The Bulletin of the American Academy of audiology
AUDIOLOGY TODAY
VOLUME 14
NUMBER 2
march/ april 2002
Caring for America’s Hearing
AMERICAN ACADEMY OF AUDIOLOGY • 8300 GREENSBORO DRIVE • SUITE 750 • M cLEAN, VA 22102-3611
MARCH/APRIL
VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
EDITORIAL BOARD
BOARD OF DIRECTORS
Editor
Jerry L. Northern
President
Angela Loavenbruck
Vice President, Professional Services, HEARx Ltd.
Editorial Office
2681 East Cedar Avenue, Denver, CO 80209
(303) 777-4300, FAX (303) 744-2677, jnorth1111@aol.com
Loavenbruck Audiology, P.C.
5 Woodglen Drive
New City, NY 10956-4237
eartoday@aol.com
EDITORIAL STAFF
Sydney Hawthorne Davis
Gyl Kasewurm
Academy National Office
McLean, VA
Professional Hearing Services
St. Joseph, MI
Suzanne Hasenstab
Diane Russ
Medical College of Virginia
Richmond, VA
Beltone Electronics Corp.
Chicago, IL
EDITORIAL ADVISORY BOARD
Lucille B. Beck
H. Gustav Mueller
V.A. Medical Center
Washington, DC
Audiology Consultant
Castle Pines, CO
Carmen C. Brewer
Georgine Ray
Washington Hospital Center
Washington, DC
Affiliated Audiology Consultants
Scottsdale, AZ
Marsha McCandless
Jane B. Seaton
University of Utah
Salt Lake City, UT
Seaton Consultants
Athens, GA
Jane Madell
Steven J. Staller
Beth Israel Medical Center
New York, NY
Cochlear Corporation
Englewood, CO
Patricia McCarthy
Deborah Hayes
Rush-Presb.-St.Luke’s Med. Ctr.
Chicago, IL
The Children’s Hospital
Denver, CO
President-Elect
Brad Stach
Past President
David Fabry
Central Institute for the Deaf
4560 Clayton Avenue
St. Louis, MO 63110
bstach@cld.wustl.edu
Mayo Clinic, Audiology Sect. (L5)
200 1st Street, S.W.
Rochester, MN 55905
fabry.david@mayo.edu
BOARD MEMBERS-AT-LARGE
Term Ending 2003
Sheila M. Dalzell
Term Ending 2004
Richard E. Gans
Term Ending 2005
Brenda Ryals
The Hearing Center, Inc.
2561 Lac DeVille Blvd.
Rochester, NY 14618
sheila-larry-dalzell@worldnet.att.net
American Institute of Balance
11290 Park Boulevard
Seminole, FL 33772
rgans@dizzy.com
James Madison University
Auditory Research Lab
MSC 4304
Dept. of Comm. Sci. & Disorder
Harrisonburg.VA 22807
ryalsbm@jum.edu
Gail I. Gudmundsen
Catherine V. Palmer
GudHear, Inc.
41 Martin Lane
Elk Grove, IL 60007
gudhear@aol.com
University of Pittsburgh
4033 Forbes Tower
Pittsburgh, PA 15260
cvp@vms.cis.pitt.edu
Robert W. Sweetow
Gail M. Whitelaw
University of California Medical
Center - San Francisco
400 Parnassus Avenue
San Francisco, CA 94143-0340
rwsweetow@orca.ucsf.
Ohio State University
141 Pressey Hall
1070 Carmack Road
Columbus, OH 43210
whitelaw.1@osu.edu
ACADEMY MEMBERSHIP
DIRECTORY
NOW ONLINE AT
www.audiology.org
Kathleen Campbell
SIUSchool of Medicine
P.O. Box 19629
Springfield, IL 62794-9629
kcampbell@siumed.edu
Holly Hosford-Dunn
P.O. Box 32168
Tucson, AZ 85751-2168
tucsonaud@aol.com
The American Academy of Audiology is a professional
organization of individuals dedicated to providing
quality hearing care to the public. We enhance the
ability of our members to achieve career and practice
objectives through professional development, education, research, and increased public awareness of
hearing disorders and audiologic services.
AUDIOLOGY TODAY welcomes feature articles, essays of professional opinion, special reports and letters to the editor. Submissions may be
subject to editorial review and alteration for clarity and brevity. Closing date for all copy is the 1st day of the month preceding issue date.
Statement of Policy: The American Academy of Audiology publishes Audiology Today as a means of communicating information among its members about all aspects of
audiology and related topics. Information and statements published in Audiology Today are not official policy of the American Academy of Audiology unless so indicated.
Audiology Today accepts contributed manuscripts dealing with the wide variety of topics of interest to audiologists including clinical activities and hearing research, current
events, news items, professional issues, individual-institution-organization announcements, entries for the calendar of events and materials from other areas within the scope of
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VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
3
AUDIOLOGY TODAY
INSIDE THIS ISSUE
•
VOLUME 14, NUMBER 2, 2002
NORTHERN LITES
The Best of Times?— Jerry Northern
7
ARTICLES
Clinical and Research Concerns Regarding The 2000 APD Consensus Report
14
— Jack Katz, Cheryl Deconde-Johnson, Susan Brandner, Teryl Delagrange,
Jeanane Ferre, John King, Kossover-Wechter, Jay Lucker, Larry Medwetsky,
Richard Saul, Gail Gegg Rosenberg, Nancy Stecker & Kim Tiller y
A Sound Foundation Through Early Amplification
19
— James Jerger & Musiak
Better Hearing Institute Launches New Physician
Referral Development Program — John Olive, Jr.
The Year In Review — David Fabry
Honors Of The American Academy of Audiology
23
26
28
CONVENTION 2002
Amy Tan To Address Opening General Assembly!
What? You Wanna’ Be The CONVENTION PROGRAM CHAIR?
New Night And New Time!
Attractions In Downtown Philadelphia
Luncheon Presentations By Outstanding Student Researchers
Research Committee Sponsors Two Featured Sessions
Don’t Miss These Events At 14th Annual Convention!!
President Angela Loavenbruck Invites Audiologists
to Make History In Philadelpha
It’s Not Too Late — Sign Up For A Pre-Convention Seminar
34
35
36
36
38
38
39
41
43
ARTICLES
The Audiology Matching Program For AuD Students
46
— Ian Windmill, Barry Freeman & Patricia Kricos
ARTICLE
Integrated Oral Deaf Education Approach:
New Challenges, New Rewards, Better Outcomes — Linda Dye
49
— Kelly Tremblay & Lisa Cunningham
AMERICAN BOARD OF AUDIOLOGY
Learn More About Certification—Come On By And Chat!
52
ARTICLE
www.audiology.org! Featured Among “Best Of The Web”
59
VIEWPOINT
Clarifying America’s Hearing Healthcare Team — David Fabry
President’s Message
8
60
Washington Watch
45
Executive Update
11
Classified Ads
48
Letters to the Editor
12
News & Announcements
54
AAA Board of Directors
members completing their
terms of service to The
Academy include Gyl
Kasewurm, David Fabry,
Brad Stach and Alison
Grimes. Fabry becomes PastPresident and Stach becomes
President-Elect as they
continue to serve on The
Academy Board of Directors.
4
AUDIOLOGY TODAY
American Academy of Audiology
8300 Greensboro Drive, Suite 750
McLean, VA 22102-3611
PHONE: 800-AAA-2336 • 703-790-8466
FAX: 703-790-8631
Laura Fleming Doyle, CAE • Executive Director
ext 211 • ldoyle@audiology.org
Cheryl Kreider Carey • Deputy Executive Director
ext. 208 • ccarey@audiology.org
Roni Carr • Office Manager
ext. 213 • rcarr@audiology.org
Sydney Hawthorne Davis • Director of Communications
ext. 204 • sdavis@audiology.org
Laura Michele Franchi • Membership Benefits Coordinator
ext. 210 • lfranchi@audiology.org
Daryl Glasgow • Director of Finance
ext. 212 • dglasgow@audiology.org
Tina Lynn Mercardo • Exposition Assistant
ext. 203 • tmercardo@audiology.org
Glorymae Martin • Education Coordinator
ext. 216 • gmartin@audiology.org
Meggan Olek • Director of Education
ext. 206 • molek@audiology.org
Sarah Sebastian • Membership Coordinator
ext. 217 • ssebastian@audiology.org
Nina Sims • Bookkeeper
ext. 209 • nsims@audiology.org
Edward A. M. Sullivan • Director of Membership
ext. 205 • esullivan@audiology.org
Marilyn Weissman • Director of Certification
ext. 202 • mweissman@audiology.org
Delores Willett, CEM, CMP • Director of Expositions
ext. 207 • dwillett@audiology.org
Annette Williams • Convention Coordinator
ext. 215 • awilliams@audiology.org
Alice Wynkoop • Receptionist
ext. 200 • awynkoop@audiology.org
48
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MARCH/APRIL 2002
The Best
of Times?
Jerry L. Northern, Editor
I
t ought to be the best of times. All the indicators are in
place. The mass migration of audiologists toward a
fully doctoral profession gives us the best-educated
hearing professionals in history. The continued
technological explosion gives us “smart” amplification
devices that audiologists can fine-tune to compensate for
any and every type and degree of hearing loss. The science
of computerized hearing aid tuning has become incredibly
precise guided by the best in software applications.
Attention to patient satisfaction and positive clinical
outcomes is at an all time high. The expanding aging
population should be our best economic indicator as their
hearing losses will surely require the best efforts of
audiologists and be the promise of the security and
success of our profession in the future.
Then how do we explain the lack of growth in our
profession of audiology and the flat hearing aid market that
has been our burden for nearly four years? Where is the
promise of better things to come? I read with great
interest, and genuine concern, our trade journals where the
search for explanations consumes the editorial pages.
David Kirkwood, of The Hearing Journal, identifies two
factors of cause: (1) the plunge in the stock market, that
began early in 2000, which has reduced the fixed incomes
of many older Americans, and (2) the reduction in overall
interest rates which has cut into the retirement portfolios of
our senior citizens. If this rationale is to be accepted, then
logic would say that hearing aids are simply too expensive
these days, and the purchase of these devices creates too
much of a financial stretch for most people - who are not
sure if hearing aids really help, anyway. These resounding
arguments prevail in spite of the studies that show, again
and again, the many personal benefits provided through
the use of hearing aids.
To be sure, the recent tragedy of September 11th created a
heavy anchor for the US economy and caused us all to take
a new look at our inner selves, the lives we lead and our
relationships with others. But, in my mind, such
introspection should create a new recognition of existing
hearing problems should actually stimulate actions to rectify
hearing handicaps so that we can enjoy life to the very
fullest. And yet, as we struggle with the decreasing demand
for our diagnostic services, we watch the hearing aid market
flatten out. Sergei Kochkin’s recent MarkeTrak survey (The
Hearing Review, 55:1, December, 2001) confirms a snail’s
pace of growth in hearing instrument market penetration
mostly reflective of the increase in binaural fittings - but it
still looks like we are fitting the same old patients with newer
and higher priced hearing aids. A significant fact noted in
the MarkeTrak report is the decrease in physician screening
for hearing loss in their patients, which indeed has direct
bearing on the number of their referrals to audiologists.
The question that should be on all of our minds is what
VOLUME 14, NUMBER 2
can we do to turn these trends? The real growth potential
for all of us lies in the oft-quoted bounty of 22 million
elusive persons reported to be suffering from hearing
impairments that need our services. While individual
audiologists are making better salaries and creating higher
incomes from their practices, the logic of the trends would
suggest that we are selling the same number (or fewer) of
hearing aids at higher prices and improved profit margins.
In the bigger picture, however, we are facing an uncertain
and unsettled future due to the lack of growth in our
particular marketplace.
Fortunately many are working on these problems. The
Academy has focused on providing means to help our
members market their services through the development of
the Front Line Office Training Kit and the “Building Bridges”
Physician Referral Kit. These are extremely useful marketing
tools that have received wide acclaim from audiologists who
use them. If you have not examined the kits closely yet, be
sure to stop by The Academy Center booth in the
Philadelphia Exhibition Hall, and take one or each of the kits
home with you. Your office or practice will benefit from both
of these instructional packages produced by the Marketing
Committees of The American Academy of Audiology.
Be sure to read in this issue of Audiology Today about the
new Physician Referral Development Program recently
unveiled by the Better Hearing Institute (BHI). John Olive,
Executive Director of BHI, has created an innovative and
exciting program to build referral relationships with
primary care physicians. The BHI program features two
interactive CD-based continuing education activities. The
first CD, designed for the audiologist, teaches the
necessary steps required to market hearing services and
establish referring relationships with community
physicians. The second CD is to be distributed by
audiologists to their new physician contacts. The second
CD is an AMA accredited continuing education course in
management of patients with hearing disorders. The
course features a lecture from a nationally noted otologist
(Dr. Michael Glasscock of Nashville, TN) who clearly states
(more than once for the benefit of the primary care
physician!) that 90% of patients with sensorineural hearing
loss cannot be treated medically or surgically and require
referral to an audiologist for hearing aids.
Ironically, Shakespeare, in Love’s Labour’s Lost (1595),
wrote, “A jest’s prosperity lies in the ear.” Well, we
certainly hope our prosperity also lies in the ear! Our
challenge is to make this the best of times and there is no
time like the present to get started. Now is the time and
the tools are at hand. We have waited long enough for
someone else to do the task for us. Perhaps the best
results will be achieved when audiologists really commit
and take the necessary actions to make hearing an
important health issue in our nation.
AUDIOLOGY TODAY
7
angela loavenbruck
ll professions have certain essential
characteristics that set them apart from other
occupations. These characteristics include a
body of expert knowledge, a high degree of self
regulation embodied by stringent academic
standards and a code of ethics, a commitment to life
long learning and most importantly, a fiduciary
responsibility to place the needs of clients ahead of the
self interest of the practitioner. Many believe that the
most important assumption underlying the interaction
between health care professionals and their clients is
that the advice and treatment provided is not
Angela
influenced by practitioners’ self interests. The values
of professions include honesty, altruism, service to others,
commitment to excellence and accountability.
Throughout its history, the American Academy of Audiology has
focused on improving audiologists’ ability to provide hearing health
care services by stressing our role and identification as autonomous
“diagnosing and treating” professionals. In this vein, our efforts to
change the SOC codes for audiology, to change Medicare and other
third party payer regulations to permit direct access to our services,
and to change the Medicaid definition of audiology and to identify
licensure as the critical entry level credential are all ongoing. In
keeping with our identification with the critical characteristics and
values of other diagnosing and treating healthcare professionals,
two important Academy goals have come to fruition this year, and
will continue in the coming years.
ETHICS TASK FORCE
The Ethics in Audiology Presidential Task Force, established by
David Fabry, presented its first report to the Board at its January
meeting. The Task Force (Lu Beck, Dennis Van Vliet, Fred Bess,
Patti McCarthy, Gail Gudmundsen, David Hawkins and Brian
Walden, chair, was charged with providing a “written report to the
Board that identifies areas that require updated or new ethical
standards in response to changes that have occurred within
audiology, the health care professions, government regulations and
industry.” Among the areas that the Task Force identified as
needing study were issues such as the relationship between industry
and researchers, unethical practices in the conduct of human
research and violations of patient confidentiality. The Task Force
chose to examine the relationship between practitioners and
industry for its first report.
The report was a thorough and sobering examination of this
issue, and of a number of common business interactions between
audiologists and the hearing aid industry that must be examined to
protect our identity as a profession. For example, a survey
completed by the Task Force indicated that there are significant
differences in the way consumers and audiology practitioners view
these interactions with the hearing aid industry. Consumers always
viewed the activities as greater conflicts of interest than did
8
AUDIOLOGY TODAY
practitioners, a perception that has the potential to
harm the underlying trust our patients must have
in their interactions with audiologists.
We are not the only profession re-examining
our relationship to industry.
The American Medical Association has
embarked on an ambitious long-range plan to
improve ethics education, particularly as it
applies to the interactions between physicians and
the pharmaceutical industry. A recent article in
the Journal of the American Medical Association
indicated that physicians’ prescribing practices do
Loavenbruck change based on gifts such as meals, conferences,
and other perks received from drug companies.
These findings, as well as other ethical concerns, have led the AMA
to form a joint effort between medical societies and industry to
improve ethics education and to examine and change the interaction
between physicians and the pharmaceutical industry.
The Academy Board has begun deliberating on the
recommendations of the Ethics Task Force. Most certainly, we intend
to engage in serious dialogue with our members, with other audiology
professional associations and with our industry colleagues to arrive at
the best way to carry out our responsibilities as professionals.
Throughout the year, I will be presenting the Task Force report and
recommendations at audiology meetings across the country. I look
forward to the discussion and member input that will result. As with
the medical profession, our interaction with the hearing aid industry
is necessarily intimate, because we use their products to treat our
patients. The industry has been enormously generous in its support
of our conferences and other educational and professional efforts. We
are all invested in making sure that our relationship meets the highest
ethical standards.
ACCREDITATION
The American Academy of Audiology is supporting the formation
of a new vehicle for accreditation of academic programs granting AuD
degrees in audiology. The new independent organization,
conceptualized in cooperation with The Academy of Dispensing
Audiologists, is called the Accrediting Commission on Audiology
Education (ACAE). The Commission had its first meeting in Atlanta
on January 26 and 27, and has begun the process of preparing for
recognition by the Office of Post-Secondary Accreditation of the US
Department of Education. The new accrediting body is specifically
focused on professional education culminating in the AuD degree. The
Academy is committed to the need for an independent AuD accrediting
body, and we are confident that the Commission will enhance our
identification as autonomous diagnosing and treating professionals.
As we start another year of challenges for our profession, I
look forward to the input, opinions and advice of the members of
this Academy and to seeing all of you in Philadelphia for “History
in the Making.”
MARCH/APRIL 2002
Executive
UPdate
Laura Fleming Doyle, CAE
AMERICAN ACADEMY OF AUDIOLOGY CONVENTION AND EXPO 2002
Make the most of your convention experience
BY NOW YOU SHOULD BE REGISTERED TO ATTEND
the largest annual educational program of, by and for audiologists. Making
the commitment to attend the American Academy of Audiology’s 14th Annual
Convention & Expo is truly a gift to yourself. This is your time to get away
from the routine, rejuvenate your energies and renew your excitement about
your career.
Take full advantage of the meeting and the time you have in Philadelphia by
utilizing the on-line itinerary. Start by reviewing your Preliminary Program and
Registration Book. Select those events that interest you and complete the online itinerary on The Academy website (www.audiology.org/convention/2002).
By spending a little time preparing, you’ll get the most out of your time at
Convention 2002.
Learn what’s new while earning CEUs. With eleven educational tracks this
year, attendees have plenty of great sessions to choose from. You can remain
in your area of expertise or broaden your horizons by selecting something from
each track. Sessions on Cochlear Implants, Rehabilitation and Tinnitus/
Hyperacusis have increased to the point that they now have their own tracks.
Also new this year are tracks geared specifically for students and an exhibitor
track that provides training on specific products.
Allow ample time to explore Expo 2002 with more than 220,000 square
feet of the latest innovations in hearing health care. The Academy has
dedicated exclusive time for attendees to visit the exposition hall on Thursday
from 12 noon to 6:00 p.m. when no other activities will be competing for your
attention. This is the time to target the companies that you would like to learn
more about or talk to the representatives of the companies that you currently
work with on a regular basis. The exposition allows you the opportunity to
learn something new about the products that are available to you while also
giving you some hands-on time with new technology. Meeting with a variety
of vendors and learning about what they have to offer can be equally as
important as the educational sessions.
Bring an extra supply of business cards and network. Use the time in
between sessions and as you walk through the exhibit hall to renew old
acquaintances and make new friends. These contacts can be beneficial
throughout the year. Contacts made at convention can provide advice on how
to handle a particular situation. They can also prove useful when looking to fill
a position or even find a new job.
Learn more after you get home. This year, The Academy will provide each
attendee with a CD-ROM of session handouts. When you get home, you can
use this as a reference to refresh your memory about a session you attended
or to take a look at a session you were interested in but just couldn’t fit into
your schedule. If you find that you missed an interesting session, you can still
hear what was said by purchasing the audiocassette of the session in
Philadelphia or after you return home at www.audiology.org.
