With challenges there are oppor-tunities. The boomer generation needs our services. Our industry partners are developing incredible technology. We are a doctoral-level profession and we have greater influence on coding and reimbursement. We are posi-tioned to help more patients than ever, allowing greater opportunity for audiologists to achieve their professional and personal goals.

Three main areas I feel will allow audiologists to capitalize on this opportunity include strategic planning, public awareness, and member involvement. Our position is not accidental. The strategic planning of our leader-ship has guided us to this point. Decisions made today impact all of our preferred futures. We must continue to express the message that audiologists are best prepared to manage hearing and balance care. Increasing aware-ness will also increase patient-constituents demanding direct access to audiology. More audiologists must be encouraged to participate on Academy committees, con-tact elected officials regarding legislative concerns, and contribute to our PAC and Foundation.

I am honored to be nominated and hope to serve in this capacity. This is our Academy, our Board of Directors, and our opportunity.

steven d. sederholm, audOwner and Clinical Service Provider, Audiology Doctors of

Florida, Corp., Boynton Beach, FL

EducationBA: Speech Communications, Jacksonville University, 1984MA: Audiology, University of Florida, 1988AuD: Audiology, University of Florida, 2000

Position StatementIn more than 20 years of owning my clinical practice, I fully recognize that our patients must be granted direct access to the practitioners most qualified to treat those with hearing and balance disorders. It is finally time for audiologists to serve as the gatekeeper for those patients we serve. To expedite this objective, Academy leadership must continue to address priorities necessary to make this goal a reality. These priorities should include:

� Direct access: Our patients must be afforded the opportunity to see the most qualified provider without the requirement of a physician referral.

� Aggressive political action: Lawmakers must be made aware of who we are, what we do, and the high level of cost-effective services we provide to consumers.

� Promotion of the profession: While the Academy must continue to support effective public relations and national marketing campaigns, members should be provided the tools necessary to effectively market in their locale.

� One accrediting body: Programs should be accredited by and for audiologists.

� Evidence-based care: The Academy must continue to develop a “blueprint” for clinical care. Further, more outcome data will need to be collected to demonstrate the value of audiology services.



Academy News

members at Large

Jennifer B. shinn, phdChief of Audiology and Associate Professor, Department of

Otolaryngology, University of Kentucky, Lexington, KY

EducationBA: University of Vermont, 1998MS: East Carolina University, 2000PhD: University of Connecticut, 2005

Position StatementAudiology is a wonderful profession, and I feel fortunate to have dedicated my life to it. While the audiology com-munity clearly faces challenges, I see many wonderful opportunities to advance our field, and I welcome the chance to share my passion with our Academy members and its leaders.

As an Academy, we have a commitment to invest in our patients, our profession, and our future. In order to do so, we must focus on our core values of leadership, advo-cacy, education, public awareness, and research. I believe that it is critical to situate the Academy as the leader with respect to audiological care and to patients and profes-sionals, at both state and national levels. In doing so, we must continue our efforts to move forward by making hearing health care both accessible and affordable to all patients. I also fully support our commitment to enhanc-ing student education, as our students are our future. Like many audiologists, and as a clinician and researcher, I will also encourage our goal to continually advance our field through audiological research.

I truly hope to have the privilege and honor of continu-ing to serve our profession in a meaningful way through this national leadership role.

alicia d.d. spoor, audPrivate Practice Audiologist, A&A Hearing Group,

Rockville, MD

EducationBA: Audiology and Speech Sciences, Michigan State University, 2002MS: Audiology, Gallaudet University, 2005 AuD: Audiology, Gallaudet University, 2006

Position StatementI consider it a tremendous honor to be nominated for a member-at-large position on the American Academy of Audiology’s board of directors. My contributions during the three-year term will come with both a top-down and bottom-up approach. Working at the national level, I will enthusiastically support direct access legislation and work with state audiology academies to pass independent and autonomous licensure laws that will support audi-ologists as the primary hearing and balance health-care professional and dispenser of amplification. Secondly, I will strongly support the development of audiology undergraduate education and graduate accreditation to attract more diversely educated and competent graduate students, and help foster an earlier preceptor/student-clinician relationship. Meeting in the middle, I will also promote increased consumer and general population education about hearing and balance health care, hearing protection, amplification, and the patient-professional relationship. I look forward to the opportunity to rep-resent audiologists and the profession of audiology as a member-at-large, and will be receptive to your valuable input and act as a common voice during my term. Thank you for your vote!



