Audacity Issue 9 by Audacity magazine

Audacity ...a British Society of Audiology Publication

issue 9 February 2017 .................................

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Hear and Now: Impact of the Genomics England

100,000 Genomes Project for the Hearing Impaired and for the Auditory Clinical and Research Communities Introduction

*Jun Shen, Ph.D., FACMG Department of Pathology, Brigham and Womenâ&#x20AC;&#x2122;s Hospital, Harvard Medical School, Boston, MA 02115, USA. Harvard Medical School Center for Hereditary Deafness, Harvard Medical School, Boston, MA 02115, USA. Laboratory for Molecular Medicine, Partners Personalized Medicine, Partners HealthCare System, Cambridge, MA 02139, USA. E: jshen5@partners.org

*Cynthia C. Morton, Ph.D, FFACMG Departments of Obstetrics and Gynecology and of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. Harvard Medical School Center for Hereditary Deafness, Harvard Medical School, Boston, MA 02115, USA Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA. Division of Evolution and Genomic Science, School of Biological Sciences, Manchester Centre for Audiology and Deafness, Manchester Academic Health Science Centre, University of Manchester, UK. E: cmorton@partners.org, cynthia.morton@manchester.ac.uk * Corresponding authors

In December 2012, British Prime Minister David Cameron launched the ambitious 100,000 Genomes Project (https:// www.genomicsengland.co.uk/the-100000 -genomes-project/). On 5th July 2013, the 65th birthday of the National Health Service (NHS), Secretary of State for Health Jeremy Hunt, announced the establishment of Genomics England, the company that runs the 100,000 Genomes Project. This government funded and

operated grand-scale research project aims to identify the causes of cancer, rare diseases, and infectious diseases, and to improve health care through sequencing the complete content of DNA of an individual, the genetic makeup known as the genome, for up to 100,000 people in the UK. Individuals enrolled in the 100,000 Genomes Project are patients with cancers and rare diseases and their family members who have not yet received a conclusive molecular diagnosis of the aetiology. By comparing genomes of affected and unaffected individuals, or of cancerous and normal tissues in the same individual in cases of cancer patients, and by statistically analyzing the large number of samples included in the project, it has promised to yield exciting findings that will guide the diagnosis and treatment of diseases.

Opportunities offered to the domain of hearing

The 100,000 Genomes Project targets three focus areas: rare diseases, infectious diseases, and cancers, because genetic changes to the DNA are often involved in their cause. The definition of a rare

disease varies in different countries and regions around the world. In the UK, a rare disease is one that affects less than 1 in 2,000 individuals in the general population. Although collectively hearing impairment is quite common and does not meet the definition of a rare disease, there are hundreds of different types of hearing loss with distinct aetiologies. Each type of hearing loss may present unique features either affecting extra-auditory organ systems as in syndromic hearing loss, or exhibiting distinctive tonotopical and temporal audiology profiles. Therefore, individuals with hearing impairments are eligible for enrollment in the 100,000 Genomes Project. Other than neurofibromatosis type II, hearing loss is generally not associated with a tumor of unknown molecular aetiology. However, cancer chemotherapy drugs, such as cisplatin and carboplatin, are known to cause ototoxicity. Similarly, some antibiotics used in treating patients with infectious diseases are also ototoxic. Therefore, drug induced hearing loss could be expected to be more prevalent in patients with cancer and infectious diseases in the 100,000 Genomes Project than in the general population. Taken together, the 100,000 Genomes Project will provide significant insights into the genetic causes of rare forms of hereditary hearing loss and genetic susceptibilities to ototoxicity. Findings will benefit patients, audiology professionals and researchers.

