• 2013111251221-Vancouver.jpg

Opening ceremonies


OPENING CEREMONIES
Sunday, september 18, 2016

18:00 - 19:00


OPENING CEREMONIES
 
SPEAKERS
Communication in an Aging World: Getting Ready
Yves Joanette | BIO
Gael Hannan | BIO    
             
GIT HAYESK DANCERS    

 

Contributed Posters and Podium Papers 

 


round table sessions


Monday, september 19, 2016

08:15 - 10:15


BRAIN IMAGING IN AUDIOLOGY, RESEARCH AND CLINICAL PRACTICE
 
Leading edge developments in the use of brain imaging in assessment of auditory function. Relationship between imaging and function, Brain imaging advances that may relate to audiology. Cognitive changes and connections.

LEARNING OBJECTIVES
After this round table, learners will be able to:
  1. Explain age-related changes in the neural processes that are involved in identification and localisation of auditory objects
  2. Describe how animal experiments have informed an understanding of the relationship between neural and behavioural processing of auditory information
  3. Describe the effects of peripheral hearing loss on the central auditory nervous system and its interaction with other brain regions
Chair: Peter Thorne | BIO
  Speakers:

 Dan Sanes | BIO
"Can transient hearing loss harm the developing nervous system?"

Deafness research seeks to understand the consequences of permanent hearing loss. However, when it occurs during childhood, even a transient period of hearing loss can induce deficits in perception, speech, or language skills. One explanation for this is that transient hearing loss causes irreversible changes to the developing nervous system, thereby degrading central auditory processing. I will present evidence from basic research studies that support these concepts. Following a transient period of juvenile hearing loss, we find functional impairments to auditory cortex synapses that last into adulthood. Moreover, this cortical dysfunction is associated with an increased risk for deficits in auditory perception and perceptual learning. One plausible basis for the observed learning deficits is that hearing loss causes long-lasting impairments to brain areas downstream of auditory cortex that are commonly associated with cognitive abilities. In fact, following a brief period of hearing loss, synaptic transmission fails to develop properly in two downstream targets that are associated with reward learning (striatum) and mnemonic processing (perirhinal cortex). Taken together, our results suggest that a brief period of developmental hearing loss can derail both sensory and non-sensory neural mechanisms, thereby increasing the risk of long-term behavioral problems. (supported by DC011284 & DC014656)

Learning Objectives:

  1. Understand the evidence that the developing brain may be harmed by even a transient period of mild hearing loss.
  2. Describe the relationship between hearing loss-induced central nervous system deficits and auditory behavior.
  3. Recognize that hearing loss leads to changes in non-auditory regions of the nervous system that may impact cognitive skills.
 

 Claude Alain | BIO
"The Object-Related Negativity: A Neural Metric to Assess Concurrent Sound Segregation from Infancy to Old Age"

Our ability to perceptually segregate sounds that occur simultaneously is paramount for understanding speech in adverse listening conditions.  In a series of studies, we have described a novel event-related potential (ERP) component, now known as the object-related negativity (ORN).  The ORN is elicited when a listener perceives concurrent sound objects.  In cases of bistable perception, the ORN “comes and goes.”  In the laboratory, this component can be evoked using the mistuned harmonic paradigm.  Most people presented with a harmonic complex in which the tonal elements are all integer multiples of the fundamental frequency report hearing a single, ‘buzz-like’ sound.  However, when one of the lower harmonics is mistuned sufficiently, they report hearing the mistuned harmonic “pop-out” such that two sounds are perceived; a buzz-like sound plus another sound with a pure tone quality. The ORN is also observed when concurrent sounds are segregated based on location cues or when there is a difference in onset asynchrony.  It has been used to study concurrent sound perception in infants, children, young and older adults with and without hearing impairments, and to assess hearing difficulties in noisy environments.  Its use opens research and clinical opportunities to objectively quantify deficits in concurrent sound segregation and perception across a wide variety of contexts and populations.

Learning Objectives:

Participants who attend this presentation will be able to:

  1. Understand evidence-based information and advances in neuroelectric activity reflecting concurrent sound perception
  2. Portray the developmental changes in concurrent sound segregation and its neural correlates
  3. Described the role of ORN in assessing central auditory processing disorders
 

Larry Roberts | BIO
"Electrophysiological and metabolic imaging of tinnitus from cochlea to brain"

While most (arguably all) cases of chronic tinnitus are related to some form of peripheral hearing pathology, the tinnitus percept itself is generated not by increased pathological neural activity occurring in the cochlea but by neuroplastic changes that occur in central auditory structures when the brain loses its input from the ear. Results from metabolic (fMRI, PET) and electrophysiological (EEG, MEG) imaging of brain network activity in individuals with tinnitus are presented that support this conclusion. Neural changes seen in primary auditory cortex appear to relate most closely to the tinnitus percept while those observed in other brain regions reflect the consequences of tinnitus-related neural activity for cognitive and emotional processing or correlated attributes of tinnitus including somatosensory modulation and hyperacusis. Electrophysiological imaging of the auditory midbrain combined with cochlear modeling suggests a potential window on hidden synaptic loss in the cochlea that may explain tinnitus observed with clinically normal audiograms. Applications based on these results are leading to improved methods for hearing assessment and give some hope of relief from chronic tinnitus although at present elimination of the tinnitus percept in the absence of hearing restoration remains an elusive goal.

Learning Objectives:

  1.  Identify several types of neural changes that occur in auditory pathways following hearing impairment and consider how these changes are believed to contribute to tinnitus and hyperacusis;
  2. Understand why hearing impairment originating in the cochlea can be hidden from the audiogram, whether such impairment may contribute to tinnitus with normal audiometric thresholds, and how hidden hearing loss may be detected by other measures;
  3. Describe the time course of noise-induced cochlear injuries, how they may be expressed first as tinnitus and altered sound level tolerance, and implications for hearing health policy.

tuesday, september 20, 2016

08:15 - 10:15


EVIDENCE BASE FOR BEST PRACTICE: RESEARCH AND APPLICATIONS
 
The Round Table will provide an overview of the foundations of Evidence-Based Practice along with examples of evidence and its application in a range of audiology contexts.

LEARNING OBJECTIVES
After this round table, learners will be able to:
  1. Understand the principles of Evidence Based Practice (EBP)
  2. Gain knowledge about a range of applications of EBP in clinical practice
  3. Identify barriers and facilitators to EBP
  4. Understand how to relate research evidence to consumers

Chair: Louise Hickson | BIO
 Speakers:

Lena Wong | BIO
"The essence of Evidence Based Practice (EBP)"

Although there is an increasing emphasis on Evidence Based Practice (EBP), clinicians may not have a clear understanding of what it is and how to apply EBP. In fact, many clinicians may feel that EBP is a cookbook approach to clinical service provision or it is too time consuming and difficult to implement in daily clinical settings. This presentation will provide an overview of the steps involved in EBP and how clinicians, with an emphasis on resources that may make EBP plausible in a busy clinic.  Specifically, background information about EBP will be presented, followed by a discussion of the first four steps of the process: (1) ask a question, (2) access the information, (3) appraise the articles, and (4) apply the information.

Learning Objectives:

  1. To understand the principles of Evidence Based Practice (EBP)
  2. To describe the four steps of EBP
  3. To list the resources that a clinician could employ to facilitate EBP
 

Terry Chisolm | BIO
"Implementing Evidence-Based Practices: The Role of Manualization"

Healthcare practitioners are increasingly embracing evidence-based practice as a decision-making process that incorporates the best available evidence about effective interventions.  Often, the interventions are formalized into step-by-step manuals.  In this session, the development of a manualized intervention approach for older adults with hearing loss will be described.  Preliminary results of the use of f the manualized intervention, developed for a proposed multi-site randomized controlled trial, aimed at examining the potential for audiological intervention to slow the rate of cognitive decline in the elderly will be described.  The benefits and limitations associated with local implementation of a manualized intervention will be discussed.  Work supported by NIA R34AG046548 and funding from the Eleanor Schwartz Charitable Foundation.

Learning Objectives:

  1. The participant will be able to describe the steps involved in the development of a manualized intervention.
  2. The participant will be able to compare and contrast the benefits and limitations of local implementation of a manualized intervention.
  3. The participant will be able to describe the components of an EBP manualized intervention for older adults with hearing loss.
 

Thais Morata | BIO
'Hearing loss Prevention: from “says who” to “show me the evidence'  

Occupational health agencies, researchers and policy makers have recognized the need for evidence on the effectiveness of interventions designed to reduce or prevent work-related hearing loss.  While many workplaces comply with legal or obligatory requirements and implement recommended interventions, the continuing high rate of noise-induced hearing loss casts doubt on the effectiveness of these programs. Publications documenting the effectiveness of these actions are recent and few. Our objective in this presentation is to describe two approaches adopted by the US National Institute for Occupational Safety and Health to obtain and examine evidence of the effectiveness of interventions to control noise exposure in the workplace and prevent hearing loss. The first approach was to conduct research, including systematic reviews focused on such interventions.  In this presentation we will discuss Cochrane reviews that examined interventions to promote the use of hearing protections and other efforts to control noise and promote hearing loss prevention. The second approach taken to obtain information on the effectiveness of interventions involved the creation of an incentive program, Safe-in-Sound Excellence in Hearing Loss Prevention Award™ that makes it attractive for industry personnel to volunteer their success stories by nominating their hearing loss prevention strategies for an award. 

Learning Objectives:

Upon completion of this session, the participant will be able to:

  1. Demonstrate an understanding of the translation of research to practice in hearing loss prevention, and be prepared to be an effective consumer of the latest research and knowledge bases that support practice and contribute to the growth and dissemination of research and knowledge.
  2. Recognize the need and approaches that will allow him/her to be a lifelong learner, by keeping current with evidence-based professional practice, and engage in continuing competence and professional development activities.
  3. Locate pertinent Cochrane resources and reviews, and define what are answerable questions and eligible sources of evidence for a Cochrane Review.

Wednesday, september 21, 2016

13:45 - 15:45


HEARING: A GLOBAL PUBLIC HEALTH PRIORITY
 
Hearing health contributes significantly to years lived with disability, especially for people over 70 years of age who now live more years but have reduced quality of life. In the rapidly changing world, innovation challenges us to curate the best knowledge, experience and procedures to enable citizens with hearing problems to get the best support and solutions. Adrian Davis will present a population hearing health framework using collaborative research with the Global Burden of Disease team in Seattle to frame the narrative of the impact that hearing problems have on individuals, families, communities and populations. Lesley Burn and Adrian Davis will report on work with Better Value Healthcare in Oxford, UK to innovate across healthcare science; they have shown the advantages of forming peer-to-peer networks in paediatric audiology and also how these networks can innovate in bringing the benefits of new technology to adults with hearing problems. Howard Hoffman has curated epidemiological data for the USA and other countries to show trends in prevalence and etiology that can support good policy and services. Satvinder (Pearly) Dhingra will illustrate the path to the future where data analytics can guide us to provide best services for those with hearing and related problems.

LEARNING OBJECTIVES
After this round table, learners will be able to:
  1. Understand the Global Burden of Disease programme conclude about the disabling burden that is attributable to hearing loss in their own country
  2. Understand what is value based care
  3. Understand how might value based care be applied to hearing healthcare in an individuals population / country
Co-Chair & Speaker:

Adrian Davis | BIO
"Population Health Perspective for Hearing Health and Hearing Loss"

The Global Burden of Disease work shows that hearing loss is the number one contributor to years lived with disability (YLD) in those over 70 years of age. Advances over five decades have led to dramatic increases in life expectancy and years of life free from diseases. However, every country still faces outstanding healthcare problems. The over-arching problem is massive unwarranted variation (defined by Wennberg as “variation in utilization of healthcare services that cannot be explained by variation in patient illness or patient preferences”. These variations reveal four other problems: 1. patient harm from over diagnosis and over treatment; 2. inequity from underuse of high-value services by certain groups; 3. waste from anything that does not add value to the outcome for patients or uses resources that could give greater value elsewhere; 4. failure to prevent conditions when possible. Every healthcare service, especially hearing healthcare, faces new challenges of rising need, which in most countries will increase faster than the resources available. These problems will not be solved by the injection of more money, structural organization, or technology. We need a new solution: Value-based healthcare with four new types of interventions: cultural change, patient-centered care, population healthcare and systems.

Learning Objectives:

  1. To explain how to use peer-to-peer networks to improve hearing health services
  2. To describe the effects of using peer-to-peer networks on paediatric diagnostic audiology
  3. To describe the effects of using peer-to-peer networks on adult rehabilitative audiology
 Co-Chair:

 Satvinder "Pearly" Dhingra | BIO
"Past, Present and Future of Public Health Research"

In the past, researchers were able to assume that their population health research approximated to random probability samples. They based their confidence in their estimates by relying on statistics and proven methodologies. Today, because of technological and cultural shifts, land line and cell phone sample frames are not as reliable as they once were. Participation rates have plummeted and research participants are hard to keep engaged, forcing research to use access panels. Thanks to unrelenting advances in portable technology, we now have tools to empower communities and their residents to create their own sustainable changes in health-related behaviors. In the near future, we will see cloud-based population intelligence platforms—secure communities of members that health researchers turn to for ongoing real-time feedback and insight. These data will augment traditional probability survey data and prove to be very effective when balancing time, cost, quality, and utility of the data being collected.

Learning Objectives:

  1. Explain the gap between theory and practice of probability-based samples and traditional modes of data collection [face-to-face, mail and random digit dialed (RDD) telephone]
  2. Demonstrate how and why research in the coming years will be done using community intelligence platforms, which enable ongoing engagement in two-way conversations
  3. Separate the signal from the noise, and demand faster, better, and cheaper modes of data collection than traditional RDD telephone surveys
 Speakers:

Lesley Burn | BIO
"Hearing: a global public health priority"

From its launch in 2002, the English Newborn Hearing Screening Programme (NHSP) identified a number of serious incidents where children with hearing loss were not being appropriately diagnosed after being identified by the screening technology.  The quality assurance programme introduced in 2006 stimulated both a national appraisal of the quality of service delivery and also the development of service driven initiatives to improve quality, such as the introduction of clinical networks which at the outset focused on ABR quality. This has noticeably, through annual quality assurance, indicated improved quality of paediatric audiology diagnostics.

The new drive to focus on value in the English National Health Service (NHS) has stimulated further service driven innovation complementing value promotion levers available through commissioning mechanisms or national quality improvement systems such as Improving Quality in Physiological Services (IQIPS).

The presentation will outline progress to develop an integrated systems approach to the delivery of services for both children and young people, and adults with hearing loss.  It will chart the development of locality networks who are working in partnership to deliver an integrated system of care across the complexity of health, social care, education and employment services within the context of NHS England’s Action Plan on Hearing Loss.

Learning Objectives:

By the end of the session participants will:

  1. Understand progress made across England to develop an integrated systems approach to the delivery of services to both children and young people, and adults with hearing loss
  2. Understand how networks of integrated care are delivering improvements in hearing health for children and young people, and adults in England
 

 Howard Hoffman | BIO
"Epidemiology of Adult Hearing Impairment and Disorders: Perspectives from Population-Based Studies in the United States and Globally"

 Epidemiology studies the distribution, correlates, and outcomes of human health conditions for the purpose of improving health and quality of life.  This presentation examines distributions through space and time of age-specific prevalence and risks for adult hearing impairment (HI).
   Typically, HI is defined by pure-tone averages (PTA) of thresholds at four frequencies, 0.5–1–2–4 kHz, >20 dB hearing level (HL), or >25 dB HL, in better ear (BE) or worse ear.  “Disabling” HI is defined as “BE, PTA>35 dB HL”, where hearing aids/other rehabilitation is often recommended.  Prevalence and risk factors are also examined for hearing disorders, e.g., tinnitus – perception of bothersome ringing/roaring/buzzing in the ears/head lasting 5 minutes or longer during the past 12 months, and hyperacusis – bothered by everyday sounds or noises that don’t bother most people.
   Global prevalence of disabling HI is approximately 15%.  In U.S. adults, 10% report tinnitus and 6% hyperacusis, while disabling HI occurs in 2% aged 45–54, 8.5% aged 55–64, 25% aged 65–74, and 50% aged 75+ years.  Age/aging is the dominating risk factor, but other significant ones (noise, congenital/genetic, infection, ototoxicity) offer intervention opportunities.  Population-based hearing exams/interview surveys are essential to improving prevention knowledge and rehabilitation effectiveness.

Learning Objectives:

  1. To understand variation in space and time of the prevalence and risk factors for age-specific adult hearing impairment
  2. To discover the age-specific prevalence and risk factors for selected hearing disorders, tinnitus and hyperacusis, which also contribute to the overall hearing health burden of disease and “disability” of affected individuals
  3. To demonstrate how epidemiological studies are used to discover and assess risk factors for hearing impairment and disorders as well as for tracking knowledge and effectiveness of prevention and rehabilitation measures

 

isa -world health organization (WHO) lecture


WEDNESDAY, september 21, 2016

13:00 - 13:45


MAKING HEARING CARE ACCESSIBLE FOR ALL
 
WHO programme for prevention of deafness and hearing loss has a vision of a world in which no person experiences hearing loss due to preventable causes and those with unavoidable hearing loss can achieve their full potential through intervention, education and empowerment. 360 million people across the world live with disabling hearing loss. Resources and services for hearing care are least available in those parts of the world which have the greatest need. The WHO programme aims to develop and strengthen hearing care activities in its Member States (countries). It does so through the development of comprehensive hearing care strategies in partnership with governments and national agencies. To support its efforts, WHO develops evidence-based and validated tools for advocacy and technical guidance. In recent years,

WHO has launched a number of initiatives which include the World Hearing Day; Make Listening Safe; and Childhood hearing loss: act now; here is how! Partnerships are key to WHO’s work in this area. It is essential that all stakeholders in the field of hearing care, such as: international organizations, national governments, ear and hearing care professionals and civil society work together to create a global movement for promoting access to hearing care for all.

LEARNING OBJECTIVES
After this lecture, learners will be able to:
  1. Sensitize the delegates to the WHO programme for prevention of deafness and hearing loss
  2. Share the public health aspects of hearing care
  3. Arouse interest in the global movement for making hearing care accessible to all
WHO Lecturer:   Dr. Shelly Chadha | BIO
       

 

Glorig Lecture


WEDNESDAY, september 21, 2016

16:15 - 17:00


LISTENING IN NOISE
 
Listening in noise is the first problem experienced as hearing loss commences, and the problem that brings most people to the hearing clinic.  It is also the major problem experienced by children with spatial processing disorders, and probably other types of auditory processing disorder. Listening in noise is also the key to assessing hearing remotely when the test must be done via diverse unknown headphones and tablet devices or computers.  This talk will show how binaural beamformer microphones can be used to improve listening in noise for people with sensorineural hearing loss, and how training in spatialized noise can be used to completely overcome the deficits experienced by children with spatial processing disorder.  The talk will also show how adaptive speech-in-noise tests can be combined with adaptive tone-in-noise tests, and adaptive speech tests in quiet to remotely and automatically not only detect hearing problems, but also determine whether the problems arise from sensorineural loss, conductive loss, or auditory processing disorders / language disorders, even in children as young as 4 years of age.

LEARNING OBJECTIVES
After this lecture, learners will be able to:
  1. Operate principles of a binaural beamformer and the advantages it provides;
  2. Understand the characteristics of spatial processing disorder and methods for remediating it;
  3. Understand some methods for detecting hearing loss and auditory processing disorders in children via the internet.

Glorig Lecturer: Dr. Harvey Dillon | BIO
       

 

featured sessions


Monday, september 19, 2016

10:45 - 12:15

HEARING LOSS IN CHILDHOOD: CONSEQUENCES OF MISSING A MOVING TARGET IN BRAIN DEVELOPMENT
 
Hearing loss in childhood: consequences of missing a moving target in brain development. In this panel, we aim to discuss the implications of abnormal hearing within the moving target of auditory development. Although children are typically born with hearing, their auditory system is immature. The hearing pathways develop over time, becoming increasingly specialized as children listen and respond to the many different sounds around them. The developing auditory system is particularly vulnerable to deviations arising from a lack of normal input to the ears and/or auditory pathways. Activity-dependent processes can be arrested and compensatory plasticity promotes reorganization which may not be possible to reverse with later treatment. Efforts to detect these changes as early as possible have encouraged screening programs and promising new techniques to emerge. Yet, questions of how best to treat identified problems remain. Auditory prostheses will not restore normal ears; rather, these devices improve input to the hearing pathways and brain with the intention of maintaining the developmental trajectory for all parts of the system. How close are we to hitting these “moving targets”?

