Better and better effects ofdeafness treatment especiallyin smaller and smaller childrenencouraged us to look for newtechnological solutions. As a

result, we have received a newgeneration of cochlear im-plants from researchers in bio-engineering and producers.

Some of the earlier implantsseem to be totally archaic today.Together with evident advance-ments for better speech coding,strategies were used in new im-plants to provide optimize pa-tients’ communication with theenvironment.Otosurgeons developed their

skills andwere able to take advan-tage of the latest scientific andtechnological achievements. Overthe years, the approach to post-operative rehabilitation and con-trol of the applied cochlearimplants has varied as well. Selec-tion criteria for implantation havechanged gradually. Therefore, indi-cations have been extended for

younger and younger children, notonly for those with total deafnessbut also with better partially pre-served hearing. A number of scien-tists in various parts of the world– in the USA, Australia and Eu-rope looked for newways to achievethe best final efficiency of the app-lied cochlear implant, to offer ourpatients, especially children moreand more to ensure free communi-cation with the environment.It was always a challenge re-

garding how to approach to pre-serve the smallest residualhearing and then use it. Appre-ciating the role of the scientists,it is impossible to not rememberthe role of the p atients and theirfamilies, parents and care-givers.It is they who have considerablyhelped to develop new conceptswhich, looking back, should beconsidered a common success

today. It was the mother whooften did not take off the hearingaid from the other ear which ap-parently gave no benefit.Thus, she proved that combined

acoustic and electric stimulation ispossible and faster progress in re-habilitation may be the effect ofthat. I mention that because in myclinical practice I havemet such fa-milies and such children. I have theirrefragable impression that some-times practice was way ahead ofscientific evidence and we shouldbow with all the respect to it.The series of European confe-

rences known as ESPCI has pla-yed an outstanding role in thedevelopment of new technologies,surgery and rehabilitation.Achievements of individual scien-tists, clinics and multicentric in-vestigations could be presentedand shared with many there.

The idea of combining electricalstimulation via cochlear implantwith acoustic amplification pro-vided by a hearing aid was ini-tially described by Dooley et al.in 1993 as Bimodal hearing inthe context of a cochlear implantused with contra-lateral residualhearing. Undoubtedly, one of theimportant achievements was theidea of combining electrical sti-mulation of the cochlear implantwith acoustic amplification usinga conventional hearing aid,named electro-acoustic stimula-tion by prof. Christopher v. Il-berg in 1999, or simply Hybridstimulation by prof Gantz. EASor Hybrid stimulation was notonly theoretically justified butalso clinically proven to benefitpatients with atraumatic intra-cochlear insertions of refinedelectrode arrays. (cont. on p. 2)

On behalf of the 9th ESPCI hosts, I would like to invite all of the Con-gress’ participants and accompanying persons to visit the Internatio-nal Center of Hearing and Speech in Kajetany.This time we will not carry out any medical procedures – we would liketo get to know each other better during informal chats and have fun.To celebrate your visit to Kajetany, our friends artist have prepared aspecial concert, to which I invite our guests. For us and our patients theCenter is a special place, a place for which we raised funds ourselves– nearly 80 percent. It is the effect of the whole team’ s hard work.

We and our patients feel here as being at home. That home opens itsdoors for the international multidisciplinary scientific community – gu-ests of the ESPCI in Warsaw.Busy with our everyday clinical and research work, we usually do nothave enough time to look at the world from a different perspective. The-refore, I am convinced that this meeting in Kajetany will give us lots ofunforgettable memories, will make you want to come back and that theevening shall remain long in the hearts and minds of our guests.

Prof. Henryk Skarżyński and his team

International Center of Hearing and Speech of the Institute of Physiology and Pathology of Hearing Foundation of Medical Development "HOMO HOMINI"

Prof. HENRYK SKARŻYŃSKI, M.D., Ph.D.President of the 2009 ESPCI

ISSUE 3 MAY 14 – 17, 2009 Warsaw, POLAND

CONGRESSTRIBUNE

Ladies and Gentlemen, Distinguished Guests, Dear Friends!

Beyond Rehabilitation -– round table discussion moderated byProf. Sue Archbold p. 3

New Technologies -– telemedicine p.4

Events of the Day -– people and sessions in the flash p.6-7

T H E 9 T H E U R O P E A N S Y M P O S I U M O N P A E D I A T R I C C O C H L E A R I M P L A N T A T I O NOR G A N IZ ER S:

G OL DE N S P ON SO R S: S ILV ER SP ON SO R :

IN THE ISSUE:

Invitation to the Garden Party PROGRAM OF THE GARDEN PARTY:

20:00 Prof. Henryk Skarżyński’s welcome

speech at the main tent

20:05 Studio Buffo Show – live music concert

22:00 Live music – disco

23:10 Fireworks show

23:10 Live music – disco

22:00Buses first departure at

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MAY 14 – 17, 2009CONGRESS TRIBUNE ISSUE3

2

EUROPEAN HEARING PRESERVATION

Partial Deafness TreatmentFor the first time, we presentedour effects of significant residualhearing preservation and combi-ning electrical stimulation in oneear with acoustic in the other, atthe ESPCI in Antwerp in 2000during a satellite symposium or-ganized by MED-EL company.We presented preservation of