Do something good for yourself! There is a wealth of information in
Philadelphia just waiting for you. Use your time to the greatest advantage, then
go home with a renewed vigor towards your career and all that you can do to
benefit your patients. Not only will you have a great professional week in
Philadelphia, but your patients will ultimately benefit by receiving the best
quality hearing health care from their audiologist. Finally, congratulate yourself
on taking care of your patients and taking care of your career by attending the
number one audiology convention in the world.
VOLUME 14, NUMBER 2
ACADEMY CENTER
Make sure The Academy Center, located in the Exhibition
Hall, is at the top of your list of things to see at Convention this
year. Our newly expanded area will house The Academy’s
related organizations in addition to the latest and greatest
Academy products and convention gear. You’ll find interactive
marketing tools, educational products, limited edition
Convention 2002 souvenirs to add to your collection and much
more! Remember to save plenty of room in your suitcase!
Here’s what you’ll find at this year’s Academy Center:
AAA Foundation
American Academy of Audiology PAC
American Board of Audiology Certification
International and Diversity Center
National Association of Future Doctors of Audiology
The Academy Store
Publications & Marketing Tools
Sponsor Card Raffle
AUDIOLOGY TODAY
11
Hear Ye…Hear Ye
LETTERS TO THE EDITOR
ARE WE REALLY HELPING
PEOPLE HEAR BETTER?
By the time I finished reading the
November/December 2001 article, “Are We
Really Helping People Hear Better?” (pp. 4041), I was in utter bewilderment. What was
this article trying to say? That if we only
follow the recommendations in the final
paragraph — provide good technical skills,
spend time with patients, counsel and share
expertise - we can turn things around and
help more people hear better? Surely these
practices are already part of each
audiologist’s day! My general impression
was, “If only we try harder, more people will
be helped” - and it sounded like it had been
written after a particularly discouraging day
at work.
Over several days, however, bewilderment
turned into recognition: wait a minute, I’ve
heard this discouragement expressed before,
and so have we all. The underlying reason
may be that the profession of audiology,
unlike other helping professions, has not yet
talked about what we mean by helping. This
article implies that we see helping as changing
people, almost in spite of themselves, and
because we know best, we need to “get them
to use hearing aids” - in other words, doing
something to or for another, essentially
imposing our will on another, without that
person’s full engagement - even when we
know the natural reactions to these efforts are
resistance and resentment. Do we try to
“help” patients by coercing or persuading or
cajoling them into hearing help, without their
full commitment? If so, we are out of step
with other helping professions, which operate
with these principles: (1) when a person has a
life problem, only that person can change it;
and (2) the role of the helper is to facilitate and
support that process, not be the actual change
agent. The differences between these two
perceptions in helping - changing vs.
supporting change - have profound
implications on service delivery and patient
outcomes - and the long-term job satisfaction
of the helper.
We as a profession need to talk about our
perception of our role as helpers, or we will
burn out from the despair of ineffectiveness.
Audiology continues to mature, but a
fundamental question of “who we are”
remains unanswered: are we helpers who
“know what is good for the patient” and
therefore expect compliance, or are we
12
AUDIOLOGY TODAY
helpers who support the patient as he or she
accepts the challenges involved in aural
rehabilitation?
I thank Cynthia Beyer for writing and for
providing a springboard for this overdue and
vitally important discussion.
—Kris English, Pittsburgh, PA
ELECTROMECHANICAL NOT
ELECTROMAGNETIC
In the January/February 2002 issue of
Audiology Today, an overview on implantable
hearing devices by Jonathan Spindel reflects
the exciting technological advancements
taking place in the field of amplification.
Middle ear implants are an innovative, viable
amplification alternative for the sensorineurally hearing impaired patient population
and audiologists are faced with the challenge
of acquiring and digesting a completely new
set of technical expertise in order to make
well-informed patient care decisions regarding
the applicability of new or different amplification technologies to their patient populations. From this perspective, the readership
may benefit from clarification of statements
made in reference to the Otologics MET
Ossicular Stimulator implantable device.
Although the transducer of the MET
Ossicular Stimulator incorporates magnetic
components, the transducer is an electromechanical, not an electromagnetic transducer. The frequency response of an electromechanical transducer is flat, which plays a
pivotal role in providing the ability to deliver
high levels of output uniformly across the
audiometric frequency range.
Spindel mentions that a potential
disadvantage of the MET Ossicular
Stimulator involves “relatively large MET
piston attached to the incus could act as a
massload to the middle ear” and that this
effect may “impact residual hearing” and
“create a potential risk to the middle ear’s
ability to respond to sudden pressure
changes”. From a technical perspective, the
probe tip of the Otologics MET Ossicular
Stimulator’s transducer is advanced within a
laser-made hole on the body of the incus to a
point of minimal contact with the ossicular
chain. The device does not mass-load the
ossicular chain; rather, it rests in a relative
“free-floating” state. During the postoperative healing period, a fibrous union
forms over the surface of the laser made hole,
creating a natural connection of the device to
the ossicular chain, however, this fibrous
union does not occur within the confines of
the laser made hole. A slight stiffening of the
middle ear may occur and manifest as a
reduction in post-operative static compliance. These changes are negligible and
merely reflect an inherent property of the
physics of sound. The middle ear is,
therefore, able to respond to pressure
changes effectively.
—A.U. Bankaitis, Otologics, Boulder, CO
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MARCH/APRIL 2002
CLINICAL AND RESEARCH CONCERNS
REGARDING THE 2000 APD CONSENSUS REPORT AND RECOMMENDATIONS
Editor’s Note: The Report of the Consensus Conference on the Diagnosis of Auditory Processing Disorders in School-Aged Children is
a statement prepared by a group of 14 senior scientists and clinicians who met at the Callier Center for Communication Disorders in Dallas,
TX from April 27-29, 2000. The Consensus Statement was published in the October (Vol. 11:9) issue of the Journal of the American Academy
of Audiology, pgs 467-474 by J. Jerger and F. Musiek. The full text of the Report of the Consensus Conference on the Diagnosis of APD in
School-Aged Children is posted on The Academy website <www.audiology.org/professional/jaaa/ll-9a.php>.
In his editorial preface, Jerger, stated that the reality of auditory processing disorders in children can no longer be doubted and that the
real challenge to audiologists is to accurately diagnose the disorder. The conference produced several recommendations including specific
tests to be included in a screening and a recommended minimal diagnostic test battery for school-aged children with Auditory Processing
Disorders (APD).
Apparently, not all audiologists practicing in the area of Auditory Processing Disorders in children agreed with the consensus statement
as reported in JAAA. The following paper was submitted to Audiology Today by a group of 13 concerned clinicians and scientists challenging
the merits of the recommendations made by the Dallas consensus group. Upon receipt of this dissenting opinion manuscript, the paper was
forwarded to Jerger for response. Below we have presented both the dissenting viewpoint paper and Jerger’s response. The full text of the
reply to the consensus report may be seen at <www.audiologyonline.com>
Katz, Jack, University at Buffalo, SUNY, Buffalo, NY
Johnson, Cheryl DeConde, Colorado Department of Education,
Denver, CO
Brandner, Susan, Audiology Associates of Freehold, Freehold, NJ
Delagrange, Teryl, Greensboro Ear, Nose & Throat Assoc.,
Greensboro, NC
Washington, DC
Medwetsky, Larry, Rochester Hearing and Speech Center,
Rochester, NY
Saul, Richard,
Neuro-Audiological Associates of Boca Raton,
Boca Raton, FL
Ferre, Jeanane, Central Auditory Evaluation and T reatment,
Oak Park, IL
John, University of Miami Ear Institute, Miami, FL
King,
Kossover-Wechter, Denise
Lucker, Jay, Private Practice Specializing in Auditory Processing,
Rosenberg, Gail Gegg, Interactive Solutions, Inc., Sarasota, FL
Stecker, Nancy, University at Buffalo, SUNY, Buffalo, NY
Tillery, Kim, SUNY College at Fredonia, Fredonia, NY
Legacy Good Samaritan Hospital,
Portland, OR
The Report of the Consensus Conference on the Diagnosis of
Auditory Processing Disorders in School-Aged Children, based on a
conference held in Dallas, TX, was published by Jerger & Musiek
(2000). The Consensus Conference recommended specific
procedures for the screening and diagnosis of Auditory Processing
Disorders. A group of clinicians working in the area of auditory
processing disorders in children met over the past year to discuss our
concerns regarding the recommendations of the Consensus
Committee. To be sure, consensus conferences may guide
professionals by updating information and clinical regiments (specific
or general) based on research and clinical findings. We believe that the
consensus report authored by Jerger and Musiek (2000) falls far short
of the desired result, and we offer the following response, concerns
and considerations regarding the Consensus Committee’s
recommendations and the future directions of APD research.
PHILOSOPHY
The Consensus Report focused on a clinical approach paradigm
that is aimed at ruling out other factors with children seen for APD
testing. The group proposed that two tests, dichotic digits and gapdetection, should be used for APD screening. They further
recommended, “in order to provide the minimum amount of
information necessary” for evaluation, that eight tests (or types of
tests) should be used to ascertain the APD diagnosis. They further
state that children identified to have APD may instead have attention
deficit hyperactivity disorder (ADHD), reading, language, or
learning problems, autism and/or reduced intellectual functioning
leading to a mis-diagnosis of APD. Although audiologists must be
14
AUDIOLOGY TODAY
alert to other problems that masquerade as APD, we believe this
should not be the focus of the evaluation. The disorders listed by the
consensus group, if present, may actually be the result of APD and
therefore the presence of the associated disorder increases, rather
than decreases, the likelihood of APD (ASHA, 1996). The most
likely reason why a child is referred for evaluation of APD is that the
school and/or parents want to find out (a) if APD is present in the
child, and if so, (b) what specific auditory difficulties are present so
that therapies can be administered to help the child. Therefore, in our
opinion, the audiologist’s most valuable role is guiding the
management of the child with APD – an area not addressed by Jerger
& Musiek (2000).
The ASHA (1996) Guidelines on Central Auditory Processing have
a broader and, to our way of thinking, a more appropriate goal to
develop an APD intervention program, “that will improve the everyday
function and satisfaction of people who come to us for care.” We
believe that auditory processing requires an educational model to help
these involved children rather than a medical (diagnostic) model. Their
medical-diagnostic focus make the Consensus Committee’s
recommendations too heavily oriented to differentiating APD from
other disorders — instead of describing the auditory processing
problems in terms that promote the seeking of remedies. We are not
aware of research studies that show that audiologists mislabel children
with other disorders as having APD (Arnst, 1982; Musiek et al., 1991;
Riccio, et al., 1994; Tillery et al., 2000).
We are a group of clinical/educational audiologists who are
concerned that the Consensus Report has little research or clinical
support and may actually reduce our effectiveness in providing
audiological services. Typical APD diagnostic testing does not
MARCH/APRIL 2002
CLINICAL AND RESEARCH CONCERNS
REGARDING THE 2000 APD CONSENSUS REPORT AND RECOMMENDATIONS
require heavy emphasis on physiological measures or the extensive
test batteries recommended by the Consensus Committee. Increased
testing time increases cost, and also may have an adverse effect on
test performance. This extensive battery will sharply limit the
families or school systems that could afford this unnecessary
expense—facts acknowledged in the Consensus Report.
The Consensus Report provided only a list of suggested readings
with their report and did not provide research references to support
their recommendations. Therefore, the reader does not know which
statements are supported by research and which are simply the
opinions of the authors. In a consensus statement, and certainly one
which contains such specific regulations, the absence of citations is
unacceptable, and to our knowledge, unprecedented. Members of
our group reviewed the “suggested readings” and provided
supplemental reference sources. We reviewed the literature for
information regarding the specifically recommended audiological
tests. We did not consider research studies on adults or those studies
dealing with CNS lesions unless we could not find appropriate
literature on APD in children.
The Jerger & Musiek article suggests a Minimal Test Battery
(MTB) as the minimum required for proper APD testing of children.
Therefore, we assumed that these vital tests would have (a)
appropriate norms, (b) literature support describing the test
population, (c) sensitivity and specificity data, and (d) be in common
use by audiologists (i.e., clinically validated). We also considered it
important to see what the recommended test data would provide
about the child’s disorder that would guide audiologists in the
management and remediation of the child struggling with APD.
Because the Dallas APD Consensus Conference was held in April of
2000, our literature review include materials published up to and
including April 2000.
Procedural Concerns. A ‘consensus’ statement should take into
account differing points of view. Although all members of the panel
may be highly qualified professionals, the APD consensus panel
appears to over-represent certain professional groups while omitting
others. For example, the consensus statement makes specific
recommendations regarding screening procedures, presumably to be
used by audiologists in schools, but not a single educational
audiologist was included on the panel. Yet, educational audiologists
are those most likely to be involved in screening, diagnosing and
remediating APD in school-aged children.
PROFESSIONAL CONCERNS
The screening and the diagnostic tests specifically recommended by
the Consensus Committee for use with school-aged children are not
widely ‘field tested’by audiologists1 and have limited value in remedial
programming for children with APD. Thus, if a child indeed is shown
to have APD, what guidance for therapy would the recommended test
battery provide?
In regard to the recommended Minimal Test Battery (MTB), the
report recommends that “…the set of procedures listed [below] is
suggested as the minimum necessary test battery,” but adds that,
“Some clinicians may choose to carry out additional testing” (p. 471)
thereby implying that these particular tests are needed for all children
evaluated for APD. With regard to screening tests, and presumably
tests in the MTB, Jerger and Musiek (2000) indicate the tests should
meet, “acceptable psychometric standards… [including] sensitivity
and specificity, the predictive values of positive … and validity” (p.
469). We believe none of the tests recommended by the Consensus
Committee meet acceptable psychometric standards. We have no
argument with the recommendation for pure-tone threshold tests,
VOLUME 14, NUMBER 2
word recognition tests [at PB-Max], and immittance audiometry
measures as these procedures are well accepted by audiologists
(Martin et al., 1998 p. 96-97) and serve a functional purpose in the
auditory processing test battery.
PHYSIOLOGIC MEASURES
Research has not substantiated the premise that physiological
measures play an important role in typical auditory processing
assessment and it does not seem that a positive physiologic finding
from the three recommended physiologic tests of the MTB
(Otoacoustic Emissions – OAEs; Auditory Brainstem Responses ABR; and Middle Latency Responses - MLR) would be beneficial to
the remediation of a child diagnosed with auditory processing disorder.
Otoacoustic Emissions (OAEs). There is research evidence that
suppression of OAEs may occur in cases involving central auditory
lesions. However, the Consensus Committee recommend OAEs for
routine APD use because OAEs are, “…useful in ruling out inner ear
disorders” (p. 471). We can find no research studies to suggest that
children with APD have a high risk or incidence of inner-ear
pathology. In fact, for general purposes, pure-tone thresholds reflect
cochlear pathology at lower hearing levels than OAEs. Kemp (1978)
has shown that OAEs are absent in inner ear lesions with thresholds
>30dB and according to Katz and Amorim (2001) children seen for
APD rarely have >30dB sensorineural hearing losses. We believe
that a recommendation that APD screening of children with
sensorineural losses of >30dB be tested with OAEs would be more
justifiable. Martin et al. (1998), state that 11% of audiologists use
OAEs for primarily diagnostic purposes. Presumably then, the use of
OAEs to identify inner-ear pathology, without sensorineural hearing
loss in children seen for APD is rare. Because OAEs offer little
information for assisting children with their auditory processing
deficit, the recommendation of OAE testing as part of the MTB
appears to be without merit.
Auditory Brainstem Response (ABR). Jerger & Musiek (2000)
recommended ABR and Middle Latency Response (MLR) as part of
their MTB because they are, “…key measures of the status of
auditory structures at brainstem and cortical levels” (p. 472). We
were unable to locate auditory brainstem-based research studies to
support its general use with this population. The Consensus
Committee provides no evidence that the VIII nerve or brainstem is
at risk in children with APD. Because of the minimal contribution of
auditory brainstem testing results and the added time and expense
required for such measurements, it is our conclusion that ABR
evaluation is inappropriate for the MTB.
Middle Latency Response (MLR). Jerger and Musiek (2000)
provide no suggested readings on MLR to help justify its routine use
in children seen for APD evaluations. In fact, in the research study
most closely associated with children and APD, Kraus et al., (1985)
found no MLR differences between control children and those who
had learning disabilities, language delays, mental retardation, or
multiple handicaps. Kraus et al. point out that there is much
variability in pediatric MLR results until about 10 years of age, and
it is well recognized that MLR results are easily influenced by many
other uncontrollable variables. In addition, a paper published by
Jerger & Jerger (1985) presented a number of CNS case studies in
which the authors concluded, “Our enthusiasm for the clinical
application of middle and late potentials must be tempered, however,
by the divergence of opinion about the stability of these potentials as
a function of age and test condition” (p. 35). Chermak & Musiek
(1997) reported that MLR measurements are “new and partially
experimental” (p. 138).
AUDIOLOGY TODAY
15
CLINICAL AND RESEARCH CONCERNS
REGARDING THE 2000 APD CONSENSUS REPORT AND RECOMMENDATIONS
We found no research that provides justification for including
MLR in a Minimal Test Battery for APD. Specifically, (1) the MLR
test is not sufficiently sensitive even in cortical lesion cases, (2) use
of the MLR with children under age 10 is problematic because of its
variability, ( 3) the MLR is not widely used in audiology and only
rarely used in testing children with APD, and (4) it is not clear how
MLR would contribute to making appropriate recommendations if a
child “failed” the testing procedure.
BEHAVIORAL MEASURES
Performance-Intensity Word Recognition. Jerger & Musiek
(2000) state that performance-intensity (PI) function tests are
“essential for exploration of word recognition over a wide range of
speech levels and for comparing the performance on the two ears” (p.
471). However, we found no research showing performance-intensity
word recognition function testing for evaluating APD or literature
support for including the Performance-Intensity Word Recognition
test as part of the MTB.
Dichotic Digits. The Consensus Committee recommends
inclusion of dichotic digits for both APD screening and as part of the
diagnostic MTB. Musiek et al. (1991) stated that dichotic digits
testing “…appears to have potential value as an audiological
screening test for CANS involvement” however, “…more clinical
research (especially prospective studies) must be done” (p. 113). We
found only one study in children with APD. It showed that frequency
patterns and competing sentences tests were more sensitive than the
dichotic digits tests (Musiek et al., 1982). A serious limitation of the
dichotic digits test is that there is no national pediatric normative data
available. Musiek’s administration instructions indicate “We strongly
recommend that you collect your own norms in your own area.” (p.
2). A recommended universal screening (or diagnostic) test should
not depend on audiologists obtaining their own normative data.
Musiek provides no norms at all below 7 years-of-age. Therefore,
again it would appear that the recommended test, dichotic digits, does
not meet a reasonable standard as a routine screening or diagnostic
test for all children seen for APD.
Duration Pattern Sequence. We find no information to elevate
the duration pattern sequence test to the level of Minimal Test Battery
stature. There is no available literature to support duration pattern
sequence as a test for children with APD and we found no normative
data for this testing procedure. The single reference provided with the
test instructions was carried out with central and cochlear lesion
patients and not with children with APD (Musiek et al, 1990).
Consequently, we find no scientific or clinical support for including
the duration pattern sequence as part of a minimal test battery for
children with APD.
Temporal Gap Detection. The consensus report describes this
procedure as “a short silent gap inserted in a burst of broad-band
noise” as one of two recommended screening procedures and also as
part of the diagnostic MTB. Although a pure-tone Auditory Fusion
Test – Revised Version was developed by McCroskey and Keith
(1996), this pure tone procedure is apparently not the test that they had
in mind. Despite the importance placed on the gap detection test, we
found no broadband noise procedure to be commercially available
DISCUSSIONAND RECOMMENDATIONS
According to Jerger & Musiek’s (2000) statement that
“Acceptable psychometric standards should be met by any screening
instrument” (p. 469), not one of the tests that they specifically
recommend in their screening tests or Minimal Test Battery meets
their own standard. At a minimum, we believe that any recommended
VOLUME 14, NUMBER 2
procedure must have age-appropriate norms and be validated on
children with APD.
For children with APD our goal is to address their learning and
communication difficulties rather than to determine if
pathological/physiological auditory variations are present. Screening
and assessment batteries must consider factors associated with
children’s learning and listening difficulties.
In conclusion, we recommend that another consensus conference
be developed, that includes educational audiologists as well as
researchers and clinicians from related professions who assess/treat
children with APD everyday in schools and clinics. The conference
should develop a screening/assessment APD document that is based
on documented scientifically sound research, and should include
treatment and management recommendations. Until such a
conference is held, the ASHA (1996) consensus statement remains
the best available guideline.