Academy News

New Year, New opportunities

to advance direct access

By Melissa sinden

d ecember 31, 2011, marked the end of the first half of the 112th Congress. As we

now embark on this election year, Congress will work to tie up loose ends before heading back to their congressional districts in late sum-mer to campaign in anticipation of re-election. This is a great time to push for initiatives that are impor-tant to you as an audiologist. Let your representatives know that support of audiology-related issues—such as direct access (H.R. 2140)—influences your votes for their re-election. Here are five easy ways you can make an impact this month:

1. Locate your representative and send him or her an e-mail by visiting the Legislative Action Center on the Academy Web site: http://capwiz.com/audiology/home/. This action takes less than 30 seconds and can be extremely influential. As Congress is work-ing to prioritize which initiatives to address before adjourning, your e-mail can help persuade them to pass direct access. Remember that you can edit any of the letters

provided, so consider sharing how direct access would directly and positively impact you and your patients.

2. Ask your state association to send a letter of support on letterhead to your representatives, as well as Congressman Mike Ross, the spon-sor of direct access. Even if some of the representatives in your state have already cosponsored the bill, it can be helpful to send a letter. Members of Congress appreciate hearing from associations back in their states. A sample letter, as well as a list of current cosponsors may be found on the Direct Access page of the Academy’s Web site: www.audiology.org/advocacy/ federal/congressionalissues/Pages/DirectAccess112thCongress.aspx. Also consider reaching out to your state’s Hearing Loss Association of America (HLAA) chapter or state organization for a letter of endorsement. Please send a copy of any support letters to Melissa Sinden, the Academy’s senior director of government rela-tions at [email protected].

3. Make a contribution to the Academy’s Political Action Committee (PAC). Given that 2012 is an election year, members of Congress need political con-tributions more than ever. The American Academy of Audiology, Inc., PAC is the perfect means to support candidates who back audiology-related issues and serve as allies for the profession on Capitol Hill. By contributing to the PAC, you can help ensure that these representatives are re-elected and that their support on behalf of audiology issues is retained in Congress. You can find out more, make a one-time contribution, or sign up to be a monthly contributor on the PAC page of the Academy Web site: www.audiology.org/advocacy/pac/pages/default.aspx.

4. Schedule a visit with your mem-ber of Congress. You can set up a meeting during a time when your representative will be back in the state simply by calling the district office and asking for his or her availability. If the member

washington watch


washington watchAcademy News

is not available in a timely man-ner, consider meeting with one of his or her very capable staff members to advocate on behalf of direct access and other issues important to the profession. Feel free to bring your colleagues and/or patients along. There’s strength in numbers! Find your representa-tives/contact information here: http://capwiz.com/audiology/dbq/officials/. Once you have scheduled a meeting, you can review tips for conducting a suc-cessful visit on the Key Contacts page of the Academy’s Web site: www.audiology.org/advocacy/keycontacts/pages/default.aspx. Remember, if you plan to be in the nation’s capital, Academy

staff is happy to help you set up a meeting in your representative’s Washington, DC, office. You may e-mail Melissa Sinden at [email protected] for assistance.

With all the campaigning that will be taking place this year, consider attending a town hall event or the like. You can be made aware of these events by visiting your member of Congress’ reelection Web site where you can often sign up to receive information about local events and town hall meet-ings. These types of opportunities can be helpful in raising aware-ness for audiology issues. Your representative may also publish a newsletter that contains valuable

information events happening in your district.

5. Don’t forget to ask 10 of your friends, patients, and colleagues to complete steps one through four above! Consumer-based information is always available at www.howsyourhearing.org.

Melissa Sinden is the senior director of government relations for the American Academy of Audiology.