77.3 perc. of residual hearing inover 62 patients. We also indica-ted that the precondition of sucha procedure was following theoptimum, least invasive surgicalapproach – “the Round WindowApproach”. It should be pointedout, at that time it was surpri-sing, because the most commonwas cochleostomy to approachscala tympani, made a little tothe front of the round window, inthe wall of the inner ear whichwas defined as “Soft Surgery”strategy.The growing material regar-

ding children with various, big-ger and bigger residual hearingwas consistently presented at allconsecutive European conferen-ces in the ESPCI series in Spain,Switzerland and Italy, at Ameri-can conferences and during a se-ries of specialistic conferences“Hearing Preservation Wor-kshop”. Consequent developmentof our program with the roundwindow approach resulted in se-lecting a new group of patients inwhom the size of the ganglioncells population in the apex of thecochlea, representing normal to-notopy, allows them for commu-nication with the external worldwithout any amplification of so-unds through conventional hea-ring aids.Such condition of hearing has

been defined as partial deafnesstreated using cochlear implants –“Partial Deafness Cochlear Im-plantation” (PDCI). For the firsttime in the world, an adult pa-tient with partial deafness wasoperated on by my team in 2002.We presented his results at the“Hearing Preservation Wor-kshop” in Indianapolis in the fallof 2002.During the following meetings

all PD patients were presented.Satisfactory hearing preserva-tion in 90 perc. of adult patientsallowed for surgical treatment ofa child with partial deafness inlate 2004. Till now, the growinghomogenous group of childrenwith practically unchanged hea-ring after cochlear implantationin 100% is the only one presented

in world literature and duringthis conference. PDT is no doubta great scientific and clinicalachievement which shows us newways of cochlear implants pro-gram development especially inchildren. Consequently, we maysay today that we witness unu-sual changes in the field of tech-nological development of cochlearimplants, in perfecting speech co-ding strategies, implantationstrategies, speech processor fit-ting strategies, new types of elec-trodes as well as software forfitting and telefitting.The theoretical basis of combi-

ning two methods of hearing res-toration through amplification ofthe existing hearing, applyingconventional hearing aids andcomplementation of the lost hea-ring abilities in high frequenciesusing cochlear implants hasbeen proven in everyday clinicalpractice. It has been proven thatsynergism exists between thepreserved natural hearing of dif-ferent degrees and electricalhearing which may be additio-nally amplified by acoustic sti-mulation.

After I implemented the firstprogram of deafness treatmentusing cochlear implants in Po-land in 1992 and getting expe-rience based on 2500 operationson children and adults, I decidedto approach the problem of hea-ring preservation from a slightlydifferent perspective. I came to

a conclusion that contemporaryunderstanding of “Partial Deaf-ness” (PD) is a little different,and the selection criteria for ap-plication of various acoustic and

electric amplifications providingconventional hearing aids, middleear implants and cochlear im-plants may be changed, extendedand be complementary.This new approach should

allow for new chances and possi-bilities for patients who did notbenefit from conventional hearingaids and not qualify for cochlearimplantation.This new approach shows, that

looking at hearing examinationresults which may indicate par-tial deafness (PD), we may rea-listically talk about its treatmentusing the latest technologies. Ithas been demonstrated on theprocedure algorithm below.

Algorithm of treatment proce-dure selection in patients withpartial hearing impairment cal-led partial deafness. Develop-ment of a new conception, whichcomprises earlier accomplis-hments of a number of eminentscientists, shows the position oftheir achievements and composes

within our crucial attainment, ispermanent hearing effect in casesof its good preservation in low fre-quencies and electrical comple-mentation in the other (EC).

To define the turning point intreatment of different typesof PD, we were empoweredby the following:

a)10 years of observationsand treatment of hearing

impairment with different de-gree residual hearing preserveddefined today as partial deafness(PD) in 1357 patients – childrenand adults with combined stimu-lation (ES);

b)almost 7 years of followup of 72 adult patients

with preserved good hearingafter the surgery in 88.7 perc.. inlow frequencies and complemen-ted electrically (EC);

c)nearly 5 years of follow upof 21 children with 100

perc. preserved good hearing inlow frequencies after cochlearimplantation and complementedelectrically (EC);

d)6 years of new acousticstimulation (AS) using

Vibrant Soundbridge implants in42 patients and temporary appli-cation of conventional hearingaids before deciding about im-plantation in 729 patients;

e)17 years of experiencewith round window ap-

proach in the first stage of thecochlear implants program inWarsaw which for the last 10years have gained new meaningfor preservation of residual hea-ring and set the basis for succes-sful treatment of partial deafness(PDT);

f)Over the last 10 years pro-ving the usefulness of thepossibility of significant or nor-mal hearing preservation usinga few types of such as Med-Elelectrodes and recently the newelectrodes in Nucleus implant.

The challenge we set for our-selves for the 9th ESPCI inWarsaw was to scrupulously in-vestigate experiences of a num-ber of scientists, centres, and topropose a new look at treatment

of different types of partial deaf-ness, which will be the greatestchallenge for our society in thenext few years, which could ex-pand and put in order new indi-cations for upcoming groups ofpatients giving them new chan-ces and possibilities. I take thisopportunity to invite you to par-ticipate in the lecture today, du-ring whichI will present the results of our

clinical follow up. I would like toannounce that a monograph de-voted to hearing preservation intreatment of partial deafness en-titled “Hearing Preservation– Partial Deafness Treatment” isin its final stage.For the past several years,

the practical approach to reali-zation of that program has beenshown live during demonstra-tive surgeries, numbering froma few to a dozen or so a day. It isalso possible to get acquaintedwith the results and meet withthe patients during "WindowApproach Workshops”.Working on partial deafness

has been a great challenge forour team and a stimulus for de-velopment in various directions.It has concerned elaborationand implementation of newdiagnostic methods, hearingscreening programs, new sets ofaudiological tests, psychoacous-tic methods and functional ima-ging methods.Recently, we have been im-

plementing a European Uniongrant funded project, “Remedia-tion of Hearing Loss – HearingTreat”. Since 2006 the Institutehas been leading the “HearingTreat” project, which is aimedto optimize the outcomes ofPDCI with the application ofstate of the art tools and inno-vative research methods develo-ped and put into practicerecently in leading centres ofhearing research.I would like to acknowledge

the contribution of our part-ners: prof. Blake Wilson – over-seas expert, prof. Frans Coninxfrom Cologne Universtity, HoseLuis Padilla from University ofGranada, dr. Sophia Kramerfrom Amsterdam, prof. PatricZorowka and prof. Kurt Step-han from Innsbruck University,dr. Marek Polak from Med.-Elcompany.