Benefits to patients with hearing loss

Currently only a third of patients with hearing loss will receive a conclusive molecular diagnosis after having the most comprehensive genetic tests for known hearing loss genes. There are three types of missed diagnoses. First, genetic changes may be detected by current tests, but it

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16 remains uncertain as to their clinical significance due to a lack of data as the frequency of a similar genetic finding in individuals with normal hearing is unknown. Second, current tests for known hearing loss genes mainly cover genomic sequences that encode proteins. Causal genetic changes occurring in “padding” sequences, known as non-coding regions of the genome, may remain undetected as they do not directly encode protein but regulate how the genomic DNA is transcribed into RNA, which is in turn translated into protein. Third, there are certainly new genes for hearing loss yet to be discovered. The 100,000 Genomes Project will illuminate each of these areas (Table 1). With large genomic sequencing data from both individuals affected with hearing loss and with normal hearing (including unaffected family members and other individuals enrolled in the 100,000 Genomes Project for other diseases), our ability to determine the pathogenicity of a genetic change will be greatly enhanced. The whole genome sequencing approach by the 100,000 Genomes Project will cover non-coding regions and regulatory elements in known hearing loss genes and detect chromosomal structural abnormalities, as well as genes previously unknown to cause hearing loss. It is reasonable to expect that not only will a much higher proportion of patients in the 100,000 Genomes Project receive conclusive genetic diagnoses, but that the knowledge generated will also solve even more cases around the world.

Benefits to researchers in the auditory field

The 100,000 Genomes Project also offers researchers and clinicians an opportunity to work together to analyze data and make new discoveries. Any qualified individual can apply to become a member of the Genomics England Clinical Interpretation Partnership (GeCIP). GeCIP operates in domains including the Hearing and Sight Domain with the Hearing subdomain led by Professor Maria Bitner-Glindzicz at the Institute of Child Health and Great Ormond Street Hospital, University College London. The

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Table 1. 100,000 Genomes Project will improve molecular diagnosis for patients with hearing loss Category

Current genetic testing for hearing loss

100,000 Genomes Project

• Inability to interpret identified genetic changes due lack of data

• Large samples size both with hearing loss and with normal hearing • Familial segregation information available

• Only coding regions and splice sites included

• Non-coding regions and regulatory elements covered • Copy number variation and structural abnormalities detected

• Limited to known hearing loss genes

• Able to identify new genes

Hearing and Sight Domain welcomes individuals (https://www.genomicsengland.co.uk/clinical-interpretation-par tnership-applications-open/) from both clinics and academic institutions and includes NHS clinical disease experts, healthcare professionals, and trainees, as well as international collaborators. The massive amount of whole genome sequencing data together with carefully curated clinical information from medical records will empower new research activities. For example, innovative computational and analytical algorithms are being developed to interrogate the data; novel genes for hearing loss will be discovered, large scale genome-wide association studies on susceptibilities to drug ototoxicity will be empowered, previously unknown molecular mechanisms and pathways of distinct types of hearing loss will be elucidated, and new drugs and ideas for therapeutic treatments may follow.

Benefits to audiology professionals

While the 100,000 Genomes Project is a research program, it will dramatically impact the whole of audiological clinical

practice. It is an exciting time for audiology professionals to understand genomics and to integrate genetic findings in patient care. Doubtless, many questions remain to be answered. Will specific types of hearing loss be differentiated based on the genomic information and audiology findings? Which genetic test should a patient undergo? What kind of management plan will yield the most optimal outcome, given an individual’s genomic information? How will individuals’ personal genomic information impact their response to various types of treatment? British audiology professionals sit at the forefront to revolutionize the future way patients with hearing loss will be treated. To get involved they can actively participate in genomics education programs, recruit patients into the 100,000 Genomes Project, join the Hearing subdomain of GeCIP, nominate a specific type of hearing loss as a rare disease, and begin to translate genomic information into professional practice.

Conclusion

The 100,000 Genomes Project will transform health care service in the UK and around the world. It is a huge groundbreaking undertaking of the NHS. However, the wealth generated by the effort in terms of knowledge and new ways of treating and preventing diseases will be priceless. Audiology professionals are in an enviable position with this golden opportunity to embrace the tidal wave of genomic information.

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Recording Electrically-evoked Auditory Cortical Responses (EACR) in CI recipients CD

Introduction

Andy J Beynon, PhD, MSc, MA Head Audio-Vestibular EP Lab, E.N.T. Dept, Radboud University Medical Centre, Nijmegen, The Netherlands. Clinical Scientist / Ass. Professor, ‘Hearing & Implants’, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University, Nijmegen, The Netherlands. Corresponding address: Radboud University Medical Centre, E.N.T. Dept. Audio-Vestibular EP Lab P. van Leijdenlaan 15, 6525 EX, Nijmegen, The Netherlands. T. +31 31 24 3614965 E. andy.beynon@radboudumc.nl

Take home message Taking into account a few prerequisites, objective electrophysiological assessment in CI patients is similar to conventional acoustic assessment, since electrical stimulus artifacts play, especially compared to peripheral responses, an inferior role in cortical recordings.