Did you know that as an Academy member, you can…Save money on � Auto insurance � Business owners insurance � Professional liability insurance � Health/life/long-term care insurance—

individuals and employees

� Calling card � Academy credit cards � Credit card payment processing—special

rates on transaction fees charged for your business’ credit payments

� Car rental

Promote yourself with � Compensation and Benefits Survey—

make sure you are competitively compensated

� Fellow logo—use on your Web site and stationery

� Direct Connect—link from our Web site to yours

� Framing—for personal recognition

� Messages On Hold—promote yourself, audiology, and hearing health care to patients on hold

� HEARCareers—post resumes and search job listings for free

� Resume Review Service

Learn more about these benefits at www.audiology.org, search keyword “benefits.”

aNews title


Academy NewsJust Joined

New members of the american academy of audiologyJennifer Brannon, MAStacey Cohen, AuDDavid Cooper, ScDThomas Dolan, PhDColleen Edwards, AuDCarl Finley, AuDSteven Forsey, AuD

Jessica Frankel, AuDDana Gaubatz, AuDSheila Gray, MSMark Gustina, MSMarcie Hoskyn, AuDIkechi Iheagwara, ScDAnn Kiesow, AuD

Carolina LealBeth Lillywhite, MAMartin Mahoney, AuDJoanne Marvin, MSNancy McIntosh, AuDVincent Miraudo, MSLilian Muniz, PhD

Gina Richards, AuDMandy Santos, AuDYong Hon SimDaniel Troast, AuDEsther Zhang, AuD

New members of the student academy of audiologySandra Abou-HamdanNicole AddeoElizabeth AitkenBrittany AlexDavid AndreaggiSanghmitra ArvindekarTrinity AzevedoAshley BahrEric BarrettCorrine BartonKarianne BarwickRiley BassLindsay BaumanAlyssa BeatonJenna BeaulieuSydney BednarzSophia BehrmannFlorence BelhassenKaren BellJennifer BellisMarisa BellottiAbby BennettAriel BennettHeather BentonSara BernhardJaclyn BewickRachel BishopKirsten BockKelly BohlanderKolette BohrKamila BomeCassandra BosworthKalyn BradfordHolly BridgesDeirdre BristerJonathan BrittianAshlynn BroussardWarren BrownBrandon BruceElizabeth Buell

Eric BunnellKelly BurgdorfKatie BurkeJacob BurrowsJennifer ButlerChalese ButtarsAlicia ByerlyJohn ByramSarah ByrnesKristen CalabreseJennifer CampoloAshley CannonQuinlin CardTeresa CernyKayla ChauvinLaura ChenierKelsey ChristKate ChristiaensAlexis CohanJessica CollierChelsea ConradCaitlin CooperSarah CoppingerSarah CordingleyKathleen CostiganAlexandra CostlowCaitlin CotterSasha CousinsSarah CrowErin CunninghamMegan CurrieMichelle CurtisRebecca DameKristen DavisRobin DembeckNicole DevonScott DeWittAmanda DiamondJenn DillehayWilliam Dillon

Lauren DiPasqualeKatelyn DiPietroSamantha DixonShane DollarhiteChelsae DonleyKristen D’OnofrioElyssa DoomKrista DornbosZoe DossAlesya DraganchyukNicole DrakopoulosJessica DrescherJenna DubeChristopher DurhamMary Rose DurkinNicholas DursoBob DwyerChristina DykielKristen EdwardsFaria ElbabourDavid EngelmanHolly ErbaughMegan EspinosaJulia FahrneyAshley FazioRebecca FillmoreMelissa FlingSean FlowersAnna FordCarly ForemanCynthia FreyAnna FryAnnette GarcedKristin GeisslerIrene GelbhauerSara GerstleAlexandra GeryJoshua GilbertAllison GoffNatalie Goldgewicht

Lindsay GordonAlison GorenAndrea GrahamBrandi GreenhouseJennifer GroeneveldKatherine GroonVauna GrossMandi GrummLisa GuerraDanielle HagemannEllen HambleySonia HamidiLauren HarrisonAngela HaydenDanyelle HayesLarissa HecklerAllie HeckmanChristine HeintskillEmily HendersonMarcus HendersonAmber HicksRachel HigginbothamKatelyn HillMelanie HillNaomi HixsonKelee HoffmanMarie HolbrookAmanda HookJennifer HooperBriana HorganLishuang HuangBrittany HubbardGrace HunterJohn IdemaDeanna IffAmy IngramMonique IrwinKathleen JastrombAnna JochumLana Joseph


