Abstracts

President’s Lunch and AGM

Dr. Salima Jiwani, President of CAA hosts the lunch which includes the CAA AGM and awards ceremony.

Managing Cerumen

  • Pre-Conference Workshop A

Cerumen management is a task which Audiologists are interested in adding to their list of competencies.  This workshop is designed to address core issues in cerumen management in order illustrate the main areas that are required for competency.  Following the lecture based portion of this presentation, a brief opportunity is allowed for hands-on training and skill acquisition.

Learning Objectives: Upon completion of this symposium, participants will be able to:

  1. Describe patient demographics of groups most likely to have impacted cerumen
  2. List the most common reflexes that can be triggered during cerumen removal
  3. Describe potential beneficial functions of cerumen
  4. Understand the importance of infection control when removing cerumen
  5. Identify a variety of techniques that can be used to remove cerumen.
  6. Identify how cerumen and tinnitus/temporary thresholds shift are connected
  7. Understand modifications of techniques for patients with a perforated tympanic membrane or patients with tympanostomy tubes.
Pre-Conference Workshop B

Counseling Tools for Living Well with Hearing Loss and Tinnitus

We are living in an era where there is a growing, ageing population worldwide. More people are living longer, and more people are living longer with chronic & debilitating health conditions that impact on their quality of life. Hearing loss and tinnitus affect a significant number of people worldwide and it important to consider the prevalence of these conditions not only in the ageing population, but also in the younger generation where noise exposure can impact on these. There are ever increasing pressures on healthcare budgets and when it comes to designing healthcare, we have to think about providing the best possible care, as well as care that provides value for money. Person centred care (PCC) should be the standard of care, rather than the exception. Various healthcare organisations around the world, including the World Health Organisation advocates for and promotes the delivery of PCC, yet, it is still not considered “business as usual”.

To enable this, healthcare services must change, and the relationships between healthcare providers and patients must change. Can we afford NOT to be person centred? Any course of action that is not in line with a patient’s preferences and priorities is potentially a waste of time & financial resources (Trueman et al, 2010). There is a global trend in modern day healthcare to design services with patients (rather than for or to patients). The question to the patient is changing from the historic “What’s the matter with you?”  to a more modern and inclusive “What matters to you?” (Barry & Edgman-Levitan, 2012). The baby boomer generation wants and expects a personal experience and this also includes their healthcare experiences. PCC facilitates these personal experiences by focussing on PCC principles in healthcare delivery.

In this workshop by the Ida Institute, we will focus on:

  1. Exploring how we can find out what matters to our patients and how we can help them to live well with their hearing loss
  2. How to include communication partners in the rehab process and consider the notion of third party disability
  3. Delivering tinnitus management in a person centred manner

PCC is core to the Ida Institute’s mission and for PCC to succeed, we need to commit to working in a person centred way. This interactive workshop will provide an opportunity to learn more about person centred care and reflect on daily practice using ethnographic films and group discussions.

Opening Keynote

Sound Processing in the Brain: What Have We Learned From Music?

To make sense of sound, there is a wide activation of sensorimotor, cognitive, and reward circuitry in the brain (1). Active and repeated engagement with sounds that activate all these circuits, therefore, is a route to honing our brain function. Playing music is like hitting the jackpot for the brain because it requires the motor system, deeply engages our emotions, and absolutely gives us a cognitive workout. We have employed a biological approach, the frequency-following response (FFR), to reveal the integrity of sound processing in the brain and how these brain processes are shaped by music training. We have found that music works in synergistic partnerships with language skills and the ability to make sense of speech in noisy, everyday listening environments (2). We have found that music brings about a “speeding” of auditory system development, and a tendency toward a reversal of the biological impact of poverty-induced linguistic deprivation. The generalization from music to everyday communication illustrates both that these auditory brain mechanisms have a profound potential for plasticity and that sound processing is biologically intertwined with listening and language skills. Playing music gives the brain the tools to make sense of sound. These findings have the potential to inform health care, education, and social policy by lending a neurobiological perspective to the efficacy of music for improving auditory communication skills.

Learning Objectives:

  1. Discuss how the cognitive, sensorimotor, and reward systems contribute to auditory processing
  2. Describe some positive outcomes that have been seen in musicians
  3. Describe some ways that the frequency following response is enhanced in musicians

References

  1. Kraus N, White-Schwoch T (2015) Unraveling the biology of auditory learning: a cognitive-sensorimotor-reward framework. Trends in Cognitive Sciences 19(11): 642-54.
  2. Kraus N, White-Schwoch T (2017) Neurobiology of everyday communication: what have we learned from music? The Neuroscientist 23(3): 287-98.