For many decades, objective electrophysiological measurements have been part of the auditory assessment in patients with hearing disorders. In the ‘70s, recording of auditory cortical responses (ACRs) was used to assess hearing thresholds, but thanks to the development of computers in the ‘80s, the popularity of the auditory brainstem responses (ABR) increased as averaging the ABRs became relatively easy. In contrast to cortical evoked responses, brainstem recordings do not require active attention of the hearing impaired subject, thus being a perfect objective clinical tool to determine hearing thresholds (sound detection) in ‘difficult-to-test’ patients (e.g. children, those with complex additional needs and malingerers), even under anaesthesia.

tro-cochleography) or brainstem (ABR), later latency potentials can be used to assess auditory cortical discrimination (e.g. cognitive P300, Mismatch Negativity) or detection of changes in tonal and/ or speech stimuli (e.g. Acoustic Change Complex, ACC). Nevertheless, one should be aware that ACR recordings implicitly require active attention, significantly improving the neural response quality. Electrophysiological assessment is also of importance for cochlear implant (CI) recipients. Objective measurements to assess or even to predict optimal neural auditory processing in these patients are still of clinical and research interest because they improve our insight in neural processing induced by electrical stimulation. By using sound field setups or more sophisticated customized research setups, electrically-evoked auditory cortical responses (EACR) are within reach.

In the last decade however, cortical responses have gained interest again as the gap between audiology and other auditory related sciences, such as neuro-cognitive science, auditory translational research and psychophysiology becomes smaller. Besides, central auditory pathologies nowadays require more additional information from evoked responses originating from beyond the level of the brainstem.

Recording acousticallyor electrically-evoked responses in CI recipients: what is the difference?

In contrast to peripheral brainstem responses, auditory cortical responses (ACR) reflect auditory processing that covers our complete auditory neural pathway up to the primary auditory cortex. Besides determining auditory thresholds, cortical potentials are also very useful to gain insight in exogenous discrimination at the cortical level, neural plasticity and (endogenous) top-down processing (Cone-Wesson et al, 2003). Therefore, in contrast to exogenous peripheral evoked potentials at the level of the cochlea (elec-

With electrically-evoked EPs, two options are possible: direct intracochlear stimu-

Generally, these responses are quite similar. The main difference is the way stimuli are presented to the subject. Acoustically, stimuli are usually generated by the evoked potential (EP) device itself, and sent to a headphone, a loudspeaker in the sound field, or the audio-input of the hearing prosthesis. Simultaneously, a 5V TTL pulse is internally sent to trigger the EP system to start capturing all patient EP data for further recording, averaging and analysis.

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18 lation of electrodes or indirect sound field stimulation using the speech coding strategy (MAP) that is programmed in the speech processor, followed by intracochlear stimulation. With direct intracochlear stimulation, an external electrical stimulator (usually the CI manufacturer’s hard/software) generates the electrical stimulus, typically a biphasic pulse or pulse train, that is directly sent via the speech processor to the implant, bypassing the recipients’ speech processor MAP. With indirect stimulation, an acoustical stimulus is sent to the speech processor via a loudspeaker in the sound field or the audio input of the speech processor, using the recipients’ personal MAP. In both conditions, the speech processor is used to activate one or more specific electrode sites of the implanted intracochlear array, but the advantage of indirect stimulation enables the use of other stimuli than biphasic pulses, such as speech stimuli, processed through the MAP. A setup for a simple single channel recording is shown in Figure 1. However, with respect to electrical stimulation and data acquisition, a few points of interest should be taken into account. First, your EP device should be able to accept an external trigger pulse from the CI stimulating hard/software, so that data averaging is perfectly time-locked with the stimuli that are presented by the CI stimulator. This might require a trigger cable that connects the CI stimulator with the EP device, requiring a machine-specific connector (e.g. mini-jack, BNC connector), that can be home-made or that is sometimes supplied by the specific EP manufacturer. Regarding the EP acquisition, cochlear implant devices can induce huge electrical artifacts in the evoked response. One should distinguish two types: 1) the ‘power-up’ artefact and 2) the actual electrical stimulus artefact. The first one is caused by small packages of energy, typically presented sub-threshold, and are continuously sent to the implant to ‘power up’ the implanted stimulator: it is this energy that is needed to keep the implant working, i.e. delivering sufficient electrical charge to stimulate the auditory nerve.These ‘power ups’ are usually recognized as low amplitude periodic ‘spikes’ in the running EEG