REFERENCES
American Speech-Language Hearing Association Task Force on Central Auditory
Processing Consensus Development (1996). Central auditory processing:
Current status of research and implications for clinical practice. Amer J Audiol,
5 (2): 41-54.
Arnst DJ (1982) SSW test results with peripheral hearing loss. In DJ Arnst & J
Katz (Eds) The SSW Test: Development and Clinical Use. College-Hill Press:
San Diego, CA., 287-293.
Chermak G, Musiek F (1997). Central auditory processing disorders: New
perspectives. San Diego: Singular Publishing Group: San Diego, CA.
Jerger J, Musiek F (2000) Report of the Consensus Conference in the diagnosis
of auditory processing disorders in school-aged children. JAAA 11, 467-474.
Jerger S, Jerger J (1985) Audiological applications of early, middle and late
auditory evoked potentials, The Hearing Journal, 38, 31-36.
Katz, J, Amorim, PM (2001) Puretone thresholds in children seen for CAP
testing. SSW Reports, 23, 16-17.
Kemp, D (1978) Stimulated acoustic emissions from within the human auditory
system. Acoust Soc Am; 64: 1386-1391.
Kraus N, Smith D, Reed N, Stein L, Cartee C (1985) Auditory middle latency
responses in children: Effects of age and diagnostic category.
Electroencephalography and Clinical Neurophysiology, 62, 343-351.
Martin F, Champlin CA, Chambers JA (1998) Seventh survey of audiometric
practicesin the United States. Journal American Academy of Audiology, 9, 95104.
McCroskey RL, Keith, RW (1996) Auditory Fusion Test - Revised: Instruction
and User’s Manual. Auditec of St. Louis: St. Louis, MO.
Musie, F, Baran J, Pinheiro M. (1990) Duration pattern recognition in normal
subjects and patients with cerebral and cochlear lesions. Audiology, 29:304-313.
Musiek, F, Geurkink, AN, Keitel (1982). Test battery assessment of auditory
perceptual dysfunction in children. Laryngoscope, 92: 251-257
Musiek F, Gollegly K, Kibbe K, Verkest-Lenz S. (1991) Proposed screening test
for central auditory disorders: Follow-up on Dichotic Digits test. The
American Journal of Otology, 12 (2), 109-113.
Riccio CA, Hynd GW, Cohen MJ, Hall J, Molt L (1994) Comorbidity of central
auditory processing disorder and attention-deficit hyperactivity disorder.
Journal American Academy Child Adolescent Psychiatry, 33, 6, 849-857.
Tillery KL, Katz J, Keller W (2000) Effects of methylphenidate (RitalinTM) on
auditory performance in children with attention and auditory processing
disorders. Journal Speech-Language and Hearing Research, 43 (4), 893-901.
1
Since the publication of Jerger & Musiek (2000) the use of these tests has
increased as many audiologist have attempted to comply with their
recommendations.
AUDIOLOGY TODAY
17
ON THE DIAGNOSIS OF AUDITORY PROCESSING DISORDER
A reply to “Clinical and Research Concerns Regarding Jerger & Musiek (2000) APD Recommendations
James Jerger,
Dallas, TX and
We welcome this opportunity to clarify a number of issues
relating to the diagnosis of auditory processing disorder (APD) in
children. We shall discuss the following points:
1) It is important to disentangle diagnosis from treatment.
2) It is important to disentangle APD from other problems such as
attentional and linguistic disorders.
3) There are different approaches to diagnosis, each with unique
advantages and disadvantages.
4) The diagnosis of APD lacks a gold standard.
5) Electrophysiological and electroacoustic measures are central to
the diagnosis of APD.
6) There is time. You just have to take it.
1) Diagnosis vs Treatment
The concept of diagnosis can only exist within a coherent
conceptual framework. The problem with some previous statements
and communications on this issue is that they lack such a framework.
Professionals become dedicated to one viewpoint and their findings
tend to support that viewpoint. If, for example, you think that APD is
a problem in “processing factor x” then you design a test to measure
“ processing factor x” and administer it to a suspected child. If the
child does poorly, then you conclude that the child must have an
auditory processing problem due to poor “processing factor x “and
the treatment avenue is self evident. If the child seems to be doing
better after the treatment, then you must have been right in the first
place. The circularity of this argument should be obvious. The
question of whether the child’s poor performance on the “processing
factor x” test might be due to some other relevant factor is seldom
addressed. This is not how diagnosis is supposed to proceed.
Our position is that APD is an auditory-specific perceptual deficit
in the processing of speech input, usually in hostile acoustic
environments. It follows, therefore, that a diagnostic evaluation must
use tests which examine such processing ability in a variety of ways.
We see the principal diagnostic problem, however, as assuring that
poor performance on such tests is due to an auditory-specific deficit,
rather than due to one or more of the many other reasons why a child
might perform poorly in such situations. Cacace and McFarland
(1998) summarize the problem well:
“The obvious limitation with inclusive definitions of [APD] is that
individuals with problems that are not of a perceptual nature are at
risk for misclassification” (p.356).
It is certainly the case that appropriate intervention must derive
from accurate diagnosis. If a child’s listening problems are due to an
attentional deficit disorder, this implies a different approach to
intervention than if the problems are due to a specific language
impairment. And a diagnosis of auditory processing disorder implies
yet another set of intervention strategies. But the diagnostic problem
must be viewed independently. The object of diagnosis is to diagnose
the problem correctly, not to design an intervention strategy for it.
The question of what is an appropriate intervention strategy for
children with APD is another problem altogether, and one purposely
not addressed in our document. Certainly, treatment for APD is an
important issue. Indeed it perhaps warrants a Consensus Conference
devoted exclusively to the many issues surrounding the various
current intervention strategies.
In our conference we sought only to suggest adequate approaches
to the single question ,”How can we improve our ability to detect an
auditory-specific perceptual disorder?”
VOLUME 14, NUMBER 2
Frank Musiek,
Storrs, CT
The motivation for addressing this question in the context of a
Consensus Conference was the growing concern among many of us that
APD may be grossly overdiagnosed if clinicians rely exclusively on one
or a few behavioral instruments that fail to address alternative
explanations for poor performance. Clearly these behavioral tests detect
a problem. The difficulty is that they do not distinguish among a variety
of possible underlying causes. A case in point is what many have come
to call the “marshmallow effect”. In a recent issue of JAAA, Shlomo
Silman, Carol Silverman and Michelle Emmer (2000) reported results
on three children who had been initially diagnosed elsewhere with APD
as a result of poor performance on either the Willeford or SCAN
batteries. In each case performance became normal when correct
responses were reinforced with a reward of the child’s choice. One child
requested roasted marshmallows. With this reward, performance on the
Competing Sentences Test of the Willeford battery improved from 0%
on the right ear, and 60% on the left ear, to 100% on both ears.
2) APD vs ADD, SLI, and Dyslexia
In order to maintain a clear focus on the accurate diagnosis of
APD, it is necessary to view it as a discreet entity, apart from other
childhood problems. Many view APD as the root cause of problems
like SLI, ADD and Dyslexia. The “Concerns” document to which we
are replying puts it very succinctly:
“The disorders listed by the consensus group, if present, may
actually be the result of APD and therefore the presence of the
associated disorder increases, rather than decreases, the likelihood
of APD”
In our view this is an exceedingly slippery slope. First, whether
APD is at the root of such problems as SLI and Dyslexia is presently
a matter of some contention. Cacace & McFarland (1998) took a
close look at this assertion. They concluded:
“A review of relevant literature on this topic suggests that the
modality specificity of auditory-based learning problems has seldom
been established” (p. 356)
and again:
“...there has been considerable debate as to whether SLI may be
caused by perceptual deficits or whether these effects are unique to
verbal communication” (p.362-63)
and again:
“Limitations resulting from non-auditory processes, necessary to
succeed on sensitized auditory tasks, would adversely affect
performance in children with ADD. Given the supramodal nature of
this disorder, one must seriously question how the situation is clarified
by classifying children with ADD as having [APD].” (p. 364)
One cannot rule out the existence of APD in association with other
problems, but, to make an accurate diagnosis of the APD component,
one must disentangle it from these other problems. If for example, a
child has SLI, then, irrespective of what caused the language disorder,
it becomes very difficult to say that poor performance on a test of
speech understanding is due to an auditory-specific perceptual deficit
rather than to the language disorder. The danger here is that people
begin to reason backwards too readily. For example, if APD causes SLI
and the child has SLI, then he must also have APD. At this point it takes
very little evidence to convince some persons of the presence of APD.
It is important to recognize, also, that the complete assessment of
these children is best accomplished by a team approach.
Differentiation among the various disorders that may underly a
child’s problems requires input from specialists in a number of areas.
The role of the audiologist is auditory assessment.
AUDIOLOGY TODAY
19
A reply to “Clinical and Research Concerns Regarding Jerger & Musiek (2000) APD Recommendations
3) More Than One Approach to Diagnosis
One way to decide whether an individual is not normal on a
particular dimension is to compare his/her performance with the
range of performance of “normal” persons. If you have a test
instrument designed for 9-year old boys, then you first administer the
test to a large sample of 9-year old boys. (Parenthetically we might
add that the advice to obtain local norms for any behavioral
procedure has a good deal of merit, especially if the test materials
include speech samples. Issues of diversity, dialectal variation, and a
variety of other factors unique to the local situation sometimes render
national norms of questionable value).
In any event normative data allow you to make the not
unreasonable assumption that the test scores will be normally
distributed, to compute the standard deviation, and to set a fail
criterion at some outcome score which encompasses a large portion
of the distribution (such as 2 standard deviations or 1.64). If a child
falls outside this region you conclude that his performance is not
within normal limits; ergo he is abnormal. You recognize (or at least
you are supposed to recognize), that 5 of 100 normal children
performed at this level or worse, or, alternatively, that there are 5
chances in 100 that you are going to be wrong in coming to the
conclusion that the child is abnormal, but you are willing to assume
the risk. You are comfortable in all of this because the test has been
“normed.” The fact that a child whose performance is just inside the
95% region, let’s say at the 94% boundary, is termed normal doesn’t
bother you because you are working with a “normed” instrument. Or
maybe it does bother you just a little. Two children perform within
one percentile of each other, yet one is normal and the other is
abnormal. Perhaps you might decide that the boundary is too strict.
Instead of 2 standard deviations, maybe one standard deviation
would pick up more deviants. So you set the boundary at one
standard deviation. The number of perfectly normal children who
perform at this level or worse has now risen from 5% to 16% but that
doesn’t bother you because, after all, you are working with a wellnormed instrument.
This approach to diagnosis is the legacy of the early 20th century
mental measurement movement. The original idea was to rank order
children according to their abilities, usually to predict academic
achievement. How well it has succeeded in this arena is still a matter
of some contention. For our purposes it is sufficient to note that there
are better approaches to diagnosis. One is diagnosis by exclusion, an
approach based on the principle that the best way to confirm a
hypothesis is to fail in every attempt to disconfirm it. You list all the
possible reasons why a 9 year old boy would have trouble hearing in
noisy places, then attempt to systematically exclude all possibilities
except an auditory-specific perceptual deficit. One example is to
compare performance on analogous auditory and visual tasks, an
effective way of ruling out a number of extra-auditory factors related
to performance in the test situation. Again, Cacace & McFarland
(1998) put it very well:
“ ...the primary deficit with [APD] should be manifested in tasks
requiring the processing of acoustic information, and should not be
apparent when similar types of information are processed in other
sensory modalities.” (p. 356)
A related approach to diagnosis is to allow the 9-year-old boy to
serve as his own control. You can, for example, compare
performance on the two ears. If there is a large interaural discrepancy,
this argues strongly for an auditory-specific problem. Dichotic tests
are particularly effective here. Another way in which the child can
serve as his own control is to study performance at different sound
intensity levels. Substantially poorer performance at high intensity
20
AUDIOLOGY TODAY
levels as compared to more moderate levels has been related to
auditory processing problems at specific levels within the auditory
system. This is the basis for the performance vs intensity, or PI,
function as a method for studying speech understanding over the
entire auditory area.
Suffice it to say that there is more than one avenue to the
diagnosis of auditory processing disorders. It is not necessary to rely
on the relatively weak approach in which the child’s absolute
performance is compared to a norm.
4) No Gold Standard
Data on the sensitivity and specificity of a diagnostic test or test
battery are certainly desirable. They require, however, a “gold
standard” by which the success or failure of the diagnostic instrument
may be assessed. We can educe the sensitivity and specificity of the
ABR as a detector of acoustic tumors, for example, because the
surgeon’s knife provides the gold standard. Either there was or there
was not a tumor. But no gold standard exists for auditory processing
disorder. Thus there can be no data on the sensitivity or specificity of
any test purporting to diagnose this malady.
Incidentally, the area of treatment for APD suffers a related lack
of statistical support. Treatment efficacy is best confirmed, for
example, by a double-blind, randomized trial. A large number of
children diagnosed with auditory processing disorder is randomly
assigned to different treatment groups. One group receives the
treatment under study. The other group receives equal “hands on”
time, but that time is spent on activities unrelated to the rationale for
the treatment under investigation. Both the investigators and the
children are “blind” to group assignment. Such trials have not yet, to
our knowledge, been carried out in systematic fashion for any
proposed APD treatment regimen.
5) Electrophysiological and Electroacoustic Measures
One important dimension in the differential diagnosis of auditory
processing disorder is to differentiate APD from speech
understanding problems due to malfunction at either the auditory
periphery or the low brainstem level. We now know that a pure-tone
audiogram within “normal limits” does not guarantee normality at
the auditory periphery. And we know that problems of dys-synchrony
in the brainstem auditory pathways (sometimes called auditory
neuropathy) produce a distinct problem in speech understanding
requiring specific intervention techniques. The best, and virtually
only, techniques we currently have available for excluding these two
possibilities are evoked otoacoustic emissions (EOAEs) and the
auditory brainstem response (ABR). Before you can say that a child’s
listening problems are due to a disorder in the processing of auditory
information at a relatively high level in the central auditory system,
it is essential to rule out peripheral disorders at the hair cell level and
low brain stem dys-synchrony problems. This can only be
accomplished by EOAE and ABR. They are viewed as essential
components of a comprehensive diagnostic battery for APD.
Another reason for encouraging the use of electrophysiological
measures is that, if we are ever going to have a gold standard for
APD, it will probably be in the form of electrophysiological
measures. They offer a powerful set of techniques for potentially
separating auditory-specific deficits from multi-modal disorders.
There is particular promise in ongoing research with the middle
latency response (MLR), the late vertex response (LVR) and the
family of event-related potentials (ERPs) especially in differentiating
auditory from non-auditory factors.
6) Make time for doing it right
The complaint that diagnostic testing takes too much time, or is
MARCH/APRIL 2002
A reply to “Clinical and Research Concerns Regarding Jerger & Musiek (2000) APD Recommendations
too expensive, is something you hear whenever there is an attempt to
upgrade services. But the accurate diagnosis of auditory processing
disorder is too important to be governed by arbitrary time limits. In
many school districts, diagnosticians spend 6-8 hours evaluating
children for possible learning disability. Is auditory processing
disorder so unimportant that we cannot devote even a few hours to its
accurate diagnosis?
It is certainly the case that many environments lack the tools
necessary for a full electrophysiological and electroacoustic testing.
The solution is not to conclude that they are irrelevant, but to refer the
child to a facility that can provide the services.
SUMMARY
1) It is important to consider diagnosis and treatment as separate
issues. The purpose of diagnosis is to assure that we have
identified the problem accurately, not to design an intervention
regimen.
2) It is important to consider APD as a discreet entity apart from
ADD, SLI, and Dyslexia. Assuming, without objective
justification, that APD is a root cause of such problems is a
slippery slope.
3) There is more than one approach to diagnosis. Comparing
absolute performance to a norm may not be the strongest
technique. It seems more rigorous to proceed in terms of
excluding extra-auditory factors that may contribute to poor
listening.
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AUDIOLOGY TODAY
4) Sensitivity and specificity are desirable attributes, but there is no
gold standard that makes it possible to derive data on sensitivity
and specificity of any purported diagnostic test of APD.
5) Electrophysiological and electroacoustic measures are
indispensable components of a diagnostic test battery for APD.
6) If you can’t find the time, and/or can’t afford the expense, to
carry out a well-derived diagnostic evaluation, refer to someone
who can.
7) The Consensus document has never been viewed as the final
answer to APD diagnosis. We can only hope that it is a start in
the right direction. Our thinking will certainly change as we
learn more from research. Our approaches to the problem may
change, and future consensus conferences will undoubtedly
reflect these changes. We are convinced, however, that by taking
advantage of developments in all areas of contemporary auditory
research it is possible, at the present time, to sharpen our
diagnostic acumen.
REFERENCES
Cacace A and Mcfarland D.(1998). Central auditory processing disorder. J Speech,
Lang & Hrng Res 41:355-374.
Silman S, Silverman C and Emmer M.(2000). Central auditory processing disorders
and reduced motivation:three case studies. J Amer Acad Audiol 11:57-63.
MARCH/APRIL 2002
John Olive, Jr.,
BHI, Alexandria, VA
erhaps the most revealing statistic about the
state of hearing healthcare in the U.S. is the
fact that 28 million people have hearing loss
(1 in 10 of the American population) but fewer
than 20% of those people have ever sought
treatment of any kind or obtained hearing aids.
Whatever methods we have tried as an
industry… whatever messages we have
delivered… whatever audiences we have targeted
or image we have tried to project, we have never
reached more than one fifth of those who need
our services! And year in-year out, these dismal
unmet numbers remain the same.
behavioral and social functioning.
• Amplification is highly effective in treating
sensorineural hearing loss which accounts
for approximately 90% of all patients.
The Better Hearing Institute in Washington,
D.C. has developed a new plan to change our
current flat market status. In 2001, BHI launched
its most ambitious undertaking ever in its 30year history: The Physician Referral
Development Program based on informal dinner
meetings designed to bring audiologists together
with local physicians for networking and referral
development purposes. For 2002, the BHI
program has been redesigned and expanded to a
national scale. As of January of this year, the
program is open to every hearing professional in
the United States (for more information and
enrollment, visit us online at:
www.betterhearing.org).
The 2002 BHI Physician Referral
Development Program is founded on several
basic principles:
• Primary care physicians (Internists, Family
Practitioners, Geriatric specialists, etc.)
dominate the healthcare landscape as
gatekeepers and primary referral sources.
There are more than 240,000 primary care
physicians (PCPs) in the U.S. versus only
8,000 Ear, Nose, Throat physician
specialists.
• Primary care physicians have never
considered hearing loss to be particularly
important. The PCPs rarely perform
screening tests for hearing loss, and they
rarely encourage their patients to seek the
services of an Audiologist.
• Patients trust their primary care physicians
and they are heavily influenced by their
physician’s advice and guidance.
• We will never reach the unidentified 22
million Americans who have hearing loss
until we reach their family physicians. If the
family physician does not think hearing loss
VOLUME 14, NUMBER 2
is important, the patient will also reflect that
same apathetic opinion about their hearing.
When family physicians finally realize the
importance of identifying and treating
hearing loss in their patients, the size of our
industry will easily double or triple.
• Hearing professionals must position
themselves as an essential part of
mainstream healthcare — the treatment
of hearing loss must become a medical
necessity— and audiologists will find
their place as one more spoke in the
wheel of specialists that surround a
primary care practice.
Today, we have new information about
hearing loss and hearing aids based on
substantive research studies. For the first time
in the history of hearing healthcare, we have
clinical study results that definitively conclude:
• Hearing loss is not a benign condition. It
profoundly impacts quality of life and
multiple aspects of physical, cognitive,
To an audiologist, this may not seem like
earthshaking news. However, to the primary
care physician…to the person who has always
thought “hearing loss is just part of getting
older,” hearing loss can be ignored with no
negative implication. We often hear physicians
say, “There is nothing you can
do about your hearing
loss.” To the
physicians who have
used all these
clichés for
decades and have
driven patients
away from our
offices by their
dismissive
attitudes about
hearing loss, this
new clinical research
data will hopefully change
their thinking, their attitudes
about hearing loss, as well as their
practice patterns forever.