Opening Reception

Join us for appetizers, and a cash bar. This is a great opportunity to meet old and new friends.

Towards an Improved Sub-Classification of SNHL Spectrum Disorder

  • TA1

We should at least call sensorineural hearing loss a spectrum disorder (SNHL SD) just as we did with auditory neuropathy after it was realized that there were so many different etiologies and manifestations. This lecture will review studies in animal models of SNHL in which different causes of hearing loss are explored (e.g. ototoxic drugs, genetic mutations, old age, viral infection, cochlear hypoxia, acoustic trauma etc.) and that cause distinctively different types of structural damage (e.g. to stria vascularis, to outer haircells, to the stereocilia, to the inner haircell synapses and spiral ganglion). The talk will outline how these different types of cochlear lesion result in different types of functional deficit.  Given the extremely wide variation in types of SNHL, why do we rarely attempt a sub-classification?

From investigative clinical studies and animal model research we can start to predict deficits based on the cause and an understanding the likely substrate of anatomical damage.  If we pay more attention to aetiology we can distinguish classes or sub-types of SNHL. This in turn will narrow our focus on treatment and rehabilitation strategy and provide more accurate prognosis.

Learning Objectives:

  1. To explore the anatomical damage to the cochlea, and associated functional deficits in a range of animal models of sensorineural hearing loss (SNHL).
  2. To provide a greater understanding of different sub-types of SNHL based on structural deficits and on etiology.
  3. To encourage the development and clinical use of a sub-classification scheme for SNHL

Listening with Cochlear Implants

  • TA2

Although cochlear implant users communicate well in ideal conditions (quiet room with one or two conversational partners), they still face significant difficulties in background noise or reverberation. The musicality of sounds is often lost with cochlear implants, and patients have problems with tasks that require pitch sensitivity, such as music perception, speaker identification, and voice emotion recognition.  Tonal language speakers with cochlear implants also show deficits in identifying lexical tones, which involve rapid pitch changes in words.

Despite these degradations and ensuing difficulties, the device supports reasonable degrees of speech communication in adult users and spoken language development in child users. This success is in part due to advancements in technology, biomedicine, surgical approaches, audiology and speech therapy. In addition, the listening brain contributes a great deal, continuously filling in and reconstructing the talker’s intended message from the degraded input, using cognitive resources and linguistic knowledge acquired from a lifetime of experience with communication.  In children, these resources are more limited than in adults, and in aging patients, some of these resources may be declining. In this presentation, I will discuss how cochlear implants transmit speech information to the listener, explain the primary limitations, and comment on clinical implications.

Learning objectives:

After attending this presentation, the audience will be able to:

  1. Describe how cochlear implants work
  2. Explain why sounds are degraded through cochlear implants
  3. Discuss the consequences of sound degradation in cochlear implants for speech and music perception
  4. Describe factors that might play a role in listening through cochlear implants across the lifespan

Keeping It Real: An Introduction to Person Centred Care & Motivational Tools

  • TA3

Person-centered care (PCC) is advocated by the WHO and many healthcare systems globally. But do we know what PCC really is and why it is relevant for our practice today? Does it work and do we have time in our busy clinics for PCC? In this talk we will unpack the basic elements of PCC and explore how we might use its principles to understand patient motivation as it relates to hearing care.

Motivation is critical to positive patient outcomes. Patients who are motivated to improve their hearing are much more likely to go ahead with treatment and reap the benefits of assistive listening devices and rehabilitation. By encouraging patients to uncover their own internal motivation and address and resolve ambivalence, hearing care professionals can help patients become self-motivated to act on their hearing loss.

In collaboration with hearing care professionals around the world, the Ida Institute has developed tools and methodologies that hearing care professionals can use to help patients identify their own motivation and articulate a positive vision of how better hearing can help improve their quality of life. The tools are based on the principles of patient-centered care which put the patient’s needs, desires, and perspectives at the center of attention and involve the patient in decision-making and goal-setting for their own treatment.

In this talk, participants will learn about the principles of patient-centered practices and be introduced to the Ida Motivation Tools: The Line, the Box and the Circle. These three simple, but highly effective clinical tools are designed to help hearing care professionals have a structured conversation with their clients about their motivation and ambivalence. The tools offer an effective way to get to the core of the patient’s issues and concerns in a limited amount of time and help patients make important decisions about their treatment.