Academy NewsJust Joined

Katie KahlertKendall KalasAmy KalenderianCarrie KelmHeather KerstetterJeffrey KingRebecca KingmanMallory KislowKatherine KlebanMegan KobelHilary KramerDaniel KrassLindsey KunschRebecca KyllonenMelanique LaBeaudSamantha LaForteRebecca LangerJennifer LasmanAlisha LathamEmma LeBlancBinna LeeKatelyn LeitnerJessica LevensonMegan LiddellAshley LindbergSheli LipsonSteve LiuAndrea LiuzzoAlyse LombardiAngela LongJenna LoomisRailyn LopezKeri LowHeather LucianiTelani LuederErin LustikBethany MageeMonica MajewskiKelsey MannMisty MannAshley MarcusChristine MarinoAlisa MarleyPatthida MaroongrogeJamie MarottoAllison MartinelliIvelisse

Martinez-MontalvoLauren MatskoLindsay MayDana McAdams

Brendan McAteerSarah McCarthyAbby McClellandErin McDermottStephanie McLearNancy McLellanCarin McNiffMark McOmieAlexandra MelahnRoberta MichelsJessica MiddaughMegan MillerAshleigh MohneySanghyuk MoonDonna MooreTracey MoskatelRebekah MostJanelle MostadAbby MottKara MouzinJennifer MuehlebachTia MulrooneyVanessa MustoZarina NaizamLaci NamkenAmy NellomsMorgan NelsonKendra NeugebauerMichelle NeurohrMeredith NitcherNicole NordalKathryn NowakJessica NygrenLindsay OldhamDanielle O’NeilMary OwenJessicca PadreElizabeth PaineEmily PajevicBrittany PanettaLauren PasquesiEvans PembaShaila PerezMaria PomponioBridget PooleMia PozzangheraAnna PragerKrystal PriorKarlee PuschCarmen PustejovskyMichelle Ramacca

Ella Raposo-SacksSherry RauhTyler RaupThomas RecherNicholas ReedNichole ReedLisa ReedyAlexandra ReichKatelyn ReillyJessica RenouxSusan RichmondAaron RicksWilliam RoachDaniel RobertsDavid RobinsonVanessa RogersLauren RolloElizabeth RooneySarah RumbergerMeagan RuthKaitlyn SabriCara SandersonKylie SandorEmily SansomCaitlin SappVictoria SarbinLeigh SauerbierLaura SauthoffSara SchaetzkaJillian SchmidtJaclyn SchnelleJaclyn SchurmanEdith SchwartzErik SengstackenEric SeperEmily ShamblinLauren ShastanyBrittany SheldonTiffany ShermanElizabeth ShieldsElizabeth ShobelMichelle SimhaCaitlin SimmonsCarla SisselskyMariah SkinnerLyndsey SpencerOlga StakhovskayaMadeline StarkeyMichelle StephensMadelyn StevensJennifer Stockwell

Megan Lisbeth StrangEmily SussmanLukas SuvegElizabeth SwartzBritta SwedenborgSamantha TarsiBrittany TharpSarah ThomasMonika TiidoAnia TomasikNatasha TrozzoloStephanie TulumbaLaura TybergDana UlakovicJaclyn UtzYolanda ValentinAngela VandoliKrystal VeraDanielle VerrilliVictoria VidmarWhitney VineyardBrittany ViniarskiAlison VogelienMadeline VojakSamantha VroomanJohnna WallacePeggy WarnerKrista WatermanKatherine WebbMichael WehbyKristen WesselLauren WhiteErin WhitelyMarcee WicklineDaniela WijnperleRachel WilsonShannon WintersStacy WintrowErin WittersKristen WolfeWhitney WoodsNatalie WyattNicolle YopaCristina YorkeMatthew YoungArtem YusupovVjolka Zaka


Academy Newsfoundation update

aaa foundation announces audiologyNow!® Lecturers

r ichard Danielson, chair of the AAA Foundation Board, recently announced that presenters for the Foundation –

sponsored AudiologyNOW! Featured Sessions had been finalized. “The Foundation has arranged for two distinguished speakers on topics that will be of special interest to those attending this year’s conference in Boston,” he stated. “Any audiologist who strives to affect positive influence on the behavior of patients and staff will benefit from the per-spectives offered in our inaugural Improving Patient Care through Innovation in Workplace Management Lecture. In addition, audiologists treating infants and children will find this year’s Marion Downs Lecture on pediatric ves-tibular issues particularly enlightening.”