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Describe how early auditory experience influences brain development
  2. Explain what infants and children listen to as they learn to speak and read
  3. Recognize that there are variations of auditory development even in children with normal audiograms
  4. Plan treatment of hearing loss in children considering both sensory and cognitive processes
Chair: Karen Gordon | BIO
Speakers:

Dr. Steve Lomber | BIO
"How Brain Development Depends on Acoustic Experience"

A remarkable property of the brain is its capacity to respond to change. Among other functions, this neuroplastic process endows a complex nervous system with the ability to adapt itself to its environment but, at the same time, also makes it vulnerable to impoverished sensory or developmental experiences. In all sensory modalities, the processes underlying normal cortical development depend upon external stimuli. During development, sensitive periods seem to exist during which the presence of external stimuli are required in order to trigger the subsequent steps in normal development. Unfortunately, in cases of sensory deprivation, such as congenital deafness, this process is arrested. Fortunately, it appears that this situation can be reversed in individuals that receive cochlear prosthetic devices. In this presentation we will examine psychophysical, anatomical, and functional imaging evidence showing the importance of acoustic experience for normal brain development and how even a brief period of acoustic exposure early in life can have a dramatic influence on cortical development.

Learning Objectives:

  1. To learn how the absence of auditory input during brain development alters the developmental trajectory of auditory cortex and how even short periods of acoustic experience during development can have a major influence on cerebral organization
  2. To appreciate how cochlear implants can re-establish an auditory cortical organization similar to that of a hearing child
  3. To learn how anatomical, electrophysiological, and functional imaging techniques can be used to examine the functional organization of the auditory cortex in hearing, deaf, and cochlear implanted subjects
 

Dr. David Moore | BIO
"Contribution of peripheral and central auditory processes to understanding listening difficulties (aka Auditory processing disorder, APD) in children"

Listening difficulties in children with audiometrically normal hearing are quite common. These children may be assessed for APD or for a wide variety of learning disorders (e.g. ADHD, SLI dyslexia, ASD). Difficulties in all groups typically include hearing in challenging environments and falling behind at school. Listening involves bottom-up sensory processing, and high-level cognitive functions that can interact with upcoming auditory signals via efferent auditory pathways. Previously, we found that sustained attention is a more robust predictor of listening ability than threshold on spectral and temporal auditory tasks in typical 6-12 year old children. Listening was assessed by performance on a speech-in-noise task and by caregiver’s ratings of listening and communication abilities. Other recent studies have also found a primary role of cognition associated reported listening difficulties. However, audiometric thresholds are not great predictors of listening ability at suprathreshold levels or in challenging environments, so it is possible that previously unexplored bottom-up factors may contribute to listening problems. I will present the latest evidence concerning the roles of bottom-up and top-down pathways in listening difficulties. I will argue that this approach is a more appropriate framework for further clinical evaluation and management of ‘auditory processing disorder’ than the current approach.

Learning Objectives:

  1. Understand the concept that listening is based on sensory and cognitive processes
  2. Review evidence in favour of top-down and bottom-up explanations of listening difficulties
  3. Consider whether ‘hidden hearing loss’ may underlie listening difficulties
 

Dr. Janet Werker | BIO
"Perceptual foundations of language acquisition: Surprising new findings"

The process of language acquisition begins in perceptual development long before infants produce or even understand, their first words. In this talk, I will review the rapid changes in auditory, visual, and multimodal speech perception that occur in the first months of life as infants attune to the properties of the native language (or languages, if bilingual), and how the perceptual attunement sets the stage for language acquisition. I will then present evidence that, while under typical circumstances the timing of perceptual attunement seems to be constrained by maturation, there are identifiable variations in experience and in the context of language acquisition that can modify this developmental trajectory. Along he neural underpinnings of speech perception as well as of age related change will be briefly discussed. The theoretical and applied implications of these findings will be discussed.

Learning Objectives:

  1. To learn about the speech perception capabilities of young infants, and how they change across the first year of life. This includes learning how infants respond to speech vs non-speech, the level of detail they are able to use in phonetic discrimination, how phonetic discrimination is both similar and different in infants growing up in different language environments, and how infants growing up bilingual are similar and different to monolingual infants in their phonetic category learning and phonological development.
  2. To learn about some of the procedures that are used to test speech perception in infants. This includes acquiring a basic familiarity with both behavioral testing paradigms (looking, sucking) as well as electrophysiological (ERP) and neuroimaging (functional Near Infrared Spectroscopy, fNIRS) methods.
  3. To have some familiarity with how visual information in talking faces and sensori-motor information from the infants’ own oral motor gestures interacts with, and influences, auditory speech perception. To consider the implications of these findings for the practice of audiology.
 

Dr. Nina Kraus | BIO
"The importance of everyday listening: Unraveling the biology of language development"

Forming sound-to-meaning connections is an essential building block to learning how to read. Compelling research in the past decade establishes tangible biological signatures of language ability including reading. Our biological approach, which gauges the processing of a range of facets of sound, from the timing of consonant formants, the processing of harmonics in sounds, hemispheric dominance, and more, can be harnessed as a biomarker of preliteracy skills in young children.

We are following a group of pre-schoolers from age 3 on. We have found that a child’s brain response to a speech syllable in a noisy background tracks with their language development and is powerfully-predictive of future language and literacy[1]. Applying that same model to a group of older children revealed a similar relationship with reading and language skills.

It appears that a firm neural underpinning at a crucial age forms the basis of sound-to-meaning transformations that, in turn, facilitate listening skills important for language development. An objective neural measure serves as a biomarker of this transformation and allows identification and remediation of children at risk for language learning problems. A long-term goal is to employ this biological approach as a component of newborn hearing screening, opening a window onto the learning brain long before language acquisition.

Supported by the National Institutes of Health (R01 HD069414).
[1] White-Schwoch, T., Woodruff Carr, K., Thompson, E. C., Anderson, S., Nicol, T., Bradlow, A. R., Zecker, S. G. & Kraus, N. Auditory processing in noise: A preschool biomarker for literacy. PLOS Biol. 13, e1002196 (2015).

Learning Objectives:

Attendees will be able to:

  1. Describe the importance of forming sound-to-meaning connections in the process of learning how to read.
  2. Describe the objective brain measures that provide a glimpse of future literacy outcomes in pre-readers.
  3. Understand the fundamental sensory-cognitive-motor-reward brain mechanisms that converge into an objective biological marker.

AUDITORY AND COGNITIVE AGING: FROM SOUNDS TO MEANING
 
Over the past decade there has been an explosion in research activity related to the behavioral and brain mechanisms that regulate the perception of speech in noise. This increase in scientific interest has been motivated in part by advances in brain signal processing, which now highlight in more details the role of brainstem and cortical regions in processing speech sounds in adverse listening conditions. In this symposium, we will discuss recent research on age-related hearing loss and its potential impact on brainstem and cortical activity and explore new research avenues. Several research themes will be covered including the role of expertise, context, knowledge and memory in processing speech in noise.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand evidence-based information and advances in neuroimaging and aging research
  2. Portray the effects of age and hearing loss on auditory and speech motor systems
  3. Describe the role of musical training in mitigating age-related declined in central auditory processing
Chair: Claude Alain | BIO  
 Speakers:

Yi Du | BIO
"Motor Compensation for Speech Perception in Adverse Listening Conditions in Young and Older Adults"

Understanding speech in noisy environments is challenging, especially for senior listeners. The decline-compensation hypothesis posits that deficits in sensory processing caused by background noise can be counteracted by compensatory recruitment of more general cognitive areas. I will present data from fMRI studies that explore the role of the speech motor system as a compensatory mechanism during impoverished speech representations in the auditory cortices in both young and older adults. I will show that the specificity of phoneme representations is greater in frontal speech motor areas (i.e., Broca’s area and left ventral premotor cortex) than auditory cortices during syllable in noise identification regardless of age, a finding that we interpret as the neural basis of sensorimotor integration that may facilitate speech perception. I will also show that the up-regulation of activity along with preserved phoneme specificity in frontal speech motor regions of older adults provide a means of compensation for decoding dedifferentiated speech representations in the auditory system. Our findings emphasize the compensatory role of motoric predictions in speech perception at adverse listening conditions, which is more so for older relative to young adults. This may shed lights on rehabilitative strategies and training regimens for better speech comprehension in seniors.

Learning Objectives:

By the end of the talk, audiences should be able to

  1. Understand the sensorimotor integration theories of speech perception.
  2. Understand the relationship between two characteristics associated with aging during speech in noise perception: frontal overactivation and neural dedifferentiation.
  3. Recognize the motoric contribution to speech perception in adverse listening conditions and consider the role of the speech motor system in future speech comprehension studies.
 
 

Gavin Bidelman | BIO
"Age- and training-related plasticity in the auditory neural processing of speech: Connecting periphery to percept"

Aging is associated with declines in auditory processing including speech comprehension abilities. In a series of studies, we have evaluated both brainstem and cortical speech-evoked brain responses to elucidate how aging impacts the neural transcription and transfer of speech information between various levels of the auditory nervous system. Behaviorally, we find that older adults with and without hearing loss show slower, more variable speech classification than younger listeners, which coincides with reduced brainstem amplitude and increased, but delayed, cortical speech-evoked activity. We have also observed higher redundancy (i.e., lower interdependence) in speech information transferred along the auditory pathway from brainstem to cortex in older listeners, implying less neural flexibility in the aging auditory brain. Interestingly, these age-related changes in speech coding seem to be mitigated in older adults with musical training. Compared to their nonmusician peers, older musicians show higher temporal precision in their neural encoding of speech at multiple levels of the auditory system (brainstem and cortex) and are better able to differentiate speech perceptually. We propose that musicianship might offset age-related declines in speech listening by refining multiple levels of neural speech representations; this enhanced signal processing allows more behaviorally relevant information to be carried along the auditory pathway and subsequently used for robust speech perception. Collectively, our findings reveal that musical training offsets declines in central auditory brain processing that accompanying normal aging and may serve as an effective means to bolster speech listening skills that decline across the lifespan.

Learning Objectives:

At the completion of this talk, participants will achieve the following outcomes:

  1. Learn how neuroimaging techniques (EEG) can be used to assess auditory brain function (e.g., speech processing) in normal and hearing-impaired listeners. Additionally, participants will be able to summarize how certain aspects of brain activity are related to behavior and could be used as an objective measure to predict auditory perceptual skills (e.g., speech understanding).
  2. Gain knowledge of how normal aging and hearing loss (presbycusis) (i) differentially affect the neural encoding of speech information at subcortical compared to cortical levels of the auditory system and (ii) how changes in central auditory processing relate to behavioral deficits in speech perception.
  3. Learn how forms of auditory experience/learning affect neurophysiological function and whether or not the aging brain is still capable of showing positive change with experience (i.e., neuroplasticity). In particular, audience members will learn how musical training might be used to maintain, slow, or even counteract age-related changes in speech listening skills that normally decline across the lifespan.
 
 

Ann Eddins | BIO
"Relating perceptual deficits in older adults to dynamic changes in cortical processing"

Advancing age is commonly associated with auditory perceptual deficits in temporal processing, spatial processing, and speech understanding in noise.  For years, the conventional view has attributed these deficits largely to changes in peripheral function; however a growing body of evidence now suggests that both brainstem and cortical regions play a prominent role in influencing these perceptual measures.  We have used a combination of behavioral and cortical event-related measures to characterize dynamic changes in cortical processing associated with age-related monaural and binaural perceptual deficits.  In some cases, older adults have more robust cortical responses than younger adults, consistent with age-related modulation of central inhibitory mechanisms.  In other cases, older adults have smaller responses than younger adults, suggesting an age-related decline in temporal coding precision.  Further, we have examined aging effects on the cortical distribution of neural activity within and across hemispheres during auditory tasks using source localization and connectivity analyses.  These measures show that older adults often have a broader distribution of activity across hemispheres (i.e., reduced asymmetry) which may be due to adaptive mechanisms or altered neural networks needed to maintain perceptual performance.  Implications of these findings will be discussed in relation to clinical evaluations and intervention strategies. 

Learning Objectives:

  1. Understand auditory perceptual deficits associated with aging and age-related hearing loss.
  2. Describe some of the neural mechanisms thought to underlie the perceptual deficits.
  3. Discuss the implication of behavioral and cortical age-related changes on clinical evaluation and intervention.
 
 

Bernhard Ross | BIO
"Perceptual binding in young and older listeners"

The common complaint of elderly people, 'I can hear you, but I cannot understand' indicates that aging affects perception in addition to gradually elevating hearing thresholds. Auditory perception, the ability to interpret sound and add meaning to the acoustical input, requires combination of elementary features of complex stimuli into an auditory object. The neural network underlying this process of feature binding is widely unknown. It has been proposed that synchronization of high- frequency oscillation in neural networks may serve an effective alternative to binding via hard-wired connections because binding in an oscillatory network can be dynamically adjusted to the ever-changing sensory environment. Previously, we demonstrated in young adults that gamma oscillations are critical for sensory integration and found that they were affected by concurrent noise. Here, we aimed to support the hypothesis that stimulus evoked auditory 40-Hz responses are a component of thalamocortical gamma oscillations and examined whether this oscillatory system may become less effective in aging. In young and older adults, we recorded neuromagnetic 40-Hz oscillations, elicited by monaural amplitude-modulated sound. Comparing responses in quiet and under contralateral masking with multi-talker babble noise revealed two functionally distinct components of auditory 40-Hz responses. The first component followed changes in the auditory input with high fidelity and was of similar amplitude in young and older adults. The second, significantly smaller in older adults, showed a 200-ms interval of amplitude and phase rebound and was strongly attenuated by contralateral noise. The amplitude of the second component was correlated with behavioral speech-in-noise performance. Concurrent noise also reduced the P2 wave of auditory evoked responses at 200-ms latency, but not the earlier N1 wave. P2 modulation was reduced in older adults. The results support the model of sensory binding through thalamocortical gamma oscillations. Limitation of neural resources for this process in older adults may contribute to their speech-in-noise.

Learning Objectives:

  1. 40-Hz Steady-state oscillation in thalamo-cortical loops serve as a neural mechanism of sensory binding.
  2. Central masking affects binding of sensory information into a meaningful object
  3. Limited neural resources for sensory binding in older adult contribute to impaired speech-in-noise
 

IERASG: USING EVOKED POTENTIALS TO SOLVE CLINICAL PROBLEMS
 
In this session, the use of auditory evoked response potentials in clinical audiology will be illustrated in examples of knowledge translations bridging research and practice.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. To adapt their own clinical practices based on the examples provided
  2. To explain the reasons for selecting ERP tests for specific clinical purposes
  3. To explain how ERP test results complement other components of the case history
Chair: Suzanne Purdy | BIO
 
 Speakers:

Andy Beynon | BIO
"Audio-vestibular assessment in Cochlear Implants"

In contrast to more peripheral auditory evoked potentials (EP), cortical EPs covers sound processing of the complete auditory neural pathway. Besides determining thresholds (bottom-up processing), cortical potentials are also useful to gain insight in the neural plasticity and top-down processing in children and adults. Compared to peripheral EPs (cochlear, brainstem), later latency potentials might  reflect auditory cortical discrimination (cognitive P300, MMN) or detection of changes in tonal and speech stimuli (ACC). In CI recipients, similar experiments can be performed electrically using conventional or customized CI interfaces to present the electrical stimuli.

An overview of our present electrophysiological CI research and clinical assessment for auditory detection and discrimination at the cortical level will be addressed, including direct and indirect electrical CI stimulation, main differences between acoustic and electrical EP recordings, and future applications for speech processor fitting.Since the CI candidate profile has been changed the last decade, an increased number of patients with residual hearing receive CIs. Consequently, besides auditory, the importance of pre- and postop vestibular assessment has been significantly increased too. Use of simple clinical vestibular tests that improve preop counseling and postop follow up of CI candidates will be addressed.

Learning Objectives:

  1. Participant will know which electrically-evoked auditory evoked potentials can be used for clinical application to assess auditory cortical detection and discrimination of sounds
  2. Participant will have insight in the state-of-art how evoked potentials can be used for clinical fitting of cochlear implant patients
  3. Participant is able to apply simple tests to assess the vestibular function in young CI candidates or users
 
 

 Mridula Sharma | BIO
"Auditory selective attention and P300"

Mridula Sharma¹ , Megan Lower¹, Pragati Rao Mandikal Vasuki¹, Ronny Ibrahim¹, Joaquin Valderrama³, Susan Small²
¹ Linguistics department, Macquarie University, Sydney Australia, Hearing CRC
² University of British Columbia
³ National Acoustics Laboratories, Australia

Selective auditory attention is of interest and regarded as necessary when understanding speech in the presence of noise. The underlying processes of this skill are not that well understood. The purpose of this study was therefore to investigate the underlying markers of this skill using adult participants in bilingual (Mandarin-English) and monolingual (English) speakers. Two groups of ten normal-hearing monolingual and ten bilingual (English-Mandarin) young adults participated in this study. Each participant was presented 2 blocks of stimuli trains at 10dB SNR. One block referred to as discrimination paradigm had /da/ interspersed with /ba/ such that the presentation was /da, ba, ba/ with 60% probability of /da/ occurring in first position. The remaining two trains had /da/ occurring in either second or third position with 10% probability. CAEP data was collected from 25 electrodes. P1-N1-P2 and P300 are evaluated for /da/ when presented in different temporal positions. Wavelet time-frequency analysis is performed to analyse the epoched frequency band power information and cluster permutation statistics is used to test the differences across the groups and conditions. The presentation aims to discuss the ERP as well as time-frequency results as a measure of selective auditory attention in young adults.

Learning Objectives:

  1. Define selective attention
  2. Describe the methodology for P300
  3. Describe the differences between time and frequency domain analyses
 
 

Bob Burkard | BIO
"From bench to bedside in ERA: s faster always better?"

Digital signal processing has been used to enhance the collection and analysis of auditory evoked potentials (AEPs), which in many instances improves their clinical applications. In this presentation, we will describe two processing approaches that hold promise to make the collection of AEPs for efficient. First, we will talk about using various signal processing strategies which allows collecting AEPs at much faster rates than allowed by conventional averaging. Faster rates saves in obtaining an average to a constant number of stimuli. However, the amplitude change with increasing rate combined with other changes that might degrade the signal-to-noise ratio (such as jitter in the interstimulus interval) must be considered when estimating the relative efficiency of these approaches. We will present advantages these approaches offer in terms of more fully assessing adaptation of the response. In our second approach, we will discuss the advantages and potential disadvantages of using chirp stimuli, rather than clicks (or tonebursts), for hearing screening and threshold estimation. Issues such as the need to change optimal chirp duration with level, limited data in hearing-impaired subjects and infants, and exactly where along the cochlear partition that the auditory brainstem response arises (based on stacked ABR data) will be discussed.

Learning Objectives:

  1. The attendee will be able to describe the effects of increasing rate on the auditory brainstem response
  2. The attendee will be able to describe both the advantages and disadvantages of MLS versus CLAD approaches to obtaining ABRs at high stimulation rates
  3. The attendee will be able to describe where along the cochlear partition broadband transient stimuli are predominantly evoked, based on the Stacked ABR approach
 
 

Barbara Cone | BIO
"What can we learn about infant speech detection and discrimination from cortical auditory evoked potentials? "

 In the first study, infants with normal hearing were tested using tonal and speech stimuli. All CAEP tests were completed while the infants were awake and engaged in quiet play. CAEP latency-intensity input output functions were steeper in infants compared to adults. CAEP amplitude growth functions with respect to stimulus SPL were adult-like at this age, particularly for the earliest component, P1–N1. Infant perceptual thresholds were higher, on average, than levels at which CAEPs could be obtained.
 
In the second study CAEPs were obtained for vowel tokens presented in an oddball stimulus paradigm.  CAEP component amplitudes and latencies were measured in response the change in vowel type. CAEP amplitudes for vowel change were statistically significant when presented at a rate of 2/s. The CAEP amplitude differences for vowel contrasts could be used as an indicator of the underlying neural capacity to encode spectro-temporal differences in vowel sounds.

Learning Objectives: 

  1. List the stimulus and recording parameters needed to obtain CAEPs in infants.
  2. Compare the differences in CAEP latency and amplitude that exist between infant and adult responses.
  3. Critique the findings from perceptual and electrophysiologic methods of estimating speech feature detection and discrimination.
 
 

John Durrant | BIO
"Low-rate, longer-latency equivalent steady-state responses and removing the time-frequency barrier",
Durrant, JD¹, Ozdamar, O², and Cone, B³. ¹University of Pittsburgh; ²University of Miami; ³University of Arizona, USA.

Objective audiological tests of today emerged from over a half-century of research of electric response audiometry (ERA), effectively following two methodological streams--transient-evoked versus steady-state response (SSR) testing. Although transient-evoked potentials have enjoyed the wider-spread use clinically, particularly the auditory brainstem responses (ABRs), there has been underuse of (transient) long-latency responses (LLRs: cortical auditory evoked potentials [CAEPs]) in subjects unlikely to be testable in awake/alert states, including very young children. The aim of this presentation is to clarify the perceived difference in transient versus SSR tests and show that LLR/CAEP using steady-state methodologies has efficacy for use in infants and young children. Recent advances include frequency-domain approaches collectively, not only to short- (ABR) and middle-latency transient responses, but also to LLRs/CAEPs, namely ASSRs at repetition/modulation rates of 80Hz, 40Hz, and 20-5Hz respectively--even down to 0.75 Hz--without sacrificing time-domain analyses. The near future of research and development thus promises the clinician options for information desired rather than choices that compromise one “view” (frequency-domain) for the other (time-domain). The authors of this presentation have been principle innovators in these areas of advance and contributed relevant publications as career-long workers in ERA and related areas of evoked response testing.