Prof.HenrykSkarżyński,M.D.,Ph.D.President of the 2009 ESPCI

“Electrical complementation of partiallynormal hearing is possible and expected.”

cn�nua�on from 1

PDT TODAY INCLUDES A MULTIDIRECTIONAL APPROACHThe acoustic stimulation alone in so called borderline patients (“Acoustic Stimu-

lation” - AS ), electric stimulation as a complement to the existing good hearing

in low frequencies (“Electrical complement” – EC), with amplification in the aco-

ustic part – Hearing Part Amplified, combined electro-acoustic stimulation (“Elec-

tric-Acoustic Stimulation” – EAS), and electric stimulation alone in case of failure

and loss of partial hearing (“Electric Stimulation” – ES)

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Beyond rehabilitation – Round Table

COCHLEAR IMPLANTATION IN CHILDREN:

The “Beyond Rehabilitation”round table discussion, altho-ugh less than one hour inlength, will probably go downas one of the most action-pac-ked, detail-rich hours of the 9thESPCI Congress. So much in-formation, so little time.

Sue Archbold provided the ope-ning remarks, focusing on deve-lopments in the area of longterm strategy for CI procedures.In particular, the overall ques-tion of who exactly is responsiblefor for the long-term manage-ment of pediatric CI patientswas introduced. Stating thatwhen people ask the ques-tion,“What is your rehabilitationphilosophy?” She told the au-dience, “I don't have one”. Shewent to explain that given thediversity of patients and theirdifferent sets of needs, any stra-tegy one proposes needs to takethis fact into account.So, the question arises then,

what is needed? What do “they”want? Prof. Archbold stated thatparents need to realize CI is not aquick fix, and that ongoing sup-port is needed from parents andteachers; nor is CI amiracle cure.Next up, Alex Wheeler from

NDCS briefly summarized datafrom a three-part study usingoutcome measures, written ques-tionnaires and in depth inter-views to examine the waycochlear implantation impactson communication choices andthe experiences of families. Thestudy found tha t parents choose

the most effective way of com-municating with their child, butretain as their goal the develop-ment of oral communicationskills. For many this is a journeyin which different approachesare utilized at various stages inthe child's development and inlater years, the use of sign lan-guage may re-emerge alongsideoral communication a a secondlanguage.Changing candidature: do we

know how to support these chil-dren and families in short andlong term? De Raeve L. FollowingWheeler's presentation, Leo DeRaeve gave an overview of thechanging selection criteria beingemployed in qualifying candida-tes for CI procedures. Generally,the average age of patients hasdecreased considerably, withsome implantation taking place inpatients as young as five monthsof age. Additionally, among thebiggest developments, he notedthe transition from unilateral tobilateral implantation. Anotherissue for consideration is thequestion of children from a signedbilingual setting, and how to sup-port these children and their fa-milies.He presented the results of

a study that compared a group ofearly implanted children educa-ted in a signed bilingual settingin the Netherlands, and a groupfrom a monolingual setting inFlanders. The results showedthat the Flemish children hadbetter speech intelligibility andspoken language development,

expressive and receptive. Therewas more variability in theDutch group. However, as DeRaeve pointed out, we should notconclude that only languageinput makes the difference, be-cause the educational settingswere so different.In terms of general conclu-

sions, he stressed the need forprofessionals to be flexible, con-tinually updated with the latesttechnology, but also to be pro-perly trained in working withvery young children and their fa-milies, to provide an environ-ment which will utilize theuseful hearing while meeting thelinguistic and curricular needs ofthe children, to meet the psycho-social needs of this group as theygrow through adolescence and towork with other professionals.Despite the amount of progressthat has been made, there rema-ins a great deal of work to do ina number of areas.Beyond rehabilitation: Chan-

ging education- what is neededin education for long-term sup-port Okalidou A. Areti Okalidoufrom the University of Macedo-nia provided an insightful snap-shot of the current state ofeducational support for CI stu-dents in Greece. She pointed outthat the current model usuallyplaces CI students with a deafteacher, and no oral language isused in lessons. Moreover, theoverall lack of audiological servi-ces and appropriate equipmentposes a challenging issue. Shewent on to outline the results of

a pilot program for long-termsupport, which was funded by aEuropean Union grant of127,000 euros, whose purposewas to enhance students skillsfor audition of spoken language.Taking place over a 4.5 month

period, the study conducted con-tinuing education seminars forschool professionals,one-to-onestudent assessments in theareas of hearing, audition, spe-ech and language, and self-es-teem to assess educationalneeds. The student outcomes in-dicated the need for more audi-tion and more language to affectbetter academic achievement.As for teacher outcomes,

knowledge gains included a bet-ter understanding of CI func-tion and CI education as awhole. Skill gains included IEPimplementation, inter-discipli-nary collaboration for feedbackand monitoring progress. In thefinal analysis, she underlinedthe fact that to expand andbuild a long term support struc-ture for long term outcomes inlanguage competency and lear-ning requires funding, and lotsof it, from the authorities res-ponsible.Cochlear implantation servi-

ces' change is overdue O'Donag-hue G.MThe session's finalspeaker, Gerry O'Donahue, boo-kended his brief presentationwith two complimentary quota-tions to illustrate the mainpoint of his talk. Citing Confu-cius' well known saying “Onlythe wisest and stupidest men

never change”, he went on to re-mind audience members of thepioneering work done by Djurnoand Eryies who performed in1957 the first CI attempt inParis. An image of the huge de-vice (by today's standard) wasshown on screen. O'Donaghuealso paid tribute to the work ofWilliam House, who “took CIand made it what it is today”.He mentioned the strength ofHouse's character and the tena-city on his part that was requi-red to make CI a reality, whichwas controversial at the time.Concerns at the time includedthe fear of damaging intracoch-lear structures; losing residualhearing; the risk of meningi-tis/infection; the effects of chro-nic electric stimulation.There were also serious issues

regarding device failure, porta-bility, the need for repeated sur-geries, and/or frequent hospitalvisits. O'Donaghue went tosummarize the advantages anddisadvantages of the so-called“medical model” vs. the “hospi-tal model” and stressed the im-portance of bringing care closerto home/community in order tomake it more family friendly,less intimidating, less costly,and of course, more efficient.But of course, change does notcome easily, or without a cost.Ending his presentation withanother famous quote, this oneby Woodrow Wilson, O'Donag-hue reminded us: “If you wantto make enemies, try to changesomething.”