Physicians only refer their patients to people
they know and trust. Regardless of how powerful
our message is, nothing will change in a family
physician’s practice pattern until he meets a
qualified audiologist and develops that personal
sense of trust when referring a patient for
evaluation and treatment. This is the process
physicians go through with every other clinical
discipline (both physician specialties like
cardiology, and non-physician specialties like
home health nursing). For this reason, the BHI
Physician Referral Development Program is built
completely on the concept of preparing every
audiologist to build one-on-one relationships with
their own target referring physicians and then
placing all the right marketing materials in the
audiologist’s hands to make the effort a success.
The new BHI Physician Program is now
available on CD-ROM for universal access by all
interested audiologists. The program features a
comprehensive training module on The Basics of
Physician Marketing. Enrollees learn directly
from primary care physicians and other
successful audiologists what works in marketing
AUDIOLOGY TODAY
23
hearing services and what does not work in
physician outreach. The BHI CD training module
spells out the strategies that will lead to new
referral relationships with targeted physicians.
Make no mistake, however — the physician
marketing process requires discipline and
commitment —but it works!
The “crowning jewel” of the physician
program is BHI’s one-of-a-kind accredited
Continuing Medical Education course for
physicians on CD-ROM. This interactive CD is
approved for 1-hour of CME/CEU for physicians,
nurse practitioners, registered nurses and
physician assistants in the United States and
Canada. The BHI CD-ROM educational program
focuses on:
• The prevalence of hearing loss in the primary
care practice.
• Clinical studies which prove the importance
of treating hearing loss and the effectiveness
of amplification.
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AUDIOLOGY TODAY
• The fact that 90% of all patients with hearing
loss are not amenable to medical/surgical
intervention and the treatment of choice is a
direct referral to the audiologist for
evaluation and treatment, usually with
custom-fitted hearing devices.
A complete package of other marketing
materials accompanies the physician continuing
education CD-ROMs along with informative
strategies for how to use the materials to
establish familiarity and trust with family
physicians and their staffs. BHI Physician
Referral Development Program enrollees will
receive unlimited supplies of physician materials
as soon as they complete the online interactive
training module on physician marketing.
The Physician Referral Development
Program represents the unified commitment of
the entire hearing industry (manufacturers,
suppliers, professional organizations) to build a
lasting bridge to primary care medicine. More
importantly, it reflects the industry’s
acknowledgment that YOU, the local hearing
professional, are the ONLY person who can
effectively reach the primary care physician and
earn his referrals. This is a program built entirely
on the realization that we must empower the
front-line clinician. Physician referral
development is purely a person-to-person
endeavor. The Better Hearing Institute has
channeled 100% of its energy into creating a
program that will revolutionize this industry one
audiologist at a time. We need everyone to
become involved in this national effort to
increase the provision of audiologic services to
the millions of unidentified persons with hearing
loss. We sincerely believe that the most
important first step in joining this new
movement is to enroll in the BHI Physician
Referral Development Program at
www.betterhearing.org.
MARCH/APRIL 2002
David Fabry,
Academy Past President
“Never mistake motion for action”— Ernest Hemingway
I began my term of office in
January, 2001, filled with optimism
and armed with the guidance
provided by The Academy’s newly
updated strategic plan. As I reflect
on the past fifteen months, I realize
that my definition of “signal-tonoise ratio” has expanded from a
term used in hearing aid research
to include the separation of the
important things in life from
Brownian motion. The tragedies of
September 11th reminded us all too
well of this reality, and the past
several months have provided an
opportunity to re-evaluate goals
David
and priorities, in the hopes of
separating “action” from “motion.”
Throughout, the Staff and your Board
continued to carry out the business of
The Academy, rededicated to focus on the
“big picture.” The next few paragraphs
will provide a progress report on a few of
the critical elements of The Academy’s
strategic plan.
Transitioning profession to doctoral
level: The evolution to the Doctor of
Audiology (AuD) is well underway. In
fact, it has been so successful that there
are probably more AuD programs than
PhD students in Audiology. This
identifies (at least) two huge remaining
challenges: development of rigorous
accreditation standards and a renewed
focus on research and scholarly activity.
During the past year, The Academy Board
has met with various “stakeholders”
representing academia, practice,
professional association and
governmental officials to discuss both of
these issues.
One result has been the formation of
the Accreditation Commission on
Audiology Education (ACAE), an
independent entity with representatives
from The Academy, The Academy of
26
AUDIOLOGY TODAY
Increased third-party reimbursement:
At Convention 2001 in San Diego,
Health and Human Services Secretary
Tommy Thompson spoke in support of
The Academy’s charge to the Centers
for Medicare and Medicaid Services
(CMS) to speak with one voice
regarding audiology. As of this date,
the proposed regulation to unify the
language used to describe a “qualified
audiologist” has not been promulgated,
but our efforts continue. As I told
Secretary Thompson (a fellow
Wisconsinite) on the podium, Green
Bay Packer fans waited thirty years for
Fabry prepares to ride off into the sunset. a return to the Super Bowl, and
audiologists have been similarly patient
Dispensing Audiologists (ADA) and
regarding the Medicaid regulation.
academia. This group has begun to
The reason for our persistence on this
develop an accreditation plan specifically
issue is that The Academy is committed to
for academic programs offering the AuD
the ideal that, similar to other diagnosing
degree. The current accreditation of
healthcare professionals, qualified
audiology graduate programs specifically
audiologists should be identified by: 1)
excludes those that provide educational
the AuD, 2) a national entry-level
opportunities for existing professionals to
examination, 3) state licensure, and 4)
earn their AuD via distance education.
continuing education. While Certification
Accreditation of these programs is
should remain a voluntary credential for
essential, and serves as a catalyst for the
audiologists, mandatory entry-level
development of an independent
certification is outdated and redundant.
accreditation plan devoted exclusively to
Updating the Medicaid regulation is but a
audiology. This will take time, cooperation,
step in the journey towards limited license
and money, but the process has begun.
practitioner status.
The issue regarding the lack of PhD
Consistent with across-the-board cuts in
students is more troublesome. Other
Medicare reimbursement, several codes for
organizations, including the American
diagnostic audiology procedures declined for
Auditory Society (AAS), have persuaded
2002, but vestibular reimbursement rates
the National Institutes on Deafness and
increased. Reimbursement for aural
Other Communication Disorders (NIDCD)
rehabilitation provided by qualified
to provide travel scholarships to PhD
audiologists remains a priority, and will be
students attending their convention.
essential if legislative efforts continue for
Why not us? We must do a better job of
third-party reimbursement of hearing aids
making scientists feel at home in The
(e.g. the Foley Bill). The Academy has made
Academy, and we will continue to work
it clear that our focus is to ensure quality of
collaboratively to identify mechanisms
patient outcome, contain costs and provide
for attracting the best and brightest
improved access to hearing healthcare. As
students to our profession for the AuD
such, any future legislation for third-party
and PhD.
reimbursement should include: 1) consumer
MARCH/APRIL 2002
The Year In Review
and practitioner choice, 2) “balance billing”
for advanced technology, 3) reimbursement
for aural rehabilitation provided by qualified
audiologists and 4) coverage for hearing aid
repairs and service.
Promote Awareness of the Profession of
Audiology: Much debate has been given
to the America’s Hearing Healthcare Team
Initiative (AHHTI) introduced by the
American Academy of Otolaryngology
(AAO) in May 2001. The Academy has
voiced strong opposition to AHHTI,
primarily due to ambiguous roles of the
audiologist and commercial hearing aid
dealer, which are confusing and
potentially misleading to the consumer.
Although the AHHTI is reputed to be a
joint marketing effort, it has already been
used to create the impression of a unified
front on legislative efforts that are very
detrimental for audiology. Regardless of
the intent, The Academy continues to be
in favor of an “all-pro” team committed to
VOLUME 14, NUMBER 2
quality hearing healthcare, and has
communicated this emphatically and
regularly to AAO’s leadership.
Audiology is a good profession,
but the contributions of all
are required to take action
and make it great.
The Academy’s Building Bridges
Physician Marketing Kit, introduced in
San Diego, continues to provide an
excellent method for audiologists to
market directly to physicians who are
often the “true” gatekeepers for hearing
healthcare. Future efforts should
consider nurse practitioners and
physician’s assistants, as well as directto-consumer marketing efforts.
In his new book “Good to Great”,
author Jim Collins contends that good is
the enemy of great. That is, the vast
majority of businesses, institutions,
professions, and people fail to become
great because so many settle for “good
enough.” As I reflect on my term as
President, I cannot resist the temptation
to wonder whether this is true of my
term, our Academy, and to a larger
extent, audiology. Granted, I am in no
position to complain; I have traveled the
world “on my ears,” and audiology has
enriched my life in many ways. I have
been fortunate to work with outstanding
Staff, Board and Committee members. I
have tremendous colleagues in our
audiology and otorhinolaryngology
departments. As I ride off into the
sunset, I challenge each of you to
become involved in volunteer service.
Audiology is a good profession, but the
contributions of all are required to take
action and make it great. Thanks for the
opportunity to serve as your President; it
has been an honor.
AUDIOLOGY TODAY
27
H OHNOH
ONO
ROSNROS R S
OF THE AMERICAN ACADEMY OF AUDIOLOGY
The Honors of The Academy
recognize the achievements of
individuals whose contributions
set a standard of excellence for
the profession. This year’s
illustrious group of honorees
have distinguished themselves
for their innovative research,
clinical expertise, dedication and
PAUL KILENY
CAREER AWARD IN
HEARING
JANE BARAN
CLINICAL EDUCATOR
AWARD
28
AUDIOLOGY TODAY
leadership contributions to the
profession and were nominated
by colleagues who documented
and commented on their many
professional and personal
accomplishments.
The Academy thanks the
members of the Honors
Committee for their outstanding
efforts in selecting these role
models who have dedicated their
careers to improving the lives of
persons with hearing loss.
The 2002 Honors
Committee included:
M i chael Wynne, (Chair),
D ebra Abel, Rose A l l e n ,
John Ferraro, Robert Nov a k ,
Je ff Nye, Richard Ta l b o t t
and Jenny Web e r.
We encourage members of
The Academy to attend the AAA
Foundation Celebration of
Legends in Audiology and
Honors program on Thursday,
April 18th from 6-8pm during
Convention 2002 in Philadelphia.
The American Academy of Audiology is proud to present its Career Award in Hearing to Paul
Kileny. An American Academy of Audiology Founder, Kileny has made innumerable significant
contributions to the advancement of audiology in his 24-year career. Kileny represents the
clinician/researcher in the truest sense, and is a role model to younger members for his ability to
combine clinical practice with effective research. From his time as a doctoral student to the present,
he has persisted in pushing the envelope of what is considered the “traditional” scope of audiology
practice. Among his many accomplishments are his pioneering contributions in the areas of
vestibular assessment and rehabilitation, infant hearing screening, intraoperative neurophysiological
monitoring, endogenous evoked potentials and cochlear implantation. Kileny’s current work as a
director and clinician at the University of Michigan Health System has had a direct and indirect
positive impact on countless patients across all areas of hearing healthcare. He has served well our
profession as an ambassador to other health care and medical specialties, such as otolaryngology
and pediatrics. He is a Scientific Fellow of the American Academy of Otolaryngology-Head and
Neck Surgery and is a recent recipient of that Academy’s Honor Award. Finally, he has published
more than 100 manuscripts in peer-reviewed journals and 22 book chapters and other invited
publications. With his active willingness to address professional and technical issues, we are indeed
fortunate for the numerous outstanding contributions made to the field of hearing by Paul Kileny.
Innovative, insightful, passionate, empathetic, devoted, perceptive, enduring, informative and
supporting are just some of the adjectives used to describe the qualities of this year’s recipient of
the Clinical Educator Award. Jane Baran, Professor in the Department Communication
Disorders and an Associate Dean of the Graduate School at the University of Massachusetts,
Amherst, has long been recognized by her students, colleagues and patients as the consummate
mentor and professional. All those who come in contact with her for her tutelage, research
activities, clinical abilities and expert advice respect her. She has received numerous teaching
grants and awards at the University of Massachusetts, and is a three-time nominee for the Beltone
Distinguished Teacher in Audiology Award. She was the recipient of the Honors of the
Massachusetts Speech-Language-Hearing Association in 1990 awarded to her for her service as a
sapient resource, confidant and friend to students and to colleagues. Baran is well known to all
for her open door policy, and she maintains a balance between demanding instructor and
supportive mentor. She readily shares her enthusiasm for audiology and, in the process, fuels a
fire in her students to reach their maximum potential in the classroom, in the clinic, in the
laboratory and in their careers. Baran’s caring demeanor, her understanding of audiology and her
dedication to her students makes her the consummate teacher, allowing the knowledge domain to
literally “come to life” in every interaction. Jane Baran is a source of inspiration and continues to
provide a positive influence for her countless students, colleagues, patients and friends.
MARCH/APRIL 2002
H OHNOH
ONO
ROSNROS R S
OF THE AMERICAN ACADEMY OF AUDIOLOGY
GARY JACOBSON
JERGER CAREER
AWARDS FOR
RESEARCH IN
AUDIOLOGY
LINDA HOOD
RESEARCH
ACHIEVEMENT AWARD
Gary Jacobson is honored with the Jerger Career Award for Research in Audiology, which
recognizes his outstanding contributions to our field as a clinician, a pioneer and consummate
researcher working in the areas of evoked potentials, interoperative neurophysiology, tinnitus and
vestibular disorders. Throughout his entire career, Jacobson has always have been engaged in some
research endeavor. He has published over 100 manuscripts in a wide variety of scientific journals.
Jacobson is recognized as a leading expert in electrophysiological measures of audition, balance
function and its testing, and self-assessment inventories. His work on developing protocols to
determine functional status of patients and outcome measures for audiological protocols is without
parallel working with colleagues on such inventories as the Dizziness Handicap Inventory, the
Tinnitus Handicap Inventory and the Hearing Handicap Inventory. Jacobson is a founding member of
the American Society of Neurophysiological Monitoring and currently serves on the Board and
Scientific Advisory Committee of the American Tinnitus Association. He participates in expert
panels for the National Institutes of Health, National Science Foundation and the Federal Drug
Administration. He serves on numerous editorial boards for professional and scientific journals. He is
currently the Editor in Chief of the American Journal of Audiology. It takes only one short moment
with him to fully perceive his extraordinary humanity through his caring, wit, and collegial spirit. As
the Division Head of Audiology at the Henry Ford Health System, he is regarded as a visionary
leader, an extraordinary manager, a supportive supervisor, a gifted teacher and a skilled clinician.
As the recipient of the Research Achievement Award, Linda Hood is one of those rare researchers
who are equally gifted and respected for their scientific and their clinical accomplishments. Hood
bridged the gap between hearing science and clinical audiology by developing a better understanding
of audition in normal and disordered human auditory systems through applications of both animal
and computer models. Hood’s research has strengthened our understanding of the underlying
neurophysiologic mechanisms of fluency disorders and language deficits as well as the functional
significance of the auditory efferent system and more recently, the characteristics of hereditary
hearing loss. She has authored two textbooks, published over 60 scientific articles, and participated
in hundreds of oral presentations at professional and scientific meetings. The quality of her research
is evidenced by her success in obtaining extramural grants, having received well over a million
dollars in support of her research endeavors. Hood is recognized by colleagues and students alike
for her unselfish and resolute dedication to share her knowledge and time with others. Her passion
for her profession is also defined by her exemplary professional service through her activities for
many scientific and professional committees and by having served as the fourth President of The
Academy of Audiology. Linda Hood has set the highest of standards for the scholar/clinician as the
recipient of the Research Achievement Award, and she has done so with grace and charm.
2002 Audiology PAC
Posters Are Here!
Show your support for audiology by making a contribution to the American
Academy of Audiology’s PAC. Stop by the PAC Booth at Convention 2002 (located
in The Academy Center), and pick up your limited edition print from the “Caring for
America’s Hearing” poster series.
VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
29
HO
ONO
RON
SROS R S
HNOH
OF THE AMERICAN ACADEMY OF AUDIOLOGY
ANNA NABELEK
PROFESSIONAL
ACHIEVEMENT AWARD
JULIA ROSKAMP
HUMANITARIAN AWARD
GEORGE SPIRAKIS
HUMANITARIAN AWARD
30
AUDIOLOGY TODAY
The Professional Achievement Award this year honors a University of Tennessee faculty
member who has made extensive, outstanding contributions in the understanding of room
acoustics and was the first investigator to study systematically the combined effects of noise and
reverberation on the speech perception of listeners with hearing impairment. Anna Nabelek is
recognized as an authority on the degradation of acoustic cues by noise and by reverberation
and, among acoustical consultants, she is considered the leading expert regarding room
acoustics requirements for listeners with special communication needs. Nabelek’s work is
routinely cited in the literature and her data are used as guidelines for designing classroom and
lecture halls for listeners with hearing problems. Her comparative study of assistive listening
systems was the first of its kind and allowed a more scientific approach to selection of assistive
listening systems for a designated environment. Since those early studies, her work has found
application in the design and implementation of speech enhancement systems where she has
presented and published extensively. Nabelek has received continuous funding from the
National Institutes of Health (NIH) for 21 consecutive years, from 1974 to 1995. Her current
grant support funds research on the relation between acceptable noise levels and hearing aid
outcome measures. She is a gifted scholar, a talented teacher and a skilled mentor. It is indeed
our pleasure to recognize the remarkable contributions of Anna Nabelek with the Professional
Achievement Award.
There is no greater validation of Julia Roskamp’s merit for this year’s Humanitarian Award than
our inability to notify her of this award because she was busy evaluating the feasibility of
establishing a hearing clinic in Jos, Nigeria. Throughout her audiology career and often at her own
expense, Roskamp has given unselfishly of her time and resources to serve less-fortunate children
and adults with hearing loss in impoverished countries around the world. She has traveled to Haiti
nine times since 1996 to evaluate hearing loss in children and adults. In Haiti, she has dispensed
180 hearing aids, established a classroom for young deaf children, helped establish the first eye
and ear rehabilitation clinic, and developed the first earmold laboratory in that country. In 1999
and 2001, Ms. Roskamp traveled to Guadalajara, Mexico to evaluate hearing loss in children and
adults through mobile clinics. In every instance, she has placed her work with the unfortunate and
impoverished above her personal comfort and convenience to provide the necessary amplification
and education. She gives tirelessly and unselfishly. Julia Roskamp is truly an outstanding and
compassionate audiologist who exemplifies the best in our profession.
Known as a “dedicated and sincere Ambassador of Audiology,” The Academy is pleased to honor
Gregory Spirakis with the Humanitarian Award. Since the summer of 1997, Spirakis has
provided hearing services to the children in Moldova, a country located between the Ukraine and
Romania in the north central part of the former Soviet Union. Traveling to Balti that year, he was
able to test and fit 25 children with hearing aids. His work was the first humanitarian efforts ever
received by the residents of this Moldovan city. Following a 36-hour air trip and a 100 mile of road
travel, Spirakis with his colleague, Sybil Prewit, spent six days providing audiological services for
deaf and hard-of-hearing children in the region. When not seeing patients with hearing loss, he
taught Moldovan doctors how to order and fit hearing aids from German and Swiss manufacturers.
He continues to remain close to the people of Balti and he frequently corresponds to individuals in
the region to answer questions about hearing, hearing loss and hearing aids. In addition, he
continues to provide hearing aid batteries, earmolds and supplies. In May 2000, he returned to
Moldova with $50,000 in donated supplies, antibiotics and audiology equipment, and purchased a
building to provide for the hearing needs of the people that have touched his heart and soul. As a
result of his sustained efforts and contributions, Gregory Spirakas has made the world a better place
through global friendships and healthier children.
MARCH/APRIL 2002
AMERICAN
ACADEMY
OF
AUDIOLOGY •
C O N V E N T I O N
PHILADELPHIA
2 0 0 2
Amy Tan, Celebrated Author, to Address General Assembly!
Attendees at the 14th Annual Academy
Convention will be delighted to know
that one of the most highly acclaimed
writers of our time, Amy Tan, will be
the Keynote Speaker at the Opening
General Assembly in Philadelphia.
Tan is a beloved, best-selling novelist
whose works include The Joy Luck
Club, The Kitchen God’s Wife, A
Hundred Secret Senses, and two
children’s books.
AMY TAN, born in Oakland, California, was
reared by parents who immigrated to the United
States from China. Her family moved
constantly when she was a child eventually
settling in bustling Santa Clara, California. In a
recent speech, Tan revealed that the frequent
moves were difficult for her. “I moved every
year, so I was constantly adjusting…living in
my own imagination.” That imagination helped
her win an essay contest at the age of eight and
from that day on she dreamed of becoming a writer.