The selected AudiologyNOW! speakers are:

� Linda Luxon, CBE BSc FRCP, emeritus professor of audiovestibular medicine at University College London, will pres-ent the 2012 Marion Downs Lecture in Pediatric Audiology. Dr. Luxon’s lecture, The Dilemma of Dizziness in Children, will address causes, diagnoses, and manage-ment of vestibular issues in pediatric patients during her presentation on Thursday, March 29, 10:00-11:30 am. The Marion Downs Lecture is funded annually with a generous grant from The Oticon Foundation.

� Candace Bertotti, MPA, Harvard University, a national speaker and workshop facilitator at VitalSmarts, will present Influencer: How to Create Change in Your Audiology Workplace during her ABA Tier 1 sessions on Saturday, March 31 (10:00-11:30 am and 2:00-3:30 pm). VitalSmarts speakers are consultants to the Fortune 500 and have addressed audiences around the world—changing cultures and lives with their research and content. As the inaugural speaker for the new Workplace Management Lecture, Ms. Bertotti’s interactive session will address daily challenges faced by audiologists in all practice settings. Phonak Hearing Systems, Inc., has provided the generous funding that supports this new lecture.

“The attendees at AudiologyNOW! are very fortunate to have these superb educa-tional initiatives available this year,” added Danielson. “We thank our friends and col-leagues at The Oticon Foundation and Phonak for their support and these two generous philanthropic gifts.”

For more information about both of these exciting educational opportunities in Boston, contact the AAA Foundation office at 703-226-1049.

Last chance! map applications due January 13

a udiologists who wish to attend AudiologyNOW! but are experiencing financial hardship are encouraged to

apply for convention travel and registration support through the Foundation’s Member Assistance Program (MAP).


foundation updateAcademy News

The MAP application is due January 13, and is available at www.audiologyfoundation.org and www.audiologynow.org. Applications received by the deadline will be evaluated and reviewed by the award committee.

Notification of awards will be made by January 31.

MAP 2012 is underwritten in part by Auban, Inc., and Oaktree Products, Inc. Thank you, MAP supporters!

three events, one cause: Have fun at audiologyNow! while supporting the aaa foundation

t he Foundation has amped up the excitement in Boston with three benefit events you won’t want to

miss. The fun starts even before convention begins with the online Auction 4 Audiology. Running March 19–31, you’ll be able to bid on one-of-a-kind music memorabilia, getaways, electronics, gift cards, audiology items, handcrafted art, and more. In Boston, get a close-up look at your favorite auction items at the AAA Foundation Booth and place a bid on the spot. You can also bid from your home, office, hotel room, or anywhere with computer access. Score a must-have item while supporting the AAA Foundation! For more information (including how to donate an item), visit www.biddingforgood.com/auction4audiology.

Kick-off AudiologyNOW! with food, wine, friends, and a Boston Harbor view at this year’s Happy Hour with a View on

March 28, 5:30–7:30 pm. Held at the Seaport’s Lighthouse Ballroom on the South Boston Waterfront, you can enjoy the festivities while raising money for the Foundation’s programs in research and education.

The party continues at the inaugu-ral Student Academy of Audiology/AAA Foundation Cheers for Ears benefit event at Harpoon Brewery from 7:30 to 9:00 pm. The craft brews and appetizers will taste even better with the knowledge that proceeds sup-port student initiatives.

Tickets for the Happy Hour with a View ($75 members/$25 students) and Cheers for Ears ($25 members/students) are available with your AudiologyNOW! registration at www.audiologynow.org. For more infor-mation, contact the Foundation office at 703-226-1048.

See you in Boston!

New An Ear to the Ground Report available as thank You gift for donors

L ast year, the Academy released a new report on future trends that are expected to impact the science and practice of audiology. This report, An Ear to the Ground: Forces Affecting the Future of Audiology, is now available as a free gift for all donors who make a contribution

to the AAA Foundation of $250 or more before April 1. Visit www.audiologyfoundation.org, call the Foundation office (703-226-1048), or visit the Foundation Booth at AudiologyNOW! to make a gift…and receive this new account of the latest information on developments in sociodemo-graphics, technology, the environment, economics, policy, and politics that will impact your profession.