This coupon entitles you to a discount

for EFAS 2011.

Each coupon is worth a 5 % discount.

Collect all four coupons to receive a total

discount of 20% off the conference fee.

GET THE TOTAL DISCOUNT OF 20% FOR EFAS 2011!

COLLECT ALL ISSUES OF THE CONGRESS TRIBUNEOrganisers

Institute of Physiology and Pathology of Hearing Warsaw, Poland The Audiology Section of the Polish Society of Otorhinolaryngologists and Head and Neck Surgeons

Congress Secretariat phone: +48 22 356 03 66 fax: +48 22 356 03 67 e-mail: efas2011@ifps.org.pl

Institute of Physiology and Pathology of Hearing www.efas2011.org

Moderator: Prof. Sue Archbold

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May 14 – 17, 2009CONGRESS TRIBUNE ISSUE 3

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Tele-medicine:cost benefits for patients,e-learning benefits for doctors

T he “tele-medicine”is a sig-nificant advancement inmedical science. In recentyears, it has become in-creasingly popular both in

Europe and the United States,and is also constantly developingin Poland.

It allows a highly qualified specia-list to remotely take part in a surgi-cal operation live, in real time fromany locationwith an appropriate in-ternet connection. Moreover, it pro-duces significant savings as “noteveryone has to be everywhere”.Nowadays everybody concerned

with reducing costs of treatment isvery much interested in these newtechnologies in the medical scien-ces – says Professor HenrykSkarżyński, director of the Insti-tute of Physiology and Pathologyof Hearing.Hospitals save most when they

can have the most renowned spe-cialists evaluate complicated ra-diological images withoutemploying them in every medicalfacility. Based on the long expe-rience of our Institute of Physio-logy and Pathology of Hearing,most of the benefits for patientscome from participating in diag-nostic screenings of sense organsfor large numbers of children andyouth. Thanks to this procedure,we can quickly diagnose early sta-ges of illness. An excellent exam-ple is the Institue's ownprogramme for early detection ofhearing disorders, named “I canhear”. Detection of little advanceddisorders gives the chance tolower the cost of surgical ear treat-ment by 65-70 perc. – explainsProfessor Skarżyński.Tele-consultations are the other

most effective and visible exampleproducing significant benefits forpatients. These have been conduc-ted on a large scale between theInternational Center of Hearingand Speech and associated branchcenters in Poland.Thanks to these consultations,

the doctors from the Warsaw in-stitute are in full contact with pa-tients and have full access to allthe information about their ear di-seases conditions without the ne-

cessity of travelling to distanthealthcare facilities.The Institute of Physiology and

Pathology ofHearing is the first suchinstitution inPoland that provides e-learning courses in otolaryngology,audiology and phoniatrics in theframe of continual education for doc-tors. The e-learning courses are pla-ced on a specialized multimediae-learning platform which was lau-ched in 2005.The system enables organization

and management of distance lear-ning. In addition, the institute hasintroduced its “Educational Portal ofthe Institute of Physiology and Pat-hology of Hearing”, than comple-ments existing e-learning platform.Students can log in to the demon-strational version of the e-learningplatform in order to become familiarwith this method of education.

According to Assoc. prof. KrzysztofKochanek, a co-author of the e-lear-ning platform, such amethod ofme-dical education provides a widevariety of possibilities. The widerange of multimedia internet cour-ses should be aimed at doctors who,according to the Decree of the Mi-nister of Health dated October 6,2004 regarding professional qualifi-cations of doctors and dentists, areobligated to regularly upgrade theirskills. The basic advantage of thiseducational method is the fact thataccess to the on-line material isavailable at any time from any in-ternet-equipped location.This is very important for those

who do not have time to take part inthe stationary training sessions atremote locations.Multimedia-basedcourses provide a more interactiveexperience for the students and lead

naturally to better assimilation ofknowledge. Assoc. Prof. K. Kocha-nek also adds the platform providesquick and objective checki ng of testresults and makes learning itselfmore individual.The Institute of Physiology and

Pathology of Hearing has been de-veloping its training and educatio-nal activities since 1996. Thetraining programme is aimed atvarious groups of specialists trea-ting people with hearing, speech,voice and language communica-tion disorders, as well as dealingwith parents and patients them-selves. The training courses pre-pared by the Institute ofPhysiology and Pathology of Hea-ring, based on the incessant edu-cation requirements also includespecialized courses for the otola-ryngologists, audiologists, pho-

niatrists, hearing aid specialists,Otosurgery Academy, Study ofObjective Hearing Testing and theOtoacustic Emissions.The Institute has also developed a

special qualifying course for the pro-fession of hearing aid specialists,which is delivered through the socalled “blended learning” method.All kinds of information technologiesare used in order to support the edu-cation process.The main goal of the Institute of

Physiology and Pathology of Hea-ring training program is to pro-vide high quality trainingsessions, making use of the latestinformation technologies in orderto improve the skills and know-ledge of Polish doctors to a levelcomparable to the standards of theleading nations of the EuropeanUnion.

The widespread use of the cheap Internet communication can support the effectiveness of treatment, lower itscost and provide a unique chance for doctors to improve their skills and knowledge.

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It is entirely thanks tothe friendliness of theESPCI 2009 organizersthat I had the opportu-nity to write in theconference magazine.Thus, let me start bythanking them for ha-ving given me thishonor.