Learning Objectives:

After this presentation, participants will be able to:

  1. Describe why only pragmatic issues make differences in time- versus frequency-domain tests of auditory evoked potentials (AEPs), namely that these views derive form a “two-way street”.
  2. Summarize recent evidence that steady-state analyses are applicable a low rates of stimulus repetition (modulation frequencies) and identify test advantages of such/related approaches to even long-latency-equivalent responses, particularly promising for testing late/cortical responses in young children.
  3. Identify issues of research and development of steady-state-response approaches that promise ultimately to permit analyses in either domain without compromising choices, that is either time and/or frequency views from the same recordings.
 

TINNITUS: EARS AND BRAINS  
Although much progress has been made, tinnitus is one of those hearing-related conditions which remains a scientific and clinical enigma. Tinnitus is a symptom, not a disease in its own right and so there are numerous different risk factors for developing the condition. The main risk factor is hearing loss, but this association is not simple or straightforward. Nevertheless, because otological conditions, especially high-frequency hearing loss, present one of the major risk factors for tinnitus, the auditory phantom sensations are often considered to be a neuroplastic response to sensory deprivation. This presentation entitled “Tinnitus: ears and brain” takes you on a journey through the peripheral and central auditory system, from cochlear abnormalities that might be the initial source of tinnitus, through the cascade of neural changes in the ascending auditory pathway that are more likely to maintain the condition. Invited speakers are experts in animal and human models of tinnitus. Their talks will introduce you to the techniques and methods that they use, and will share with you some of the insights from their research as well as some of the challenges of working in this dynamic and exciting field.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Develop an ability to explain to patients what might be causing their tinnitus
  2. Be confident about describing some of the latest research on tinnitus to patients
  3. Understand some of the challenges of conducting high quality tinnitus research so that you can better critically evaluate studies and reports that you might read in the future

Chair & Speaker:

Prof Deborah Hall | BIO
'How informative are biomarkers in clinical trials for chronic subjective tinnitus?'

Many studies are published based upon the premise that the phantom percept of tinnitus can be evaluated by measuring brain derived electromagnetic oscillations. A brief review of the electroencephalography (EEG) and magnetoencephalography (MEG) literature in humans however fails to demonstrate any clear relationship between tinnitus presence and frequency band power in whole scalp or source oscillatory activity, at least one that can withstand rigorous  independent replication. Despite this uncertainty, a preconception persists that such a relationship exists and that resting state EEG could be utilised as an outcome measure for clinical trials of tinnitus interventions, e.g. as a neurophysiological marker of therapeutic benefit. Furthermore, a number of clinical trials of tinnitus are utilising EEG power spectra as outcome measures, e.g. clinicaltrails.gov identifiers: NCT02383147, NCT00926237 and NCT01541969.
In this talk, I will present data from our team that examines the validity of whole scalp power spectra as a marker of tinnitus severity and hence as a physiological outcome measure in clinical trials. Our findings raise several general implications for the use of neuroimaging biomarkers in future clinical trials.

Learning Objectives:

  1. Understand why biomarkers might add value to evidence supporting the clinical efficacy of a tinnitus intervention.
  2. Critically evaluate brain imaging data collected from a recent clinical trial.
  3. Learn about the future directions for neuroimaging as a tool for clinical research.
  Speakers:             

Prof Alan Palmer | BIO
"Biomarkers for Tinnitus"

In the last ten years research into the brain mechanisms underlying tinnitus has progressed rapidly. In part this has been due to the development of believable animal models. It has become clear, that various changes in the anatomy and physiology of the auditory system accompany tinnitus, though they may not necessarily be causal. We have been attempting to use both human subjects with tinnitus and an animal model of (acute and chronic) tinnitus to elucidate biomarkers for tinnitus. We have analysed a large database of anatomical MRI scans of subjects with and without tinnitus seeking morphological correlates, without being able to replicate similar claims in the literature. We have, however, shown changes in human oscillatory brain activity (using MEG) in tinnitus sufferers and have early indications of similar changes in an awake animal model of tinnitus. We have also developed a variant of the pre-pulse inhibition model for detecting tinnitus in animals and have shown that some of the physiological changes often associated with tinnitus may be more of a reflection of the consequences of hearing loss. We are currently investigating whether a similar objective means of detecting tinnitus might be applicable to humans. Finally, we are looking at possible contributions of neuromodulator mediated plasticity to the generation or maintenance of tinnitus.

Learning Objectives:

  1. The nature of animal models of tinnitus Over the last 15 years many animal models of tinnitus have been developed. This represents a major step forward as previous tinnitus research using animal models had always been based upon the presumption that the animal was perceiving tinnitus. The earliest of these involved conditioned behaviour and demonstrated unequivocally that various insults to the auditory system could evoke tinnitus in animals. However, these tests are time consuming and more recently other reflex based approaches have become dominant. These more recent tests have some face validity, but are still somewhat controversial.
  2. Changes in the central nervous system that may underlie the generation of tinnitus A variety of techniques have shown changes in topographic organization and neurotransmitter expression associated with hearing loss and tinnitus. At present it is not known unequivocally which of these changes is correlated or causal in terms of the mechanisms of tinnitus generation. Some of the recent data that underlie various hypothesis for tinnitus generation will be discussed.
  3. Is peripheral pathology always necessary for generation of tinnitus? Although tinnitus is a symptom with a variety of etiologies most models of tinnitus involve an initial trigger provided by some form of loss of nerve fibers and the compensatory changes that occur. While tinnitus without hearing loss is reported some researchers suggest that this merely reflects less severe and hence undetected hearing loss.
 
 

Dr. Phillip Gander | BIO
"Human neuroimaging of tinnitus"

Scientific investigation of tinnitus has increased rapidly in recent decades which can be attributed to a greater focus on neurophysiological models and advances in human brain imaging. These changes have enabled researchers to investigate potential mechanisms for tinnitus in the human brain. A review of the different approaches to human neuroimaging will be given along with a summary of findings as they relate to tinnitus, highlighting recent work. These findings point to a large number of brain regions that may be involved in the experience of tinnitus, which further highlights the complexity of the condition and the difficulty that exists in identifying a target for treatment. To increase the chances for research findings leading to an effective treatment the growing field of the neuroscience of tinnitus will need to bridge the gap that currently exists between the animal models and the human neuroimaging data. Discussion will include possibilities for how the field can move forward.

Learning Objectives:

  1. Understand different approaches to human neuroimaging and what they might be able to offer regarding tinnitus mechanisms.
  2. Learn about the current state of human neuroimaging tinnitus research and what it has informed to date.
  3. Learn about the future directions for human neuroimaging in tinnitus.
 
         

Monday, september 19, 2016  

13:30 - 15:00

EXTRA-MUSICAL BENEFITS OF MUSIC TRAINING
 
Recent evidence suggests that music training may support hearing functions beyond music. This session will consider the available behavioral and neural evidence for extra-musical benefits drawing on research from different methodological approaches.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand specific populations that may benefit from music training
  2. Understand types of benefits obtained from music training
  3. Understand brain plasticity linked to music training
Chair & Speaker:

Frank Russo | BIO
"Effect of Choir Participation on Speech-in-Noise Perception and Neural Timing in Hearing-Impaired Older Adults"

Hearing loss is associated with increased risk of cognitive impairment and decrease in quality of life. This talk describes a study that investigates whether musical training can improve four aspects of auditory perception: perception of speech in noise (SIN), pitch discrimination, identification of emotion in speech, and the neural response to brief auditory stimuli known as the frequency following response (FFR), measured by electroencephalography. This study also examines several measures of cognition (working memory, inhibitory control of attention) to examine the extent to which gains in auditory perception may be due to cognitive abilities.

Learning Objectives:

  1. Learn about specific types of music training implemented
  2. Learn about audiological, cognitive and neural measures used to track progress
  3. Learn about types of sub populations that may benefit optimally from music training
Speakers:

Claude Alain | BIO
"Benefits of Musical Training and Bilingualism on Auditory Working Memory"

Musicians and bilinguals often show superior performance in auditory tasks that involve executive functions and working memory (WM).  This advantage might be driven by intrinsic biases in processing sound identity (what), sound location (where) or both.  Here, we used functional magnetic resonance imaging (fMRI) to measure brain activity while English monolinguals, bilinguals, or monolingual musicians performed a WM task for sound identity (what) or location (where).  Musicians showed better performance than non-musicians and bilinguals in WM for sound identity whereas all three groups were comparable in auditory spatial WM.  Notably, bilinguals showed better performance at the “where” than the “what” task, but their performance at the “where” task did not differ from that of the musicians and monolinguals.  The analysis of fMRI data revealed a double dissociation with greater activation in inferior frontal gyrus (IFG) when attending to sound object identity whereas attending to sound location yielded greater activation in inferior parietal lobule (IPL).  Region of interest analysis showed greater activation in right IFG and right IPL in musicians than non-musicians or bilinguals during the spatial WM task.  The increased activation in musicians may reflect a more efficient processing strategy and show that auditory ventral and dorsal pathways are influenced by experience.

Learning Objectives:

Participants who attend this presentation will:

  1. Gain knowledge on the brain processes supporting auditory working memory and how these are influence by musical training and bilingualism
  2. Portray the effects of musical training and bilingualism on executive processes that allow us to dynamically manipulate and prioritize co-existing information in working memory
  3. Distinguish how musical training and bilingualism influence auditory processing in general and auditory working memory in particular
 

Dr. Nina Kraus | BIO
"How experience tunes the hearing brain: What have we learned from music?"

An exciting facet of language is its link to music: musical and rhythmic ability track with language ability and music training can improve reading skills. A shared link between reading and music is reliance on biological processing of sound. It is essential to learning how to read—forming sound-to-meaning connections is a fundamental building block. And sound processing, by many definitions, is enhanced in musicians. Compelling research in the past decade or so has demonstrated tangible, measurable biological signatures of language ability including reading. Our biological approach, which provides a profile of the brain’s ability to process the fast elements of sound, also shows enhancements in musicians. With these findings in mind, in the past few years, my group has launched multiple lines of neuroeducational research, exploring the biological underpinnings of brain plasticity. We are specifically interested in the benefits of actively playing music, and have followed the academic performance of two groups of young, underserved public-school students longitudinally as they receive school-based music lessons, with a particular emphasis on biological changes. We have found that with two years of music training, literacy skills are enhanced, coinciding with changes in biological profiles that include a faster, more stable representation of sound. This represents a “speeding” of auditory system development, and a tendency toward a reversal of the biological impact of poverty-induced linguistic deprivation.[1-2] Playing music has given the brain the tools to make sense of sound.

Supported by the National Science Foundation, the Mathers Foundation, the Hugh Knowles Center, the National Association of Music Merchants, and the National Academy of Recording Arts and Sciences.
[1] Kraus N, Slater J, Thompson E, Hornickel J, Strait D, Nicol T and White-Schwoch T (2014). Music enrichment programs improve the neural encoding of speech in at-risk children. Journal of Neuroscience. 34(36): 11913-8.
[2] Tierney A, Krizman J, Kraus N. (2015) Music training alters the course of adolescent auditory development. Proceedings of the National Academy of Sciences 112(32): 10062-7.

Learning Objectives:

Attendees will be able to:

  1. Understand the neural signatures that are common to reading and music.
  2. Describe some facets of linguistic deprivation that school-based music programs can counteract.
  3. Understand the concept of “neuroeducation” and how it can inform school curriculum.

AUDITORY AND LANGUAGE PROCESSING IN OLDER ADULTS  
Spoken language plays a central role in most of our lives, and clinical interventions are centered around optimizing speech comprehension. Despite widespread changes in brain anatomy and cognitive function, many older adults are able to maintain high levels of successful speech comprehension. However, the mechanisms by which they do so differ from young adults. Furthermore, auditory processing challenges—such as those caused by background noise or age-related hearing loss—challenge older adults’ sensory and cognitive systems to a greater degree than those of young adults. In this session we will provide an overview of the most salient cognitive and brain systems involved in adult language processing, how these change in normal aging, and the ways in which auditory challenges such as background noise or hearing loss impact speech comprehension. We will discuss different levels of language processing, including single words and sentences. No background in brain imaging is assumed, and general principles will be emphasized in addition to specific findings.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Know the most common cognitive and neural changes that occur in normal aging.
  2. Understand different cognitive and neural processes that support different levels of language processing (single words, sentences, discourse).
  3. Appreciate multiple ways through which changes in auditory function might affect language processing, particularly in older adults.
Co-Chair:

Jonathan Peelle | BIO
"Individual differences in neural systems supporting speech comprehension"

How does hearing impairment affect the way our brains process speech? I will review data from behavioral and brain imaging studies that speak to the added cognitive demands associated with acoustic challenge. Evidence from multiple sources is consistent with a shared resource framework of speech comprehension in which domain-general cognitive processes supported by discrete regions of frontal cortex are required for both auditory and linguistic processing. The specific patterns of neural activity depend on the difficulty of the speech being heard, as well as the hearing and cognitive ability of the listeners. Although frequently studied in the context of adult aging, these principles have broader implications for our understanding of how auditory and cognitive factors interact during spoken language comprehension.

Learning Objectives:
Following this presentation, listeners will be able to:

  1. Identify multiple brain regions that older adults use differently than young adults when understanding spoken language
  2. Understand how listeners may balance various auditory and cognitive brain networks during successful speech comprehension
  3. Appreciate advantages and challenges of measuring auditory and cognitive skills in individual listeners
  Yune Lee | BIO
Speakers:

Mark Eckert | BIO
"Value from Listening: Neural Systems that Support Speech Recognition in Challenging Conditions"

Speech recognition in challenging listening conditions engages neural systems that inhibit potentially distracting information and monitor performance so that listeners can adjust behavior to optimize understanding. These systems include a group of cingulate and inferior frontal brain regions that are increasingly active when listening conditions decline. This increased activity appears to reflect the value of listening, in part because elevated activity in these brain regions predicts word recognition on a subsequent trial. This observation provides support for hypotheses that elevated frontal activity is compensatory. Older adults demonstrate benefit from this elevated activity, but to a lesser extent compared to younger adults, perhaps because difficulties sustaining attention on a speaker increase with age. Intention and attention systems will be discussed in the context of when and why older adults experience communication difficulties.

Learning Objectives:
Following the talk attendees should be able to:

  1. Identify non-auditory brain regions that are up-regulated in challenging listening conditions.
  2. Understand when and why these non-auditory brain regions are engaged (or not) in challenging conditions and the extent to which this activity reflects compensatory neural activity.
  3. Understand the relative importance of intention and attention for explaining speech recognition difficulties in older adults.

 

 

Natalie Phillips | BIO
"Aging, Hearing Loss, Cognitive Function, and Dementia:  What are the links?"

People with hearing, vision, and/or cognitive problems have poorer health outcomes, possibly due to due to common age-related mechanism(s), iatrogenic problems in the health care system, and/or the decay of social networks.  There is a strong relationship between sensory impairment and cognitive function.  Hearing impairment is independently associated with incident dementia and there are parallel findings for visual impairment.  Potential mechanisms for these relationships include common biological substrates, the exhaustion of cognitive reserve, environmental deafferentation, and/or increased social isolation from communication difficulties.  This presentation will provide a current review of the research findings concerning the relationships between sensory impairment, cognitive impairment, and dementia in older adults.  It will also present an overview of the Canadian Consortium on Neurodegeneration in Aging (CCNA), a nation-wide research consortium aimed at understanding the mechanisms of neurodegenerative illness.  It focuses on prevention, treatment, and improving the quality of life of those with dementia.  Extensive clinical, biomedical, cognitive, and brain imaging data will be collected on 1600 participants who range from having no clinical impairments in cognition, to those suffering from various forms of dementia.  This presentation will describe how the CCNA will provide a platform for conducting research on the relationship between sensory function, cognitive function, health, and quality of life in older adults with dementia. 

Learning Objectives:

Following this presentation, participants will able to:

  1. Describe current research findings concerning the relationship between sensory impairment and cognitive impairment;
  2. List current definitions of common neurogenerative diseases in older adults;
  3. Describe the research objectives and design of the Canadian Consortium on Neurodegeneration in Aging;
  4. List the sensory and cognitive assessment tools used in the CCNA.

HEARING AIDS: EARS AND BRAINS  
It is widely recognized that hearing instruments such as hearing aids do more than increase the audibility of a signal; they also stimulate the central auditory system. The ability to quantify brain activity in response to amplified sound therefore offers many opportunities for clinicians and neuroscientists. Some examples include using EEG measures to assist with the fitting of hearing aids, as well as to define central contributions to hearing aid success. Future generations of hearing aids are also being designed with brain contributions in mind. Therefore, in this session; we will review the current state of the field Hearing Aid/Brain science with the following learner objectives in mind:

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Explain how EEG is being used to verify hearing instrument fitting in children and adults.
  2. Identify potential central contributions to hearing aid success.
  3. Identify long-term effects of amplification on the human brain as well their function.
  4. Recognize future directions in instrument design and fitting.
Chair: Kelly Tremblay | BIO
Speakers:

Viji Easwar | BIO
"Objective outcome measures of hearing aid fittings"

The interest in using auditory electrophysiological measures as objective means to evaluate and predict hearing aid benefit has increased significantly in the last decade. The goal of using electrophysiological measures tends to vary between children and adults with hearing loss. Nevertheless, there are several measurement-related challenges relevant to all aided electrophysiological measures. This talk will discuss the different types of electrophysiological methods that have been proposed and used for evaluating hearing aid benefit. Applications and limitations of such methods, and multiple factors such as stimulus protocol, hearing aid signal processing and listener-related variables that play a role in such evaluations will be discussed.

Learning Objectives:

As a result of attending this presentation, attendees will be able to:

  1. List the different electrophysiological methods suggested for measure hearing aid benefit
  2. Describe merits and limitations of using aided electrophysiological outcome measures in individuals with hearing loss
  3. Identify known factors that need to be considered while measuring neural responses to hearing aid processed sound
 

Curtis Billings | BIO
"EEG approaches to assist with HA fitting, and future HA design"

There is clinical and scientific interest in establishing a physiological measure to assist in the hearing aid fitting/verification process, or to improve our understanding of how the brain changes over time with amplification. Furthermore, assistive listening devices, including hearing aids, are being designed to modify settings based on neural input from the user. Available data will be presented to address the potential uses and existing limitations of these three emerging applications of electrophysiological methods.

Learning Objectives:

  1. Participants will be able to explain possible uses and limitations of using aided evoked potentials.
  2. Participants will be able to describe the current state of hearing aid acclimatization research.
  3. Participants will be able to understand current and possible future applications of auditory brain-computer interfaces.
 

Kristina Backer | BIO
"Effects of HA amplification on the neural representation of auditory and visual memory"

Aging is often accompanied by sensorineural hearing loss (presbycusis), as well as declines in certain cognitive abilities, such as selective attention and working memory. These age-related declines in perceptual and cognitive processing can interact, impacting speech comprehension, especially in acoustically adverse situations. Yet, even though presbycusis can have a significant consequence on speech communication and quality of life, about two-thirds of older adults, who could benefit from hearing aids, reject treatment (NIH-NIDCD). Furthermore, it remains unknown how a history of hearing aid treatment may impact perceptual and cognitive processes that are engaged during successful listening. In this talk, I will present results from an ongoing project that aims to elucidate how presbycusis, with and without a history of hearing aid treatment, impacts not only brain activity at the level of auditory cortex, but also higher-level cognitive processes.

Learning Objectives:

  1. To learn how presbycusis, with and without hearing aid treatment, can impact auditory processing.
  2. To learn how presbycusis, with and without hearing aid treatment, can impact cognitive processing.
  3. To learn how neurophysiological measures are being used to determine the effects of hearing loss and hearing aid use on the brain.
   

Matt Winn | BIO
"Objective measures of effort and speech perception in HA users."

This presentation will explore aspects of speech perception that are not tapped by conventional word recognition tasks, but are crucially important to the success of a person communicating in the real world. These topics span from higher-level aspects of communication, such as prediction/anticipation and listening effort, to the very fine-grained details of phonetic perception and cue integration. The impact of listening effort will be discussed with regard to its economic, social and psychological impact, as well as its impact on language processing. Results from various experiments will demonstrate that measures of listening effort complement conventional audiological measures and may be a way to measure progress in areas that have been traditionally difficult to quantify.

Learning Objectives:

  1. To recognize the economic, social and psychological impact of elevated listening effort for people with hearing impairment
  2. To identify the limitations of word recognition scores as a measure of communication skills
  3. To interpret pupillometric measures of listening effort and recognize their limitations
  4. To recognize ways in which measures of phonetic perception and listening effort can complement current practices in audiology to serve as outcome measures.