Surrounded by influences from both Chinese and American
culture, Tan has written about her difficulties assimilating
into the mainstream, American world as a child, often at
the expense of her Chinese heritage.
Amy Tan
Tan was educated at San Jose State University and the
University of California at Berkeley and went on to become
a consultant to programs for disabled children. Her novels
depict the tensions between mothers and daughters as well
as the relationship between Chinese American women and
their immigrant parents. Influenced by the style of
American author Louise Erdrich, Tan’s work has become
emblematic of other American works of fiction that give
particular attention to ethnicity, family history, and the
articulation of female voices.
Tan’s first novel, The Joy Luck Club, examines the
relationships between four Chinese-born women and their
American-born daughters. The critically acclaimed novel
became the longest running bestseller on the New York Times
34
AUDIOLOGY TODAY
bestseller list in 1989. The probing work has been translated
into over 20 languages, including Chinese, and was
transformed into an award-winning motion picture in 1993.
Tan’s second novel, The Kitchen God’s Wife, focuses on a
single mother-daughter relationship and describes the
mother’s efforts to survive in China before and during
World War II. Additional works by the acclaimed novelist
include the children’s books The Moon Lady and The
Chinese Siamese Cat and the novel The Hundred Secret
Senses. In Tan’s fourth novel, The Bonesetter’s Daughter,
a Chinese American woman traces her ailing mother’s past
through a bundle of writings she has found.
In addition to being a writer, Tan is a member of a “vintage
garage” rock ‘n roll band called The Rock Bottom
Remainders. Other members of the band include renowned
authors, Stephen King, Dave Barry, and creator of “The
Simpsons,” Matt Groening. The Academy expects a standing
room only crowd as we welcome Ms. Tan to the podium at the
14th Annual AAA Convention on Thursday, April 18 at 10 am.
MARCH/APRIL 2002
AMERICAN
ACADEMY
OF
AUDIOLOGY
C O N V E N T I O N
•
PHILADELPHIA
2 0 0 2
WHAT? You Wanna’ Be the CONVENTION PROGRAM CHAIR?
The Academy’s annual
The Philadelphia Convention is
convention is a monumental
practically around the corner and
event that is the largest
believe it or not, I feel great about
gathering of audiologists in the
what’s upcoming! We have a
world! As such, the convention
superb roster of courses and
must provide attendees with
events, and we are looking
cutting edge technology in its
forward to topping last year’s
amazing Exposition, and
Convention attendance!
world-class education at
Philadelphia is a fabulous venue
beginning, intermediate and
for this “history-in-the-making”
advanced levels to meet the
convention. I am proud of the
President Angela Loavenbruck and Philadelphia Convention
needs of audiologists in a
hard work that went into
Program Chair Barbara Packer discuss last minute details of The
variety of practice settings. The
Convention 2002, and am so
A
cademy’s 14th Annual Convention.
convention must also provide
satisfied with what promises to be
optimal settings for attendees to
the audiology event of the season!
my Convention Program Committee. These
network, to have meetings, and to just have
were people I had worked with over the years.
This has been an extremely rewarding
fun with old and new friends!
I asked audiologists to serve that I knew I
volunteer opportunity for me to serve my
could count on to meet deadlines and timelines profession and my audiology colleagues from
So, I am often asked how and why would a
as
well as be innovators, “good thinkers” and
busy audiologist take on the burden of
around the world. It is an experience that I
planners. I also realized that I needed to
Convention Program Chair? How does one
happily recommend to those members who
cultivate a strong relationship with The
organize, implement and manage this huge
are looking for a way to become involved
Academy national staff members in McLean,
commitment while maintaining a full-time
with The Academy. If you have questions,
VA. Our national convention staff group is
job, a more-than-full time family, and maybe
watch for me in the convention halls of
incredibly experienced, and I knew that they
even maintain one’s sanity???? There is
Philadelphia or feel free to write to me at
could always be counted on to assist me and
indeed a method behind this madness....
packerb@nova.edu.
to offer support and guidance.
I began the journey to Convention Program
Chair by working on as many sub-committees
EGISTRATION XPRESS
as possible related to convention planning. I
found it was helpful to learn about convention
Wednesday, April 17 only (12-6pm). Badge Holder/Ribbon Pickup Counters will be
from the best so, I volunteered at the State level conveniently located at the Marriott and Loews Hotels. If you pre-registered and received your badge
(at Florida Academy of Audiology and at
packet in the mail, you can pick up your badge holder and Convention materials and bypass the registration
Florida Speech-Language-Hearing
area at the Convention Center by redeeming your Convention Bag ticket at either of these hotels.
Association) committees. I then volunteered at
the National level — serving on the Local
Arrangements Committee and the Education
HUTTLE ERVICE
Committee. Over the past three years, I
Complimentary shuttle service will be provided from the official Convention hotels to the
chaired the Sub-Committees on Local
Pennsylvania Convention Center. Check the shuttle information signs in your hotel for schedules,
Arrangements, Featured Sessions, and
additional information, and frequency of service. Please contact The Academy’s Meetings
Research Poster and Podium Committees. I
Department at 1-800-222-2336 ext. 215 prior to your arrival in Philadelphia should you require
participated in numerous planning meetings
wheelchair accessible transportation.
and on many national telephone conference
calls. I went to many different conventions (in
and out of our field) and I observed what went
ECORDING
well, and what did not. I asked many questions
Unless otherwise noted, the Pre-Convention Workshops, General Assembly, Featured
and kept copious notes on the answers as well
Sessions, Instructional Courses and Research Podium Presentations offered at Convention 2002
as my observations of meetings.
will be recorded and for sale. An order form will be included with materials distributed in your
Convention
packets. Cost for the recordings will be $12 if purchased during Convention 2002 and
But, the most important thing before taking the
$13 if ordered by mail following the Convention. Inquiries should be referred to: Hour Recording
reins, was to assemble the very best people I
Company, P.O. Box 1299, St. Petersburg, FL 33731 (neil@hourrecording.com).
could to serve as Sub-Committee Chairs on
R
E
NEW!
S
S
R
VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
35
AMERICAN
ACADEMY
OF
AUDIOLOGY
C O N V E N T I O N
•
PHILADELPHIA
2 0 0 2
New Night and New Time!
Opening night reception to be held on Wednesday this year!
The 14th Annual Convention & Expo officially kicks off on
Wednesday night this year with the Opening Night Reception.
Attendees will have an opportunity to meet old friends and enjoy food
and libations in an atmosphere of cool jazz in the Grand Hall of the
Pennsylvania Convention Center. The Grand Hall and Ballroom
occupy the renovated Reading Terminal Train Shed, the oldest
surviving single-span arched train shed roof structure in the world,
and the only one of its kind remaining in the United States. Few
venues offer the colorful past of this historic setting.
In the 1880s and 1890s, great train terminals sprung up in many of
the nation’s large cities as the Industrial Revolution chugged on and
corporate competition grew. One manifestation of this corporate
rivalry was architectural braggadocio, a phenomenon in which giant
railroads were building magnificent palaces for their passenger trains,
their riders, and, most of all, their own corporate images.
In 1889, the Reading Railroad announced it would build a state-ofthe-art train shed in Philadelphia at 12th and Market Streets. The new
train shed promised to be the biggest of them all, fronted by a splendid
pink and white eight-story office building. Fortunately, after much
debate, it was decide that the markets currently occupying the same
location on which the railroad proposed to build its new terminal
would be purchased for one million dollars. The markets would be
relocated within the new train shed beneath the elevated rail tracks.
Reading’s new train shed would be different from all others in that it
had a gastronomic bazaar tucked away in its cellar.
The Reading Railroad Terminal opened in 1893. The exterior of
the building reflected the traditional construction materials of the
historic Philadelphia streetscape; internally, it combined state-of-theart-meeting facilities with a hotel-like ambiance. The eight-story
Reading Terminal Headhouse lodged the original administrative
offices, lobby, and ticket office of Reading Train Station. From 1893
until the Reading Train Station ceased operations in 1984, the station
served as a terminus for millions of commuters, shoppers and visitors
to Philadelphia.
In 1985, the train shed above the Market fell silent when the city’s
commuter-rail system was rerouted to bypass the terminal. After
several years of negotiations and false starts, the Pennsylvania
Convention Center Authority was created to convert the Reading
Terminal into a spectacular entranceway to the new Convention
Center. Philadelphians, with fire in their eyes, immediately demanded
assurances that the venerable gustatory jewel under the silent tracks
would be part of the rehabilitation plan for the building. It was agreed
and construction to revitalize the Market began in the early 1990’s.
The Reading Terminal Headhouse opened its doors as the
Pennsylvania Convention Center’s new entrance in February of 1998.
The renovation of the facility also preserved the Reading Terminal
Market on the ground level of the Train Shed, maintaining the
continuous use of that location as a market place since 1653. Located in
the heart of downtown Philadelphia, the marketplace makes this
Convention Center one of the few such major facilities actively
integrated into an urban center allowing visitors access to a host of
restaurants, shops, cultural institutions and other downtown amenities.
Attractions in Downtown Philadelphia
Independence National Historical Park:
The popular park includes the Visitors
Center, Liberty Bell, Independence Hall,
Congress Hall, Old City Hall, New Hall
Military Museum, Edgar Allen Poe National
Historical Site and other favorites. It is open
daily from 9 a.m. to 5 p.m. Admission is free.
Call 215-597-8974.
Betsy Ross House: The restored twostory colonial home is open Tuesday to
Sunday from 10 a.m. to 5 p.m. A $1
contribution is expected. Call 215-627-5343.
Fireman’s Hall: The restored 1903
firehouse, with original equipment from 1731
to 1907, is open Tuesday to Saturday from 9
a.m. to 5 p.m. Admission is free. Call 215923-1438.
Fairmount Park: The park includes the
Horticultural Center, Japanese House and
Gardens, and many authentic early-American
36
AUDIOLOGY TODAY
houses, including
Strawberry Mansion,
Belmont Mansion and Ohio
House. The park is open all
year, as are most of the
houses. Standard admission
is $2.50.
Franklin Institute
Science Museum: This
facility includes the Science
Center, Fels Planetarium,
Mandell Futures Center,
Tuttleman Omniverse
Theater and Benjamin
Franklin National
Memorial. The hours and
admission prices vary. Call
215-448-1200.
Academy of Natural Sciences
Museum: Exhibits include Outside-In, the
Dig, Spiders and Project
Dinosaur. The museum is
open weekdays from 10
a.m. to 4:30 p.m.;
weekends and holidays
from 10 a.m. to 5 p.m.
Admission is $6.50 adults
and $5.50 for children 3
to 12. Call 215-299-1000.
Philadelphia Museum
of Art. Founded in 1876,
the museum includes art
from Asia, Europe and
the U.S. It is open
Tuesday to Sunday from
10 a.m. to 5 p.m. (until
8:45 p.m. on Wednesday).
Admission is $7 for adults, and $4 for
children 5 to 17, students with IDs and
seniors. Call 215-763-8100.
MARCH/APRIL 2002
AMERICAN
ACADEMY OF
AUDIOLOGY •
C O N V E N T I O N
LUNCHEON PRESENTATIONS BY OUTSTANDING STUDENT RESEARCHERS
The Student Research Forum & Luncheon presents an excellent opportunity to explore the results
of extraordinary research projects completed by audiology graduate students. Each award recipient,
who will receive a $500 cash award from The Academy along with a plaque recognizing his or her
achievement, will discuss the results of their award-winning research. In addition to basking in the light
of exceptional research, participants will enjoy a complimentary lunch. Take the opportunity to hear the
best in audiology graduate student research and to interact with these students and their advisors by
attending the Student Research Forum and Luncheon on Friday, April 19th from 11:30am to 1:00pm.
Student Research Winner and Presenter: Rachael Frush
SR 101 Evaluating the Benefit of Directional Patterns in Hearing Aids
The investigator measured functional benefit from specific directional patterns
in listeners with hearing loss. Participants were fit with Starkey prototype digital
hearing aids using NAL-NL1 guidelines. Real-ear polar patterns for individual
listeners were measured, and individual differences reported. Participants
completed laboratory tests comparing the directional patterns in several real-world environments. The
research analyzed resulting differences in speech recognition, sound quality and listener preference.
Advisors: Dianne Von Tasell & Peggy Nelson
Student Research Winner and Presenter: Stephanie Leigh Adamovich
SR 102 Evaluation of Personal FM System Using the HINT
This study examined the sensitivity of the Hearing in Noise Test (HINT) to
changes in listener performance associated with the use of a personal FM
system. Sentence reception thresholds of 20 adult listeners with normal pure
tone thresholds were obtained using HINT procedures with and without a
personal FM system. Significant changes in HINT results were obtained when the FM system was
employed, suggesting that this test may be appropriate to evaluate FM system benefit
Advisors: James Dean & Ted Glattke
Student Research Winner and Presenter: M. Samantha Lewis
SR 103 Speech Perception in Noise: Directional Mics or FM Systems
The present investigation compared hearing aids in omnidirectional mode
(HA), hearing aids plus directional microphones (HA+DM), and hearing aids
coupled to Frequency Modulation (HA+FM) systems in improving speech
perception for individuals with sensorineural hearing loss. Speech perception was
assessed by HINT sentences, while multitalker babble served as the noise competition. Results
indicated that while all amplification systems improved speech perception, the HA+FM configuration
provided the greatest enhancement in speech perception.
Advisors: Michael Valente & Carl Crandell
Student Research Winner and Presenter: Nadine Anne Jacob
SR 401 An Age-Related Influence on Spatial Audiometry
Nadine Jacob explored whether the age-related decline in dichotic listening
reflects a reduction in spatial hearing. Older subjects were grouped according to
dichotic performance and compared to younger subjects on a virtual listening task.
Word recognition scores were obtained in noise at two signal-to-noise ratios.
Results showed a significant left ear performance reduction in older subjects with dichotic deficits.
Advisors: Brad Stach & Walter Green
Student Research Winner and Presenter: Saravanan Elangovan
SR 801 Endogenous vs. Exogenous Origins of Mismatch Negativity ERP
This industrious student investigated the relationship between the size of the
mismatch negativity response and the strength of neuronal refractory/recovery
effects in 12 adults. In tests where identical standard or deviant auditory stimuli
were presented either alone or in oddball stimulus sequences, both MMN and
refractory difference waveforms were derived from the N1 and P2 components of the EEG. A
significant correlation occurred between MMN size and neural refractoriness suggesting
contamination effects of refractoriness on the MMN.
Advisor: Jerry Cranford
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AUDIOLOGY TODAY
PHILADELPHIA
2 0 0 2
RESEARCH COMMITTEE SPONSORS
TWO FEATURED SESSIONS
The Research Committee has devoted
special attention to creating two Featured
Sessions that are designed to focus attention
on research that is essential for expanding the
scientific base of audiology. The first
session, Behavioral Measures &
Consequences of Cochlear Nonlinearity,
will be presented by Andrew Oxenham, an
acclaimed research scientist and principle
investigator at the Massachusetts Institute of
Technology. Oxenham holds a PhD in
Experimental Psychology from the
University of Cambridge in England and is a
faculty member of the Harvard-MIT Speech
and Hearing Sciences Program.
The special research presentation will
discuss the following:
Physiological studies have shown that
sound processing in the healthy cochlea is
highly nonlinear. In particular, quiet sounds
are amplified, while loud sounds are not.
This “dynamic compression” is lost when the
outer hair cells in the cochlea are damaged.
The perceptual effects of cochlear
compression and a loss thereof, in normal
and impaired hearing, will be reviewed.
Methods for estimating cochlear compression in humans using behavioral techniques
will also be discussed.
A second research presentation entitled
Effects of Dyslexia & ADHD on Auditory
Temporal Processing will be presented by
Lincoln Gray, celebrated scientist and
Professor and Director of Research at the
University of Texas Medical Center in
Houston. Gray received a dual PhD in
Neuroscience and Zoology from Michigan
State University.
The second research presentation will
confer the following information:
Significant deficits in auditory processing
in reading disabled (RD) children have been
found, but only in tasks involving rapidly
changing speech or speech-like sounds.
Comorbid attention deficit disorder (ADHD)
causes additional hearing deficits. The effects
of RD and ADHD on auditory processing
seem additive, and deficits in many takes are
only seen in children with both RD and
ADHD. The speaker will present research
that proves that ADHD also causes an
increase in false-alarm rates in the presence
of a distracting masker.
MARCH/APRIL 2002
AMERICAN
ACADEMY
OF
AUDIOLOGY
C O N V E N T I O N
Don’t Miss
• PHILADELPHIA
2 0 0 2
these events at the 14th Annual Convention!!
Unveiling of
Exposition 2002
The Grand Opening of the Exhibit Hall will
take place Thursday, April 18, at noon
immediately following the General
Assembly. With more than 200 companies
exhibiting, attendees will be introduced to
the newest innovations and technologies
designed to make your practice setting
operate more efficiently.
Exhibit Hall Hours:
Thursday, April 18 noon–6:00pm
Friday, April 19 10:00am–5:00pm
Saturday, April 20 10:00am–4:00pm
reception also provides a wonderful chance
to network and collaborate with colleagues
who work in a variety of practice settings
around the globe. In addition, partakers can
seize the opportunity to get acquainted with
Student Volunteer
Orientation
It takes the efforts of hundreds of
volunteers to make The Academy’s
Convention a success. Once again this year,
over 300 student volunteers from around the
country are expected to contribute a few free
hours of their time to participate in the
Student Volunteer Program. In exchange for
helping with Convention, volunteers receive
complimentary registration to the 14th
Annual Convention & Expo. All Student
Volunteers are required to be in Philadelphia
to attend the Student Volunteer Orientation
that will be held on Wednesday, April 17
from 5-6pm. Following the completion of
the orientation, convention-goers can partyon at the Opening Night Reception that
immediately follows.
Academy International
Reception
Convention attendees are in for a treat
when they attend the International Reception
at the Marriott Hotel on Thursday evening.
What a fabulous opportunity to get to know
colleagues visiting from abroad! The
VOLUME 14, NUMBER 2
the leadership of the American Academy of
Audiology. This year, the International Award
recipient will be honored during the reception
and will make a few brief remarks that are
certain to inspire enthusiastic attendees.
Services at 800-776-4500 or e-mail
cgroetsch@siemens-hearing.com.
Open Houses
For the second year in a row, several
universities will use Saturday night from
6:30-8:30pm to invite students and alums to
mingle with professors and administrators.
The Academy initiated the Open House
concept last year and the overwhelming
success of the affair created another
Convention tradition. Last year’s event was
so successful that the Academy has invited
state organizations to participate this year.
Enjoy a great ending to the Convention by
attending a party sponsored by your alma
mater or state organization and revel in the
company and stimulating conversation of
current and former schoolmates and
colleagues. Check your final program for
room locations.
Trivia Bowl and
Reception
Participants certainly will want to make
room in their busy Convention schedules to
attend the Trivia Bowl on Saturday, April 20
from 4:30-6:30pm. Each year, seasoned
veterans, practitioners and researchers vie
for the title of Trivia Bowl Champs. The
battles can become quite ruthless! Get some
friends together and start a team of your
own this year, and challenge your memory
and your knowledge while joining colleagues
for drinks and hors d’oeuvres. The overwhelmingly successful student category will
once again be offered allowing students to
compete against each other. The kings of
trivia, Jerry Northern and Gus Mueller, will
serve as hosts for this fun-filled event! For
more info, contact Siemens Marketing
AUDIOLOGY TODAY
39
AMERICAN
ACADEMY
OF
AUDIOLOGY •
C O N V E N T I O N
STOP
Don’t pass the
Academy Center
/Check Us Out!
Check out The Academy Center for the
latest and greatest Academy products and
Convention gear. This is where you’ll find
interactive marketing tools, educational
products, and special Convention 2002
souvenirs to add to your collection. Remember to save plenty of room in your suitcase!
This year, The Academy Center will also
include the following organizations:
AAA Foundation
Once again, the AAA Foundation will be
raising funds for the “Enable and Assist”
program. This program proves funding for
practicing audiologists who wish to return to
school to obtain a doctorate degree. The
“Enable and Assist” program also provides
scholarships, grants and low-interest loans
to qualified audiologists enrolled in
accredited doctoral programs. In addition to
the booth, the AAA Foundation will be
auctioning some fantastic items at The
Academy Honors reception on Thursday
evening.