This interactive talk will involve participants in discussions and reflection about patient-centered practices. Participants will watch real-life videos of patients in clinical situations and at home talking about the challenges of daily life with hearing loss. Based on these videos, participants will be able to try out the tools and learn to apply them in clinical encounters with patients of their own.

At the end of this talk, participants will be able to:

  1. Describe what person-centered care is and what it means to work in person-centered ways
  2. Understand why recognizing client stages of change can help create better care and treatment outcomes for people with hearing loss
  3. Identify client ambivalence to change and how to address it
  4. Apply the motivation tools in their own practice

Knowledge-Guided Hearing: The Benefit of Familiar Voices

  • TA4

People often have to listen to someone speak in the presence of competing voices. Much is known about the acoustic cues used to overcome this challenge, but almost nothing is known about the utility of cues derived from experience with particular voices—cues that may be particularly important for older people and others with impaired hearing.  In a series of recent work, trainees and I have investigated the benefit to intelligibility realized when someone is listening to a person they know. We have replicated previous work demonstrating a robust benefit for the voice of a long term spouse (Johnsrude et al, 2013) and extended it to less familiar voices, and we have also demonstrated that the acoustic features that people use to understand a familiar voice differ from those used to recognize a voice as familiar, indicating that the way voice information is processed depends on the perceptual goal of the listener. Finally, the benefit to intelligibility of a familiar voice depends on the type of masker used: the results suggest that the cognitive processes recruited to understand speech spoken by a familiar voice differ, at least somewhat, from those recruited to understand a novel voice.

Learning objectives:

  1. Describe how acoustic information and knowledge are combined in auditory perception.
  2. Describe the evidence showing that familiar talkers are better understood than unfamiliar talkers when competing talkers are present.
  3. Describe the evidence showing that the acoustic cues that listeners use to identify a person by voice are different from those used to realize an intelligibility benefit.
  4. Describe the evidence showing that the familiar-talker benefit to intelligibility is probably due to reduced
  5. Predict listening situations in which listeners will be able to benefit from the presence of a familiar talker in a complex listening environment.

Factors Limiting Spatial Hearing Performance with Bilateral Cochlear Implants and First Steps to Reduce the Shortcomings

  • TA5

A wealth of bilateral CI studies have demonstrated that careful matching and balancing of left and right stimulation in controlled laboratory settings typically results in a fair sensitivity to interaural level differences (ILDs) and in some sensitivity to interaural time differences (ITDs). However, with their own processors in typical listening conditions, many factors work against an optimal exploitation of the interaural differences.

Today’s device technology and fitting procedures are mostly ear specific and multiple open questions remain about the optimal stimulation strategy and fitting for bilateral CI users. Over the past years, we have made the list of open questions longer by identifying additional problems. At the same time, we try to make the list shorter by suggesting stimulation strategies and fitting routines that are bilateral CI specific. This talk will start with demonstrating how ITD and ILD information is distorted and omitted by the devices and by the impaired auditory system. In the following experimental data from interaural electrode pairing and from speech coding-oriented studies with bilateral CI users is presented. This includes a demonstration that some CI users can localize speech solely based on ITD cues. Where possible, consequences for the fitting of bilateral CI users are discussed.

Learning objectives:

  1. Understand the specific fitting needs of bilateral CI users
  2. Improve in inferring how the choice of the speech coding strategy impacts individual performance

Large Scale Hearing Screening Program for Adults: A Progress Report

  • TA6

A critical component of public health programs consists of offering a sensitive screening program that can be administered to a large segment of the target population. Previous hearing screening programs intended for older adults have not all been successful. A research program was developed to identify components of a hearing screening program that will increase the number of the participants who adhere to the follow-up recommendations provided when a referral is indicated.

Three issues are being investigated:

  1. Which type screening procedure is best suited for a large scale hearing screening program administered in a public area (single question vs. 15-item questionnaire vs. a simplified hearing detection task)
  2. Is adherence to the post screening recommendation higher when the results of the screening test are provided by the family physician rather than by a research agent
  3. Is compliance to the referral better when the recommendation consists of an invitation to take part of a 2-hour group information/discussion session lead by an audiologist or when it consists of a recommendation to get an full assessment by a hearing health care professional?

A description of the screening program will be provided and the preliminary results of the study will be summarized

Learning objectives:

  1. Be able to describe the components of a hearing screening program for older adults conducted in the waiting area of a consortium of family physicians.
  2. Understand the weight that family physicians have on the delivery of hearing health care services for older adults
  3. Understand that the provision of hearing aids may not be the ultimate goal of hearing screening programs intended for older adults.