Undeserved as the honor is, I willtry to explain why they have givenme a chance to address the confe-rence. Briefly, the main reasonmay have to do with my unusual

professional profile thinking of, let’s say,the “average” conference attendee. Asa professor in the Department of SocialPsychology and Methodology of BehavioralSciences at the University of Granada,I was not involved in the cochlear implantfield at all a few years ago. I teach psycho-metrics to graduate students of Psycho-logy. Furthermore, my research topicshave been questionnaire adaptation anddesign over the last fifteen years. On top ofthat, they chose me out of 80000 people in-cluding students, professor, administrationstaff and service personnel; 28 differentcentres, 69 degree programs, 132 doctoratestudent programs, etc. You are right. Itwas surprising that someone like me wouldbe attending the ESPCI 2009 conferencewith such an unlikely background.

For the last five years, I have consulted onvarious cross-cultural health surveys forpublic bodies such as the Spanish Statisti-cal Institute and for private companies. Asthe person in charge, I took part in the de-sign and adaptation of national and inter-national health surveys such as theEuropean Health Interview Survey, theSpanish National Health Survey, the Spa-nish Disability Survey, etc. I am alsoa member of several workgroups and taskforces whose missions are to improve ques-tionnaire and survey questions for both so-cial and health research. Along with thisexperience in health topics, I became inte-rested in the cochlear implant field thanksto the one of the most outstanding depar-

tments in cochlear implants in Spain: theORL Service in the “San Cecilio” HospitalClinic in Granada. Under the direction ofDr. Manuel Sainz, the service carries outimpressive treatment and does some re-markable research. My first step in thecochlear implant field was to supervise twodoctoral dissertations whose topics were todesign questionnaires to measure auditorydevelopment and quality-of-life indicators.

Having hardly started working on adap-ting and designing subjective measures,I had to face a new challenge. I was invi-ted by Prof. Henryk Skarżyński and histeam to participate in the Remediation ofHearing Loss Project. Funded by the MarieCurie Host Fellowships for the Transfer ofKnowledge, the main project objective wasto transfer knowledge to the Institute ofPhysiology and Pathology of Hearing (Po-land), and improve the skills of the Insti-tute’s researchers to perform advanced

research. Leaving aside project tasks rela-ted to electric and acoustic stimulation, wit-hin the task of developing new diagnosticmethods the research team have conductedseveral investigations into adapting origi-nal versions of auditory questionnaires intoPolish and designing questionnaires of sub-jective measures. Needless to say that bothadaptation and design projects have beenperformed in accordance with professionalstandards. Let me say a few words aboutone of the projects in which I have been in-volved so as to illustrate the kind of projectperformed by the Polish research team.

The aim of the project was to adapt the Lit-tlEARS questionnaire into Polish. The Po-lish research team became aware that theadaptation needed to be carried out accor-ding to guidelines proposed by professionalorganizations from the very beginning ofthe task. Before going any further, any ad-aptation process is not quite as simple asit could seem at first. Regardless of how ex-perienced the translators might be, a goodadaptation is not a simple matter of trans-lation, as some or even many of the origi-

nal questions may well have subtle but im-portant differences in interpretationswhen translated into another language. Inaddition, some words or expressions haveno direct equivalents in the target lan-guage. In short, the belief that “anyonewho knows the two languages can producean acceptable translation of a test” is re-garded by experts as naive and unrealistic.A “back-translation” method was used toassure identical or highly similar interpre-tations between the original version of theLittlEARS questionnaire and versiontranslated into Polish. Although the back-translation method can help assure com-parability of meanings across languages,subtle differences in languages, or the so-metimes substantial differences in cultu-res of different countries using differentlanguages, can affect the results obtainedwith the translated version. Thus, a fullpsychometric evaluation of the Polish ver-sion of the LittlEARS questionnaire was

conducted in order to be confidence aboutthe validity of the results. Such demandingwork could not have been done without theinvolvement in the project of focused andfriendly Polish researchers among them,let me mention Artur Lorens, Anita Ob-rycka, and Agnieszka Pankowska as re-presentatives of the Unit of CochlearImplants at the Institute of Physiology andPathology of Hearing.

Talking about professional standards andguidelines, I would like to get more out ofthis opportunity to insist on how importantit is to meet them when developing subjec-tive scales especially in the field of cochlearimplants. Questionnaires can be designedfor a wide range of purposes and for verydiverse populations. The quality of the in-formation provided by questionnaires de-pends on to what extent questionnairedesigners are aware of the methodologycriteria that their tools must meet. Ques-tionnaire designers should make a solidcase based on psychometric evidence tojustify the use of the questionnaire insteadof an alternative assessment device. Thin-

king of the “high-stake” decisions whichare made using these subjective scales, itis particular crucial to follow high stan-dards of quality in the field of cochlear im-plant. Fortunately, there are valuableguidelines and professional standardsavailable such as Standards for Educatio-nal and Psychological Testing (AERA,APA, NCME, 1999), Guidelines for TestAdaptations (van de Vijver and Hamble-ton, 1996). I cannot help but recommendchecking theses documents before andthrough out the questionnaire adaptationor design processes. Professionals involvedin designing subjective measures must in-creasingly pay attention to the quality ofour questionnaires, as users (patients, pa-rents, stakeholders, etc.,) will becameknowledgeable about these assessment in-struments thank to the Internet, suppor-ting associations, helping groups, etc.

Lastly, I would like to thank to ESCPI2009 organizers for inventing me to takepart in the conference. I am absolutely con-vinced that the ESCPI 2009 will be a veryexciting meeting not just for the topics thatwill be addressed, but also for the nume-rous opportunities to share experiencesamong professionals involved in the coch-lear implant field from different perspecti-ves. As you probably have been able to seefrom this article, I have become very fondof this research area; so enthusiastic thatI hope to keep on researching subjectivemeasures for cochlear implant interven-tions at least the coming years.