Audiologists enjoy good wine and good company at Happy Hour 2011.

There were over 100 great items bid on in the 2011 auction. Don’t miss your chance to grab a “must-have” in this year’s online Auction 4 Audiology, running March 19–31.

Get the Latest Tools to Educate Your Patients

Available through the Academy Store.To order, visit www.audiology.org and search key words “Academy Store.”

How’s Your Hearing?Ask an Audiologist!

American Academy of Audiology

How's Your Hearing? Ask an Audiologist! brochure for patients

$40/pack of 100

Hearing Aids

American Academy of Audiology

Hearing Aids brochure for patients

$40/pack of 100

Audiogram of Familiar Sounds

$20/tablet of 100

AUDIOGRAM OF FAMILIAR SOUNDS

FAINT

0

10

20

SOFT

30

40

MODERATE

50

60

LOUD

70

80

VERY LOUD

90

100

110

UNCOMFORTABLE 120

PAINFUL & DANGEROUS

130

140

125 250 500 1000 2000 4000 8000FREQUENCY IN CYCLES PER SECOND (Hz)

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DEC

IBE

LS (d

B)

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W W W. AUDIOLOGY.ORG | W W W.HOWSYOURHE ARING.ORG© American Academy of Audiology

NO R M A L H E A RING R A NG E


cLassified ads

The ABA is offering two certification exams on April 1, at AudiologyNOW!® 2012, in Boston.

Cochlear Implant Specialty Certification Exam (8:00am)

Pediatric Audiology Specialty Certification Exam (11:00am)

� Demonstrate to colleagues, other health-care providers, patients, and employers that you have a high level of knowledge by passing a rigorous exam in a specialty area of audiology.

� Demonstrate your adherence to high standards of ethics and continuing education.

Applications due February 1, 2012.

Visit www.americanboardofaudiology.org for more information on certification and specialty certification programs and to download applications.

Apply Today

Ohio

Assistant/Associate Professor: Dept. of Communication Sciences and

Disorders at the University of Cincinnati is seeking applications for a nine-

month tenure track faculty position in audiology to begin August, 2012.

Responsibilities include research and teaching in hearing processes and

disorders, with preference for expertise and research in pediatrics and

cochlear implants. Qualifications include: Ph.D., eligibility for the ASHA

CCC-A and state licensure, evidence of research productivity, publications

and potential for external funding, evidence of excellence in teaching.

Post-doctoral research experience is preferred. Applicants should apply

at www.jobsatuc.com and should attach a letter of application and cur-

riculum vita, Send letter of application, curriculum vita, three letters of

recommendation, reprints of publications and other supporting materials

to: Search Committee, Communication Sciences and Disorders, PO Box

379, University of Cincinnati, Cincinnati, OH 45267-0379. For additional

information regarding this position, please contact Robert Keith at robert.

[email protected]. The University of Cincinnati is an EOE employer with

a commitment to creating a more diverse workforce. Candidates who

contribute to that goal are strongly encouraged to apply. Review of appli-

cations will commence immediately and continue until position is filled.

PennsylvaniaUniversity of Pittsburgh

Assistant/Associate Professor

Hearing/Vestibular Science

Department of Communication Science and Disorders

School of Health and Rehabilitation Sciences

Asst/Assoc Professor: Nine-month tenure-track position in the

Department of Communication Science & Disorders, University of

Pittsburgh. Strong foundations in psychological and physiological acous-

tics with a preferred research focus in human auditory physiology and/

or vestibular function. Ph.D. or equivalent degree in Audiology, Hearing

Science, Communication Disorders or related field. Duties include

research, didactic and laboratory teaching and departmental, university

and professional service. Send curriculum vitae, letter of interest, and

three letters of recommendation to Dr. Malcolm R. McNeil, Department

and Search Committee Chair, Dept. of Communication Science &

Disorders, 4033 Forbes Tower, University of Pittsburgh, Pittsburgh, PA

15260. Review of applications will begin January 01, 2012 and will con-

tinue until the position is filled. AA/EOE/ADA.

(The University of Pittsburgh is an Affirmative Action, Equal Opportunity

Employer.)


cLassified ads

Your Year-Round

Audiology Employment

Resource

FREE Job Posting Days for Employers Attending AudiologyNOW!®Starting December 28, with purchase of 30-day job posting.