Sound Processing in the Brain: What Have We Learned from Concussion in Athletes?

  • TP1

The auditory system is a uniquely complex sensory system and sound processing relies on exquisite temporal precision to integrate signals across neural synapses. Given this complexity and precision, together with the fact that axons of the auditory system are highly susceptible to damage caused by mechanical force, we have begun investigating the auditory processing consequences of concussion. In two cohorts, adolescents being treated for concussion in a sports medicine clinic and NCAA football players, we have discovered that 1) listening to speech in noise is disrupted following a concussion (1), 2) the objectively-obtained frequency-following response (FFR) to speech is disrupted in following a concussion (2), 3) FFR disruption tracks with other non-auditory post-concussion symptoms (2), and 4) there is physiological evidence of a long-term auditory processing declines in student-athletes who had suffered a concussion one or more years in the past compared to controls with no history of concussion (3). Together these findings of auditory pathophysiology following head injury suggest that the auditory system should be included in the assessment and management of sports-related concussion.

  1. Thompson EC, Krizman J, White-Schwoch T, Nicol T, LaBella C, Kraus N. (2018) Difficulty hearing in noise: a sequela of concussion in children. Brain Injury doi:10.1080/02699052.2018.1447686.
  2. Kraus N, Thompson EC, Krizman J, Cook K, White-Schwoch T, LaBella CR. (2016) Auditory biological marker of concussion in children. Nature: Scientific Reports 6: 39009.
  3. Kraus N, Lindley T, Colegrove D, Krizman J, Otto-Meyer S, Thompson E, White-Schwoch T (2017) The neural legacy of a single concussion. Neuroscience Letters 646: 21-3.

 Learning Objectives:

  1. Describe two attributes of the auditory system that make its scrutiny in head injury logical
  2. Discuss how the frequency following response is affected by concussion
  3. Discuss how the affected components of the frequency following response tie in to auditory processing in concussion

Counseling in Pediatric Audiology: Helping Parents Engage & Children Advance

  • TP2

Through effective audiologist-parent partnerships, audiologists can help parents of pediatric patients recognize barriers to intervention and identify effective solutions. Parents can experience a variety of barriers. Many parents are unfamiliar with hearing loss and need information about hearing related issues, or they may experience financial difficulties. Barriers such as needing information or finding resources are external barriers. Parents may also experience internal barriers, such as having difficulty accepting the hearing loss diagnosis, feeling sad, or lacking confidence about how to manage the technology. To be effective in helping parents, audiologists need to counsel each family according to their unique needs by assessing for and addressing external and internal barriers that are interfering with the intervention process. When audiologists build a trusting relationship with parents, there can be increased shared decision-making and better adherence to implementation strategies, and this can lead to improved outcomes. Audiologists, however, may experience a variety of barriers implementing counseling strategies that address adjustment and psychosocial challenges. Audiologists can help parents adjust and engage by incorporating key counseling skills within their routine practices.

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

  1.      Describe common barriers parents report that interfere with hearing aid use
  2.      Describe three ways audiologists’ thoughts or actions can interfere with effective communication
  3.      List four key communication strategies that can help engage parents

Ida Telecare: Engaging Clients Before & After Appointments

  • TP3

Over the past twenty years, advances in technology have revolutionized the way we interact with each other, buy products, access and deliver services and develop our knowledge and skills. As the physical barriers to interaction have lessened, an on-demand culture has emerged in which we interact and engage at times and in ways that were previously not possible.

These developments are also changing the way healthcare services, including hearing healthcare, are being delivered. People with hearing loss can be diagnosed, counselled, and fitted with hearing aids online. They also have online resources teaching them how to self-manage their hearing loss and improve daily communication available at their fingertips.

Such telehealth services offer people with hearing loss enormous flexibility and the ability to access hearing care when and where they need it, reduce or eliminate travel time and consult remote experts to whom they might not otherwise have access. For professionals, telehealth offers the opportunity to deliver traditional services in new ways and even offer services previously not possible. It also enables them to reach new client groups, offer more personalized care and more easily include communication partners in the rehabilitation.

However, despite the many benefits, there are also concerns about how to deliver high-quality services and care through telehealth solutions. These include concerns about getting technology to work properly at both client and clinic ends as well as worries about how to deliver person and family-centered care and build trusting relationships with clients and their families through remote interaction.