International &
Diversity Center
The International and Diversity Center is
a place for international visitors to have their
questions answered. All audiologists can
pick up translated literature, find out about
upcoming events to be held abroad, and
obtain application forms for The Academy
Research/Humanitarian Grant and AuD
scholarships for culturally and linguistically
diverse populations.
American Academy
of Audiology PAC
The AAA-Political Action Committee
(PAC) assures members that their voices
will be heard and represented in
Washington, D.C. The Academy’s political
resources are used solely to increase
awareness and to promote the audiology
profession. In the past year, the AAA-PAC
has made historic progress in the
recognition of our profession. Please stop
by, pick up a poster with each donation, and
help advance our cause. Your support is an
investment in your future!
PHILADELPHIA
2 0 0 2
National Association
of Future Doctors of
Audiology (NAFDA)
NAFDA is a professional student organization
dedicated to the advancement of education
and technology training in the profession of
Audiology. NAFDA supports and promotes the
AuD degree as providing the standard of
education needed to prepare audiologists for
the changing health care system. NAFDA
provides assistance to students involved in a
variety of research and outreach endeavors.
American Board of
Audiology (ABA)
Board Certification in Audiology —
The profes sional crede ntial
administered by audiologists for
audiologists. You can submit your
application for ABA Certification at the
ABA booth in The Academy Center.
The Board has waived the $75
application fee through July 4, 2002.
Take advantage of this special
discount today!
President Angela Loavenbruck Invites Audiologists to
Make History in Philadelphia!
THE WORD IS OUT...
Philadelphia is the place to be in 2002!
That’s great news for the 7,000 audiologists
we expect to see at the American Academy
of Audiology’s 14th Annual Convention &
Expo, April 17–20 at the Pennsylvania
Convention Center. I hope you’re planning to
be one of them.
At Convention 2002, you’ll be
learning about new audiology research,
seeing the latest in hearing technology,
and catching up with colleagues, both
old and new. Be sure to join us for
cutting edge Featured Sessions on such
41
AUDIOLOGY TODAY
topics as genetic hearing loss and hair
cell regeneration. Join us for hundreds
of educational sessions, a new focus on
consumers and an exhibit hall that will
take your breath away.
Philadelphia offers a fabulous
backdrop for Convention 2002. Within a
day’s drive for 40% of the country’s
population, Philadelphia brings together
history, health care and higher education
in an unforgettable style all its own. The
Pennsylvania Convention Center, with its
historically certified Reading Terminal
Train Station, is one of the finest meeting
spaces in all of America. The Liberty Bell
and Independence Hall will motivate you
as you walk the streets of our Founding
Fathers. The restaurants will delight, the
shops will inspire, and the nightlife will
dazzle. From cutting edge culture to
cobblestone streets, The City of Brotherly
Love offers something for everyone. (If
you want to see for yourself, just visit the
Philadelphia Convention & Visitors Bureau
Web site www.pcvg.org.)
So what are you waiting for? Join us
in Philadelphia for the American
Academy of Audiology’s 14th Annual
Convention & Expo...and you’ll be part of
“History in the Making.”
MARCH/APRIL 2002
AMERICAN
ACADEMY
OF
AUDIOLOGY •
C O N V E N T I O N
PHILADELPHIA
2 0 0 2
It’s not too late – Sign up for a Pre-Convention Seminar!
Once again, the 14 th Annual Academy
Convention will offer a plethora of
educational opportunities for
audiologists of all ages in all practice
settings. Wednesday has been set aside
by the Program Committee as a day to
expand the Convention by allowing
attendees an opportunity to derive
additional educational information
organized by the Education Committee.
Participants can spend an entire day or
part of a day discovering fresh insights
into the latest developments in the field
of audiology. Space is limited for these
exceptional courses. Those intending to
participate should register online at
www.audiology.org before traveling to
the Convention.
Wednesday, April 17, 8:30am–12:30pm
Exceptional Customer Service = $$$
Experienced practitioners Holly
Hosford-Dunn, Gyl Kasewurm and
Frank Butts will present this thoughtprovoking seminar on customer service.
Excellence in customer service is the
hallmark of business success and can be
the key differentiator between
competitors in any field. When a
company’s service is exceptional,
customers are more likely to perceive
benefit and to spread favorable word-ofmouth impressions. But what exactly is
exceptional service? The presenters will
discuss a model for creating a team
approach to customer service and will
provide information on portraying
exceptional customer service through
advertising and marketing efforts. In
addition, the presentation will provide
practical insight into ensuring that
exceptional customer service touches the
heart of the business and remains the
highest priority for the practice and staff.
Wednesday, April 17, 1:30pm–5:30pm
Achieving Optimal Reimbursement
Presenters Paul Pessis and Alan
Freint are sure to stimulate interest in
this topic. By far, the biggest hurdle that
practicing audiologists face is keeping
abreast of changes in reimbursement,
legislation and insurance coding. At
VOLUME 14, NUMBER 2
frequent intervals, rules and regulations
are revised, potentially impacting our
daily lives. Since there is no publication
that summarizes this information, this
workshop will distill the various items
into a workable course. The intent of
this seminar is to bring to the forefront
the most important and pressing aspects
of the challenges day-to-day audiology.
The seminar will examine Medicare
Provider status rules of proper billing;
ICD-9 coding; Specificity insurance and
reimbursement; Establishing a fee
structure; Interpretation of Explanation
of Benefit statements; Maximizing
payments; Electronic billing and other
informative topics.
Wednesday, April 17, 9:00am–5:00pm
Diagnosis and Intervention for Infants
with Hearing Loss
As Universal Newborn Hearing
Screening Programs become a reality in
many states, audiologists are realizing a
need to re-tool and update their practice
skills. Experts from health centers and
universities across the country including
Wendy Hanks, Patricia Chute, Allan
Diefendorf, Michael Gorga, Vishakha
Rawool and Jackson Roush will provide
a full day of education in physiologic
and behavioral assessment approaches,
amplification tactics including assistive
devices and cochlear implants, and
family-centered counseling approaches.
The morning session will focus on
physiologic and behavioral assessment
by providing information on family
counseling and protocols for diagnostic
use of Auditory Brainstem Response and
Steady State Evoked Potentials,
behavioral assessment techniques for
infants, and counseling families of
newly identified children. The afternoon
session will emphasize protocols for
providing optimal amplification and
validating the appropriateness of
amplification for infants. This course is
intended for a range of attendees,
including beginners and novices.
Audiology Higher Education: From
Student Recruitment to Accreditation
Co-sponsored by the Council of AuD
Program (CAuDP)
This session, presented by Robert
Sevier and Karen Kershenstein, will
spotlight emerging trends that can
impact a University’s ability to recruit
students, raise dollars, and market our
training programs. The first part of the
program (90 minutes) is on the creation
of an integrated marketing strategy. The
second half of the morning (90 minutes)
is designed to focus on developing a
brand to attract students and donors to
the profession and our respective
university programs. In addition, a
panel of leaders in audiology professional education will be assembled to
discuss emerging issues for education.
Audience participation will be encouraged. The discussion will include State
licensure issues; The fourth year of
training; Recognition of Doctor of
Audiology as a first professional degree;
Preserving the integrity of the research
doctorate; and Emerging issues related
to audiology education.
Vestibular Grand Rounds: Diagnostic
and Treatment Challenges
Dizzy-gurus Richard Gans and Gary
Jacobson will discuss the diagnosis and
treatment of vestibular and balance
disorders. Audiologists who wish to
advance their knowledge base and
pursue vestibular and balance specialization, particularly with challenging
patients, should find this workshop
highly beneficial. A Grand Rounds
format will be used to present a variety
of interesting and challenging cases
with children and adults. Background
information, descriptions and explanations will be presented. Although
balance disorders affect individuals
throughout the lifespan, dizziness is the
most common complaint of persons
over the age of 70. The purpose of this
segment of the presentation will be to
describe the epidemiology of falls in the
elderly, endogenous and exogenous risk
factors associated with falls, assessment
tools and intervention methods.
AUDIOLOGY TODAY
43
WA S H I N G T ON WAT C H
DIRECT ACCESS FOR MEDICARE BENEFICIARIES
s you know, AAA and The Academy of
Dispensing Audiologists (ADA) have been
urging the Centers for Medicare & Medicaid
Services (CMS) to eliminate Medicare’s physician
referral requirement for audiologic diagnostic tests.
Such a change would allow Medicare beneficiaries to
go directly to an audiologist for hearing and balance
tests. In the past, CMS has raised three concerns
about permitting Medicare beneficiaries direct access
to audiologists: (1) CMS has stated that it may lack
statutory authority to make this change; (2) CMS has
expressed concerns about the impact of direct access
on patient care; and (3) CMS has raised concerns that
eliminating the physician referral requirement might
lead to over-utilization of audiology services and
increase costs to the Medicare program.
While AAA and ADA have not received an answer from CMS,
these recent developments bring us one step closer.
METAWORKSREPORT FINDINGINSUFFICIENT DATA REGARDING
A
CMS DECLINES TO INITIATE A NATIONAL
COVERAGE DECISIONREVIEW PROCESS
As last reported, AAA and ADA had formally
requested that CMS initiate a National Coverage
Decision to allow Medicare beneficiaries direct access
to audiologists for diagnostic tests. By letter dated
January 11, 2002, CMS declined to do so. The
reasons for this decision were: (1) the physician
referral requirement is embodied in a regulation (42
C.F.R. § 410.32) and eliminating the requirement
would require notice-and-comment rulemaking to
amend that regulation; and (2) the physician referral
requirement is needed to ensure that diagnostic tests
are medically necessary.
While not what we had hoped for, the CMS response does contain
some positive elements. First, the letter implies that CMS has the
statutory authority to allow direct access. By stating that the
physician referral requirement can be eliminated by amending its
regulations, CMS is effectively saying that such a change would not
require legislation. In addition, the letter suggests that CMS’ main
reason for not moving forward with direct access has more to do with
cost concerns than patient care concerns. The letter characterizes the
physician referral requirement as a way to ensure that audiology tests
are medically necessary and not “screening.” (If you have any data
showing that other health insurers that already allow direct access to
audiologists for diagnostic testing have not experienced overutilization, please share it with The Academy.)
The decision on direct access now goes to CMS’ Center for
Medicare Management (CMM). AAA will check on the status of the
issue and will push to receive a final decision as soon as possible. An
answer from CMS, even an unfavorable one, would be helpful,
because it would allow us to move forward by raising this issue at a
higher level
In other news, CMS has delayed the effective date for the 2002
Medicare payment rates for hospital outpatient services. The new
2002 rates will go into effect at an unspecified date but no later than
April 1, 2002. In the meantime, CMS will pay hospitals for outpatient
services using the payment rates in effect on December 31, 2001.
CMS also has clarified that audiology graduate students (i.e., AuD
graduate students in their fourth year) may participate in providing
services to Medicare Part B beneficiaries, provided a qualified
audiologist is in the room for the entire session, directs the services,
is not engaged in treating another patient or doing other tasks at the
same time, is responsible for the assessment/treatment of the patient,
is recognized by the beneficiary as the responsible professional, and
signs all documentation.
Marshall Matz
CLINICAL OUTCOMES OF PATIENTS WHO SEE AN AUDIOLOGIST
WITHOUT A PHYSICIAN REFERRAL
Last year, CMS referred the direct access issue to its sister agency,
the Agency for Healthcare Research and Quality (AHRQ), and AHRQ
in turn referred the issue to MetaWorks, one of its Evidence-based
Practice Centers. MetaWorks was given a narrow charge: review the
recent literature (January 1, 1996 - August 1, 2001) for reliable studies
regarding health outcomes for patients with hearing loss or dizziness
who see an audiologist without being first examined by a physician.
MetaWorks’ report concludes that the existing literature does “not
provide any direct evidence or clinical trial data addressing the
clinical outcomes of patients who see audiologists for preliminary
evaluation of hearing loss or dizziness…” In other words, the
literature is too limited to draw any conclusions regarding the clinical
impact of direct access. The report, however, expresses some doubts
about allowing patients complaining of dizziness to see an audiologist
first. According to the report, it is “essential that practitioners who
evaluate patients with dizziness rule out the rare but critical
diagnoses” of potentially life-threatening conditions (e.g., ischemic
heart disease, cardiac arrhythmias). However, MetaWorks was not
certain that audiology students receive instruction and experience in
ruling out life-threatening causes of dizziness. In addition, according
to the report, the “vast majority of patients with dizziness do not
require audiological examination.”
The report’s inconclusive conclusion is not a surprise. AAA was
aware of the lack of literature on this issue. Nevertheless, AAA feels
that CMS is unlikely to argue that direct access to audiologists
compromises patient care when it is already permitted by the Veterans
Administration, the Federal Employees Health Benefit Program, and
many private health plans.
Submitted by Marshall L. Matz, Esq., and Robert Hahn, Esq., Olsson, Frank and Weeda, PC, Washington, DC and Craig Johnson, AAA
Governmental Affairs Chair, Baltimore, MD
VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
45
THE AUDIOLOGY MATCHING PROGRAM
FOR AuD STUDENTS
Ian Windmill,
Louisville, KY;
A skills validation study completed by
ASHA in 1995 highlighted the differing
perspectives of university programs and
practicing audiologists in terms of the
necessary knowledge and skills a student
should possess at graduation. This study
found the academic and experiential priorities
established by universities for their graduates
did not match the priorities of practicing
audiologists. These results served to validate
the long-standing criticism of university
programs regarding their ability to prepare
students to meet the demands of contemporary audiologic practice. The advent of the
AuD degree programs and the transition of
audiology to a doctoring profession has
provided academic programs with the
opportunity to rethink academic training
including the clinical experience afforded
students. Taking advantage of this opportunity, clinical audiologists and university
programs have joined to create the Audiology
Matching Program (AMP). The AMP is a
national program that “matches” 4th-year
students from university programs to
dynamic clinical sites who have a declared
commitment to the education of audiology
students. In this manner the universities and
clinical sites undertake a joint responsibility
for education and training of the next
generation of audiologists
THE EXTERNSHIP EXPERIENCE
The fourth year of an AuD program is
generally held to be a full-time clinical
experience and students are required to
spend the majority of their time in patient
care activities. Many universities are unable
to provide the volume of patient care
activities this would require, and therefore
must rely on external sites to provide this
training. The AMP is a method to facilitate
this link, particularly with sites distance to the
university. As this program will utilize clinical
sites external to the university and prior to
graduation, the term “externship” has been
adopted as the appropriate descriptor of this
program, although clinical sites will be free to
use appropriate related terms, e.g. intern,
resident, etc., as descriptors.
The externship experience is intended to
provide the student with a broad based
clinical experience in the diagnosis,
treatment, management and prevention of
hearing loss. Examples of a broad based
experience include exposure to areas such as
diagnostic audiology, amplification, cochlear
implants, pediatric audiology, counseling,
46
AUDIOLOGY TODAY
Barry Freeman, Ft. Lauderdale, FL; and patricia kricos, Gainsville, fl
assessment and management of vestibular
disorders, educational audiology, audiologic
treatment, auditory processing disorders, etc.
Few sites may be able to provide the entire
set of experiences necessary to embrace all
these areas, however, sites should be able to
provide some significant degree of diversity.
Moreover, an externship site does not have to
be defined narrowly as a single clinical entity.
The externship experience may be provided
at a single site, multiple sites, or in a
consortium arrangement.
THE MATCHING PROCESS
A matching program provides a
systematic and fair process to help students
obtain externships in a clinical location of
their choice, and to help clinical locations
obtain students who complement their
practice. The most common use of matching
occurs in medicine whereby students
graduating from medical school are
“matched” to residency training sites. Oneyear prior to the beginning of their 4th year,
AuD students will be provided with a listing
of all participating externship sites in the
country. This listing will include the practice
location and type, the staff, types of patients
served, affiliated sites, salary and benefits,
etc. Approximately nine months prior to the
externship, students will begin to apply
directly to the externship sites they feel meet
their educational needs or professional
direction. Externship locations will interview
and evaluate each applicant according to their
particular standards and/or needs. After the
completion of the interview process, both
students and the clinical sites will submit
confidential “ranking” of their preferences.
A computer program will then match the
students to clinical sites based entirely on the
preferences of each as stated in the
submitted rankings. The result is that each
student is placed with the most preferred
externship locations that also ranked the
student, but who did not fill their positions
with more preferred applicants. Conversely,
the clinical sites are matched with their most
preferred students who did not match to
other sites. The matching process uses the
rank ordering of preferences by both the
student and the clinical sites, with an
algorithm that sorts through the myriad of
possibilities to match student preferences of
specific clinical sites to the sites preferences
of specific students.
Because the AMP is a national program,
all participating universities will be linked to
every participating externship site. Doctor of
Audiology students from any university may
participate in the program.
CRITERIA FOR CLINICAL SITES
While similarities between the externship
experience and the Clinical Fellowship Year
may be obvious, several important distinctions
can be made. First, the CFY was a postgraduate experience where the externship is
an experience obtained prior to graduation. A
second distinction is the rationale behind the
experience. The CFY experience assured the
opportunity for professional guidance that was
at the discretion of the graduate and
supervisor. The externship program requires
that clinical sites have specific educational
components, supervision by on-site
professionals, and a relationship with the
student’s university program. Finally, the
externship experience will utilize a computerbased process to facilitate the matching of the
students to the sites, negating the need for
clinical sites to commit resources to
advertising, recruiting and hiring.
COMMITMENTS
Successful implementation of the AMP
will require a unique and daring commitment
from universities, students and host clinical
sites. Universities will have to buy into a
program that is coordinated on a national
level rather than a local level, and thus will
have to relinquish some control over student
placement. Universities must also understand
that not all students will be matched in the
program, and that the responsibility for 4th
year training still resides within the university
program should this occur.
Clinical sites must commit to the idea of
accepting and training students as much as a
year in advance of the match. Clinical
experiences, benefits and educational
commitments must be met. In addition,
there is no guarantee of matching a student
to site, yet the site must still be a committed
participant in advance.
Students who commit to the matching
program must agree to accept the will of the
computer match otherwise the process
becomes superfluous. Other students who
were desirous of a particular site would be
denied the opportunity, and sites that
counted on having a particular student would
also be denied important opportunities.
BENEFITS
Universities must expend valuable yet
shrinking resources in locating, evaluating
MARCH/APRIL 2002
THE AUDIOLOGY MATCHING PROGRAM
FOR AuD STUDENTS
and negotiating sites that can meet the needs
of 4th year students. As every AuD program
must provide this experience, the total dollars
expended across the country in this endeavor
is substantial. The AMP will provide a means
of developing a national listing of clinical
sites that meet criteria for educational
experiences, thereby reducing the costs to
individual universities.
These same benefits will accrue to clinical
sites participating in the externship program.
Externship hosts can fill personnel needs
while keeping costs low. Compared to
students completing a master’s degree, AuD
students will bring a more substantive
knowledge base, a greater range of clinical
skills, and more overall experience into the
4th year. This should be of practical benefit to
the clinical site both in terms of a reduction
in time necessary to “train” the new
employee as well as in the overall financial
return to the practice.
The audiology matching program is the
result of a collaborative effort between
university programs, audiology practice sites
and professional organizations which
collectively have recognized the need to work
jointly in assuring not only the appropriate
evolution of the profession, but also in
assuring the integrity of the educational
process. The Audiology Matching Program
(AMP) provides a process by which 4th year
audiology students can obtain positions in
dynamic clinical environments to complete
the experiential component of their training.
The AMP presents a unique and dynamic
opportunity to further enhance the training of
students as well as strengthen the
relationship between universities and
audiologic practices.
If you would like to consider being an
externship site and participate in the
Audiology Matching Program, contact one of
the individuals listed below, the American
Academy of Audiology, or attend the Round
Table discussion of the program at the 2002
Convention in Philadelphia.
Ian Windmill, imwind01@louisville.edu
Barry Freeman,freemanb@fcae.nova.edu
Pat Kricos, pkricos@csd.ufl.edu
Ross Roeser, roeser@callier.utdalla.edu
Deborah Carlson, dlcarlso@utmb.edu
David Fabry, fabry.david@mayo.edu
VOLUME 14, NUMBER 2
Criteria for AuD Externship Sites
The following represent general criteria that clinical sites must meet in order to be
considered as a participant in the AuD Audiology Matching Program. These are preliminary
criteria and more substantive criteria will evolve as the matching program matures. These
criteria were developed by a panel of university faculty and practicing audiologists.