LISTENING EFFORT: EARS AND BRAINS  
It is a common complaint that listening seems effortful when conditions for communication are suboptimal. One of the challenges for audiologists is to find ways of making listening less effortful for clients who are hard of hearing. Neural markers of listening effort including pupil dilation (obtained using pupillometry) and the Blood Oxygen Level Dependent (BOLD) response (obtained using functional Magnetic Resonance Imaging, fMRI) may provide important information about the connection between ears and brains. Listening to speech in background noise compared to listening to speech in quiet is associated with greater pupil dilation as well as greater BOLD response in speech processing areas of the brain. Further, there is evidence that activation of the neural substrate of listening in noise is modulated by top-down factors including cognition and knowledge. An exciting possibility is that brain training can ease listening effort. This featured session brings together latest developments in the application of pupillometry, fMRI and brain training to understanding listening effort.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Identify bottom-up and top-down factors that can influence listening effort
  2. Describe how pupil dilation and the BOLD signal can be used as neural markers of listening effort
  3. Discuss how brain training can ease listening effort
Chair: Mary Rudner | BIO
 Speakers:

Ingrid Johnsrude | BIO
"Listening effort, and the cognitive demands imposed by noisy and ambiguous speech."

When speech is heard in the presence of background sound, or when hearing is impaired, the sensory information at the ear is often too ambiguous to support speech recognition by itself. Two active areas of research are relevant to how we manage to recognize speech in challenging situations. First, I will review recent literature related to the different cognitive demands imposed during naturalistic perception of speech, and how different types of knowledge (such as the meaningful context within which an utterance is heard, or familiarity with someone’s voice, or familiarity with the reverberation characteristics of a particular space) may mitigate these. I will present recent work that illustrates the importance of different sources of knowledge, and how these may act to facilitate speech understanding. I will also survey evidence indicating how selective attention may facilitate speech perception in noisy environments. Finally, I will conclude by describing how listening effort – a concept that has recently become more popular in audiology since it may relate to important individual differences in outcome after intervention that are otherwise unexplained by speech-perception measures - can be understood in relation to different cognitive demands imposed during perception of noisy and ambiguous speech.

Learning Objectives:

  1. Describe different ways in which knowledge and experience can facilitate perception of noisy and ambiguous speech.
  2. Describe different cognitive demands imposed during perception of noisy and ambiguous speech.
  3. Recognize that listening effort can be understood as the interaction between listening conditions and cognitive factors.
 
 

 Claes Moller | BIO
"Can cognitive training improve speech-in-noise-understanding in persons with hearing loss ?"

The aims of the study were to explore whether cognitive training can improve working memory capacity and other executive functions and whether this can improve speech- in- noise understanding. A training program (Cogmed) during 5 weeks was used in an experimental group (hearing impaired) and a control group (normal hearing. Measurements were made before the training period, after and after 6 months. The test battery included audiological (pure tone, speech reception test, HINT) and cognitive tests (Verbal ability, executive functions, reading span, SICSPAN) well as fMRI. Gathering of data was finished November 2015 and results will be presented.

Learning Objectives:

  1. Can cognitive training improve speech-in-noise understanding in persons with hearing impairment?
  2. Will fMRI show that behavioral improvements are accompanied by regional changes in neural activation?
  3. Is it possible to add cognitive training to auditory rehabilitation ?
 
 

Stefanie Kuchinsky | BIO
"Assessing listening effort: Theoretical and methodological considerations"

Speech recognition in background noise often requires substantial effort, especially for older adults with hearing loss. In order to identify when and why listening effort emerges, a number of metrics have been proposed. This presentation will focus on studies of effort that have utilized pupillometry, an autonomic physiological response that is linked to a well-studied neural system. Theoretical and methodological considerations of this approach will be discussed, as well as its potential relevance to address clinically relevant research questions. Finally, this talk will outline how a better understanding of the mechanisms that underlie challenging speech recognition may be obtained by further validating measures of effort in functional neuroimaging studies. (Work supported, in part, by NIH/NIDCD and a Hearing Health Foundation Centurion Clinical Research Award).

Learning Objectives:

Participants will be able to:

  1. Identify key perceptual and cognitive challenges that contribute to listening effort in older adults.
  2. Describe research approaches for understanding the mechanisms that underlie listening effort.
  3. Discuss the potential impact of using validated measures of listening effort in clinical assessments and interventions.
 

TUESDAY, september 20, 2016

13:00 - 14:30

NEW AND EMERGING INNOVATIONS IN HEARING TECHNOLOGIES  
Analyses of the history of technology show that technologic change tends not to occur linearly over time, but instead follows an exponential trajectory. For example, Moore’s Law is the observation that the number of components in integrated circuits should double approximately every two years. Originally formulated by Intel co-founder Gordon Moore in 1975, his prediction has accurately described the pace of transistor development over the past 40 years. This and other advances in science and technology have resulted in a world that is not only changing, but one that is changing at an increasingly rapid pace. Indeed, over the past 20 years, technologies such as the Internet, smartphones, and wireless technologies (e.g., Bluetooth) have transformed modern life in countless ways. The purpose of this session is to focus on new and emerging technologies and the role such innovations have in the area of hearing instrument technologies and hearing loss rehabilitation. Special attention will focus on the role of the Internet, wireless connectivity, and smartphones in audiology.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Explain how current hearing aids are different than those available a few years ago
  2. Describe how new advances in technology will affect the development of modern hearing instruments
  3. Describe how new advances in technology will alter hearing loss rehabilitation
Chair: Gurjit Singh | BIO
Speakers:

Andi Vonlanthen | BIO
"Hearing Systems in a Connected World"

Over the last two decades hearing instruments have turned into intelligent systems offering a range of different algorithms for addressing listening needs in specific acoustic environments. More recently modern hearing systems are becoming wirelessly connected to each other to form body area networks. These ear to ear connections allow applying new features such as binaural signal processing techniques to improve communication in complex listening conditions. These algorithms can offer significant benefit in various difficult listening conditions beyond the performance of classical noise reduction and directional microphone systems. A second class of applications allows connecting hearing systems to external audio sources such as phones, remote microphones, TV, audio players etc. Such a system is particularly designed to improve communication over larger distances eg school environments and ease of use. A third set of applications of wireless connectivity includes a broad range of mobile applications offering new approaches to service delivery including the ability for remote support and interacting and controlling the hearing devices more specifically. In this talk I want to present the state of the art of hearing instrument technology and discuss future perspectives of the new technology trends.

Learning Objectives:

  1. Understanding of the ear to ear communication (binaural system) for improving speech intelligibility
  2. Understanding of wireless technology and future standards
  3. Learning about new services offered by the new wireless technology
 
 

Gitte Keidser | BIO
"Self-fitting hearing aids"

The Internet has created an opportunity to utilise direct-to-consumer device sales as an alternative hearing health delivery system. As a result, new devices have entered the market enabling users to independently fine-tune their devices at home via a downloaded computer or mobile device application. A small number of these devices are provided as entirely self-fitting devices by enabling the user to perform both the initial threshold test, which leads to a prescribed baseline response in the device, and subsequent fine-tuning; all tasks performed without the assistance from a hearing health professional. This talk will present examples of current self-fitting products, and list factors that research has identified as being important for ensuring a satisfactory outcome with these devices. Finally, the potential roles of self-fitting devices in the traditional hearing health care model are discussed.

Learning Objectives:

  1. Name and describe at least two self-fitting products
  2. List key factors that contribute to successful outcomes with self-fitting devices
  3. Describe the potential roles of self-fitting devices in a traditional hearing health care model
 
 

Brent Edwards | BIO
"Make light, not sound: Innovations in audibility with laser-driven hearing"

Current acoustic hearing aids exhibit several limitations to audibility, including limitations to high-frequency output levels, limitations to low-frequency output levels in an open fitting, and limitations to maximum gain before feedback in an open fitting. In addition to affecting sound quality and speech understanding, these limitations affect the amount of information available to the auditory system for complex auditory processing. All of the aforementioned limitations to audibility are due to the nature of the acoustic output of hearing aids, suggesting that a solution to these limitations could be a hearing aid that compensates for hearing loss without generating an acoustic signal. This talk will detail a new category of hearing aid that does not produce an acoustic output but instead uses a transducer to vibrate the eardrum directly, using light to transmit the audio signal to the transducer.  Information on the technical details of this contact hearing aid will be provided along with performance from temporal bone studies and results from a multi-site clinical study.

Learning Objectives:

Attendees of this presentation will be able to:

  1. Explain ways in which audibility is limited by acoustic hearing aids
  2. Describe how a light-driven contact hearing aid functions
  3. Summarize clinical data on the performance of a contact hearing aid
 
 

Graham Naylor | BIO
"The movement-aware listener and the movement-aware hearing aid"

Except in the researcher’s test booth, listening does not take place in a world of static sound sources, nor do listeners themselves remain motionless (not even when they try). Meanwhile, it is highly likely that our auditory system is constantly engaged in helping us to know our position and movement in the environment, and in helping us to construct a motion-aware model of the world around us. Thus there are sizeable gaps in our understanding of hearing and the impact of hearing impairment, and not least, an as-yet unexploited domain for improved hearing devices. This talk will present recent research into dynamic auditory behaviour, including some ways in which hearing-impaired listeners behave differently from normal listeners. These results suggest that future hearing technologies could provide improved benefit by including active compensation for the auditory perceptual effects of physical motion. Some novel technological possibilities will be presented, including those that compensate for these movements as well as those that take advantage of motion awareness in general.

Learning Objectives:

  1. Knowledge of current research results on dynamic listening
  2. Understanding of the dynamic listening behaviour of hearing-impaired listeners
  3. Insights into potential future hearing technologies exploiting motion information
 

DUAL SENSORY IMPAIRMENT: EFFECTS & MANAGEMENT
 
Concurrent vision and hearing impairment (termed dual sensory impairment, DSI) is strongly age-related, affecting about 6% of community-dwelling adults aged 55+ years and increasing to 26.8% aged 80+ years. It is assumed that individuals with DSI experience more than the sum of the consequences of vision or hearing impairment alone. Population-based studies show that individuals with DSI experience greater depression and functional limitations, poorer quality of life and increased mortality risk compared with those with a single sensory loss or no sensory loss. While vision is important for interaction with the physical and spatial world and hearing is important for interaction with the social world, both sensory systems can be used synergistically. For example, when listening in noisy environments, visual cues can increase speech understanding, and under poor visual conditions, echolocation can be used to support spatial perception. For individuals with DSI, this benefit can be significantly degraded. In this session, we will explore the risks associated with DSI in older adults, the perceived and measured effects on health and well-being, as well as opportunities for improved management.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand the risks associated with dual sensory impairment in older adults;
  2. Understand the barriers for management of DSI in older adults;
  3. Identify possible strategies to improve management of DSI in older adults

Chair: Catherine McMahon | BIO
  Speakers:

 Claes Moller | BIO
"Dual sensory loss/deafblindness"

The concept deafblindness includes a wide range of conditions/syndromes related to limitations/restrictions in the eye and ear which leads to different consequences in everyday life. Deafblindness limits activities of a person and restricts full participation in society to such a degree that society is required to facilitate specific services, environmental alterations and/or technology Deafblindness or dual sensory loss include some 400 syndromes as well as combined hearing and vision loss in elderly. The Swedish Research group in Deafblindness at the Swedish Institute of disability Research (SIDR) and the Audiological Research Centre Örebro University Hospital perform research in various areas such as genetics, hearing, vision, balance, psycho-social research and cognition. Specific syndromes are Usher syndrome, Alstrom syndrome, CHARGE syndrome and other rare syndromes.  A new large study on dual sensory loss in elderly is ongoing. The 15 researchers have different professional backgrounds as ophthalmologists, ENT- physicians, audiologists, psychologists, sociologists, engineers. We have one of the world’s largest clinical data bases and longitudinal studies in persons with Usher syndrome.

Learning Objectives:

  1. How common is severe dual sensory loss in elderly and which are the most common diagnoses?
  2. Can interdisciplinary research in deafblindness be of use for rehabilitation?
  3. Can state of the art genetic and clinical diagnostics increase the likelihood of treatment?
 
 

Walter Wittich | BIO
"Sensory Rehabilitation For Age-related Acquired Deafblindness: A Quebec Story"

Traditional rehabilitation approaches consider vision and hearing loss separately; however, in recent years, progress has been made to recognize the unique rehabilitation needs of older individuals with acquired deafblindness. This presentation will provide an overview on how rehabilitation services for dual sensory impairment are organized and provided within the Province of Quebec, will paint a portrait of the clients that are being served through these services, and will highlight the challenges that still need to be addressed in this context.

Learning Objectives:

  1. Participants will gain an understanding of rehabilitation service models in dual sensory loss, with specific focus on how these services are provided within the Canadian Province of Quebec, where these services are available without cost to the client
  2. Participants will be able to expand their knowledge on some of the demographic and sensory descriptor variables on the clientele that receive dual sensory rehabilitation service. Specifically, objective measures of visual and auditory function and eligibility cut-offs for service delivery will be considered
  3. Participants will be provided with specific examples and data on rehabilitation interventions and assistive technology usability in the context of deaf blindness rehabilitation for older adults with acquired impairments
 
         

INTERNET-BASED REHABILITATION  
The Internet of Things. Dr Google. Big Data. We hear these terms almost every day, but what do they mean for us audiologists and how we help our patients? The World Health Organisation defines eHealth as the “use of information and communication technologies (ICT) for health. In its broadest sense, eHealth is about improving the flow of information, through electronic means, to support the delivery of health services and the management of health systems.” This session focuses on eHealth applications for the rehabilitation of hearing impairment, tinnitus, and balance.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. List the typical steps taken in developing an Internet-based intervention
  2. Name at least three examples of audiology populations for which Internet-based interventions have been developed and tested
  3. Describe one barrier to implementation of an Internet-based intervention and propose how this barrier can be overcome

Chair: Ariane Laplante-Levesque | BIO
  Speakers:

Melanie Ferguson | BIO
"Using m-health technologies to increase access and benefits of hearing and communication-related interventions"

Over the last 8 years there has been a 5-fold increase in internet use (9% to 42%) in the 65+ year age-group; the typical age of first-time hearing aid users. More generally, access to the internet using mobile phones has more than doubled between 2010 and 2014 (24% to 58%). It is clear that the opportunities for delivery of hearing healthcare and education using m-health technologies to increase access to hearing and communication-related interventions are increasing year-on-year.

An RCT of an interactive multimedia educational programme (C2Hear), based on the concept of reusable learning objects (RLOs) and designed for first-time hearing aid users, has shown a number of benefits. These include greater knowledge of hearing aids and communication, better hearing aid handling skills, and higher use in sub-optimal users. To capitalize on the rapidly rising use of mobile technologies, C2Hear Online was made freely available in November 2015.

Mobile technologies enable tailoring to meet the needs of individuals and increase interactivity. This talk will focus on ongoing research to develop mobile-enabled individualized learning for hearing aid users, communication partners, non-audiological healthcare practitioners and the general public. The ultimate goal is to develop online self-management programmes for those affected by hearing loss.

Learning Objectives:

  1. To describe the advantages of internet-delivered rehabilitation
  2. To explain the benefits of a mobile-enabled educational programme
  3. To describe future developments in online rehabilitation
 
 

Jill Preminger | BIO
"Design Considerations for Internet-Delivered Self-Management Programs for Adults with Hearing Impairment"

Hearing impairment (HI) is a pervasive chronic condition in adults. As with any chronic condition, there are no simple treatment solutions to “cure” HI. Rather, patients and their hearing healthcare providers can select from a variety of management techniques. Group auditory rehabilitation (AR) programs are an effective method to improve outcomes in adults with HI. After completing a group AR program, many new and experienced hearing aid users demonstrate significant reductions in activity limitations and participation restrictions. Research has suggested that the greatest treatment effects are measured when AR groups include: information, communication strategy training, psychosocial exercises, and communication partners. Despite these positive findings, most audiologists don’t offer AR services beyond hearing aid fitting. In this presentation we will explore the possibility of expanding the provision of AR service delivery thorough the internet, and will focus specifically on design considerations for internet-delivered self-management programs for adults with hearing impairment and their communication partners.

Learning Objectives:

After participating in this presentation, participants will be able to:

  1. Classify behavioral change techniques that have been used successfully over the internet
  2. Identify components of self-management programs that should be used with adults with hearing impairment and how these might be implemented via the internet
  3. Clarify the importance of communication partners in auditory rehabilitation
 
 

Kristina Blaiser | BIO
"Evaluating the Effectiveness of Early Intervention Services Provided Via Telehealth"

Telepractice is one promising strategy to address challenges of distance and shortages of highly qualified early intervention providers serving children who are deaf/hard-of-hearing. This presentation will introduce findings from two recent studies examining outcomes and cost-effectiveness of tele-intervention services to children who are deaf/hard-of-hearing.

Learning Objectives:

  1. Describe the outcomes of the study from a child outcome and family involvement perspective
  2. Identify successes and challenges of implementing tele-intervention
  3. Discuss how TI may be used in interprofessional collaboration
 

CENTRAL PROCESSING  
Hearing is a complex function underpinned by analysis of sounds in temporal, spectral, and spatial domains. Anatomically, this requires transmission of the auditory signal from the ear to the auditory cortex and further processing to facilitate sound perception and recognition, attention, memory, and learning, which are all integral components of auditory cognition. Hearing impairment has a profound effect on an individual's ability to function at a personal, social, and professional level Understanding how complex acoustic stimuli are encoded along the auditory pathway and how this processing is related to lower and higher levels from the pathway can help us to better understand the processes underlying normal and altered human communication. Auditory evoked potentials (AEPs) are important tools in the investigation of auditory function because, in addition to being objective and noninvasive tests, they are

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Discuss the behavioral evaluation of the processing disorder as well as the role of Auditory Evoked Potential as a diagnostic support to evaluate auditory processing disorder,particularly in young children or individuals whose behavioral assessment is not possible.
  2. Understand how experimental work with animals is related to clinical work.
Chair: Eliane Schochat | BIO
 Speakers:

Jos Eggermont | BIO
"Animal models of auditory processing disorders"

Auditory processing disorder (APD) is a common, heterogeneous and poorly understood listening impairment that is increasingly diagnosed, especially in children and the elderly (where it could result from age-related damage to ribbon synapses in the Inner hair cell). The primary symptom in humans is poor speech perception despite clinically normal pure tone audiometry. Note that this primary symptom could also correspond to auditory neuropathy, where it is further defined with normal otoacoustic emisisons and abnormal and absent ABR. In this case it would result from defects in the OTOF or OPA1 gene expression. APD is often considered to result from bottom-up processing effects, resulting via central gain changes in processing deficits. Alternatively, pure central changes, which can be introduced by noise exposures that do not cause periphereal damage, show many of the same cortical changes. Examples are noise in NICU, late effects on prolonged conductive hearing loss in childhood, and long-term exposure to non-damaging occupational or recreational noise. I will present animal models of bottom-up and top-down deficits in cortical processing, comprising changes in neural synchrony, in frequency-place maps, and surprising differences in tonotopic compared to non-tonotopic cortex. These may underlie some of the forms of APD encountered in humans.

Learning Objectives:

  1. Animal models can provide mechanisms underlying certain forms of APD, despite the fact that diagnosing APD in animals is impossible
  2. Animal models can exist for bottom-up (problems starting at the periphery) and top-down (problems originate in the CNS) pathways potentially leading to APD
  3. Animal models suggest temporal processing deficits as an important part of APD, whereas cognitive aspects are largely inaccessible in current animal models
 
 

Frank Musiek | BIO
"The Vertebro-basilar System: Neuroanatomical and Neuroaudiological Correlates"

The blood supply to the cochlea, auditory nerve and auditory brainstem pathway is provided by the vertebro-basilar system exclusively. Because of this, when this system is compromised, a variety of common auditory and vestibular disorders evolve but often are not recognized or are misdiagnosed. To this end, the vertebro-basilar system’s neuroanatomy, pathology and related audiology will be presented in a clinical context to alert audiologists to the often overlooked impact of this important system. Specifically discussed will be our anatomical study of the vertebro-basilar system, which included investigation of cadaver brains as wells as an extensive review and synthesis of the refereed literature. The neuroanatomy focus is primarily on the central auditory brainstem pathway and course of the vessels that supply this pathway. This intricate anatomy will be supported by exquisite 3-D rotational images and constructed drawings of the human vertebro-basilar system. This will be followed by background clinical material pertaining to various disorders of the vertebro-basilar system that can affect the central auditory system. Highlighted will be case studies of vertebro-basilar disease and the effect on central auditory function. Authors: Frank Musiek, Mallory Brown, Andrew DeMarco, Barrett St. George.

Learning Objectives:

  1. Participants will be able to outline the fundamental anatomy of the vertebro-basilar system
  2. Participants will be able to discuss the effect of acute vertebro-basilar lesions on various tests of central auditory function
  3. Participants will be able to describe the relationships between auditory function and the vertebro-basilar system
 
 

Dr. Nina Kraus | BIO
"Unifying audiology, speech, language, and learning through auditory processing: Biological insights"

Auditory processing skills foster everyday communication, including understanding speech in noise, and generating the sound-to-meaning connections crucial for language and reading development. Our biological approach, the auditory brainstem response to complex sounds (cABR) is distinguished, by the use of complex stimuli such as speech, the response’s remarkable adherence to the characteristics of the stimulus waveform, and the response’s experience-dependent nature. We have employed our biological approach to people of all ages, from toddlers to older adults with hearing loss, and experimental animals, representing its value as a uniform metric.