AmericAn AcAdemy of Audiology

for more information.

Visit

TexasThe University of Texas at Dallas is seeking outstanding applicants for

a tenure-track position in the School of Behavioral and Brain Sciences/

Callier Center for Communication Disorders. The position is based at the

Callier Center for Communication Disorders, which houses state-of-the-

art research and clinical facilities and is located adjacent the campus of

the UT Southwestern Medical Center. Candidates must possess a doc-

toral degree; an established program of research or evidence of research

promise focused on hearing science/audiology. Areas of interest include,

but are not limited to: implantable devices, hearing in infants and children,

bioengineering approaches to treat hearing disorders, and imaging. We

particularly seek distinguished researchers who would be appropriate

candidates for the Emile and Phil Schepps distinguished Professorship,

however outstanding candidates at all levels will be considered.

The University of Texas at Dallas is an Equal Opportunity/Affirmative

Action employer. All qualified applicants will receive consideration for

employment without regard to race, color, religion, sex, national origin,

disability, age, citizenship status, Vietnam era or special disabled veteran’s

status, or sexual orientation. Indication of gender and ethnic origin for

affirmative action purposes is requested as part of the application process

but is not required for consideration . Review of applications will begin

immediately and will continue until the position is filled.

To apply for this position, applicants should submit (a) their current cur-

riculum vitae, (b) a letter of interest (including research interests), and (c)

letters of recommendation from (or the names and contact information

for) at least five professional references via the ONLINE APPLICATION

FORM (http://provost.utdallas.edu/facultyjobs/) Upon submitting their

preferred email address, applicants will receive instructions to access

a personalized application profile website. School hiring officials will

receive notification when application materials are posted and are avail-

able for review.


Classified and Employment Line Listing Rates for Audiology TodayUp to 50 words $125

Each additional word $2

Agency discount not valid for line listings.

Classified and Employment Display Advertising for Audiology Todayad rates 1x 6x 12x

Full-Page Black and White

$1,630 $1,425 $1,295

Full-Page 2nd Color Matched

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Full-Page Full Color $3,005 $2,800 $2,670

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$2,030 $1,815 $2,095

Half-Page Full Color $2,505 $2,290 $2,175

Quarter-Page Black and White

$880 $760 $730

Quarter-Page 2nd Color Matched

$1,580 $1,460 $1,430

Quarter-Page Full Color

$2,055 $1,935 $1,905

Agency discount of 10% is valid to recognized agencies only, not valid on line listings.

Contact Heather Troast at The YGS Group at [email protected] for more information or to place an ad.

Web Employment Postingsposting rates members Nonmembers

Single 30-Day Posting $245 $290

Single 60-Day Posting $450 $550

3 Job Postings for 1 Month $625 $750

5 Job Postings for 1 Month $980 $1,120

Resume search included with job posting.

Contact Sarah Sebastian at [email protected] for more information.

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Vanderbilt university 41, 54www.vanderbilthealth.com

weitbrect communications inc. 11www.weitbrecht.com

widex 5www.widexpro.com

Academy Products and Services Indexaaaf auction for audiology 49www.audiologyfoundation.org

aaaf Happy Hour 51www.audiologyfoundation.org aaaf scholarships and grants 43www.audiologyfoundation.org

aBa meet and greet 65www.americanboardofaudiology.org

aBa pasc and ci exams 82www.americanboardofaudiology.org

academy research conference 2012 c3www.academyresearchconference.org

audiologyNow! 2012 23www.audiologynow.org

call for Volunteers 61www.audiology.org

eaudiology 62, 63www.eaudiology.org

Hearcareers 87www.hearcareers.org

membership Benefits 76www.audiology.org

practice management tools 81www.audiology.org

push the pac 57www.audiology.org

saa cheer for ears Benefit event 47www.audiologynow.org

This one-day conference will bring together leading scientists and clinicians to discuss clinically important advances in topics ranging from the basic biology of noise-induced injury to its evaluation, prevention and treatment.

RegistRation Rates � $95 Academy Members

� $150 Nonmembers

� $45 Students

.7 academy CeUs and aBa tier-1 Ce will be offered.

to register and for more information, visit www.academyresearchconference.org.

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