The audiology externship is an organized clinical training program that, in contrast
to supervised experience or on-the-job training, is designed to provide the intern with a
planned, programmed sequence of training experiences. Clinical sites must recognize
that a fundamental focus and purpose of the externship is assuring breadth and quality
of training.
• The externship site has a clearly designated licensed, certified and/or registered
audiologist who is responsible for the integrity and quality of the training experience
and has a contractual employment agreement with the agency to be present at the
training facility for a minimum of 20 hours a week.
• Extern supervision is provided by staff members of the externship agency or by
qualified affiliates of that agency who carry full responsibility for the cases being
supervised. Supervisors need to be clearly designated by the agency as clinically
responsible for all patient care activity. Facilities and supervisors must be in
compliance to all federal and/or state laws and regulations regarding supervision of
students.
• Training sites must be willing to sign the respective affiliation agreement of the
academic program of the matched student.
• The externship experience must provide a broad based clinical experience in diagnosis,
management, treatment and prevention of hearing loss across a variety of patient
populations for each extern.
• Institutions offering an audiology externship programs must provide facilities and
equipment adequate to permit achievement of program objectives.
• A significant majority of the student’s time in the externship program should be
devoted to the direct delivery of hearing health care which includes preparation, patient
contact, report writing, and associated activities related to the care of a patient.
• The externship must include didactic activities such as case conferences, seminars, inservice training, or grand rounds.
• The internship level audiology trainees may have a title such as “intern,” “resident,”
“fellow,” or other designation of trainee status.
• Externship programs must make available descriptions of their training program that
give their applicants and interns a clear understanding of the program in terms of the
program’s training goals and objectives, training methods, content, and curriculum,
training resources, and the sites at which training and services are provided. For
programs with multiple sites, clear descriptions are given for each site of services
rendered by externs, supervision offered, and involvement of the training director.
• Internship programs have documented due process procedures, including notice,
hearing, and appeal for externs. These procedures are given to externs at the beginning
of the training period.
• The externship should be a minimum of 1500 hours and must be completed in no
more than 12 months. The 1500 hours must be in activities directly related to patient
care, but is not restricted to face-to-face contact with patients.
• Externship sites must agree to conform to all requirements regarding the necessity to
evaluate the extern in a manner prescribed.
• Externship sites are required to issue a certificate of externship completion to all
externs, which includes the word “audiology,” who successfully complete the program.
AUDIOLOGY TODAY
47
INTEGRATED ORAL DEAF EDUCATION APPROACH:
NEW CHALLENGES, NEW REWARDS, BETTER OUTCOMES
Linda Dye,
Audiologist and Director of the CCHAT Center-San Diego
A large and growing body of research demonstrates what oral
deaf educators at OPTION Schools such as the CCHAT Center-San
Diego see every day: with early identification, today’s advanced
technologies, and intensive early education, it’s possible for even
profoundly deaf children to learn to listen and talk in step with their
normal-hearing peers.
At OPTION Schools, a nationwide network of private schools
that specialize in the auditory-oral deaf education approach,
audiologists are an essential part of the team that helps children
maximize auditory and speech potential, with the goal of preparing
them for mainstream education as early as possible.
As part of a team, the educational audiologist not only fits hearing
aids and sets cochlear implants for very young children, but also
offers a much wider range of services, including aural habilitation
and parent counseling.
INFANTS ANDIMPLANTS
Where educational audiologists were once primarily in the
business of helping toddlers play catch up, today we meet most
patients as infants, and are able to guide them through a normal
sequence of language acquisition. It’s a profound shift in emphasis,
and one that demands new skills and insights. Even core tasks, such
as fitting hearing aids, require new testing protocols, observational
techniques, and hearing technologies when we’re dealing with a
young infant rather than a two- or three-year-old child.
In addition, cochlear implants have become much more common
among our tiny patients over the past few years. We now usually
know by the time a child is a year old whether a cochlear implant is
an appropriate choice. Where perhaps ten percent of our students at
CCHAT would have had implants ten years ago, at least half do
today. Other schools report even higher percentages, and the trend is
clearly that we’ll be seeing even more and even younger children
with implants soon.
Managing cochlear implants for very young children presents a
whole host of new challenges. Among these is setting levels for
patients whose ability to participate effectively and whose verbal
communication skills are virtually nonexistent. This is just one of
many times that we find it very helpful to have the audiologist be a
part of the child’s educational program. When child and audiologist
are familiar with each other, it’s easier to get an accurate read
because the child’s behavior is not colored by stranger anxiety or the
excitement of a new place, and the audiologist, familiar with the
child, can see and interpret subtle cues.
Perhaps most critical, having access to an audiologist who is on
the team and accessible means that adjustments to the child’s implant
can be made “on the fly” for continuous, consistent access to soundalways the most important goal.
development can change week by week and their communication skills
are so rudimentary that it’s important that everyone on the team is
observing and agreeing on what we’re seeing.
EDUCATING THE ADULTS
The team audiologist may also spend a great deal of time working
with parents. Few parents are familiar with hearing loss or the available
technologies when their child’s hearing loss is first diagnosed. They
need a lot of reliable information very quickly, and also time to absorb
it, especially as they may be going through the stages of grief.
As the child prepares to leave the OPTION School and enter a world
where most adults lack even basic information about hearing loss, we
also need to prepare mainstream schoolteachers. They need and want
to hear about hearing loss, the issues that arise when a child is trying to
hear over noise or distance, and ways to overcome these obstacles.
It’s an exciting time to be in educational audiology. For the first time
in history, we are able to give deaf and hard-of-hearing children their
linguistic birthright-to use the infinite plasticity of their infant brains to
build a lifetime of communication skills. The advances of recent years
make our jobs more complex, but infinitely richer-and I am only eager
to see what the next decade brings.
For more information on oral deaf education and OPTION Schools,
call toll-free 1-877-ORALDEAF (1-877-672-5332), or visit
www.oraldeafed.org.
A SEAMLESSCOLLABORATION
At CCHAT, I have worked one-on-one with children to improve
listening and speaking skills, work that historically has been outside
the scope of an audiologist. I find habilitation is a terrific tool for
getting to know the child and observing his or her hearing in action,
even though it’s an area usually reserved for teachers and speech
pathologists. And while I contribute to work that is usually the
exclusive purview of teachers and speech pathologists, they (as well
as parents) provide me with observations that can be critical in
setting hearing aids or cochlear implants. Children’s auditory
VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
48
A
M O M E N T
O F
S C I E N C E
BEYOND THE EAR — CENTRAL AUDITORY PLASTICITY
Kelly Tremblay and Lisa Cunningham, UNIVERSITY OF WASHINGTON, Seattle, WA
In the previous Audiology Today issue we
reported that cochlear hearing loss affects the
central auditory system. In this issue, we describe
how auditory evoked potentials are being used to
examine neural plasticity in humans. “Neural
plasticity” is a term used to describe a variety of
alterations in the physiological and anatomical
properties of neurons in the brain in association
with sensory deprivation or sensory stimulation. In
non-human species, changes in central auditory
function are examined by direct recordings from
various structures along the auditory pathway.
These techniques are invasive and inappropriate for
studying comparable changes in the human
auditory system. Fortunately, auditory evoked
potentials have emerged as non-invasive tools for
assessing neural plasticity in humans.
Recently, Ponton et al. (2001) used the N1-P2
complex to study the central effects of profound
unilateral deafness. The N1-P2 is a late cortical
response that is seen as a negative peak around
100 ms followed by a positive peak approaching
200 ms following stimulus onset (for a review see
Hyde, 1997). This response can be recorded
quickly and reliably in most clinical settings.
Typically, N1 and P2 responses are larger in
amplitude when measured over the hemisphere
contralateral to the ear of stimulation. However,
when patients experience profound unilateral
deafness as a result of acoustic neuroma
removal, or other otologic disorders, the typical
asymmetrical response is altered. Specifically, an
increase in N1 amplitude ipsilateral to the intact
ear is observed. Ponton et al. speculate that
increased neural activity ipsilateral to the normalhearing ear may have a compensatory purpose.
Future studies are planned to determine whether
these changes in neural activity correlate with the
behavioral ability to localize sound.
The N1-P2 complex also reflects stimulationrelated changes in neural activity. Tremblay et al.
(2001) trained young normal-hearing listeners to
identify novel speech sounds. As perception
improved, N1-P2 peak-to-peak amplitude
increased. These changes in waveform
morphology are thought to reflect increases in
neural synchrony as well as strengthened neural
connections associated with improved speech
perception. Because previous electrophysiological
studies showed changes in neural activity prior to
improvements in speech perception (Tremblay et al.
1998), the N1-P2 complex maybe used to help guide
clinicians when designing rehabilitation programs.
In fact, numerous studies are studying traininginduced physiological changes in children with
specific language impairment and people who use
cochlear implants. In addition, the N1-P2 complex
is being used to study the effects of auditory
deprivation and auditory stimulation on the
maturing auditory system.
BIBLIOGRAPHY
Hyde, M. (1997) The N1 response and its applications. Audiol Neurootol.
Sep-Oct;2(5):281-307
Ponton CW, Vasama JP, Tremblay K, Khosla D, Kwong B, Don M.(2001).
Plasticity in the adult human central auditory system: evidence from
late-onset profound unilateral deafness. Hear Res. Apr;154(1-2):32-44.
Tremblay K, Kraus N, McGee T, Ponton C, Otis B. (2001). Central auditory
plasticity: changes in the N1-P2 complex after speech-sound training.
Ear Hear. Apr;22(2):79-90.
Tremblay K, Kraus N, McGee T. (1998). The time course of auditory
perceptual learning: neurophysiological changes during speech-sound
training. Neuroreport. Nov 16;9(16):3557-60.
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49
AUDIOLOGY TODAY
JOIN IN A NEW ADVENTURE
ASSISTANT /ASSOCIATE PROFESSOR
Department of
Communication Science and Disorders
Preferred qualifications: PhD or AuD, CCC-A, broad clinical
experience, teaching experience, and >2 years experience in
clinical supervision.
Primary responsibilities: coordination of development and
implementation of clinical internships and direct supervision
in Pitt’s new AuD training program (starting Fall 2002).
Opportunities for teaching or clinical research are also robust.
The Department is situated in a progressive school of the
health professions, an integral part of the nationally acclaimed
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(an affirmative action, equal-opportunity employer). Twelvemonth contract. For more detailed information and/or to
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þ Create a confidential, online resume
þ Search categories specific to the audiology profession
þ Sign up for “Search Agents” that will notify you via
e-mail when new opportunities are posted that meet
your criteria
And it’s free…. Whether you’re a recent grad or a seasoned professional,
www.audiology.org/hearcareers can really make your search take off.
HearCareers…Real Audiology Jobs. Right
Now.www.audiology.org/hearcareers
Kick your audiology job search into high gear with HearCareers!
ASSISTANT/ASSOCIATE PROFESSOR OF AUDIOLOGY
Announcing a full time, tenure-track or non-tenured position, depending on
qualifications and interests of candidate, in the Department of
Communication Sciences & Disorders, School of Allied Health Sciences, East
Carolina University, Greenville, NC. This position is to be an integral part of a
clinical audiology concentration within the doctoral program. Successful
candidate’s qualifications include: 1) an earned PhD in audiology or the AuD
degree; 2) evidence of or potential for excellence in teaching in at least one of
the following or related areas; behavioral audiological assessment,
amplification, vestibular assessment and management, or aural
rehabilitation/cochlear implants; 3) CCC-A and eligible for North Carolina
license. The successful candidate’s primary responsibilities will involve
teaching graduate courses, providing clinical services, and supervising clinical
audiology student training experiences. Evidence of successful college student
mentoring/teaching is desired. Screening of applications will begin
immediately and continue until position is filled. Starting date is negotiable.
Send letter of interest, three letters of recommendation and resume to Rose L.
Allen, PhD, Chair, Audiology Search Committee, Dept. of Communication
Sciences & Disorders, School of Allied Health Sciences, East Carolina
University, Greenville, NC. Communications may be e-mailed to
allenro@mail.ecu.edu.
East Carolina University is an Equal Opportunity/Affirmative Action University
and accommodates persons with disabilities. Proper documentation of
identity and employability is required at the time of employment.
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AUDIOLOGY TODAY
N O R T H
C A R O L I N A
ASSISTANT/ASSOCIATE PROFESSOR OF AUDIOLOGY:
Asst/Assoc Professor: Audiology. Announcing a full time, tenure-track
or non-tenured position, depending on qualifications and interests of
candidate, in the Department of Communication Sciences & Disorders,
School of Allied Health Sciences, East Carolina University, Greenville,
NC. This positions is to be an integral part of a clinical audiology
concentration within the doctoral program. Successful candidate’s
qualifications include: 1) an earned PhD in audiology or the AuD
degree; 2) evidence of or potential for excellence in teaching in at least
one of the following or related areas; behavioral audiological
assessment, amplification, vestibular assessment and management, or
aural rehabilitation/cochlear implants; 3) CCC-A and eligible for North
Carolina license. The successful candidate’s primary responsibilities
will involve teaching graduate courses, providing clinical services, and
supervising clinical audiology student training experiences. Evidence of
successful college student mentoring/teaching is desired. Screening
of applications will begin immediately and continue until position is
filled. Starting date is negotiable.
Send letter of interest, three letters of recommendation and resume to
Rose L. Allen, PhD, Chair, Audiology Search Committee, Dept. Of
Communication Sciences & Disorders, School of Allied Health
Sciences, East Carolina University, Greenville, NC. Communications
may be e-mailed to allenro@mail.ecu.edu
East Carolina University is an Equal Opportunity/Affirmative Action University and accommodates persons with disabilities. Proper
documentation of identity and employability is required at the time of employment
MARCH/APRIL 2002
Classified Ads Classified Ads Classified Ads
CALIFORNIA
FULL TIME AUDIOLOGIST:
wanted for hearing aid dispensing practice in San Francisco, CA. Duties include
audiological testing and hearing aid dispensing. Dispensing license preferred but willing
to train. Will consider CFY. Competitive salary package. Fax resume to (415) 776-6892
or mail to P.O. Box 156410, San Francisco, CA 94115.
AUDIOLOGIST:
Children’s Hospital and Health Center, San Diego, seeks a full-time Audiologist to
offer diagnostic services, provide recommendations and administer patients’ hearing
healthcare and patient/family education. Requires a Master’s degree or AuD in Audiology,
CCC, eligibility for CA/HA licensure, and CPR certification within 3 months of hire. Two
years clinical experience in pediatric audiology testing and dispensing preferred.
Experience in cochlear implants, CAP testing and neurophysiology a plus. Would consider
training in these areas of specialty. Join us and enjoy our highly competitive
compensation package and supportive team environment. Visit us on the Web at
www.chsd.org or you may fax your resume to (858) 966-8585, or mail to: Children’s
Hospital and Health Center, 3020 Children’s Way, MC 5040, San Diego, CA 92123 or email: kdaurora@chsd.org. EOE M/F/D/V
COLORADO
ASST PROF, AUDIOLOGY: UNIV. OF NORTHERN COLORADO:
FT, tenure-track. PhD preferred. AuD or ABD with expected grad. by Aug. 2002
considered. CCC-A, CO Audiology Registration eligible. Emphasis in medical/diagnostic
audiology & one of the following: hearing science, industrial/educational audiology, aural
rehab. Evidence of potential for excellence in teaching, scholarly activity, & receipt of
external funding. Interest in distance ed & AuD program development. Review begins
3/29/02 & continues until filled. Submit current CV, letter of application, & two letters
of reference to Dr. Katie Bright, Dept of Comm Disorders, Univ of Northern Colo, Greeley,
CO 80639. Ph; 970-351-1589; Email: katie.bright@unco.edu. www.unco.edu for further
information on UNC & city. Univ of Northern Colo is an EEO/AA employer.
NEW HAMPSHIRE
DIRECTOR OF AUDIOLOGY:
Outstanding opening for a Director of Audiology located in Lebanon, New Hampshire.
Will supervise five Clinical Audiologists and work with the Chief of Otolaryngology and
Practice Manager to assure smooth department operation and a financially strong
program. Will also be a member of a scientific team dedicated to improving quality care.
Qualified candidates will have a PhD, AuD, or MA degree with extensive clinical care
experience and administrative and research interests. Salary expected to be in the
$80,000-100,000 range, depending upon qualifications. Please contact Gail Echerd at B.E.
Smith, gecherd@besmith.com, 1-800-467-9117.
OREGON
AUDIOLOGIST:
SEEKING audiologist for prominent otologist clinic in Portland, Oregon. Candidate
must have experience with hearing evaluations, vestibular testing, and hearing aids.
Testing includes ENG, CDP, ECOG, and more. There is a large hearing aid population that is
generated from the clinic work. Clinic will open an implantable hearing aid venue this
year. Earning potential is high, working conditions are excellent with pleasant staff and
well known MD, support for continuing ed., retirement, and generous commissions on
sales. Staff includes current CFY and interns. Portland has attractive attributes for arts,
gourmet dining, beautiful outdoor recreation, and a strong audiology community. Please
forward your resume to: Dr. John Epley, Portland Otologic Clinic, 545 NE 47th, Suite 212,
Portland, OR 97213. Fax: (503) 233-5160, Phone: Office Manager (503) 233-5925.
PENNSYLVANIA
MOBILE UNITS:
Industrial, Clinical, Hearing Aid Dispensing, Residential Care Services. Let our 32 years
of experience work for you. Demonstrator Units Available! Free marketing training available
with all units. LEASING AVAILABLE. HealthCare Enterprises 724-962-4051
For information about our employment web site, HearCareers, visit www.
audiology.org/hearcareers
For information or to place a classified ad in Audiology Today, please contact
Patsy Meredith at 303-372-3190 or Fax 303-372-3189.
VOLUME 14, NUMBER 2
AUDIOLOGY TODAY
51
Come on by and Chat Awhile!!!
Learn More about Certification.
Visit the ABA during Convention 2002 at The
Academy Center in the Exhibition Hall
Board Members
Chair
Robert W. Keith
William Beck
Melanie Herzfeld
Caroline Hyde
Cindy Simon
John Zeigler
Academy Board Liaison
Richard Gans,
This is the time of the year when you have received countless invitations from
manufacturers to visit their booth at the Exposition, in order to discuss their product. The
Exposition is, in fact, a wonderful opportunity to obtain firsthand information about
products and services. There is no doubt that face-to-face communication, and the
interaction that occurs, adds a dimension that cannot be obtained through the printed
media. In addition to information on devices, the convention provides you with an
opportunity to learn what your association is doing for you. In that vein, we invite you to
visit the American Board of Audiology booth in The Academy Center on the exhibit
floor. Board members will be available throughout the convention to meet with you,
answer your questions, and provide you with information on Board Certification.
Among other items we described in the last issue of Audiology Today, the board recently
voted to waive the application fee for applications postmarked between March 1 and
July 4, 2002. This will give you a $75 reduction in total fees required for Board
Certification. In addition, for the first time the ABA will take applications for Board
Certification at The Academy convention. This is only one of many ways the Board has
worked to institute improved procedures, decrease the amount of paperwork associated
with application and renewal of certification, and reduce the financial burden. Beyond
personal finances, there are many reasons for our special reduced fee offer. Audiologists
will recognize that the higher our numbers, the greater our influence is with government
agencies and insurance carriers. We welcome your presence among those who are
already certified, and we encourage you to stop by and apply for Board Certification.
Remember, some documentation will be required, and you will have to submit that later.
But you can get the ball rolling at convention.
In addition, we will be able to answer any question you have about certification, in the
broadest sense. Some of you are unsure what your state requirements are. We will have
copies of all state licensure laws at the convention, and can help you search for answers
to your questions on state licensure.
Finally, other opportunities exist at convention to learn about Board Certification. If you
are a student, we will make a brief presentation and be available for questions at the
volunteer orientation meeting. Academy members will want to attend our round table
session where there will be opportunity for open discussion of any issue you want to
bring up. This is also a chance for the ABA board to share information regarding recent
occurrences in the development of specialty certification.
This is an important time for our profession. “Winds of Change” are occurring.
Audiologists are beginning to understand their options. Application for Board
Certification in Audiology is one tangible way that you can declare your support for
audiology as an independent practicing profession.