This biological approach has proven fruitful in examining the biological underpinnings of listening difficulties. We have documented particular deficits in processing fine acoustic details in speech (timing and timbre) and in global processing features (the stability of neural activity) in children with auditory processing disorder[1] and older adults,[2] all despite normal audiograms. Importantly, we have seen brain and communication changes following auditory training, providing insights into potential interventions for these groups.[3],[4] Increases in usability and ease of interpretation of this biological metric will reach the clinic and become a routine supplement to current prevailing best practices in APD assessment.

[1] Hornickel, J. & Kraus, N. Unstable representation of sound: A biological marker of dyslexia. J. Neurosci. 33, 3500–3504 (2013).
[2] Anderson, S., Parbery-Clark, A., White-Schwoch, T. & Kraus, N. Aging affects neural precision of speech encoding. J. Neurosci. 32, 14156–14164 (2012).
[3] Hornickel, J., Zecker, S. G., Bradlow, A. R. & Kraus, N. Assistive listening devices drive neuroplasticity in children with dyslexia. Proc. Natl. Acad. Sci. 109, 16731––16736 (2012).
[4] Anderson, S., White-Schwoch, T., Parbery-Clark, A. & Kraus, N. Reversal of age-related neural timing delays with training. Proc. Natl. Acad. Sci. 110, 4357–4362 (2013).

Learning Objectives:

Attendees will be able to:

  1. Identify the auditory processing challenges that face clinicians on a daily basis that might benefit from an objective biological marker
  2. Explain the value of an objective measure for assessment and response to intervention
  3. Describe the fundamental sensory-cognitive-motor-reward brain mechanisms that converge into an objective biological marker
 

LISTENING EFFORT AND HEARING AIDS  
Optimization of speech intelligibility through the use of hearing aids (HAs) has received tremendous attention in research and clinical practice. As a result, hearing aid technology has advanced spectacularly over the years – HAs can enhance speech perception in different conditions using various signal processing algorithms. The importance of optimizing ease of listening has been widely acknowledged and the number of studies attempting to examine the benefit of HAs in terms of both performance and reduced listening effort or fatigue is increasing. Frequently applied outcome measures in these studies range from reaction time measurement in dual task paradigms to pupillometry, and self-perceived listening effort. In this session, the existing evidence related to the effectiveness of HAs in reducing listening effort will be presented. Questions that will be reflected upon are: is there an optimal methodology for reliable and sensitive measurement of listening effort in HA benefit studies? To what extent does listening effort vary between conditions where speech performance is optimized? Does the effect of hearing aid configuration differ between listeners with different ages and cognitive capacities?

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Increase knowledge about the existing evidence regarding the effect of HAs on listening effort/fatigue
  2. Identify different methods that are used to assess listening effort in HA benefit studies
  3. Understand which HA signal processing algorithms are most beneficial in terms of reduced listening effort/fatigue and learn if this benefit depends on the level of other variables (e.g. age, cognition)
  4. Generate new research questions related to the benefit of HAs in terms of reduced effort/fatigue

Chair: Sophia Kramer | BIO
  Speakers:

Thomas Lunner | BIO
"Puillometry for advanced hearing aid signal processing under ecological test conditions"

Research concerning the benefit of hearing-aid signal processing traditionally focused on the effect on speech recognition scores or intelligibility measures such as the speech reception threshold (SRT). In adaptive SRT tests used in the audiological clinic, speech is presented at SNRs that are lower than those generally encountered in real-life communication situations. At higher, ecologically valid SNRs, however, SRTs are insensitive to changes in hearing aid signal processing that may be of benefit to listeners who are hard of hearing.
Pupillometry has been found to provide an objective measure of processing effort or mental load in adverse listening situations. An increase in pupil dilation would indicate an increase in processing effort. Several studies already reported that even at high and controlled speech intelligibility levels, can effort vary depending on the noise masker. Research using advanced hearing aid signal processing shown that memory recall can be improved for the hard of hearing by applying advanced hearing aid signal processing, such as the binary masking paradigm, under ecological test conditions. Here we will present results from pupillometry experiments using advanced hearing aid signal processing under ecological test conditions.

Learning Objectives:

  1. Insights into what is ecological test conditions
  2. Insights into advanced hearing aid signal processing
  3. Insights in testing assessing listening effort with advanced hearing aid signal processing under ecological test conditions
 
 

Ben Hornsby | BIO
"Hearing aids, perceived effort and speech-processing related fatigue"

Mounting evidence suggests that speech-processing related fatigue may be an important, but often overlooked, consequence of hearing loss. Anecdotal reports, qualitative research and recent empirical work suggest the increased mental effort required to overcome hearing difficulties can, in some situations, lead to subjective reports of fatigue and to fatigue-related deficits in cognitive processing abilities. The benefits of hearing aid use on speech recognition ability are well documented and there is growing evidence to suggest hearing aid use can reduce mental effort during some speech tasks. However, research examining the benefits of hearing aid use for reducing fatigue is limited. This presentation will describe recent work from our laboratory examining the potential benefits, and limitations, of hearing aid use on mental effort and fatigue in adults with hearing loss.

Learning Objectives:

After completing this activity, participants will be able to:

  1. Define subjective and behavioral fatigue and discuss their potential impact on persons with hearing loss
  2. Describe subjective and behavioral methods for assessing fatigue in persons with hearing loss
  3. Describe the impact of hearing aid use on speech-processing related fatigue measured in the laboratory
 
 

Tobias Neher | BIO
"Noise management technology and listening effort: Acoustical and perceptual influences"

Recently, the notion that noise management technology in hearing aids may be able to reduce listening effort even when speech intelligibility remains unchanged has received considerable attention in the field of audiology. As a consequence, considerable research has been devoted to trying to understand how acoustical and perceptual factors influence the effects that these technologies have on listening effort. In this presentation, I will review some recent studies concerned with the effects of noise management technology on listening effort, as assessed using subjective and objective methodologies. Furthermore, I will discuss how acoustical changes brought about by noise management technology may influence listening effort. Finally, I will also discuss the potential influence of individual factors such as pure-tone average hearing loss and cognitive function on the extent to which noise management technology may affect listening effort.

Learning Objectives:

As a result of completing this activity, participants will be able to:

  1. Increase their knowledge about the effects of noise management technology on listening effort
  2. Understand how the acoustical effects of noise management technology may relate to changes in listening effort
  3. Generate research questions related to the potential influence of individual factors on changes in listening effort due to noise management technology
 

TUESDAY, september 20, 2016

15:00 - 16:30

ADVANCES IN TELEAUDIOLOGY ASSESSMENT  
Hearing disorders are a leading contributor to the global burden of disease affecting 1 in every 20 people globally. Unfortunately access to care is severely limited with a dearth and unequal distribution of hearing health providers. Recent technological advances and the proliferation of connectivity to the Internet are however expanding the horizon for detection and diagnosis of hearing disorders. This session will provide an update on recent advances in the assessment of hearing disorders using telehealth modes including internet-based assessment and mobile health (mHealth) solutions.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand the range of telehealth assessment modes
  2. Appreciate the role of the internet and novel technologies in increasing access to hearing health assessment
  3. Understand telehealth assessment in terms of the range of services and the current evidence
Chair: De Wet Swanepoel | BIO
 Speakers:

Robert Eikelboom | BIO
"Diagnostic automated audiometry in teleaudiology clinical practice"

Automated audiometry has been shown to be an accurate method of determining air and bone conduction hearing thresholds. Automated audiometry used within an asynchronous telehealth model shows potential for application in underserved areas and to enhance clinical audiology practice. Furthermore, our research has shown that audiologists around the world see this potential, and are ready to embrace new telehealth technologies for diagnosis and management of the hearing impaired. Not only is there the willingness, there is also a capacity in the audiology workforce to be involved in teleaudiology.
Our current research aims provide evidence that of the efficacy of diagnostic teleaudiology to facilitate its translation into clinical practice. Issues to be considered include accuracy with a clinical population, application in a clinical practice in rural and remote sites, and sensitivity as a diagnostic telehealth tool. In other studies we have validated automated audiometry in a typical ENT clinic; conducted a study in an audiology clinic considering changes in work practices, and patient and clinician feedback; developed a set of protocols to assist in tele-diagnosis; and examined remote interpretations of audiograms.

Learning Objectives:

  1. Automated diagnostic audiometry used within an asynchronous telehealth model is reliable method of assessment of thresholds in clinical populations
  2. The audiology workforce has the capacity to be involved in diagnostic teleaudiology
  3. Any variations observed between manual and automated audiometry have no significant impact on the diagnostic and referral processes
 

Dr. Lucille Beck | BIO
"Teleaudiology: Expanding Access to Hearing Care and Enhancing Patient Connectivity"

Audiology telepractice is growing in scope, as well as delivery models and applications available to clinical staff. The number of Veterans receiving care via VA’s audiology telepractice programs has increased dramatically, from 1,016 Veterans in 2011 to more than 15,634 in 2015. Audiology telepractice is currently among the top 10 VA telehealth programs. VA has endorsed a vision of audiology that is comprehensive and patient-centered which leverages the use of technological development and support personnel to meet these growing needs. VA telepractice services offer fitting and adjustment of hearing aids, as well as tinnitus and aural rehabilitation support and education groups. There is also work to expand the use of remote audiometry in a real-time, synchronous fashion, and automated audiometry in a store-and-forward telepractice model.  In addition, significant focus has been given to increasing access to services by linking patients in home environment through various connected health strategies. This presentation will provide an overview of the work completed by various pilot initiatives and joint VA partnerships. It is intended to provide a broader context for understanding diverse VA audiology telepractice programs, networks, and ongoing outcome measurements

Learning Objectives:

  1. Identify key VA pilot initiatives in moving audiology telepractice forward
  2. Identify VA telepractice outcomes and measures of patient satisfaction
  3. Discuss evolving audiology telepractice applications and their implications for expanding patient care options and efficiencies
 

David Eddins | BIO
"Waves of the future: automated and remote audiologic service delivery"

The practice of clinical audiology has experienced a remarkable expansion in scope over the past several decades and now faces exciting opportunities to expand in terms of modes of service delivery and methods of assessment, treatment, and outcome measures. Many of the current opportunities are made possible because of proven technological advances, consumer demand, and translational research that supports alternative strategies. Three areas of audiological practice will be considered. The first will focus on advanced diagnostics using automated behavioral assessment thattargets aspects of central auditory dysfunction impacting everyday communication in a variety of populations. The second will focus on developing individual signal processing strategies for hearing instruments that use realā€time behavioral responses and advanced data analytics to automatically set device parameters specific to an individual patient. The third will focus on how these advances can be realized in a manner than advances the field, involves the clinician, and is functional within the confines of current service delivery models and reimbursement constraints.

LearningObjectives:

After completing this activity, participants will be able to:

  1. Describe methods for obtaining individualized hearing instrument fittings;
  2. Understand the rationale behind advanced perceptual testing and its potential benefits;
  3. Think broadly about practical ways to expand audiology practice to achieve desirable outcomes

HEARING, BALANCE AND FALLS
 
Falls are a growing area of concern for older adults around the world. According to the World Health Organization, up to 35% of adults age 65 years and older fall each year. Fall events may result in a myriad of negative physical, emotional, and social consequences, all of which may compound to increase an individual’s overall risk of falling. Audiology patients may be at increased risk for falls. Therefore, it is imperative that audiologists—as hearing and balance healthcare professionals—are cognizant of each patient’s fall history, risk factors for falls, and methods to prevent falls. In this feature session, we will explore fall risk and its relation to hearing and balance function, and emerging research that supports audiologic involvement in fall risk identification and prevention

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Identify fall risk factors that may be present in audiology patients
  2. Describe how hearing and balance function relate to fall risk
  3. Discuss the role of audiologists in identifying fall risk and prevention needs in their patients

Chair & Speaker:

Robin Criter | BIO
"Falls in Audiology Patients"

Approximately two thirds of audiology hearing clinic patients fall within one year’s time. This is significantly higher than their community-dwelling peers, of whom one third fall each year. Additionally, audiology hearing clinic patients fall multiple times per year, putting them at high risk for sustaining an injury or additional falls. Yet, many audiologists working in the hearing clinic do not address the topic of falls due to a lack of time, training, and resources. This presentation will discuss audiology hearing clinic patient fall history, fall risk factors, and audiologic evaluations. Efficient methods of screening for fall risk in the audiology clinic will be discussed.

Learning Objectives:

After this feature session presentation, the participant will be able to:

  1. Discuss fall statistics, with an emphasis on audiology patients
  2. Identify fall risk factors that may be exhibited by audiology patients and screen patients for increased risk for falls
  3. Describe ways that hearing impairment may relate to fall risk
  Speakers:

 Jennifer Campos | BIO
"Interactions between Hearing Loss and Mobility during Realistic, Everyday Challenges"

Older adults with hearing loss fall three times more often than their normal hearing peers, yet the exact nature of this link is unclear. Our research program has pursued several lines of empirical investigation to better characterize the link between hearing loss, mobility, and falls during realistic everyday challenges. This research is motivated by at least three non-exclusive hypotheses including; 1) hearing loss taxes cognitive resources that can lead to errors that can affect mobility, 2) hearing loss causes problems with spatial orientation because binaural cues are unreliable leading to instability, 3) there are shared pathologies between the auditory and vestibular systems. We conduct these studies using virtual reality technologies which allow us to introduce highly controlled, yet realistic multisensory challenges (e.g. crossing a busy intersection while engaging in conversation). We also employ high precision motion capture systems to measure kinematic responses during, for example, single task (walking) versus dual-task (listening while walking) conditions varying in complexities. Overall, the hope is that by better understanding the link between hearing loss and mobility during realistic challenges this will help identify those at risk of falling and establish better, more ecologically valid methods of assessment and intervention.

Learning Objectives:

After this feature session presentation, the participant will be able to:

  1. Understand the different mechanisms through which hearing loss could affect mobility
  2. Consider the role that cognitive factors may play in hearing loss-mobility interactions
  3. Appreciate the benefits of expanding this research beyond traditional laboratory settings in order to evaluate perception and performance during realistic and challenging conditions
 
 

 Julie Honaker | BIO
"Examining the impact of fear of falling on balance and gait function, brain activity, and eye movement patterns"

Over one-third of adults age 65 years and older sustain a fall each year, and the risk of falling increases with advanced age. Indeed, falls are a significant medical concern and threaten independent living, quality of life, and contribute to caregiver burden for older adults. The consequences of falls range from physical injury to emotional distress in the form of depression, anxiety and fear of falling. Fear of falling again often remains the greatest concern and contributor to activity restriction in older adults. This presentation will review the impact of fear of falling on older community-dwelling individuals and patients with vestibular and balance disorders. This presentation will also discuss research examining differences in functional ability, brain activity and eye movement responses in patients with fear of falling.

Learning Objectives:

After this feature session presentation, the participant will be able to:

  1. Understand the impact of fear of falling for community-dwelling individuals and patients with vestibular and balance disorders
  2. Identify differences in patterns of neural activity for balance control in participants with fear of falling
  3. Discuss gaze patterns for patients with fear of falling when performing challenging ambulatory tasks and when viewing images of activities of daily living
 
         

INFANTS WITH HEARING LOSS: DIAGNOSIS AND REHABILITATION  
An issue that continues to challenge clinicians and researchers is the prediction of functional auditory skills in infants and young children with different types and degrees of hearing loss. Ideally, we would like to assess an infant’s speech detection and discrimination capacity, in addition to peripheral sensitivity, to guide management decisions regarding amplification and cochlear implantation. We have clinical tools that estimate hearing thresholds in infants to tonal stimuli at the level of the brainstem with reasonable accuracy when the hearing loss is primarily sensory in nature. However, we do not yet have an efficient way to assess hearing sensitivity or degree of disruption to the processing of speech features in neural hearing losses (e.g., auditory neuropathy spectrum disorder). We also have established hearing-aid verification methods to confirm audibility but we need tools to measure speech discrimination ability when infants with sensory or neural hearing loss are aided to confirm benefit. Currently, researchers are focussing on the application of behavioural outcome measures and cortical auditory evoked potentials to objectively measure speech discrimination skills in infants with hearing aids and cochlear implants. This session will discuss recent research in these areas and potential clinical applications.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Explain how cortical auditory evoked potentials (AEP), behavioural measures and parent report are used to assess auditory function and development in children with sensorineural hearing loss and auditory neuropathy spectrum disorder
  2. Describe the effects of asymmetric auditory input on the auditory cortex based on AEP data and behavioural measures that assess language skills and spatial perception
  3. Understand the benefits and limitations of AEP and behavioural measures to plan intervention and monitor progress for infants and young children who use hearing aids and cochlear implants

Chair: Susan Small | BIO
 Speakers:

Teresa Ching | BIO
"How do you know what they are hearing? Cortical assessment and functional evaluation for management of infants with hearing loss."

There is a problem that, with early diagnosis through universal newborn hearing screening and early hearing-aid fitting using established procedures, the effectiveness of amplification in providing audibility to infants with hearing loss remains uncertain. This problem is exacerbated by the presence of auditory neuropathy spectrum disorder (ANSD). This presentation provides an overview of recent research on the use of cortical auditory evoked potentials (CAEPs) and parental ratings of children’s real-world functional performance (Parents’ evaluation of aural/oral performance of children or the PEACH) to 1) evaluate audibility in infants and children with sensorineural hearing loss (SNHL) or ANSD in aided and unaided conditions; and 2) assess speech discrimination ability. Drawing on case studies, translation of research evidence into clinical practice will be described.

Learning Objectives:

Following completion of this lecture, participants will be able to:

  1. Describe the relationship between audibility and detection rates of cortical auditory evoked potentials (CAEPs) for infants with
    1. Sensorineural hearing loss (SNHL)
    2. Auditory neuropathy spectrum disorder (ANSD)
  2. Describe the use of CAEPs for assessing aided speech discrimination
  3. Outline a strategy for using CAEPs and parent reports in clinical management of infants with hearing loss.
 
 

Astrid van Wieringen | BIO
"Single sided deafness in children: risks and intervention"

As a result of newborn hearing screening single sided deafness is identified at infancy, rather than remaining undetected until a later age. On a yearly basis approximately 70 neonates have SSD in Flanders (Belgium), of whom about 40 profound sensorineural. For these children a hearing aid or a bone conduction hearing device does not provide any benefit. An increasing body of research suggests that single sided deafness is a risk factor for speech-language delay, and that behavioral and academic problems persist throughout the years. First a case–control study including 22 children with SSD and age-matched normal hearing controls will be discussed. This study shows that children with UHL lag behind in expressive vocabulary and syntactic language skills and experience difficulty with spatial perception. Second, first data of infants with SSD (< 2 years), who have been provided with a cochlear implant, will be described. A main –long term- objective is to fundamentally investigate whether some of the negative long-term consequences of SSD are reduced through electrical stimulation in the deaf ear.

Learning Objectives:

Following completion of this lecture, participants will

  1. Understand the consequences of unilateral hearing loss
    1. with regard to spatial perception,
    2. with respect to spoken language.
  2. Understand the challenges of assessing performance in infants with unilateral hearing loss (and a cochlear implant)
  3. Know which standardized outcome measures are meaningful for very young children
 
 

Karen Gordon | BIO
"Tracking effects of experience on auditory development from infancy to adolescence."

The auditory pathways undergo marked development from infancy to adolescence. We examine how input shapes the immature auditory brain by comparing normal auditory development to that occurring in children who have hearing loss and use auditory prostheses. Many of the children we study use cochlear implants, restricting the methods of functional imaging available; we thus rely on electroencephalography (EEG) to record auditory pathway responses at discrete levels from the auditory nerve to cortex. These measures reveal increasing efficiency and specialization of the auditory brain with age. Although basic pathways are formed in children with hearing loss, typical development is disrupted. Abnormalities as children use auditory prostheses reveal the importance of input to both ears in auditory development. The effects on binaural/spatial hearing will be discussed as well as implications for fitting of bilateral hearing devices in children.

Learning Objectives:

  1. To understand EEG measures of neural timing and synchrony in and between discrete areas of the auditory brain and how these measures are used to assess auditory function and development
  2. To learn that specialization of the right versus left auditory cortex occurs with development and is altered by asymmetric hearing such as unilateral cochlear implant use
  3. To consider how best to provide balanced bilateral input to children with hearing loss
 

INTERVENTIONS FOR HEARING LOSS USING HEALTH PSYCHOLOGY  
This session will begin with an overview about health psychology – why it is and why it might be of value to audiologists interested in developing interventions for hearing loss. A variety of health behavior theories will be described and their hypothetical application to audiology will be discussed. Following this, where available, empirical work in which these theories have been applied to intervention development will be described, and the measures used will be explained. Finally, ideas for future development and application of behavioral audiological interventions using principles of health psychology will be proposed. Audience participation will be encouraged throughout, but particularly during this latter section when attendees will be asked to share ideas of their own.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Specify the constructs of at least two health behavior theories
  2. Describe how at least two health behavior theories can be applied to audiological rehabilitation 
  3. Explain the rationale behind at least one intervention for hearing loss that uses the principles of health psychology

Chair: Gaby Saunders | BIO
 Speakers:

Marc Fagelson | BIO
"Traumatic exposures and interprofessional management of tinnitus"

Tinnitus is often considered an auditory disorder, however patients who associate tinnitus with trauma, or suffer from psychological injuries such as posttraumatic stress disorder report more severe and handicapping tinnitus effects than those patients without trauma histories. Neural mechanisms associated with traumatic memories, and their enduring effect on patients with tinnitus will be reviewed in this presentation. The influence of traumatic exposures and memories on sensory processing, in many patients, ensures that tinnitus persists as an attentional target with substantial perceived value. As such, fostering patients’ ability to assess accurately the importance of their tinnitus may improve management of their response to the sensation. Cognitive behavioral therapy and specific counseling strategies such as those enhancing self-efficacy may improve for patients the accuracy of tinnitus-related thoughts. A patient who recognizes the relation between tinnitus and its cause may more reasonably modify thoughts about tinnitus, thereby reducing tinnitus severity and intrusiveness. As discussed in both the tinnitus and the trauma literatures such interventions suggest clinicians provide opportunities for interprofessional care for trauma patients.