To offer hearing care professionals an easy, tangible way to get started with telehealth, the Ida Institute has developed Ida Telecare. This suite of online tools offers people with hearing loss easy-to-use resources to help them prepare for appointments and successfully manage daily communication and important decisions related to hearing. Using the platform may mean that clients are better equipped to guide clinicians on the support they need, which may in turn  help clinicians save time and ensure much more focused and productive conversations in appointments. Ida Telecare is freely available in adult and teenage versions on the Ida Institute website.

Learning Objectives:

  1. Describe the benefits to clients and professionals of engaging clients outside of appointments
  2. Use the online Ida Telecare tools in daily practice to facilitate more person-centered care
  3. Make a plan for how they can begin to use Ida Telecare in their daily practice

Genetically Engineered Mouse Models with Atypical Auditory Processing

  • TP4

Relative to recent discoveries on gene-behavior associations underlying complex disorders like schizophrenia, anxiety, and depression, basic research on human language and disorders of language has been greatly restricted by lack of pre-clinical animal models. Consequently, our insight into language-specific disabilities (e.g., dyslexia, specific language impairment) has not progressed as fast as in other comparable areas of pre-clinical research. In this talk I will present data from genetically engineered mouse models that effectively capture intermediate phenotypes directly relevant to language outcomes. Findings include complex behavioral data from mice with mutations in hearing, dyslexia, and ASD-risk genes. Overall findings speak to the impact that genetically-mediated deficits in low-level acoustic processing, neural “noise,” and/or atypical frequency discrimination might have on higher-order processing. In summary, though mice lack language, using mouse models to study the impact of gene defects on all levels of sensory processing can provide tremendous insight to the foundations of developmental speech and language (and disruptions in these processes) in humans.

Towards a Differential Diagnosis of Cochlear Synaptopathy as a Contributor to Sensorineural Hearing Loss

  • TP5

The term sensorineural hearing loss encompasses all cochlear pathologies including the loss or dysfunction of outer and inner hair cells (OHCs & IHCs), and auditory nerve fibers (ANFs).  It has recently become established in both rodent and primate models that IHC synapses with ANFs can be destroyed by noise doses that can leave the hair cells intact, resulting in an auditory neuropathy or “synaptopathy”.  Synaptopathy is also seen well before OHC loss in aging mice and humans.  While reduced wave I amplitudes of subcutaneously recorded auditory brainstem responses allow for the detection of synaptopathy in animal models, confirmation in clinical populations has proven more difficult.  Synaptopathy does not necessarily lead to elevated audiometric thresholds (giving rise to the moniker of hidden hearing loss), and its tell-tale reduction of speech intelligibility in noise can also result from central auditory or cognitive deficits.  This talk will review the pathophysiology of cochlear synaptopathy, and describe promising new approaches towards its differential diagnosis as a contributor to sensorineural hearing loss.  This could serve as an early warning of noise-induced deficits, especially in individuals with more “tender” ears, helping prevent further damage to the cochlea and its associated pathologies of tinnitus and hyperacusis.

Learning objectives:

  1. To understand the pathophysiology of “cochlear synaptopathy”, and its perceptual consequences, including impaired speech perception in noise, tinnitus, and hyperacusis.
  2. To understand the risk factors for synaptopathy.
  3. To understand how synaptopathy might be diagnosed and differentiated from more traditional outer hair cell loss.

The Changing Landscape of Audiology for Adults: Innovative Models of Care

  • TP6

A majority of adults who might benefit from hearing aids do not use them. There are a variety of barriers to care, which are dominated by issues of cost, access to services, and public awareness of the impacts of hearing loss as we age. Approaching age-related hearing loss through a public health lens suggests the need for novel care approaches in order to close the gap between the number of adults with hearing loss and the percentage of those adults who are not accessing hearing care services. Today’s presentation will focus on innovative care models that aim to increase access to affordable technology and hearing care services through community-based approaches.

Learning Outcomes:

  1.       Describe priority recommendations for hearing healthcare for adults
  2.       Discuss novel, community-based approaches to hearing healthcare
  3.       Recognize opportunities for increasing access to care for older adults

Exhibitor Reception and Silent Auction

Reception hosted by the exhibiting companies located in the exhibit hall.