52
AUDIOLOGY TODAY
MARCH/APRIL 2002
NEWS&announcements
University of Maryland Announces New Doctoral Program in Clinical Audiology
The Department of Hearing and Speech Sciences, University of Maryland, College Park, is pleased to announce
the approval by the University and the Board of Regents for a Doctoral Program in Clinical Audiology. This
program will be offered in collaboration with the Division of Otolaryngology - Head and Neck Surgery, School
of Medicine, University of Maryland, Baltimore. The program offers students the option of pursuing one of two
educational tracks, one leading to the Doctor of Audiology degree (AuD) and the other leading to the Doctor of
Philosophy degree (PhD in Clinical Audiology). The AuD track entails a rigorous academic and clinical
educational program that trains individuals to become professional audiologists; the PhD track adds to this a
layer of extensive research training, for students interested in pursuing a PhD degree. The doctoral program in
Clinical Audiology (both AuD and PhD tracks) is offered to graduate students holding a Bachelor’s degree, as
well as to professional audiologists who already hold a Master’s degree. The starting date for the post-BA
doctoral program is Fall, 2002, and applications are now being accepted for admission to this program. The
starting date for the post-MA doctoral program is Fall, 2003.
For more detailed information about the Doctoral Program in Clinical Audiology at the University of Maryland,
please see the website at www.bsos.umd.edu/hesp/AudProgBrochure.htm.
If you should have any questions, please contact Dr. Michelle Hicks at 301-405-7716, e-mail:
mhicks@hesp.umd.edu) or Dr. Sandra Gordon-Salant at 301-405-4225, e-mail: sgordon@hesp.umd.edu) for
clarification.
THE AMERICAN TINNITUS
ASSOCIATION WANTS YOU!!
TINNITUS RESEARCH FUNDING
AVAILABLE
If you need funding for a tinnitus-related
research project, please continue reading:
The ATA offers $50,000 per year for up to 2
years or a maximum of $100,000 per year for
up to 3 years for exceptional projects. Our
next grant cycle deadline is June 30, 2002.
You may access our grant application and
guidelines on our website: www.ata.org - select
“research section” on the home page.
Additional research information can be obtained
by contacting pat@ata.org or call 1-800-6348978 X215. We hope to hear from you!
Hundreds Contact Academy
For An Ounce of Prevention
The February 2002 issue of Prevention magazine featured an
interesting Mailbag letter from audiologist Deborah Pitcher
in Bloomington, IL. Deborah’s letter was a follow-up to an
earlier letter about deaf and hearing-impaired individuals
being safe drivers. Deborah stressed the importance of
hearing tests, especially for older people who may not realize
they have problem. The item closed with the offer of a free
“Hearing Loss” brochure from The Academy.
To date, more than 400 brochures have been sent to readers
wanting to learn more about hearing loss. Originally
offered as part of the Physician’s Hearing Health Kit, the
“Hearing Loss” brochure contains great information on
recognizing hearing loss, an overview of hearing aids and
includes the Hearing Health Quick Test. The “Hearing Loss” brochure is now
available in packages of 100: $40 for members; $50 for non-members.
Rush Limbaugh’s Hearing Restored
International Noise
Awareness
The seventh annual International
Noise Awareness Day is scheduled
for April 24, 2002. This annual
event, sponsored by the League for
the Hard of Hearing in New York
City, is designed to increase
awareness of the growing problems
of daily noise in our lives.
Information and promotional
materials may be obtained by
contacting Amy Boyle at (917) 3057809 or by email at aboyle@lhh.org.
Rush Limbaugh, clearly the most famous cochlear implant recipient of our time, has held a number of discussions during his
radio program over the past two months regarding his new hearing device. Limbaugh, radio’s most successful talk host with 22 million weekly listeners, heard his own radio show for
the first time in four months on January 21 since losing his hearing to autoimmune disorder. During this initial discussion, he described the audiologist’s actions in programming his
cochlear implant. Apparently, Limbaugh could not be happier with the performance of his implant and reported that he conversed by telephone with his brother (Rush used a speaker
phone while the brother was on a cell phone) the first day his device was turned on. Limbaugh reported that voices sounded much better than he expected since he was told that
sounds through the implant would sound like an AM radio station not properly tuned and that human voices would sound like the singing chipmunks.
The chipmunk analogy was indeed correct for one of the programs of the implant, but Limbaugh uses a program that sounds like an off-tuned AM radio station or micro-cassette
recording playback system. He uses a belt-worn speech processor rather than the ear level unit based on the extended battery usage. According to Limbaugh, “...as far as voices,
they sound like I remember them; maybe I wasn’t without my hearing long enough for my brain to forget the sound of speech.” About his period of deafness, Limbaugh commented
that the best thing about it was not hearing the telephone ring! Although approached by “every” television talk show for an interview, he has not decided whether to participate in other
public venues about his cochlear implant, but chooses to share his information with his extended radio shows audience. Limbaugh’s success with his cochlear implant is well
described in the audio portions of his website at www.rushlimbaugh.com. On his website, visitors can listen to Rush “...take to the air, and for the first time in months, hear how great
he sounds,” “...discuss his latest experiences with his cochlear implant,” or “...amaze us by picking out the Pointer Sisters despite his total deafness.”
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AUDIOLOGY TODAY
MARCH/APRIL 2002
www.audiology.org!
Featured Among “Best of the Web”
The American Society of Association Executives (ASAE)
selected The Academy’s web site as their featured site in March. Our
site was chosen from hundreds of association web sites for its fresh
look, up-to-the-minute information and ease of use. We submitted a
500-word description of what makes our site so special
AMERICAN ACADEMY OF AUDIOLOGY
http://www.audiology.org
The American Academy of Audiology, the world’s largest
professional organization of audiologists, is dedicated to providing
quality hearing care services through professional development,
education, research and increased public awareness of hearing
disorders. Our web site, recently redesigned with the help of db
interactive, Inc., is a proven resource for anyone who wants to stay
up-to-date with the latest developments in hearing health care and
the audiology profession.
Find An Audiologist, our most popular feature, allows a consumer
to search for a qualified audiologist in their area and print out driving
directions, courtesy of MapQuest. Similar to the Ask An Expert bulletin
board for members, Ask An Audiologist invites consumers to e-mail
their hearing health questions to our audiology expert and receive an
answer within 24 hours. New questions and answers get posted in the
archives for review by others.
www.audiology.org has become our first-line of communication
with members and the general public allowing us to cut mailing costs,
increase visibility, and keep important hearing information up-to-date.
The complete article is posted on ASAE’s web site at www.asaenet.org.
A POWERFUL TOOL FOR AUDIOLOGY PROFESSIONALS
Audiologists can find everything they need at their fingertips,
thanks to www.audiology.org Members can search for their peers
and update their own contact information through the Online
Member Directory; sign-up for the AAAlert, our “breaking news”
e-mail newsletter; and pose a question on any hearing topic – from
reimbursement issues to cochlear implant procedures – through Ask
An Expert, our interactive bulletin board.
Our unique Convention Proposal Submission and Tracking
System allows hundreds of potential presenters to submit their
information electronically. This year, the process successfully went
paperless for the very first time. Twelve reviewers from across the
country reviewed 586 proposals, collaborated with other reviewers,
selected the best submissions and scheduled times for over 150
accepted presentations to be given over a 4-day period. We’ve also
added a Personal Itinerary feature that lets attendees maximize their
convention experience by helping them schedule educational
sessions online.
New to the site is the interactive HearCareers employment area.
Audiologists can search and apply for jobs online, create a
confidential, online resume and sign up for a “Search Agent” that
will notify them via e-mail when a new opportunity is posted that
matches their search criteria. Employers can post jobs, search a
growing database of audiologists online, and view the amount of
activity each posting generates.
The Academy has just introduced the SoundOff Listserv for
Academy members only. SoundOff is an e-mail discussion list that
lets members participate in the areas that interest them. Topics
include Infant Hearing, Amplification, Convention Chat,
International Issues, Student Forum and Earwax – for a goodnatured chat on the lighter side.
A WELCOME RESOURCE FOR CONSUMERS
With more than 28 million Americans suffering from hearing
loss, www.audiology.org provides a trusted resource for hearing
health information. Loaded with up-to-the-minute information, the
Consumer Resources area can tell you what to look for in a hearing
aid, how to read an audiogram, and even provides a quick hearing
health test… right on the site.
VOLUME 14, NUMBER 2
Members of the 2001 Web Committee
Special Thanks to
The Academy’s Web Committee
Of course none of this recognition would be possible without
the hard-working Academy members who help with the focus
and content of www.audiology.org:
Jerry Northern (Website Editor)
Sydney Hawthorne Davis (National Office Staff)
Bopanna Ballachandra (Cultural Diversity)
Ruth Bentler (Ask An Expert Panel)
Jackie Clark (International & Cultural Diversity)
Sheila Dalzell (Reimbursement Issues)
Kimberley Dotson (Web Site Statistics)
Karen Jacobs (State Affiliates)
Richard Gans (Ask An Expert Panel)
Lisa Hunter (Ask An Expert Panel)
Craig Johnson (Legislative Issues)
Gyl Kasewurm (University Network)
Lina Kubli (AAA Foundation)
William Martin (Ask An Expert Panel)
Patricia McCarthy (Associate Editor, Book Reviews)
Deanna Meinke (Noise and Hearing Conservation)
Robert Traynor (International Communications)
Dennis Van Vliet (Associate Editor, Ask An Audiologist –
Ask An Expert Panel)
AUDIOLOGY TODAY
59
V I E W P O I N T
CLARIFYING AMERICA’S HEARING HEALTHCARE TEAM
David Fabry,
Academy Past President
The recent correspondence of December 10,
2001 to ASHA members accuses AAA and
ADA of presenting “misinformation”
regarding the America’s Hearing Healthcare
Team Initiative (AHHTI). Although many
would like this issue to simply go away, it is
imperative that the focus remains on its
importance to our profession, rather than a
“turf battle” between audiology organizations.
To that end, we will attempt to be as objective
as possible in our response.
In the December 10, 2001 letter, ASHA
states, “The AHHT initiative, outlined in a
joint statement with AAO...includes the
following goals:
• Increased public awareness of the impact of
hearing loss
• Serving patients by a team approach with multiple points of
entry to the hearing healthcare team
• Expanding access to care and enhancing the treatment of
hearing and balanced disorders”
Using their own words, ASHA asserts that the AHHTI is a
“public awareness activity designed to help the public and
referral groups know more about how to access the hearing
healthcare system.” The problem, as AAA and ADA saw it,
was that committing the profession to an initiative that sought
to market a team that involved otolaryngologists, audiologists,
and commercial hearing aid dealers is confusing and potentially
harmful to consumers. ASHA included a description of an
audiologist in their December 10 letter that was mutually
agreed on by AAO-HNS and ASHA, and points out that
audiologists are characterized as “autonomous and independent
practitioners.” What they fail to mention, however, is that
hearing aid dealers also agreed to a joint statement with AAOHNS that describes their role as providing, “an important entry
point into the hearing healthcare delivery system.”
Furthermore, hearing aid dealers “...are independent
professionals and...provide direct patient care... This specialist
has specific training in assessment and testing of patients who
seek rehabilitation for hearing loss…The nationally accepted
standard for Hearing Aid Specialists is certification by the
National Board for Certification in Hearing Instrument
Sciences, which awards the Board Certified in Hearing
Instrument Sciences (BC-HIS) designation.” The complete
link for this information, may be accessed from either the
AAO-HNS www.entnet.org/ahhti.html or IHS
www.ihsinfo.org/htdocs/ProfessionalAdvantage/aaoihs.asp
websites.
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AUDIOLOGY TODAY
The lack of control over the information content
distributed to consumers is a primary reason The
Academy chose not to commit audiology to the
AHHTI It appears that despite ASHA’s involvement,
language persists that obfuscates the role of audiologists and commercial hearing aid dealers to consumers. The difference of opinion between ASHA
and The Academy remains whether it is possible to
resolve this issue by “working from within.”
Audiologists should, in our opinion, be united in
our efforts to clearly define the role of audiologist as
an autonomous provider of diagnostic and
rehabilitative audiologic services. The Academy will
gladly join ASHA in marketing against any initiative
that equates the role of the audiologist and hearing
aid dealer. Furthermore, we challenge the AAOHNS to acknowledge that the patient’s best interests are served
by a team of professionals devoted to providing quality hearing
healthcare, rather than a “retail” operation.
Admittedly, commercial hearing aid dealers are licensed in
many states to dispense hearing aids, and this is largely due to
the fact that audiologists were prohibited from dispensing
hearing aids by ASHA’s code of ethics until 1978. When
audiologists began dispensing hearing aids, in large measure,
we adopted the business practices of a sales industry, and this
practice continues to evolve today. One reason why hearing aid
market penetration remains so poor may be due at least in part
to the public perception that hearing instrument dispensing is a
retail operation. The AHHTI only serves to confuse this issue
further, and this perception cannot be changed as long as
commercial hearing aid dealers are involved in an equivalent
role to audiology. If anyone doubts that commercial hearing
aid dealers will use their role on AHHTI to expand their scope
of practice need look no further than the October-November,
2001 issue of The Hearing Professional, the official bulletin of
the International Hearing Society (IHS). That issue contains an
article entitled “Preferred Practice Guidelines for Tinnitus and
Vertigo,” written by a commercial hearing aid dealer, that
provides a glimpse at their intentions.
In summary, The Academy’s decision not to commit
audiology to the AHHTI does not imply that we are opposed to
working with AAO-HNS or any other group that shares our
vision. Many of our Board members work closely with
otorhinolaryngologists on a daily basis, and we have been in
frequent contact with the leadership of AAO-HNS on a variety
of issues. That said, the patient’s best interests are served by a
professional alliance of hearing healthcare providers, rather
than a “semi-pro” team.
MARCH/APRIL 2002
American Academy of Audiology
Features Marketing Kits at Convention 2002
t is a sad fact that 75% of all hearing impaired individuals choose to do
nothing about their hearing problem. A variety of reasons exist for this
apathy/motivational paralysis. What can be done to alter this? Aside
from spousal “encouragement” the single most important factor
motivating patients to seek help for their hearing loss is a medical
recommendation. Thus, it is alarming to note that the majority (54%) of
audiologists currently receive less than half of their business from physician
referrals. It is clear that there is an unmet need for building a bridge to
improve our ability to generate business from physician referrals.
As a result, in 1997 the Marketing Committee of the American Academy of
Audiology, under the direction of Michael Marion, conducted a survey to
determine audiologists’ current practices, attitudes and perceptions with
regard to gaining physician referrals. Among the interesting findings were:
• On the average, 44% of audiologists’ business is generated from
physicians’ referrals.
• The amount of time spent on marketing activities to obtain more
physician referrals doesn’t appear to have a direct impact on the volume
of business generated from referrals. It is possible, then, that current
marketing practices employed by audiologists might not be the most
effective choices and, therefore, could be improved upon.
• Physicians in family practice and ENTs are the most important referral
sources for audiologists. Physicians in internal medicine and pediatrics
also play a significant role.
I
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AUDIOLOGY TODAY
• The most frequently employed marketing practices by audiologists to
generate physician referrals are by mail (writing letters to physicians and
sending information about their practice). Some audiologists also
attempt more personal contact by visiting or calling physicians.
• Topping the list of barriers to audiologists seeking physician referrals is
lack of time, followed by an inability to obtain direct contact with
physicians, lack of good-quality materials to send or leave behind, and
the perception that physicians do not view audiologists as health care
peers.
In 1998 The Academy convened a task force of marketing experts,
physicians, and audiologists (the latter with demonstrated success in
generating physician referrals) to review the survey results and to gain an
understanding of the most effective means of communicating with
physicians and increasing the number of their referrals to audiologists.
The objectives of the physician referral campaign were:
• To increase hearing screenings by physicians and other healthcare
providers
• To increase physician referrals to audiologists
• To enhance the professional image of the audiologist in the physician and
health care provider communities
To accomplish these objectives The Academy established a “Millennium
Marketer Program” to test physician referral campaign materials with
JULY/AUGUST 2001
Marketing Kit Featured…
practicing audiologists in a variety of settings across the country. The
materials themselves were designed to assist audiologists in building
relationships with physicians and increasing referrals from physicians. Based
on the research data generated earlier, sample Physician’s Hearing Health
Kits were constructed. The Kits consisted of a detailed instruction binder for
the audiologist, patient brochures for physicians’ office waiting areas, a
handbook for physicians describing aspects of hearing loss and audiology, a
single frequency hearing screener with instructions, and a short PowerPoint
slide show.
The Building Bridges — Physician’s Hearing Health Kit consisting of
these tools were distributed over several months to a select group of 43
Millennium Marketer audiologists representing a variety of settings
including private practices, ENT offices, hospitals and clinics. Their role was
to conduct both the initial approach activities and the follow-up activities
outlined in the binder, including hand-delivery of the American Academy of
Audiology-branded Physician’s Hearing Health Kits. The results of this pilot
project showed:
• More than half (55%) of the Millennium Marketer audiologists reported
they saw an increase in the referrals from the physicians they contacted.
• Twenty-one percent reported an increase in referrals of 5-30%; seven had
increases in excess of 30%.
• Participants reported they received the referrals immediately after their
visit with the physician; referrals from that physician tended to decline
over time following the visit.
• All participants who did not see an immediate response from their initial
visit expected to see an increase in referrals over time.
• Several Marketers with established practices did not see an increase in
referrals but believed the program will help to maintain their existing
referrals.
Among the comments were:
“The overall program comes across well—-less like a sales approach and
more like providing a service.”
“I liked the step-by-step program.”
“The program helped me get my office staff interested. It gave the staff a
letter to send and then a follow-up call script to make an appointment with
the physicians.”
Additional findings included:
• Physicians were very receptive to both the HearPen screeners and to the
information provided by the audiologists either in a written or verbal form
during the visit.
• Nearly 70% had a positive response to the kit/pen.
• The topics of most interest for the physician were:
– What services audiologists offer
– Hearing aids
– How Medicare works for referrals
– Specialty areas: newborn screening, hearing aids, etc.
– Impact of hearing loss on their patients
– The physician’s staff believe that they are the gatekeepers, perhaps
even more than the physicians
Based on the results of this comprehensive research, the final kit was
assembled under the direction of Robert Sweetow, current Academy
Marketing Chairperson.
VOLUME 13, NUMBER 4
The American Academy of Audiology Building Bridges Physician’s Hearing Health Referral Kit consists of:
1) A detailed “Building Bridges” binder for the audiologist containing:
• explanations about the rationale and development of the kit
• goals for marketing activities
• methods of selecting doctors to contact
• descriptions of the role of your staff in the marketing effort
• sample scripts and suggestions for making initial contact with
physicians’ offices
• techniques and strategies for meeting with physicians
• “lunch and learn” strategies
• examples of reports and letters to physicians
• ample physician newsletters and “sound bites”
• a tutorial on managed care
• follow-up procedures
2) A HearPen single frequency screener
3) A Power Point slide show titled “Hearing Health and Your Patients”
in a “lunch and learn” presentation format
4) A Physician’s Handbook on Hearing Health which includes:
• The Physician’s Role in Identifying Hearing Loss
• Is Hearing Loss a Health Problem?
• Demographic Overview and Early Symptoms
• A Brief Etiological Overview and Types of Hearing Loss
• Consequences of Untreated Hearing Loss
• Identifying Hearing Loss in Your Office
• Which Patients Should Be Screened?
• The HearPen Screener and Referral Criteria
• The Importance of High-Frequency Sounds
• When to Refer to an Audiologist
• Audiologists’ Scope of Practice
• Facts Physicians Should Know about Hearing Aids
• Assistive Listening Devices
• Aural Rehabilitation
5) Patient education brochures incorporating a “Hearing
Health Quick Test” for physician waiting room distribution.
The Complete Physician’s Referral Starter Kit (which includes the Building
Bridges Instructional Binder and one Physician’s Hearing Health Kit is
available for $75 to members. Supplemental Physician Hearing Health Kits
are $50 each. (Non-members pay $90 and $60, respectively.)
The American Academy of Audiology strongly believes that these products
can be of great benefit to you. Just think, if you generate even one new
referral, you will have paid for your investment. If you dispense hearing aids
to even one patient as a result of the strategies outlined in this Kit, you will
have paid for your investment for the comprehensive kit as well as an
additional 25 supplemental kits.
To order single or bulk copies of these materials or to obtain more
information, please contact Sydney Hawthorne Davis, Director of
Communications, at the National Office 800-AAA-2336, ext. 204 or by
e-mail at sdavis@audiology.org.
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