Amethodologistin the landof cochlear implants…José L. Padilla, Ph. D.

Department of Social Psychologyand Methodology of Behavioral SciencesSchool of PsychologyUniversity of Granada (Spain)jpadilla@ugr.es

Professionals involved in designing subjective mea-sures must increasingly pay attention to the qualityof our questionnaires, as users (patients, parents, sta-keholders) will became knowledgeable about theseassessment instruments thank to the Internet, sup-porting associations, helping groups, etc. Questionnaires can be

designed for a widerange of purposes andfor very diverse popu-lations. The quality ofthe information provi-ded by questionnairesdepends on to whatextent questionnaire

designers are aware ofthe methodology cri-teria that their tools

must meet.

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Chair: T. Lenarz; Moderators: B. Kollmeier, H.Verschuure: Participants: J. Durrant, A. Lorens

First, Hans Verschuure described the de-velopment and different health models ofaudiology programmes in Europe. Cur-rently, despite the growing need for spe-cialists in that field, few formalisededucation facilities exist. In most Euro-pean countries, diagnostic audiologist trai-ning is a medical speciality and togetherwith phoniatrics is part of ENT training,although the education format and lengthdiffers from country to country. The gene-ral trend nowadays, especialy in Ger-many, Poland and Switzerland, is headingtowards formalisation and certificationwithin the existing system.

Therefore, there is a need to decscribecurriculum and to decide on competencieson different levels of audiological educa-tion. At the end of the presentation, thequestion was posed: should more trainingin cochlear implant fitting be given to au-diologists?

John Durrant’s pre-sentation explained anew proffesional au-diology training pro-ject at the Universityof Pittsburg. The pro-ject is to serve mainlyas a vehicle for develo-ping an enhanced cur-riculum for pediatriceducation audiologyand to stimulate grea-ter interaction amongaudiologists, speech-language pathologistsand educators. To ad-dress the diminishingnumber of educationalaudiologists in UnitedStates, the Universityof Pittsburg is cur-rently broadening thespectrum of coursesand specialisationsoffered.

The next lecture was presented by ArturLorens. In Poland, training in audiologyand other fields of hearing, voice and com-munication disorders is carried out at theundergraduate as well as postgraduatelevel. Audiology remains in the medicalfield and is joined in one specialty withphoniatrics. The training to become a spe-cialist in audiology and phoniatrics lastsfive years.

There are also other non-medical spe-cialists working in the field of audiology,i.e. audiophonologists, speech patholo-gists, speech therapists working with thehearing impaired, clinical engineers andhearing aid fitting specialists. Birger Kol-lmeister started his speech by remindingthe audience about the meeting in Bad

Zwischenahn, themain purpose ofwhich, was to reviewthe existing program-mes in audiology in

Europe and to create guidelines for com-mon interdisciplinary university educa-tion in audiology.

The European Federation of AudiologySocieties (EFAS) concepts were overvie-

wed next. The main message stated thatuniversity training, regardless of its level,needs to be complemented by practical, cli-nical experience. This is especially true forstudents coming from other disciplines

EXPERT’S MEETING on EDUCATIONIN AUDIOLOGY AND OTOLOGY IN EUROPE(Friday, 15th May 2009)

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The 9th ESPCI press conference

During the second day of the ESPCI 2009 apress conference took place. Journalistwere interested in the matters of confe-rence

.

Main topics of presentations by A. Chang, C. Jolly, H.N.Ibrahim and A. Lesinski-Schiedel were methods of di-rect drug delivery into the cochlea.

The primary goal, as formulated by A. Chang, wasprotecting the cells from damage due to the traumacaused by the insertion of implant electrode, thus im-proving post-operative residual hearing.

Another advantage would be long-term effects ofdrugs, which might prevent degeneration of the hair-cells, and/or prevent the growth of tissue around theimplant electrode. Various methods of delivery werediscussed, including pre-operative administration of asteroid through round window – as reported by A.Chang, application of a dedicated catheter inserted di-rectly before electrode insertion, as proposedbyC. Jolly,or using implant electrode as a tool for drug delivery.

The most interesting concept, application of non-li-quid drugs, was formulated byA. Lesinski-Schiedel, whopresentedworks of the team fromHannover. It consistsin using nanoparticles embedded into the coating ofthe implant electrode. The particles are gradually relea-sed into the scala tympani providing curative effectsover a long period of time. However, this method is onan early stage of development. Othermethods are pre-sently examined on animal models, or tested on deadtemporal bone tissues. No clinical study was underta-ken yet.The discussion concentratedonmethods of tes-ting and applicability of particular drug deliverymethods. Themost advanced study seems that presen-ted by the team from Innsbruck (C. Jolly et al.), in whichfour different methods were compared, and practicalapplication of themmight be very close.

Drug Delivery – free papers session

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As a child you had acute hearing.MJ: Yes. I was born with no hearing impa-irment and brought up in the world of so-unds. My parents and the rest of thefamily could hear. I got to know the varietyand the meaning of sounds. I learned tospeak. I attended ordinary, public school.

But the world of sounds started slippingaway?

MJ: At 15, by chance, I was diagnosed witha fundamental hearing impairment, whichgot worse with every passing year. I couldstill hear low-pitched sounds but the hig-her ones were becoming more and moreinaccessible to me. The auditory informa-tion was disappearing as if someone waserasing it. I didn’t quite realise it. I didn’tknow what was happening. I was caughtbetween the world of sounds and silence. Itwas difficult to grasp or interpret the ongo-ing changes. However, everyday situationswere proving that I was different fromother kids my age, who could hear well.

What sort of alarming symptoms appea-red first?

MJ: The first noticeable difficulties were re-lated to speech comprehension. Even tho-ugh general communication was intact,certain words would get distorted becauseof my inability to catch specific sounds.After some time, it became very apparentat school, especially when teachers weredictating notes. During lessons, it got moreand more difficult to understand what theteacher was saying, what other childrenwere saying.Unconsciously, I started lip-reading. It came very naturally to me.