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Figure 1: Example of a simple single-channel recording setup: direct versus indirect stimulation

and can be temporarily switched off in most CI systems during time of recording (‘RF free period’).The second artifact is the actual ‘stimulus artefact’, due to the highrate carrier RF (radio-frequency) signal that is responsible for communication between external sender and internal receiver of the CI for actual sounds. Hence, this artefact usually has exactly the same duration as the electrical stimulus that is delivered, i.e. the length of the biphasic pulse train or speech that is streamed. It is this ‘ringing’ of the artefact that can significantly interfere with the actual auditory neural evoked response, making interpretation of the peak of interest rather difficult. Both types of unwanted artifacts are captured by the EEG surface electrodes, placed on the scalp, picking up RF activity in the area of external coil and subcutaneous implant. Nevertheless, it is possible to manage these interferences: either realtime by e.g. using shorter stimuli than the latency of the peak of interest or off-line by using post hoc statistical computational techniques, such as independent component analysis to discern artifacts from the real morphology of the auditory response (Gilley et al, 2006), the latter requiring multi-channel electrode recordings. However, a very simple and practical way to avoid any interference is to use stimuli with a duration that is shorter than the

latency of the peak of interest (Beynon, 2015). Although an event-related evoked potential is the result of a stimulus onset, any stimulus change (hence, also the offset of a stimulus) could evoke a response. For this reason, when (e.g.) the cortical N1 is our target potential, it might be an option to use a stimulus with a maximum length of e.g. 80 ms, to avoid any off-set response activity that could interfere in time window of the potential of interest (here: N1 around 100 ms post-stimulus). After all, we are mainly searching for reproducible neural synchrony! An alternative way could be to do the opposite by using a very long stimulus that exceeds the area of interest, e.g. a stimulation length of 500 ms when N1 is the area of interest: the offset response would be far beyond 100 ms. Nevertheless, in clinical practice, EEG of CI recipients might still be very noisy. In most cases, it is, however trivial, caused by just simple factors, such as internal physiological noise (EEG, ECG, EMG, EOG), external electric-induced (EF, wire length, loops, impedance mismatch) and magnetic-induced (magnetic field, RF, mains). Especially in CI recipients, signal disturbance is often caused by (too) close distance of one of the EEG recording cables and the stimulating cable of the CI processor. Simply re-positioning the wires responsible for stimulation (i.e. keep sufficient distance from recording electrodes/cables) or just

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19 twisting the recording cables is usually adequate to cancel out all interference, resulting in clean auditory responses.

Examples of clinical application: which evoked potentials might be clinically useful?

In contrast to short latency responses, such as the compound action potentials (CAP) or ABR, cortical responses are, taken into account the previous points of attention, relatively less sensitive for stimulus artifacts. After all, neural processing takes place in (sub)cortical brain areas, so the temporal region of interest is fortunately far away from the site of stimulation (see Figure 2). The most simple application of cortical slow vertex potential (SVP) recordings is to assess electrical auditory thresholds, i.e. signal detection, even in young children (Wunderlich et al., 2006). After all, cortical responses cover the complete auditory pathway, have significantly better correlations with behavioural responses compared to ECAP- or brainstem thresholds - and have already proven their clinical value (e.g. Lightfoot et al., 2006). An example of determining the auditory threshold is shown in Figure 3.

Figure 2. External input via CI leads to electro-neural transfer, followed by 4 stages of auditory processing, i.e. detection, discrimination, identification and (linguistic) interpretation, acquired with corresponding auditory evoked potentials.