Learning Objectives:

At the conclusion of this presentation, participants will be able to:

  1. Analyze audiologic results and intake questionnaire responses in order to identify the specific elements of a patient’s report that signal history of traumatic exposure;
  2. Delineate audiological and psychological consequences of traumatic exposures that influence tinnitus severity and intervention approaches;
  3. Collaborate with polytrauma and interdisciplinary team members to support interventions that provide comprehensive care to patients
 

Melissa Frederick | BIO
"Hearing Health Behavior Change in Adults"

Successful hearing rehabilitation depends to a large extent on a person’s beliefs about hearing disability and hearing aids (Knudsen et al. 2010). Data indicate that interventions can produce many positive outcomes, yet the vast majority of individuals with hearing impairment do not seek help. This presentation will discuss data from a study that utilized a brief counseling-based intervention developed from the constructs of the Health Belief Model (Rosenstock 1966) and the Transtheoretical Model (Prochaska & DiClemente 1983). The intervention would be applicable to settings such as a primary care clinic, targeting individuals who have not sought professional evaluation despite having hearing difficulties. This study included 100 Veterans surveyed twice over a 6-month period. Their baseline as well as follow-up data will be presented.

Learning Objectives:

Upon completion of this session, participants will be able to:

  1. Demonstrate a basic understanding of two models of Health Behavior Change
  2. Describe Health Behavior Beliefs and Attitudes profiles in a group of individuals who have not sought help despite reporting hearing difficulties
  3. Define the application of health behavior theory to help seeking and the acquisition of hearing aids
 

Elizabeth Beach | BIO
'Attitudes to hearing loss prevention in the context of health behaviour theory'

Most people agree that hearing is important, and yet many do not take action to protect their hearing nor do they reduce their exposure to loud situations. At NAL, we have conducted several studies investigating young people’s attitudes towards hearing loss prevention in the context of health behaviour theory. We have found there is a continuum of hearing health behaviour underpinned by associated attitudes. At one end are those who are disengaged from the topic of hearing health, many of whom do not appreciate the risks associated with loud sound. At the other end are those who are highly engaged in hearing health, and believe themselves to be personally susceptible to hearing damage from loud sound. Our challenge is to decide how best to use this information to tackle hearing loss prevention. On the one hand, there is a need to engage the majority by sending generalised messages to heighten understanding of noise-related risk and the consequences of hearing damage/loss. At the same time, there is a need to develop personalised messages and strategies to motivate individuals to change their attitudes and behaviour. The pros and cons of each approach will be discussed.

Learning Objectives:

  1. To understand the relationship between young people’s attitudes and behaviours towards hearing health
  2. To identify the two main approaches to hearing loss prevention in the context of health behaviour theory
  3. To understand the pros and cons of the two approaches to hearing loss prevention



INTERVENTIONS FOR ADULTS WITH DEMENTIA AND THEIR CAREGIVERS  
Declines in sensory and cognitive functions associated with dementia affect the quality of communication and overall well being of persons experiencing these impairments and their caregivers. Although approaches have been developed to accommodate to specific functional changes (e.g., use of assistive listening devices; memory strategies), there is a need for interventions that recognize the dynamic interdependence across functional domains. The four presentations in this symposium report on interventions that seek to increase the social, mental, and functional well being of persons with dementia and their caregivers by training them to use sensory and cognitive supportive communication strategies, materials and technology.

LEARNING OBJECTIVES:
After this featured session, learners will be able to:
  1. Understand the impact of combined cognitive and hearing impairments on family and formal caregivers and what supports they need to effectively manage communication
  2. Describe how hearing and communication interventions can promote the cognitive, social, and functional well being of persons with hearing loss and dementia
  3. Appreciate the ways in which these interventions can be effectively adapted to and delivered in different contexts and with varied partners in care

Chair & Speaker:

Jeff Small | BIO
"The use of mobile devices and communication apps to facilitate interactions with persons experiencing memory, language, and/or hearing impairments"

It is not uncommon for hearing, language, and/or memory impairments to co-occur in persons residing in long-term residential care (LTRC). These impairments, in conjunction with ambient noise and distractions, can make it challenging for staff and residents to effectively communicate during activities of daily living. Due to recent technological advances, a promising approach for enhancing communicative interactions is to pair mobile technology (e.g., tablet, smart phone) with communication Apps or “cApps”. This presentation will provide an overview of research addressing how such technology could be used by care staff in LTRC to meet the communication needs of residents who experience sensory and cognitive challenges.

Co-Authors:
Jeff Small, University of British Columbia | Rozanne Wilson, University of Washington | Alex Mihailidis, University of Toronto. Diana Cochrane, University of British Columbia

Learning Objectives:

At the end of this symposium attendees will be able to:

  • Understand communication challenges inherent in LTRC settings
  • Describe features of cApps that care staff consider to be most important in supporting communication with residents
  • Appreciate the potential, and the limitations, of currently available cApps for use in LTRC settings
 Speakers:

Kate Dupuis | BIO
"Caring for someone with concurrent hearing loss and cognitive loss: Experiences of family members"

Most individuals in the early stages of dementia are cared for at home by “informal caregivers”; typically, family members such as adult children or spouses. Care responsibilities often result in significant levels of burden and stress, with downstream effects on the caregivers’ physical, cognitive, and emotional well-being. Accumulating evidence suggests that the negative consequences of hearing loss, such as social isolation and reduced overall well-being, are not limited to the impaired individual. Rather, hearing loss, especially in older adults, can also have devastating effects on family members and caregivers. Although little research has been conducted in this area, it is likely that these effects, termed third-party disability, would be exacerbated if an individual with hearing loss is also experiencing suboptimal cognitive function. In particular, for older adults with cognitive loss, the responsibility for hearing health care may fall to their informal caregivers. Thus, it may be necessary to involve family members and caregivers of those with cognitive loss to a greater degree than is typically done for clients with normal cognitive function. Additional intervention and support may help them in dealing with increased hearing health care responsibilities. Recent data from work with family members of older individuals with both hearing and cognitive loss will be presented, and we will discuss potential changes to audiologic best practice that could serve to improve inclusion of significant others to optimize benefits for these patients.

Learning Objectives:

Audience members will be able to better understand

  1. The topic of “third-party burden” as it pertains to caregivers of individuals with hearing loss and cognitive loss
  2. How cognitive loss may interact with hearing loss to impact audiologic rehabilitation
  3. How to best include and integrate significant others into caring for individuals with hearing loss
 
 

Sara Mamo | BIO
"Aural rehabilitation for persons with hearing loss and dementia in geriatric clinic and group care settings"

Hearing loss is often overlooked and/or underappreciated when managing care for adults with dementia. However, untreated hearing loss for persons with dementia may potentially increase their risk of having further cognitive and functional decline exacerbated by concurrent hearing impairment. Further, it is likely that communication difficulties and problem behaviors that often occur as the disease progresses may be exaggerated in the presence of untreated hearing loss. The purpose of this study is to provide affordable and accessible hearing intervention to this at-risk population. Two experiments will be discussed: 1) One-on-one intervention with individuals with dementia and their caregivers in a Memory Clinic setting and 2) an adaptatiton of the one-on-one intervention for an Adult Day group care setting and the program staff. The intervention is comprised of hearing screening, learning communication strategies and training on how to use of a low-cost amplification device. The outcome measures assess a variety of domains including depression, function, behavior, communication, burden, and quality of life. Results suggest that for some participants, basic hearing intervention improved communication and reduced depression and neuropsychiatric symptoms.

Learning Objectives:

Audience members will be able to better understand

  1. The impact of Neuropsychiatric Symptoms on dementia care and the possibility to reduce symptoms with hearing intervention
  2. The need for simple solutions and the goal of improving self-efficacy to manage communication strategies and amplification
  3. The need to address the environment in group care settings prior to individualized intervention
 
 

Tammy Hopper | BIO
"Social well-being and individuals with dementia: Interventions that focus on engagement"

Social well-being is an integral aspect of health. Older adults derive physical and mental benefits from being socially engaged, yet conditions such as hearing loss and dementia often act as barriers to fulfilling social interactions. In this presentation, a review of the literature related to social isolation and dementia will be provided, with a focus on communication interventions to decrease isolation and improve social well-being, including memory books and wallets, reminiscence, and aural rehabilitation strategies.

Learning Objectives:

After this session, learners will be able to do the following:

  1. Describe the cognitive and communication functioning of individuals with dementia
  2. Discuss approaches to communication to improve life participation and social engagement of individuals with dementia
  3. Explain how to measure outcomes associated with the use of different communication approaches
 

WEDNESDAY, september 21, 2016

08:30 - 10:00

EMOTION AND HEARING AIDS
 
Auditory perception extends far beyond the pure intelligibility of speech in various listening conditions. In daily communication situations, speech sounds do not only convey information about the content but also include information about the speaker’s emotional state or intent. Emotional content is strongly encoded in the way we pronounce or intonate and accentuate utterance. Normal hearing persons are extremely well trained in identifying the emotional state especially of familiar persons. Evidence suggests that people with hearing loss have a poorer ability to identify this information. How hearing loss affects identification of emotion and intent, and the way in which hearing aids affect the reception of this information, is important to understand. The purpose of this session is to present information about how emotions are being processed by normal hearing listeners and especially what the impact of hearing loss with and with using hearing instruments on processing emotional content might be.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand how emotional content in speech is encoded in acoustic information
  2. Understand what the impact of hearing loss on perception of emotional content potentially could be
  3. Understand how hearing instrument as well as cochlear implant signal processing might impact the perception of emotional content
Chair: Stefan Launer | BIO
 Speakers:

 Gurjit Singh | BIO
"More than a Feeling: An Audiological Exploration of Speech Spoken with Emotion"

Over the past 100 years, one of the trends in audiology research has been to improve the ecological validity of the signals used to better understand hearing, hearing loss, and hearing instruments. While relatively simple signals such as pure tones continue to be important in audiology research, there has been a long-standing recognition that it is also important to understand more complicated signals such as speech, particularly when presented in different situations (i.e., from different locations, mixed with different types of maskers, etc). One important type of information carried in a speech signal is the talker’s emotional state, but to date, there is a significant lack of research investigating auditory emotion. Some important questions that have not been fully addressed include the following:

  • Do listeners with impaired hearing experience subjective deficits when listening to signals that contain auditory emotion?
  • What are the perceptual and physiological consequences of listening to signals that contain auditory emotion for individuals with normal and elevated audiometric thresholds?
  • What is the effect of aided listening on the perception of emotion in speech and on the recognition of speech spoken with emotion?

This presentation will review some of the recent findings from our group that attempts to address this gap in our understanding. Implications for research on hearing instrument development will be discussed.

Learning Objectives:

Attendees will be able to:

  1. Describe some of the subjective deficits individuals with impaired hearing report when listening to auditory signals that contain emotion information.
  2. Describe some of the perceptual difficulties individuals with impaired hearing experience when listening to auditory signals that contain emotion information.
  3. Describe how hearing instrument signal processing affects listening abilities when listening to auditory signals that contain emotion information.
 
 

Erin Picou | BIO
"The effect of hearing aids on emotional responses to sounds"

Sounds can have a profound impact on the way people think and feel about the world around them. In this session, recent work demonstrating that hearing loss alters the way people feel about sounds will be discussed. Specifically, recent data suggest that sounds elicited a weaker emotional response in people with hearing loss compared to their peers with normal hearing. Moreover, increasing the overall level of sounds did not restore normal emotional responses. Instead, listeners with hearing loss rated all higher intensity sounds, even the “pleasant” ones, as unpleasant. The implications of these findings for signal processing in hearing devices (i.e., hearing aids, cochlear implants) will be discussed. Preliminary findings suggest that specific hearing device settings may affect emotional responses to non-speech sounds (e.g., laughter, crying, music, birds). In addition, possible implications for future intervention strategies will be explored.

Learning Objectives:

Upon completion of this session, the participant will be able to:

  1. Describe the effects of hearing loss on emotional responses to non-speech sounds
  2. Describe the effects of hearing aid use on emotional responses to non-speech sounds
  3. Describe the effects of bimodal listening on emotional responses to non-speech sounds
 
 

Frank Russo | BIO
"Modeling perception of emotion in speech in hearing impaired and hearing aided users"

Two large-scale studies will be reviewed that assess perception of emotion in speech in hearing impaired and hearing aided participants. Methods include survey development, behavioral assessment and computational modeling.

Learning Objectives:

  1. What aspects of emotional communication (perception, production) present the most difficulty for hearing impaired and hearing aided participants
  2. Do the perceived difficulties in emotional communication map onto behavioral deficits?
  3. What are the most important acoustic cues to preserve in signal processing in supporting emotional speech.
 
 

Monita Chatterjee | BIO
'Voice emotion communication by children with hearing loss'

Voice emotion communication is an important aspect of social development in children. Acoustic cues for vocal emotion are multi-dimensional: the predominant cues are voice pitch, intensity, speaking rate, spectral shape, and their associated changes. Our research focuses on the impact of these cues on voice emotion recognition by children with hearing loss aged 6 – 18 years. Children with cochlear implants (CIs) experience severe spectral degradation that reduces their access to cues such as voice pitch and spectral shape drastically. Research by other investigators has shown that children with moderate to profound hearing loss also have deficits in voice emotion recognition. Children with mild-to-moderate hearing loss (MMHL) on the other hand, are expected to have only moderate degradation in spectro-temporal coding of these cues.  Consistent with expectations, our research shows that children with CIs have significant deficits in voice emotion recognition, even with child-directed speech materials that have exaggerated prosodic features. Initial analyses of voice emotion production by children with CIs also show deficits in specific acoustic contrasts, relative to NH children and post-lingually deaf CI adults. In recent work, we have developed an expanded emotion database with both child- and adult-directed speech. We hypothesized that children with MMHL would do as well as their normally hearing peers (and significantly better than children with CIs) with child-directed speech, but that the hearing loss might result in poorer performance with adult-directed speech materials (which have less exaggerated prosody). Our preliminary studies with 20 children with MMHL and 20 children with normal hearing show no significant differences between the groups in voice emotion recognition using either child- or adult-directed materials, using either accuracy or reaction time as measures. Significant effects of age and of vocabulary skills were noted, but non-verbal IQ and a parent-questionnaire-based measure of executive function did not prove to be significant predictors. Our preliminary conclusion is that children with MMHL do not have significant deficits in voice emotion recognition. These results, and results of ongoing related research in our laboratory, will be presented.

Learning Objectives:

  1. Define the acoustic cues that are important for voice emotion communication, and identify the degradations in the neural coding of these cues in populations with cochlear implants, moderate-to-severe hearing loss, and mild-to-moderate hearing loss.
  2. Describe how children and adults with normal hearing perform in a voice emotion recognition task with spectrally degraded speech, compared to how children with cochlear implants might perform
  3. Describe how children with mild-to-moderate hearing loss compare with their normally-hearing peers in voice emotion recognition, and how factors such as vocabulary, age, linguistic and cognitive function might predict their performance.
 

BRINGING SOUND TO THE PEOPLE: PROMOTING HEARING HEALTH IN THE COMMUNITY  
New methods of delivering hearing health care are needed to meet rising demand, reduce access barriers, and provide services to underserved populations. The session will focus on interventions that bring hearing health care out of the clinic and into community settings and homes. Multidisciplinary approaches are emphasized and to that end, speakers include an emergency physician, an academic audiologist, an endocrinologist, and speech and language pathologist. James Heilman, an emergency physician from Cranbrook, Canada, and the founder of WikiProject Medicine Translation Task Force, will discuss how the internet (and Wikipedia in particular) is changing how patients access health information. Caroline Jones will discuss an Australian initiative bringing hearing health care to aboriginal children in the Outback. Charlotte Jones has developed a comprehensive exercise, socialization and health education program for seniors in Kelowna, Canada, and will speak about how auditory rehabilitation is incorporated. Finally, Nicole Marrone will discuss how community health workers are providing hearing and communication therapy to low-income Spanish speakers living near the international border in Arizona. There will be ample time to discuss how the different approaches all serve the common goals of increasing access and improving the delivery of hearing health care.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand its increasing prevalence and public health burden
  2. Understand the association between hearing loss and psychosocial, cognitive, psychiatric and functional health outcomes in aging.
  3. Relate strengths and limitations of current evidence.
  4. Understand current and potential solutions to the age-related hearing loss epidemic at the individual and societal levels
  5. Identify future research needs

Chair: Paul Mick | BIO
 Speakers:

 Charlotte Jones | BIO
"Targeting Functional Fitness, Hearing and Health–Related Quality of Life and in Older Adults with Hearing Loss.Walk, Talk and Listen for Your Life."

Our overall goal is to reduce the major downstream negative psychosocial and functional physical limitations among older adults with HL.

Hearing loss (HL) is a prevalent (47% of older Canadian adults) under recognized and undertreated disability. Applying the World Health Organization International Classification of Functioning, Disability and Health (ICF), HL is associated with activity limitations, participation restrictions and physical impairments, resulting in increased risk for social isolation, depression, dementia, falls, hospitalizations and increased cardiovascular and all cause mortality. Current interventions including provision of hearing aids and training to enhance communication skills (Auditory Rehabilitation [AR]) are not holistic and do not address the physical impairments. We will present the results of a randomized controlled trial to answer the question, “In older adults with HL, what effect does a group socialization/health education and strength training-walking program added to AR have on: a) functional fitness, b) hearing–related quality of life, c) health-related quality of life, and d) measures of loneliness, isolation and social connectedness?

Learning Objectives:

  1. Become more aware of the holistic nature of hearing loss as a disability
  2. Recall the effects of auditory rehabilitation upon measures of hearing handicap and hearing-related quality of life, social isolation and loneliness.
  3. Learn about the effects of adding a group socialization/health education and strength training-walking program to AR on:
    1. functional fitness,
    2. hearing handicap and hearing–related quality of life, social isolation and loneliness.
   
 

 Nicole Marrone | BIO
"Oyendo Bien: Addressing Hearing Health Care Disparities Through a Community-based Intervention"

Although hearing loss is common among older adults, only a fraction of the United States population has access to care to manage effects on quality of life. Older adults facing health disparities may be underserved due to a lack of community resources, patient-centered factors, and/or lack of access to general healthcare. We are studying the factors that underlie treatment gaps for hearing loss in a rural, predominantly Hispanic/Latino community facing health disparities. Through a community needs assessment, key barriers and resources were identified that informed the collaborative development of a public health intervention. With the combined innovations of interdisciplinary partners from audiology, public health, translation studies, and Promotoras (community health workers), we developed a new point of access to the hearing healthcare system within a federally-qualified community health center. Oyendo Bien is a hearing health education and support program facilitated by Promotoras that is culturally relevant and family-centered. Positive outcomes from a pilot study highlight the benefits of this new point of access, supporting self-management of hearing loss and utilization of the health care system. The protocol and preliminary results of a randomized controlled trial on the effectiveness and long-term benefits of this approach will be presented.

Learning Objectives:

  1. List barriers and facilitators to managing hearing loss in a rural Mexican-American community.
  2. Explain the objectives of a hearing health program using a community health worker model.
  3. Evaluate the outcomes of a community-based program to improve quality of life with hearing loss.
   
 

James Heilman | BIO
"Why Wikipedia Matters"

Wikipedia in January of 2014 was referred to as “the single leading source of medical information for patients and healthcare professionals” by the IMS Institute for Healthcare Informatics. It is a source of information for 50% to 70% of physicians in clinical practice and has also been reported as the single most used resource by medical students.

Much of Wikipedia’s medical content is written by a core group of healthcare professionals and members of the lay public. They volunteer to do this work as they both find it a good way to learn themselves and believe all people deserve free and open access to high quality health care information. This presentation will cover both why Wikipedia matters when it comes to health care, some of the ongoing efforts to improve the site, and how you can become involved.