Evidence-Based Interventions for Aural Rehabilitation: That Was Then, This Is Now

In 2007, Arthur Boothroyd published the often-cited “Adult Aural Rehabilitation: what is it and does it work?”.  More than a decade on, this presentation will examine developments in adult aural rehabilitation (AR) to improve auditory function, activity, participation and quality of life through research relating to the four cornerstones of AR intervention: hearing aids and other listening devices (sensory management), knowledge and skill (instruction), auditory and cognitive training (perceptual training), and motivational engagement (counselling).

Self-management and behavior change are at the core of many of these interventions. There will be a focus on the need for high-quality research to provide rigorous evidence to inform clinical practice and national guidelines. Much of this new research has a theoretical underpinning (e.g. behavior change theory) to better guide the development and evaluation of interventions, increasing likelihood of implementation of research into clinical practice. The role of new and emerging technologies that support e- and m-health delivery of interventions to increase access, personalisation and engagement of patients will be highlighted. Looking to the future, the requirement for a set of relevant and appropriate outcome measures to evaluate the effectiveness of interventions trialed in clinical studies will be discussed.

Learning Objectives

  1. Describe three interventions used in adult aural rehabilitation research and explain the level of evidence to demonstrate their effectiveness.
  2. Summarize the COM-B system of health behavior change in the context of adult aural rehabilitation interventions.
  3. Discuss the benefits of delivering interventions though e- and m-health technologies.

Poster Blitz

This 15 minute presentation will allow specific poster presenters to have 2 – 3 minutes to provide highlights of their poster. There will be no time for questions, but attendees are encouraged to attend the poster presentation for further information and for questions.

 

Podium Presentations 1

  • FP1

Topics TBD

Podium Presentations 2

  • FP2

Topics TBD

Podium Presentations 3

  • FP3

Topics TBD

Vestibular Impairment in Children with Sensorineural Hearing Loss: Bearing a Load

  • FP4

This presentation will review the prevalence and impact of vestibular impairment in children presenting with sensorineural hearing loss.

Learning Objectives:

  1. Describe the common etiologies of hearing loss associated with vestibular impairment
  2. Outline the elements of a screening assessment for vestibular and balance impairment
  3. Review the known and potential impact of vestibular impairment on balance and cognition

Remote Microphone Use at Home: Impact on Parent and Child Language Production

  • FP5

The quantity and quality of speech heard by children is critical for their receptive and expressive language development.  However, children with hearing loss have difficulty perceiving speech in the presence of background noise. As such, audiologists commonly recommend remote microphone technology for use by children with hearing loss, particularly in school settings.  This technology has been studied extensively and its benefits for listening in the presence of background noise are well documented. However, rarely are such systems recommended for home use even though children spend most of their time in their homes, which can also be quite noisy.  The few published studies available have largely relied on caregiver perceptions. These perceptions suggest improved child access to speech, imitation of words and sentences, and listening skills – reports that have not been verified through systematic measures. This presentation will report on a series of studies that have compared recorded speech from caregivers and children in their homes when using and when not using remote microphone systems.  These analyses will be compared to perceived benefits of technology use and recommendations for clinical application will be addressed.

Learning objectives:

  1. List 3 caregiver perceptions of remote microphone system benefits and limitations for home use.
  2. List 2 measured benefits of remote microphone system use in homes
  3. List a potential limitation of remote microphone system use in homes

Early Intervention of Adult-Onset Hearing Loss through Amplification of Mild Sensorineural Hearing Loss

  • FP6

Early intervention of mild sensorineural hearing loss (MSNHL) through amplification may prevent the reduction of health-related quality of life. Many individuals with slight-to-mild loss wait years from the time they first notice a problem until seeking help. Evidence of the benefits of amplification for those with MSNHL is limited and auditory rehabilitation may be complex. When should amplification be considered for these patients? What does the evidence show regarding best practices for this population? What factors should be considered when fitting patients having other auditory dysfunction such as tinnitus and/or hyperacusis? We will present current evidence, use interactive case studies, and clinical outcomes from our clinics to inform the implementation of individualized auditory rehabilitation programs for patients with MSNHL through amplification.

Learning Objectives:

  1. List and explain important considerations in fitting hearing aids to patients with slight to mild losses
  2. Develop individualized auditory rehabilitation programs for patients with MSNHL

Vestibular Rehab: Assessment, Treatment and Differential Diagnosis

  • FP7

We’ve all had them – the Dizzy patient. Dizziness can be such a broad term so how do we sort this population out?  This presentation will focus on assessment of the dizzy patient utilizing vestibular and neurological assessment tools. We will review bedside vestibular assessment techniques and will discuss analysis of assessment outcomes and clinical relevance. We will also discuss the subjective history and a few key questions to ask. Then how does this information lead us to a differential diagnosis? We will review specific vestibular conditions and treatment available. Often going hand in hand with dizziness is an increased risk of falling. We will review screening tools which help identify those high risk fallers.