How did your impaired hearing effect youreveryday life?

MJ: At home I would miss the doorbell rin-ging or kettle whistling, even when I wasstanding close to the source of the sound.I was still able to register a lot of low fre-quencies, but instead of clear speech I wasreceiving mumbling.

Did your hearing deteriorate on a dailybasis?

MJ: My hearing ‘melted away’ gradually,while the list of places where I would havedifficulties communicating was growing ra-pidly. Staircases, corridors, buses, trams,department stores, the street, post office,public offices, coffee shops, theatres wereall becoming ever so tricky for me.

Whatwere thepsychological consequences?MJ: I didn’t engage in new challenges,I was afraid that I would not manage.I didn’t feel in control of my life anymore.I was afraid to trust myself. It was all con-tributing to my feeling really low.My options seemed very limited to me,I wasn’t as flexible as before. I couldn’t de-velop the way I wanted, nor be a part of so-cial or cultural life as fully as I would wishto. When I found out I was losing my hea-ring, I was in the final grade of primaryschool. I managed to finish high school andthen went on to university. Living with adisability wasn’t easy, but I learned to dealwith it. I did wonder, however, how it

would be when I started working. Thatwas a new, unknown challenge. In the end,during my final year at university, I had tojust dive in. The internships began andI had to become more active and assertive.The previous stability and order, in whichI knew how to act, had ended. Everyday,I would wake up wondering if I could do it.I had to figure out new ways to cope. I feltexhausted and overloaded.

Was that the reason you decided to havethe operation?

MJ: Yes, in the end, it was. After years offruitless attempts to find an appropriatehearing aid and trying to change the si-tuation and seeking any kind of help,I was fortunate to meet a diagnostician,who suggested a cochlear implant. I gotaccepted for the operation and afterwardsI started psycho–acoustic rehabilitation.

What were the most noticeable chan-ges?MJ: It takes weeks, months even to get ef-fects. Changes came gradually, but werenoticeable. After a break of so many years,time was necessary to get used to the so-unds I knew before and to learn new ones.But my life became easier. Now I have themeans to express myself. I have access tothe world. At last I feel in control of mylife. The decisions I make are not boundup by my limitation anymore, but are re-lated to the new opportunities stretchingin front of me. I don’t have to look at otherpeople’s lips so intently anymore. I don’thave to ask for help, because I can hear.I know when the doorbell is ringing, whenthe water is boiling, when someone is cal-ling for me from the corridor while I’m inthe other room. I don’t have to stand at the

window waiting if I invited somebody over.I feel more at ease joining a discussion ormaking new acquaintances. I don’t feel de-pendent on other people anymore. I un-derstand when someone’s usinga microphone, which used to be a nuisanceto me before – it covered speaker’s lips andaltered the sound.I am now able to listen to the radio and

watch television. I get the message in-stantly and can express my opinion stra-ight away. I can learn foreign languagesand develop my music sensitivity. I getmuch more enjoyment from music now– I can now pick out triangle, orchestrabells, tubular bells, harp, flute, violin fromthe melody. I also enjoy the whistling ofthe wind, murmur of the sea, birds sin-ging. Both as a performer and as a liste-ner, I find that singing has a newdimension for me. I can distinguish thepitch, which I struggled with before. So-metimes I even get the lyrics.

When did you decide to work with peoplewith hearing impairments?

MJ: It didn’t even cross my mind whenI was choosing my major. When I startedattending classes, however, with everystep of my education my knowledge andexperience grew, provoking thoughts ofmy future. “Where is my place”, I waswondering? As I was coming to grips withmy own disability, the topic was becomingmore and more fascinating to me. By thetime I was finishing my degree, I startedseriously thinking of working with peoplewith similar problems to mine.

So you weren’t sure? What was the deci-ding factor?

MJ: After activation of the implant, I couldobserve the changes happening every day.

I was comparing situations from beforeand after the operation. On one hand,I was filled with joy at the prospect of thehuge possibilities now openingin front ofme. But it was also a bumpy road. Eve-ryone aroundme (family, friends, teachers)expected me to instantly comprehend eve-rything. They were hoping that I would beable to use my new hearing to its full po-tential quickly. Not many people realisethat the period of being surrounded by si-lence is not just a break from receiving so-unds. There are some changes at the levelof the auditory cortex, which reorganisesitself, establishing new neuronal connec-tions. My brain adjusted to a narrow rangeof frequencies and found a way to maxi-mise the use of that information.When it suddenly got exposed to a wider

scope of sounds, at first, it couldn’t makesense of them like it used to. Even I didn’tunderstand what was happening at thebeginning. Specialists from the Implantand Auditory Perception Institute, toget-her with the rehabilitation staff of thePhysiology and Pathology of Hearing In-stitute helped me find my feet in this newsituation. Getting to know myself led to abetter understanding of other people whowent through the same ordeal. I wanted tohelp them deal with difficulties, so thatthey could use the full potential of theirnew hearing.The specialists from the institute were

enthusiastic about my idea and I startedmy work experience there. It was thenthat I finally made up my mind as to whatI really wanted to do with my life – I wasgoing to work with people who were re-turning to the world of sounds.

What exactly does your work comprise of?Could you tell us about an ordinary day atwork? In what way do your own experien-ces help?

MJ:My work is quite varied, it depends onthe stage the patient is at when they ar-rive at the institute. If the person is aboutto be qualified for a cochlear implant, myaim is to get to know that person’s currentsituation and to explain how the operationworks. When the patient begins rehabili-tation after the implant, I assist him orher with the transition through the sub-sequent stages. I can be there for that per-son through information meetings,hearing training, conversations. At the be-ginning of this journey, patients quicklyrealise they can pick up more sounds butit doesn’t necessarily mean instant com-prehension or better orientation in theirsurroundings.Without adequate support and gui-

dance, patients or the family (especially inthe case of children) can start feeling dis-couraged, irritated and withdraw from therehabilitation. Whereas, to be successful,rehabilitation needs to be run consis-tently. It is not equally easy for everyoneto find their bearings in this unusual si-tuation single-handed. My personal expe-riences make me more credible and arethe motivation, the constant reminder,that it is worth taking small steps whichultimately lead to something bigger.