Learning Objectives:

  1. What is Wikipedia and why it matters in healthcare
  2. What are some of the ongoing efforts to make it better
  3. Some of the efforts to get health care content to people in the developing world in their own language
   
 

Caroline Jones | BIO
"An early childhood program to respond to otitis media: Feedback from families"

Chronic otitis media (OM) remains difficult to treat successfully, especially for Aboriginal children in remote communities in northern Australia. In recognition of this, an early childhood program ran for several years until 2014 through Sunrise Health Service, an Aboriginal-controlled primary health service in the Katherine region of the Northern Territory, Australia. The LiTTLe Program (Learning to Talk, Talking to Learn) was a parent-implemented early childhood language and school readiness program. Parents of children aged 0-3 years, regardless of the children’s OM status, were modelled intensive talk with their children, to boost oral language development as a buffer against the impacts of chronic otitis media. Parents attended group sessions in a school-based facility for four hours a day, five days a week during school terms. Families were also connected with clinic services and ENT/audiology, and with other programs e.g. nutrition, and maternal health. The program was staffed by local Aboriginal community members undertaking childcare qualifications, supported by a visiting program manager.
In this paper we report on the results of in-depth interviews with family members who with their child participated in the LiTTLe Program. We invited the parents to respond to open-ended questions in conversational format, encompassing: (i) their general opinions about the program, (ii) their experience of the program’s implementation, (iii) their conceptions and prioritisation of ear health in relation to other child health problems, (iv) their perception of the program’s utility in promoting school readiness, (v) issues relating to program engagement and attendance, and (vi) their suggestions for improvement. This presentation will share details on the program, and its strengths and weaknesses as perceived by families.

Learning Objectives:

  1. Expand their understanding of the prevalence otitis media among Australian Aboriginal communities
  2. Learn about the strengths and weaknesses of a parent-implemented, public health style approach
  3. Deepen their knowledge of cultural differences as relevant to hearing and communication
   

GENETICS OF HEARING ACROSS THE LIFESPAN
 
Hearing loss is a common and extremely heterogeneous genetic disorder with over 100 genes and hundreds of causative mutations identified in humans. Genetic defects can target the peripheral and/or central auditory system, causing a variety of early and late-onset hearing disorders. Until recently, only a few genes were routinely tested in patients with hearing loss at birth.  However, new genome-level analysis techniques are efficient, affordable and providing insights into the pathology of middle ear, cochlear and auditory neural pathologies. In this session, we will consider the genetics of hearing across the lifespan, with topics ranging from the causative molecular mechanisms to implications for the clinical care of affected patients and their families.  A better understanding of the disease-causing molecular mechanisms and their impact on auditory system dysfunction can be gained by studying the relationship between causative gene variants and their clinical presentation, or phenotype. Genetic findings associated with early and late-onset hearing loss will be compared to the phenotype for a variety of hearing disorders. Insights gained through a genetic approach to hearing loss hold great promise for innovation in hearing health care, with the development of new diagnostic tests and more tailored interventions.

Learning Objectives:
After this featured session, learners will be able to:
  1. Learn basic genetic concepts related to human disease, including the heterogeneous nature of genetic hearing loss
  2. Describe how genetic changes are associated with early-onset, progressive and adult-onset hearing loss phenotypes
  3. Discuss the impact of genetic research on clinical care
Chair: Sue Stanton | BIO
 Speakers:

 Terry-Lynn Young | BIO
"Genetic models of human hearing loss provide homogenous patient populations"

Contributing factors to hearing loss include increasing age, genetics, environmental
exposures and chronic disease. Although the contributing factors are many, they affect critical auditory structures in similar ways, such as disrupted mechanoelectrical transduction of sound or cellular structures that support biomechanics and metabolism. However, we cannot rely on the audiogram to identify homogenous populations of patients with similar pathology. For genetic forms of hearing loss, relatives with the same gene mutation provide a homogenous cohort of patients (across the life span) with identical pathology. I will discuss how we go about finding genes that affect hearing, and provide examples of how we can combine genetics and models of adult genetic hearing loss to understand more common forms such as age-related hearing loss.

Learning Objectives:

  1. The central role of genes in hearing loss
  2. The importance of family history and applying genomics to inform clinical diagnosis and prognosis/management
  3. Reaping rewards of collaborations between families, clinicians, researchers and communities
   
 

Ann Eddins | BIO
"Beyond the audiogram: Characterizing clinical attributes of the genetics of age-related hearing loss"

There now exists an extensive literature characterizing the many genetic variations associated with age-related hearing loss (ARHL).  Most of our current knowledge of candidate genes and their impact on auditory function is based on studies of animal models, primarily rodents that have been genetically engineered, as a means of comparing their auditory aging characteristics to humans.  To date, far less is understood about the clinical attributes, or phenotype, of human genes of ARHL largely due to variability introduced by internal and external factors over the lifespan, such as health conditions, environmental factors (i.e., noise), medication, and aging itself.  This presentation will discuss approaches that may be useful in expanding our clinical evaluation beyond the audiogram, using both behavioral and electrophysiological assessments, to better characterize the influence of human genetic variants of ARHL on auditory perceptual and neural function.  It is anticipated that improved diagnostic profiles of genetic variants will lead to innovative approaches to treatment and intervention strategies. 

Learning Objectives:

  1. Learn basic auditory characteristics of animal models with genetic-based ARHL
  2. Describe challenges in identifying similar characteristics in humans with ARHL
  3. Discuss how clinical assessment tools could be used to develop clinical phenotypes of the genetics of ARHL in humans.
   
 

Lauren Gallagher & Dennis Bulman | BIO
"Enhancing Infant Hearing Screening by Testing Newborn Dried Blood Spots for Congenital Cytomegalovirus and Genetic Mutations Associated with Hearing Loss"

In Ontario, the Infant Hearing Program (funded through the Ministry of Children and Youth Services) performs hearing screening to identify infants born deaf or hard of hearing, and Newborn Screening Ontario (funded by the Ministry of Health and Long-Term Care) coordinates newborn blood spot screening for Metabolic Diseases, Endocrine Diseases, Sickle Cell Disease, Cystic Fibrosis and Severe Combined Immune Deficiency. In this presentation, collaboration between these two programs to improve the ascertainment of infants at risk for permanent hearing loss and introduce an etiologic component to infant hearing screening by testing newborn dried blood spots for congenital Cytomegalovirus (cCMV) and common genetic mutations associated with hearing loss, will be summarized. 

Learning Objectives:

  1. List four limitations of Early Hearing Detection and Intervention (EHDI) programs
  2. Discuss how CMV and genetic screening of newborn dried blood spots can improve the ascertainment of infants at risk for permanent hearing loss
  3. Review the challenges and special considerations of designing and delivering an integrated system for hearing screening in Ontario
   

TESTING HEARING AND HEARING AIDS IN REALISTIC SITUATIONS  
A major aim of audiological rehabilitation is to enable hearing-impaired people to communicate effectively in everyday life. Tests currently relied upon to obtain a measure of a client’s communication ability simulate very simplified listening conditions by, for example, presenting few and stationary sound sources and no visual distractors. Additionally, while the auditory system assists with hearing speech, the cognitive system assists with comprehension and formulating a response; i.e. the interactive part of communication. Current clinical tests do not require use of the mental resources required to actively participate in a communication situation. Finally, when using adaptive tests to compare performances with different interventions, testing often takes place using signal-to-noise ratios (SNRs) below those in which most people would choose to communicate and below the optimal SNR for hearing devices. This session will present new initiatives for obtaining a better understanding of the factors that influence the ability of a hearing-impaired person to communicate in real life, and for tapping into both the auditory and cognitive systems when measuring speech-in-noise performance in the laboratory.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. List the SNRs of common listening situations and describe how they impact on hearing-impaired listeners’ effort to understand speech
  2. Describe at least two novel initiatives for obtaining more realistic laboratory measures for a person's communication ability
  3. Describe methods that measure the cognitive effect of hearing devices

Chair:

Gitte Keidser | BIO
"A new dynamic conversations test and its sensitivity to hearing thresholds, cognition, and amplification"

There is currently no audiological behavioural test available that fully assesses a person’s ability to communicate effectively in real life, or the ability to participate in conversations with a small group of people. To fill this gap, the National Acoustic Laboratories has designed a Dynamic Conversations Test (NAL-DCT) consisting of monologues presented from differing locations, and conversations between two and three talkers. The test requires participants to listen for 2-4 minutes to passages on everyday topics and answer 10 questions “on the go” to demonstrate they can hear what is being said, keep up with the conversation, and comprehend the information. This talk presents validation data obtained with the test played back in a multi-talker background noise, and compares performance to that obtained with a traditional sentence recall test. Associations with hearing loss, cognitive factors and listening effort will also be presented and discussed.

Learning Objectives:

As a result of this presentation, listeners will:

  • Describe a new initiative (NAL-DCT) for assessing a person’s real-life communication ability
  • Describe the effect of hearing thresholds and amplification on NAL-DCT relative to a standard listening test
  • Describe how increasing the number of talkers in a conversation affects performance on NAL-DCT
Speakers:

Inga Holube | BIO
"Subjective and objective momentary ecological observations in everyday life using a smartphone-based system"

Hearing aids are designed to improve primarily speech recognition for communication. When trying to quantify the improvement in every-day listening situations, mostly questionnaires monitoring subjective impressions are used. Obtaining objective data outside a laboratory is relatively difficult, given the required equipment and its proper handling as well as privacy concerns emerging from long-term audio recordings in a non-regulated and populated environment. Therefore, a smartphone-based system was developed that allows for long-term ecological momentary assessment. This system combines descriptions of the environment and subjective scalings of speech intelligibility, listening effort, loudness, and importance of the every-day situations with objective descriptions of the signal characteristics. A simple user interface ensures that the system can be properly handled by non-tech-savvy users. As only extracted features but not the audio-data itself are stored, screening and approval of the recorded data by the test subject is not necessary. The presentation will describe the results collected by elderly normal-hearing and hearing-impaired subjects.

Learning Objectives:

As a result of this presentation, listeners:

  1. Will be able to name at least three listening situations in every-day life which are common, important, and difficult for communication
  2. Will be able to describe the acoustical properties (e.g., levels, signal-to-noise-ratios) of every-day listening situations
  3. Are aware of privacy issues when assessing every-day listening situations
 
 

Astrid van Wieringen | BIO
"True-to-life listening scenarios"

Hearing ability and potential benefit of hearing amplification are traditionally evaluated using single outcome measures (e.g. speech in quiet, one speaker). Very often these outcomes do not reflect daily hearing difficulties, presumably because the daily listening conditions are much more complex than captured by a simple measure. In order to bridge the gap between in-lab controlled measurements and self-report and to be able to evaluate hearing performance in a realistic listening environment, a novel comprehensive method for real-life assessment of auditory functioning is being developed. For this a person is immersed in a complex and challenging audio-visual environment.  Different true-to-life figures are projected from different directions in different scenarios (e.g. restaurant, train). The complexity of a listening condition is varied by combining different cues, such as auditory and/or visual cues presented separately or together, presence or absence of noise, moving sound sources…

The presentation will discuss the development of the audio-visual presentations, different scenarios and first evaluation of cues –presented individually and combined- by normal hearing and hearing impaired listeners. Combination of different cues and outcome measures will lead to the development of a comprehensive measure of listening in daily life.

Learning Objectives:

Following completion of this lecture, participants will

  1. Understand the discrepancy between single outcome measures and self-report
  2. Recognize the different multiple auditory and visual cues in daily auditory functioning
  3. Apprehend the development and evaluation of audio-visual scenarios
 
 

 Sridhar Kalluri | BIO
"Laboratory assessment of daily-life speech understanding"

There is increasing recognition in audiology that effective listening results from an interplay between sensory and cognitive elements (e.g., attention, working memory) of auditory processing. Cognitive processing takes on a particularly important role in sub-optimal listening scenarios caused by complex acoustic environments, listening goals that may change from moment to moment, hearing impairment, distortions caused by signal processing, and the effects of aging. As such, there is a need for tools to assess the impact of hearing impairment and sensory and cognitive interventions (hearing technology, auditory and cognitive training) on the cognitive elements of listening.

This presentation will review studies aimed at incorporating important elements of daily listening that engage cognitive processing into a new test of speech understanding. The new test focuses on understanding the meaning of speech rather than just hearing the phonetic elements of speech, and it incorporates the demands of daily listening such as the continuous flow of speech information and the presence of competing speech. Such research should lead to tests that are better than traditional tests at predicting the effects of treatments on real-life experiences of listening-instrument users, and thus may form a part of a toolkit that clinicians deploy for determining intervention plans for their patients.

Learning Objectives:

  1. List common features of daily-life listening that tap into auditory and cognitive resources that are not engaged by typical laboratory or clinical tests.
  2. Describe a method to capture realism of listening in daily life multi-speech environments through incorporation of cognitive complexity in a laboratory listening task.
  3. Explain how the results of a speech test when the task is to understand the meaning of speech compare with when the task is to just hear the phonetic elements of speech.
 
         

ACOUSTICS AND COMMUNICATION IN SCHOOL, WORKPLACE, HEALTH CARE AND COMMUNITY SETTING
 
Complaints are often heard about bad acoustics in a variety of real world settings, such as schools, hospitals and workplaces. In such environments, communication can be disrupted causing, for example, annoyance, learning difficulties, delayed patient recovery, and even accidents. While LEED certification has been the primary focus to target healthy and efficient environments, acoustics is often overlooked. What can and should be done to improve the acoustical characteristics of these environments so that individuals may enjoy learning, working, resting and even take part in hobbies without the addition of undue stress? Panelists will address examples of good practice and demonstrate that it is possible to avoid mismatches between the tasks to be accomplished and the environments in which they occur.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Understand acoustical characteristics of a variety of environments, such as schools, health care settings, workplaces and recognize which ones are detrimental to communication;
  2. Identify how it is possible to improve such environments in order to optimize communication;
  3. Describe the acoustical criteria related to the LEED certification

Chair: Chantal Laroche | BIO
 Speakers:

Murray Hodgson | BIO
"Subjective and objective acoustical quality in healthcare office facilities"

Health-care facilities include many non-clinical office spaces for administrative staff; the role of acoustics in these spaces has been underexplored. This paper discusses the acoustical part of a study of indoor environmental quality (IEQ) in 17 healthcare office facilities A subjective survey assessed office worker perceptions of their environments in general, and satisfaction with the acoustics. Self-reported productivity, well-being, and health outcomes were also captured. Satisfaction was lower with acoustics than with other aspects of IEQ. Satisfaction results were related to room type (e.g., open plan vs. shared vs. private office) and the absence or presence of a sound-masking system. Acoustics was the most important aspect of IEQ in predicting occupant satisfaction and well-being. Physical acoustical measurements were made in 6 types of rooms, some with sound-masking systems, to determine the acoustical characteristics, assess their quality, relate them to the building designs, and develop prediction models. Background-noise levels were measured in the occupied buildings. In the unoccupied buildings, measurements were made of reverberation times, and ‘speech’ levels needed to calculate speech intelligibility indices for speech intelligibility and speech privacy. In open offices, sound-level reductions per distance doubling (DL2) were measured. Noise isolations of internal partitions of different designs (double-plasterboard construction, modular or built in-situ, rising to the suspended ceiling or to the floor-ceiling slab, without and with doors, different amounts of glass) were measured. The acoustical characteristics were compared to design criteria to evaluate their acceptability. The results are presented, and are related to room type and partition design. An empirical model for predicting partition noise isolation, developed using regression techniques, is discussed. The knowledge gained from this study informs the decision-making of designers and facilities management for upgrades and future design projects.

Learning Objectives:

  1. Participants will appreciate that the acoustical environment is only one aspect of indoor environmental quality, but the one that the occupants of healthcare office-facilities are the most concerned about
  2. Participants will appreciate the different ways that healthcare office-facility acoustical environments can be evaluated objectively and subjectively
  3. Participants will identify factors that affect acoustical quality in healthcare office-facilities, and relate it to measurements of the objective acoustical quality of facility rooms and building elements
   
 

John Swallow | BIO
"Recent Developments in Acoustic Standards for Health Care Facilities"

Acoustic Guidelines for the design of health care facilities have only been developed in the last few years in both Canada and the United States. The available guidelines CSA/CAN Z8000  and FGI 2014 Guideline for Health Care Facilities cover many aspects of acoustic design but also present different requirements and in some cases are based on different approaches. These two standards are compared as they exist, considerations for future revisions are examined and the application of these to audiology facilities and the use of hospital facilities by the hearing-impaired are reviewed.

Learning Objectives:

  1. Know that there are Design Guidelines for HCF’s and be familiar with the scope of the guidelines.
  2. Appreciate the philosophy of the guidelines and know some of the limitations and contradictions.
  3. Know that Audiology/Hearing Impairment is not specifically addressed; identify areas where design input needs to consider Audiology/Hearing Impairment.
   
 

Sigfrid Soli | BIO
"A method for assessing the effects of ambient noise on the likelihood of effective speech communication in the workplace"

Workplace noise often has nonstationary spectral and temporal characteristics, making it difficult to determine its influence on the likelihood of effective speech communication. However, the Extended Speech Intelligibility Index (ESII) enables the influence of this noise on speech communication to be estimated. ESII analysis of calibrated recordings of workplace noise environments where hearing-critical job tasks are performed are used to estimate the likelihood that effective speech communication can be achieved with normal or raised or vocal effort by individuals with normal hearing. Similar estimates can be made for hearing impaired individuals. The accuracy of these estimates has been validated in several laboratory studies. These estimates not only to determine quantitatively the effects of workplace noise on speech communication by individuals with normal hearing, but also the additional effects on hearing impaired individuals. This method has been used to assess the impact of workplace noise on the job performance of public safety and law enforcement individuals in both Canada and the US who often must work in places where the noise environment cannot be controlled. This presentation will describe the acoustic properties of these noise environments and their effects of speech communication for normally hearing and hearing impaired individuals.

Learning Objectives:

  1. Attendees will learn how the Extended Speech Intelligibility Index (ESII) can be used to analyze workplace noise environments.
  2. Attendees will learn how ESII analyses of workplace noise environments allow identification of those environments where effective speech communication is compromised.
  3. Attendees will learn how ESII analyses can also provide objective estimates of the effects of hearing impairment on effective speech communication in workplace noise environments.
   
 

Charlotte Clark | BIO
"Noise in the school environment: effects on children’s learning and health"

Increasing pollution from transport in the urban environment, has led to a policy need to advance and synthesise knowledge about the impact of aircraft and road traffic noise exposure on children’s cognitive development, health, and well-being.  Overall, evidence for effects of environmental noise on children’s cognition has strengthened in recent years, demonstrating relationships between chronic noise exposure at school and poorer reading ability and memory. Research has also related classroom acoustic conditions to children’s learning outcomes focusing upon noise interference with verbal communication as the mechanism for the effect. Such evidence informs guidelines for external environmental noise exposure and the planning of school environments; and informs the design of the internal acoustic environment and potential interventions, although little is currently known about the effectiveness of interventions. Aircraft and road traffic noise are also associated with increased levels of annoyance in children and may be associated with raised blood pressure and hyperactivity. Environmental noise could have public health implications for children’s development and health, given the chronic nature of exposure and the number of children potentially exposed.

Learning Objectives:

  1. Learn about how environmental noise exposure at school influences children’s learning and health.
  2. Learn about the mechanisms, which might explain how environmental noise exposure at school influences children’s learning and health.
  3. Learn about environmental and acoustic guidelines for children’s noise exposure at school.
   

WEDNESDAY, september 21, 2016

10:30 - 12:00

ACCESSIBILITY AND ASSISTIVE TECHNOLOGIES: PEOPLE, DEVICES AND LIFE
 
It is commonly reported that personal hearing technology does not solve all communication challenges for persons with hearing loss particularly when they are in noisy environments. There are numerous types of assistive devices for persons with hearing aids and/or cochlear implants that allow for a significant increase in the signal-to-noise ratio. In order to determine the best arrangement for someone, a thorough assessment of their communication challenges must be completed. The TELEGRAM is one tool that can be used to evaluate communication across several areas. When the communication challenges are determined, the best network of devices can be recommended. A review of assistive technology options and clinical applications will be provided.

LEARNING OBJECTIVES:
After this featured session, learners will be able to:
  1. Use the TELEGRAM to determine the need for assistive technology to benefit those with hearing loss
  2. Describe various types of wireless remote microphone technology and how these technologies can benefit persons with hearing loss
  3. Describe how wireless technology can be of benefit in everyday situations that involve communicating in noisy environments such as dining in restaurants
Chair: Linda Thibodeau | BIO
 Speakers:

 Imran Mulla | BIO
"Wireless Hearing Devices: From Babies to Boomers"

Wireless technologies can provide a much needed option for people with hearing loss to access a wider range of listening environments and devices that many of their hearing peers would have daily access to. Connectivity to everyday devices like phones, tablets, laptops, televisions and hands free systems can significantly improve the overall quality of life a hearing technology user can expect compared to the use of their hearing device on its own. Furthermore, the ability to connect to a range of wireless microphone transmitters provides enhanced access to speech improving signal to noise ratios (SNR) for all hearing technology users regardless of their age. The current presentation will provide an overview of the potential benefits that have been noted with the use of wireless devices for different age groups. The aim is to give hearing professionals an appreciation of the potential for maximising listening opportunities for their clients.