Learning Objectives:

  1. To assist clinicians in obtaining a concise symptom history.
  2. To be able to carry out basic bedside vestibular exam.
  3. To interpret vestibular assessment results.
  4. To identify high risk fallers through basic balance testing.
  5. To identify appropriate ENT referrals
  6. To identify appropriate Physiotherapy referrals

Listening Difficulties in Background Noise: Using Electrophysiology to Complement Behavioral Measures

  • FP8

Difficulties understanding a conversation when background noise is present is a common challenge for many individuals varying across a wide range of ages and hearing impairments. A hallmark of speech understanding in noise is the wide variance in performance across individuals, despite similarities in the audiogram or even audiometric thresholds within the normal range. Our approach is to combine electrophysiology measures with behavioral outcomes to improve our understanding of speech-in-noise performance. Our hope is that a better understanding of the contributions of bottom-up and top-down processing will allow for improved assessment, allowing the clinician to tailor treatment strategies to the specific needs of the individual and to counsel patients more effectively. Results from a series of ongoing and recently published studies will be presented that characterize the effects of aging and hearing impairment on both brain and behavioral measures of speech in background noise. In addition, cognitive contributors will be discussed and the use of brain measures to predict performance on receptive speech-in-noise tasks will be presented.

Learning objectives:

  1. Explain how hearing loss and age affect speech perception in noise.
  2. Explain how hearing loss and age affect neural coding of speech in noise.
  3. Understand the need to look beyond the audiogram to explain speech perception difficulties in noise.

Forgotten Acoustics

  • FP9

Since the advent of modern digital hearing aids, we have gradually forgotten the exciting laws of acoustics and how they apply to hearing aids.  While many things can be accomplished digitally, acoustical modifications can still be the preferred approach, especially when it comes to battery life and headroom maintenance.  This talk will discuss the derivation of the use of acoustic formulae to improve hearing aid fittings, explain some unusual conductive configurations, and make you the hit of the party.

What are the basic principles that relate to the acoustics of hearing aids and the ear canal?  Does a flare need to be 3 or 4 mm (as in the case of a Libby horn) to have any advantage or is it merely a doubling of the internal diameter? What is the “amplification factor” of a tube and how does one calculate the exciting result of the degree of amplification?  And how are RECDs affected by flaccid middle ear systems?

In short, this talk will provide the formulae and the basic acoustical science that can explain all aspects of the acoustical plumbing network that was so important in the older analog days, but still have ramifications given today’s technology.

Learning Objectives:

  1. Learn the formulae necessary for understanding acoustical modifications in modern hearing aids.
  2. Learn how to modify the response of some poorly fit hearing aids.
  3. Learn why unusual audiometric conductive configurations can occur.

CAA Social Event

This year the CAA Social Event is an evening of mingling over casual food and drinks in the Hard Rock Club near the conference hotel.

We have invited a team of 3 artists who will paint on stage in an ‘art battle’.  The audience is invited to vote for their favourite paintings with the second round of painting being a battle for the ultimate favourite.  Watch the art battle, wander around the club to have fun with your colleagues and get your final bids in for our annual silent auction.  The paintings produced on stage will be auctioned to add to the Clinical Research Grant fund raising.

Social Event: Friday October, 19th, 2018

Fee: $65.00 plus tax

Using mHealth Technologies to Increase the Three I’s: Individualisation, Interactivity and Inclusivity

  • SA1

Smartphones are ubiquitous. Mobile phone-access to the internet showed a 50% increase (2014-2016) in the typical first-time hearing aid user age group. Opportunities for using m-health technologies to deliver hearing healthcare, education, and increase access to hearing-related interventions, are increasing year-on-year.

A usability study of smartphone-connected listening devices (e.g. hearing aids, PSAPs, apps) has shown benefits in existing hearing aid users (n=20). The ability to individualise, and interact with, device programmes using smartphones resulted in a greater sense of autonomy and empowerment, less frustration and greater device use. Increased inclusivity was demonstrated by greater social participation, and reports of reduced stigma as smartphones are a part of everyday life. Better information on how to use these devices was a recurrent theme.