An interview with Małgorzata Jeruzalska, an employee and patient of Institute of Physiology and Pathologyof Hearing – Educator at the Implant and Auditory Perception Institute

ErasedWith a Rubber

After activation of the implant, I could observethe changes happening every day. On one hand,I was filled with joy at the prospect of the hugepossibilities now opening in front of me. But itwas also a bumpy road.

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Here is the place where we publish photographs of our guests and friends, met in the hotel lobby, betweenlectures and during sessions.More of the photos you will find on our internet site , till May 18, 2009 visit www.congresstribune.pl

In the flesh

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MAY 14 – 17, 2009

Adding splendour to Friday’s sessions was the eve-ning’s Gala Dinner at Hilton Hotel. The numerous gu-ests could not only feast on delicious food, but alsoenjoy the splendid classical and Polish folklore musicof a violin duo. Julita and Paula Sokołowski, who in-

cyAoo

Prof. J. Helms,Prof. B. Wison,Prof. Ch. Von Ilberg

Prof. H. Skarżyński,Ms. E. Ludwikowska

Prof. J. Durrantand Prof. E. Hochmair

Julita and Paula Sokołowskie

Guest of the Gala Dinner

Toast of Friends For Ever: Prof. G Tavartiladze,Prof. B. Wilson, Prof. Ch. Von Ilberg,Prof. H. Skarżyńśki

Prof. J. Mueller

Prof. S. Archbold with her husband

Gala

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Toast to the Presidentof the Congress byProf. P. van den Broek

ve-gu-lsousicin-

cidentally are also Friends Forever of the Institute, pla-yed so well that the audience requested several encores.Among them were the Simon and Garfunkel hit “Soundof Silence”. After dessert, a toast was rasied in the nameof all the delegates by Prof. Skarżyński. Afterwards, Prof.

Paul van den Broek thanked the hosts for such a perfectlyorganised congress and even struck up a song for Pro-fessor Skarżyński – “For he’s a jolly good fellow”. He alsouncovered his Friends Forever nameplate and receivedthe traditional, symbolic Snail and Golden Patient’s Card.

Prof. G. Babighianand Prof. Skarżyński

a Dinner

Congress orgnizers

Dr L. Śliwa i doc. K. Kochanek with his wife

a Dinner

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THE INTERNATIONAL CENTER OF HEARING AND SPEECH IN KAJETANY

The Institute of Physiology and Pathologyof Hearing would not have developed soquickly or achieved as much as it alreadyhas, if there were not so many devotedfriends, both in Poland and abroad.Among them are well known institutions,foundations, as well as private investorsand public figures. They are all united bythe noble idea, which has no matchin modern medicine.

Today, each visitor entering the Interna-tional Center of Hearing and Speech in Ka-jetany passes the board detailing thepeople and institutions that have beenawarded Friends Forever status. Thisagain was Professor Skarżyński’s idea ashis way of appreciating people who hadfaith and trusted him and therefore, in oneway or another, helped to develop the in-stitute. Some of them shared their know-ledge, laid their scientific authority on theline or simply gave their time and heartsfor the project. Politicians provided theirsupport and patronage for the idea, over-stepping the boundaries of any politicalparty ideology.

Artists offered their talents organizingconcerts in order to raise money. Scientistsfrom Europe and all over the world invitedspecialists from the institute to their labo-ratories, enabling them to develop theirknowledge and learn from the best in thefield. For many friends and sponsors, thedecisive factor was the fact that the Insti-tute takes care of so many children, forwhom regaining of their hearing means re-turning to society and the chance to leadan active life. Others simply wanted to re-turn the favour or show their solidaritywith the less fortunate.

The “Friends Forever” board is vast, butstill contains empty spaces, waiting fornew friends.

�Bilateral and bimodal stimulation� Auditory brainstem implants�Middle ear implants - round table

� An interview with Prof. Henryk Skarżyński�Garden Party in Kajetany - full coverage� Everything about the 10th ESPCI in Athens

Tomorrow on eSPCi: Tomorrow in THe CongreSS Tribune:Dear Guests!Please, note that Congress Tribune willregularly appear on the website withupdated information. You may put incurrent information on the upcomingconferences. We kindly invite you tovisit www.congresstribune.pl

Friends Forever

Themarkof theextraordinary genius ofProf. HenrykSkarżyński and his Institute is the positive energyheevokes. All of celebrities andwell-known, popularjournalistshavealwaysusedsuperlatives todescribehim, sometimes affectionately calling ProfessorHomo Henricus (Janusz Michalak) or the Magician(AgataMłynarska). Here are a few accounts:

“During last 15 years I managed to change my employer se-veral times, but Prof. Skarżyński stays the same: full ofenergy and ideas, amazing manager, a go-getter who,despite all everyday problems, constantly smiles; he is kindand friendly and, on top of that, still remains a great physi-

cian and scientist. For me, the day consists of 24 hours. Loo-king at the Professor, one would have to assume, it is muchlonger than that. He always has time for us, journalists,usually after 10pm. He should be an example for other doc-tors, managers, PR specialists and journalists”.

ZbigniewWojtasiński, “Wprost” weekly magazine

“(...) 10 years ago I met a man who enchanted me. He spokeabout medicine as if he was predisposed to magically per-form miracles. Owing to his hard work, patience and deter-mination, hemakes miracles for the benefit of other people.And for that, Henryk, I admire you.”

Artur Wolski, Polish Radio 1

Journalists onHenryk Skarżyński

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