Learning Objectives:

  1. Appreciate the increased importance of an improved signal to noise (SNR) for preschool children with a hearing loss
  2. Identify situations where FM use may provide benefit to preschool children and teenagers with a hearing loss
  3. Recognise the need to consider improving SNR’s for older adults with existing hearing technologies
   
 

 Charles Laszlo | BIO
'Technology is not enough - The need for the communication specialist'

It is common professional wisdom that hearing aids and assistive listening devices (ALDs) allow people with hearing loss to function satisfactorily in their daily lives.  While these devices can provide improved sound and environmental information to users, it cannot be assumed that the communication problems of people with hearing loss are automatically solved.  ALDs are designed to perform specific functions well, but users are faced with the daunting task of selecting and ‘integrating’ the various devices into a ‘system’ that provides for their needs.  Far too often they don’t succeed.  

What is needed is a comprehensive approach to fitting hearing aids and prescribing assistive listening devices together.  This can be accomplished only if the personal circumstances and communication objectives of clients are evaluated and taken into account.  The understanding of the individual’s communication needs will then allow the specification of an integrated, comprehensive communication system for each person.  By necessity, such a process may also include non-technical measures. This approach goes beyond current professional audiological practice.  People with hearing loss now need communication specialists, and challenge audiology professionals to step into this enlarged role with commitment and enthusiasm. 

Learning Objectives:

  1. Recognize that audiologically-appropriate technical solutions do not necessarily equate with consumer satisfaction
  2. Evaluate and discuss the importance of identifying the communication objectives of clients
  3. Respond to the challenge of becoming a communication specialist
   
           

NOISE, EARS AND EVERYDAY LIFE  
Noise and hearing loss – with their associated implications on communication, employment opportunities, job performance, injury-risk, depression, and anxiety – place a significant burden on society. Noise-induced hearing loss represents a substantial portion of all hearing impairments and is nearly always permanent. The negative consequences associated with noise exposure are not confined to the workplace or the working years. Each of us encounters hazardous sound exposures during childhood and the exposures continue throughout our life span, regardless of the job(s) we perform. As noise is everywhere, the prevention of its effects requires expanding preventive initiatives to outside the workplace; it requires the integration of occupational safety and health protection with health promotion. Audiologists and public health professional’s efforts must broaden towards building a culture that promotes healthy hearing. Today we have fewer obstacles and more tools than were available in past decades, but we still need to increase our effectiveness. We need to plan for research and intervention evaluations that will result in evidence-based recommendations and practices in hearing loss and tinnitus prevention. This session will cover factors that affect our hearing health and initiatives that can impact not only individual, but society’s decisions, and determine change that improve lives.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Identify scenarios where exposure to noise or music can represent a risk to healthy hearing
  2. Identify sources of scientific evidence on intervention effectiveness to base decisions pertinent to the practice of hearing loss prevention
  3. Identify public health approaches that could enhance an audiologist’s contribution towards the prevention of hearing loss and tinnitus

Chair: Thais Morata | BIO
  Speakers:

 Peter Thorne | BIO
"What pre-clinical studies inform us about prevention and treatment of noise induced hearing loss "

Noise-induced hearing loss arises from damage to the sensory and neural tissues in the cochlea.  Animal studies have been critical to understanding the mechanisms of the injury to the ear and the relationship between noise exposure and the hearing loss or cochlear injury.  For these studies there is good evidence that the primary mechanism of the injury is oxidative stress and inflammation of the inner ear.  Armed with this substantial knowledge of the dynamics and mechanisms of injury a number of promising biomedical approaches have been developed to prevent and treat the cochlear injury and the hearing loss.  These involve prophylactic or post-exposure delivery of compounds that reduce inflammation and oxidative stress or prevent the activation of cell death pathways.  The translation of this to humans shows promise with a number of clinical trials underway, but there are a number of challenges to the treatment of noise-induced hearing loss using pharmacological approaches, particularly the method of delivery of the drugs to the inner ear for clinical settings.  Another issue is the emerging evidence of “hidden hearing loss” due to the primary injury to the auditory neurons in the absence of any hair cell injury and loss of auditory thresholds.  This raises interesting questions about the validity of the audiogram, which assesses thresholds, as a quantitative indicator of the influence of noise exposure.  This presentation will outline and discuss the important influence of animal studies to our understanding of NIHL and will consider the translation of these findings to the clinical treatment of the hearing loss.

Learning Objectives:

  1. Knowledge of the range of effects of noise on the cochlea
  2. Knowledge of the current therapeutic options for NIHL from pre-clinical studies
  3. Understanding of the clinical translation of these therapies for NIHL
 
 

Hugh Davies | BIO
"Noise exposure and cardiovascular effects"

Several decades of research has provided fairly consistent evidence of a link between noise exposure and cardiovascular disease. The source of the noise can be the workplace or community sources such as transportation noise. Chronic stress response is thought to underlie the pathological mechanism. In Europe work has been done to try and measure the burden of noise–related cardiovascular disease and to recommend “safe” levels of noise. More recently noise has also been investigated with respect to links to other chronic diseases such as diabetes, and to adverse birth outcomes among mother exposed to noise during pregnancy.

Learning Objectives

Attendees will be able to:

  1. Desccribe the non-auditory health effects of exposure to noise.
  2. Explain the hypothesized psychological mechanisms that underlie those health effects.
  3. Explain the hypothesized biological patho-mechanisms that underlie those health effects.
 
  Elizabeth Beach | BIO
"Changing perceptions and habits in the use of hearing protection devices"

Despite ongoing efforts to raise awareness about the potential harm to hearing from excessive noise levels, loud noise at work and leisure continues to be a feature of modern life. One strategy that individuals can adopt to protect their hearing and minimise the risk of hearing damage from loud environments is to wear hearing protection devices (HPDs). Recent research at NAL has investigated attitudes to hearing protection amongst i) musicians; ii) ‘clubbers’, and iii) the general public. Key findings include: qualitative studies with musicians found that increasingly, musicians are more willing to accept that it is necessary to wear HPDs at least some of the time while making music; ii) clubbers with high self-efficacy, strong affinity for music, and symptoms of hearing damage are more likely to use HPDs in high-noise nightclub environments; and iii) an online survey of more than 8000 Australians found that people are more likely to use HPDs in noisy leisure activities that are ‘work-like’ such as yardwork, or using power tools. Furthermore, those who have used HPDs in their workplace are up to five times more likely to use HPDs during leisure activities. These findings and implications for hearing health promotion will be discussed.

Learning Objectives:

  1. To understand how musicians’ attitudes to hearing protection are changing
  2. To identify the main ‘calls to action’ that motivate clubbers to protect their hearing at nightclubs
  3. To understand the relationship between HPD use in the workplace and leisure environments
 

MUSIC AS NOISE, PLEASURE, AND AS AN INPUT TO HEARING AIDS
 
Music can be quite enjoyable, but not necessarily when amplified through modern hearing aids. It also may not be enjoyable if it’s coming from the pub down the street and you are trying to sleep or listening to a band or orchestra in a room that is better suited to a Bingo Hall. Presenters will cover the following four areas: 1. Music and modern digital hearing aids- the problems, the solutions, and the future. 2. The Psychology of Music 3. Architectural acoustics and the relevant measures- a primer 4. Outside community noise and music- what can be done.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Explain the engineering limitations of most modern hearing aids for music
  2. Identify some strategies to minimize complaints about community music exposure from live performance venues.
  3. Understand the basics of room acoustics and the relevant measures

Chair & Speaker:

Marshall Chasin | BIO
"Music and modern digital hearing aids- the problems, the solutions, and the future"

Music and speech have some differences which include spectral shape, intensity and “crest factors”.  Most modern digital hearing aids cannot handle the more intense inputs that are characteristic of music.  Four new technologies and four clinical strategies will be provided to optimize hearing aids for music as well as for speech.  These technologies are designed to circumvent some problems associated with the analog-to-digital conversion process- a major weak point with modern hearing aids.

Learning Objectives:

After attending this seminar, the participant should be able to:

  1. Select software programming that is optimized for music
  2. Explain the engineering limitations of most modern hearing aids for music
  3. Identify some simple clinical strategies to improve a hearing aid for music
 Speakers:

 Frank Russo | BIO
"Perception of Music in Hearing Aids "

Hearing impairment affects the perception of sound leading to reductions in speech intelligibility and the enjoyment of music. Extensive research into the effects of hearing loss on speech intelligibility has led to various attempts to improve speech perception through hearing aids. By comparison, research into the effects of hearing loss on music perception is in its infancy. In this talk, a new objective test will be described that assesses perception of music in hearing-impaired individuals. Performance on the test by normal, hearing impaired and hearing aided listeners will be compared.

Learning Objectives:

  1. What aspects of music perception are objectively impaired by hearing loss
  2. To what extent are these losses mitigated by current hearing aids
  3. What aspects of signal processing have been implicated in poor music perception outcomes
   
 

Dr. Joseph Montano | BIO
"Aural Rehabilitation: Counseling musicians with hearing loss"

Audiologic Rehabilitation (AR) has transitioned over the years from a service specific discipline to a process with a more inclusive identity. Although there are a number of published definitions, clinical practice is often confounded by ambiguous professional roles, reimbursement restrictions and limited knowledge and skills. With the continuing evolution of health care delivery, this seminar will focus on defining AR within the context of patient-centered care.

Learning Objectives:

  1. Describe three characteristics of the psycho-social impact of hearing loss on musicians.
  2. Explain the trans-theoretical model of counseling
  3. Describe how motivational interviewing can be used in counseling musicians
   
 

William Gastmeier | BIO
"Architectural Acoustics and the Relevant Measures - a Primer"

The design of interior spaces for “good acoustics” has been defined since the early 1900’s in terms of reverberation and background sound. Both of these are highly integrated quantities which relate primarily to the overall acoustical characteristics of the space. High levels of both reverberation and background sound are well understood to interfere with the intelligibility of speech in normal hearing persons. Also well understood is that significantly lower levels of reverberation and background sound can interfere with speech intelligibility in individuals using hearing aids. The first portion of this presentation deals with these effects. Reverberation and background sound have proven to be insufficient to describe what makes a space “sound good” for music. In more recent decades, quantities related more closely to the fine structure of sound arriving at the ear and particular early arriving lateral sound have been found to be important in terms of the musical experience. Terms such as Initial Time Delay Gap, Lateral Fraction and Binaural Quality Index, Interaural Cross Correlation Coefficient and C80 are coming into more common usage. These are discussed in the second portion of the presentation.

Learning Objectives:

After attending this seminar, the participant should be able to:

  1. Explain the engineering limitations of most modern hearing aids for music
  2. Identify some strategies to minimize complaints about community music exposure from live performance venues
  3. Understand the basics of room acoustics and the relevant measures
   

HEARING, COGNITION AND SOCIAL PARTICIPATION IN OLDER ADULTS  
Increasing evidence has demonstrated a connection between sensory and cognitive aging. One possible explanation for this connection is that older adults who are hard of hearing may withdraw from social participation and that increasing social isolation diminishes opportunities for maintaining cognitive functioning. Other possibilities are that both sensory and cognitive declines conspire to reduce social participation or that reduced social participation has a negative effect on how well older adults adjust to sensory and cognitive declines. Better insight into these associations will be needed to optimize rehabilitation and to guide social policy for healthy aging. This session will explore these connection from different perspectives, including those of a consumer advocate for seniors who are hard of hearing, a rehabilitative audiologist, an otolaryngologist engaged in community-based health promotion programs for older adults, and a cognitive scientist doing longitudinal research on aging with a focus on the connections between auditory and cognitive aging.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Explain possible connections between age-related changes in hearing, cognition and social participation
  2. Relate new knowledge about the connections between age-related changes in hearing, cognition and social participation to adapt rehabilitation practice
  3. Discuss how a better understanding of the connections between age-related changes in hearing, cognition and social participation could help to improve the health and quality of life of older adults

Chair: Kathy Pichora-Fuller | BIO


 Speakers:

Paul Mick | BIO
"Hearing loss and social epidemiology"

Hearing loss is often quoted as negatively affecting social function. In this talk, basic concepts of social epidemiology will be described. Attendees will learn the differences between social networks, social support, social participation and loneliness, and whether there is evidence linking hearing loss to reductions in these domains. Evidence linking social function to other areas of health and wellness will be explored, and we will discuss whether social mediators could explain observed associations between hearing loss and cognitive declines, dementia and/or frailty.

Learning Objectives:

By the end of the talk, attendees will understand:

  1. The concepts of social networks, social support, social participation and loneliness, and why they are important to health and wellness
  2. Evidence linking hearing loss to the domains of social function described above.
   
 

Henrik Danielsson | BIO
"Modeling how early age-related hearing loss affects memory and social participation "

Previous studies have found aging effects on and interrelations between hearing, episodic memory, and social participation. Nevertheless, how age and the three concepts relate to each other is unclear. In the current study, self-reported social participation were assessed together with behavioral measures of hearing and episodic memory. Structural equation modeling was conducted on data on older adults with on average mild-moderate high-frequency hearing loss from two different databases with 297 respectively 273 participants. Analyses on both samples yielded two models with good and similar statistical properties. The two models had the following in common: Aging effects on hearing and episodic memory, effect of hearing on episodic memory; and no direct effect of hearing on social participation, whereas the models differed on the direction of the link between episodic memory and social participation as well as the existence of the aging effect for social participation. The models were confirmed in both samples, indicating robustness in the findings. Few participants in both samples were candidates for hearing aids, but most of those who were candidates used them. This suggests that, at least in the early stages of age-related hearing loss, there is no direct link from hearing loss to social participation, but there are indirect effects via episodic memory.

Learning Objectives:

  1. Compare different models of the relationships between age-related changes in hearing, cognition and social participation.
  2. Discuss the theoretical implications of how the different models fit data.
  3. Describe how the different models could translate into rehabilitation practice.
   
 

Marilyn Dahl | BIO
'Expanding the model for auditory rehabilitation - a consumer perspective'

Recent research has noted links between hearing loss, aging, cognitive decline and social functioning, although the relationship between these factors and causation is not yet fully understood.  Older adults who lack social support systems, tend to be less successful in adjusting to living with a hearing loss, including use of the hearing aid, knowledge of other assistive communication devices, and staying involved in social relationships. The approach to healthy aging is a holistic one which recognizes the importance  of maintaining active social participation in older adults. Such socialization however is difficult to maintain for those who are dealing with hearing problems.

It has been established that strategies for managing one’s hearing loss in daily living, are most effectively learned and applied through peer interaction.  This paper therefore proposes that a formal peer-interaction component be added to the existing model for auditory rehabilitation.In addition to auditory rehabilitation, attention must be paid to those varied ecological factors which interfere with and have a sabotaging effect on attempts to participate in all sorts of social interactions. One most notorious and neglected is the lack of attention to acoustic access in architectural standards of planning. A model is proposed for professional participation with consumer advocacy efforts in this regard. 

Learning Objectives:

As a result of this presentation, participants will be able to:

  1. Understand the consumer perspective on managing one’s hearing loss
  2. Discuss the suggested peer-interaction component for auditory rehabilitation
  3. Discuss the proposed model for professional/consumer advocacy for hearing accessibility in architectural standards.
   

HEARING, COMMUNICATION AND SOCIAL PARTICIPATION IN CHILDREN  
The session will present data from both the United States and Canada about children who are deaf or hard of hearing. The presenters will explore the relationship between hearing, communication and social communication from infancy through the school-aged years for children who have both bilateral and unilateral hearing losses. This session will present information from the National Early Childhood Assessment Project of children enrolled in early intervention programs across 15 states. The relationship between language and social skills will be reported for more than 1000 children enrolled in these early intervention programs. Data from the Outcomes of Children with Hearing Loss Study in the United States, examining the auditory, communication and social development longitudinally of children with mild through severe hearing loss will be presented. Data from a longitudinal study of Canadian preschool-aged children with mild bilateral and unilateral hearing loss will be presented. The social participation of school-aged Canadian children who are deaf or hard of hearing will also be discussed.

LEARNING OBJECTIVES
After this featured session, learners will be able to:
  1. Describe the relationship between language and social skills development in children in the US who are deaf or hard of hearing from birth through three years of age across 15 states
  2. Describe the development of pragmatic language skills of children in the state of Colorado who are deaf or hard of hearing between the ages of 4 to 7 years
  3. Describe the auditory, language and social skills longitudinal development of children with mild to severe hearing loss in the United States
  4. Describe the language and social development comparing children with unilateral and bilateral hearing loss
  5. Describe the social participation skill of school-aged children who are deaf or hard of hearing in inclusive settings

Chair & Speaker:

Christine Yoshinaga-Itano | BIO
"The relationship between language and social skills of deaf and hard of hearing children across 14 US states"

This presentation will provide data collected on more than 1000 children who are deaf or hard of hearing in 14 states:  Arizona, California, Colorado, Florida, Idaho, Indiana, Maine, Minnesota, North Dakota, Oregon, Texas, Utah, Wisconsin, Wyoming.  These states participate in the National Early Childhood Assessment Project:  Deaf/Hard of Hearing and are in the process of developing systems capable of collecting developmental outcomes from their population of children identified as a result of universal newborn hearing screening.  The states have committed to collect at least one common developmental assessments from all the children in their state but most are collecting both the MacArthur-Bates Communicative Development Inventories and the Child Development Inventory.  All of the states are collecting the MacArthur-Bates Communicative Development Inventories.  A few do not collect assessment data from the Child Development Inventory.  This session will report on a validation of the 1-3-6 (screen by 1, identify by 3 and in intervention by 6 months) across the 14 states.  Additionally, for the states who collect the Child Development Inventory, the relationship between social skill development and language development will be reported.  
Very little information is available about the pragmatic language development of children who are deaf or hard of hearing between the ages of 2 and 7 years of age.  The pragmatic language development of over 100 children who have bilateral permanent hearing loss in the state of Colorado will be reported by degree of hearing loss and age and will be compared to children with normal hearing.   
Data about the characteristics of the language use of the mothers of children who are deaf or hard of hearing with their infants and children will be provided.  The relationship between maternal level of education and parent talk will be present

Learning Objectives:

  1. Learners will be able to describe the relationship of identification by 3 months and enrollment into early intervention by 6 months on the developmental outcomes of children across participating states in NECAP
  2. Learners will be able to describe the relationship between social skills development and language development among children who are deaf or hard of hearing in the first 3 to 5 years of life
  3. Learners will be able to describe the development of pragmatic language skills of children who are deaf or hard of hearing as compared to children with normal hearing
  4. Learners will be able to describe the relationship between the characteristics of parent talk and language developmental outcomes
 Speakers:

Mary Pat Moeller | BIO
"Longitudinal Outcomes of Children who are Hard of Hearing"

Newborn hearing screening has prompted a new era in service delivery for infants and young children who are hard of hearing. The expectation is that these service innovations will prevent or minimize speech and language delays in these children, and further research is needed to document the degree to which this goal is being realized for children who use hearing aids.  The Outcomes of Children with Hearing Loss (OCHL) study was designed to address this question and to identify factors associated with individual differences in outcomes.   This presentation will discuss results from this prospective, longitudinal study of 317 preschoolers with mild to severe, bilateral hearing loss and a comparison group of 117 age-matched hearing peers.  The OCHL research team concluded that reduced access to auditory-linguistic input places children at risk for language delays.  This presentation will emphasize three major factors that if optimized, serve to improve access to auditory-linguistic input, and thus contribute to positive outcomes for children: 1) audibility of speech sounds with hearing aids, 2) consistency and duration of hearing aid use, and 3) characteristics of caregivers’ language input.   Language, auditory and social outcomes will be considered.  This work was supported by NIH-NIDCD R01DC009560.

Learning Objectives:

  1. Identify at least four key variables that consistently influence the outcomes of young children who are hard of hearing.
  2. List at least two reasons why comparison of a hard of hearing child’s outcomes to standardized test norms may underestimate needs.
  3. Identify four reasons why children who are hard of hearing may experience inconsistent access to linguistic input.
  4. List at least three clinical implications of the results for audiological and early intervention practice.
   
 

Elizabeth Fitzpatrick | BIO
"Early-identified children with mild bilateral and unilateral hearing loss"

Universal newborn hearing screening (UNHS) has led to an increase in the number of children with mild bilateral and unilateral hearing loss identified during the first year. Until recently, these children were typically identified at 4 to 5 years of age and little is known about the consequences of early-identified hearing loss of milder degrees. This presentation will provide a brief overview of the prevalence and characteristics of mild and unilateral loss from population-based data collected from a newborn screening cohort of approximately 150,000 children over a 12-year period (2003-2014). In addition, key findings from a multi-center longitudinal study that examined outcomes related to auditory and language development in 60 children with early-identified mild bilateral /unilateral hearing loss will be presented. Children were assessed at 12-month intervals from age 12 to 48 months. Their functioning will be compared to a group of children with normal hearing. Findings will be summarized from interviews with parents of a subset of these children regarding their experiences, concerns, and perceptions of the effects of hearing loss on their children’s functioning.

Learning Objectives:

  1. Learn about the prevalence and characteristics of mild bilateral and unilateral hearing loss in children
  2. Gain knowledge about developmental outcomes in early-identified children who have mild bilateral/unilateral hearing loss
  3. Learn about parents’ experiences and concerns when there child is diagnosed with mild bilateral or unilateral hearing loss
   

 *Please click on each Featured Session for additional information, learning objectives and chair/speaker details

speaker disclosure: click here