An RCT of C2Hear Online, an educational programme comprising 10 multimedia videos (or reusable learning objects, RLOs) for hearing aid users (n=203) showed multiple benefits. Further developments for a mobile-enhanced platform resulted in 42 short (~1min) multimedia mRLOs, which aimed to meet needs of the individual. The platform enables interactive activities to enhance knowledge. Finally, the Communication Tactics mRLO was repurposed for family and friends, where the greatest impact was shown for joint-working between couples, leading to greater inclusivity.

Learning Objectives

  1.      To describe the advantages of m-health delivery of healthcare
  2.      To explain the key benefits of smartphone-connected listening devices in terms of the COM-B model of behaviour change
  3.      To describe the key principles used in the development of individualised information for hearing aid users

Clinical Algorithm for Evidence-Based Audiologic Tinnitus Management

  • SA2

Audiology graduate programs are inconsistent in their provision of instruction regarding tinnitus management. Most programs provide minimal if any instruction. Audiologists, however, encounter patients complaining of tinnitus almost daily. This presentation will focus on evidence-based procedures for tinnitus management that can be conducted by any audiologist with relatively little impact on their normal clinical function.

A clinical algorithmic protocol will be described. Tinnitus questionnaires are essential if tinnitus-specific intervention will be performed—to obtain a baseline assessment of tinnitus impact and to assess outcomes of the intervention. However, for evaluating any patient who reports tinnitus, the initial tinnitus assessment should be limited to using a questionnaire that clearly distinguishes between a tinnitus problem and a hearing problem. One such questionnaire exists (Tinnitus and Hearing Survey), which can be used with a routine audiologic assessment to determine if tinnitus-specific intervention is needed. Tinnitus psychoacoustic testing is not normally recommended. Research has demonstrated the effectiveness of hearing aids and combination instruments (amplification and sound generator combined). Brief tinnitus counseling can also be effective. Tinnitus outcome questionnaires should only be used if tinnitus-specific intervention will be provided beyond these basic services.

Learning Objectives

Upon completion, participants will be able to:

  1. Differentiate patients on the basis of spontaneous, temporary, occasional, intermittent, or constant tinnitus
  2. Determine if a patient’s tinnitus warrants tinnitus-specific intervention
  3. Conduct an audiologic assessment that includes a tinnitus assessment

Improving the Patient Experience Through Hearing Aid Trials

  • SA3

In our outpatient, not-for-profit, hospital-based clinic, we observed that many patients with hearing loss, particularly those with newly diagnosed losses, younger individuals, those without insurance coverage, and those with borderline hearing losses would decide against treatment with amplification. Our primary goal as hearing healthcare providers is the provision of excellent, evidence-based care and (re)habilitation of hearing loss. After observing these patient trends, we decided to implement a hearing aid trial program as part of our hearing aid evaluation process to improve hearing aid adoption rates.

The purpose of this study was to determine if providing a hearing aid trial to a hearing aid candidate effected their decision to pursue amplification. Throughout the study we aimed to utilize the trial-obtained information to assist hearing aid candidates in determining whether to proceed with a hearing aid purchase, to have evidence-based reasons for selecting technology tiers for our patients, to decrease the number of patients tested but not treated, and to improve overall patient outcomes and satisfaction. This presentation will review the reasoning behind implementing the hearing aid trial program at our clinic, how it was implemented, the results of our study, case studies of individuals who participated, and future research ideas.

Learning Objectives:

  1. Determine how the pre-purchase hearing aid trial enhances the fitting protocol.
  2. Identify the impact the hearing aid trial had on the level of technology purchased.
  3. Evaluate the impact of the hearing aid trial on the patient decision to purchase.

Non-Auditory Factors that Factor into Outcomes

  • SA4

To identify the status of the hearing loss and to recommend a technology solution is to address only one aspect of the complex human we have the privilege to help. Many additional factors accompany each person that comes into the audiology clinic. For example, the patient’s motivations, biases, expectations and self-efficacy, to name just a few. Equally, the audiologist has motivations, biases, and, expectations that can interact in complex ways with the individual seeking help. In recent years, many new studies have started to provide a better understanding of how important these additional (not always auditory) factors can be when considering outcomes. These factors are relevant if we are to more clearly understand why some people are open to hearing help (and do well with what we provide) and others are not.

Learning Objective:

  1. To provide a better understanding of the additional, non-auditory factors that influence outcomes
  2. To summarize what we know currently and what we need for the future
  3. Clinicians should be better equipped to recognize these additional factors and when to use them (if they are positive) or when to avoid them (if they are negative).