Figure 3. Determining auditory threshold for a single electrode using EACRs (stimulus: 100 ms pulse train; 25 us pulse width; 500 pps; 1.1 Hz repetition rate; 0.1 Hz - 30 Hz BP filtering)

Figure 4: EACC responses by stimulating apical electrode e21 for 600 ms (blue curve: only obligatory SVP) in contrast to a stimulus of 600 ms that halfway (after 300 ms) suddenly stimulates another electrode site (other curves: obligatory SVP, followed by a second smaller response (EACC) that appears exactly 300 ms later for different electrode sites). The presence of the EACC clearly show a detection of different electrode stimulation (Beynon et al., 2010)

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20 Another more advanced goal could be to use the same SVP to assess detection of acoustical (or electrical) changes within the stimulus, also known as the Acoustic Change Complex (Ostroff et al., 1998): as a result of the change within the stimulus, another second SVP will appear with later latency in the EEG, indicating the detection of the stimulus change that took place. In CI recipients, the EACC can be used to assess perceptual changes of e.g. different stimulation rates, amplitude (loudness) or frequency changes by stimulation of different electrodes. An example of the latter is shown in Figure 4. Another cortical EPs that is easy to obtain is the endogenous P300 (or P3b) potential to assess discrimination of tonal or speech contrasts (e.g. Beynon et al, 2005). To obtain the typical positive peak around 300 ms, active attention of the subject is required. Like the Mismatch Negativity (MMN), a so-called ‘odd-ball’ stimulation paradigm is applied to elicit the target response: discrimination of sound contrast is assessed by random presentation of a few ‘deviant’ stimuli among many ‘standard’ stimuli (e.g. 15%-85%), in which - in case of discrimination – only these deviant stimuli will evoke a P300 while responses to the standard stimuli only evoke the SVP detection component. However, nowadays even linguistic processing and interpretation are within reach for many CI recipients, since most (postlingual) CI recipients are able to reach open-set speech recognition scores of 80% or more. For these cortical linguistic responses (e.g. N400 or P600 potentials), the most simple setup is to present the time-locked stimuli in the sound field, using a second computer to generate the speech tokens. Moreover, these indirect sound field presentations reflect realistic situations and do not require any sophisticated software programming that would be necessary when speech stimuli are directly streamed through the implant, the lat-

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“Electricallyevoked cortical potentials are easy to obtain”

ter often requiring dedicated research software. Another advantage of indirect sound field stimulation is that all pre- and post-processing of the CI processor are included as it is in the daily life situation of the CI recipient. Recently, a challenging setup was described to assess bimodal recipients (ipsilateral CI, contralateral hearing aid) in order to assess binaural integration of electro-acoustical information (van Yper et al, 2015). Auditory evoked potentials were obtained in unilateral and in (simultaneous) bimodal conditions: preliminary data suggest that these recordings may be very helpful to counsel CI recipients in using their conventional contralateral hearing aid.

Conclusions

With straight-forward clinical EEG hardware, it is relatively easy to perform electrophysiological cortical research in CI recipients. When EEG hardware requirements and electrical stimulus artifacts are taken into account, EACRs are helpful to determine auditory electrical thresholds of CI recipients via direct or indirect stimulation. Besides determining threshold, cortical evoked potentials are also useful to evaluate the perception of stimulus changes or discrimination of sounds and speech signals.

References – Beynon A.J., Snik A.F.M., Stegeman D.F. & Van den Broek P. (2005) Discrimination of speech sound contrasts determined with behavioural tests and event-related potentials in cochlear implant users. J Am Acad Audiol, 16: 42-53. – Beynon AJ, Keck T & Snik AFM (2010) Detection of electrical stimulus changes in the EEG: the Electrically-evoked Acoustic Change Complex. Presentation at 11th International Conference on Cochlear Implants and Other Implantable Auditory Technologies, June 30th - July 3rd, Stockholm, Sweden. – Beynon A.J. (2015) Different Clinical Setups to obtain Electrically-evoked Auditory Cortical Responses: a clinical guideline. XXIVth Biennial Symposium of the International Evoked Response Audiometry Study Group (IERASG), May 10-14, Busan, Korea. – Cone-Wesson B. & Wunderlich J. (2003) Auditory evoked potentials from the cortex: audiology applications. Current Opinion in Otolaryngology & Head and Neck Surgery, 11: 372-377. – Gilley, P. M., Sharma, A., Dorman, M., Finley, C. C., Panch, A. S. & Martin K. (2006) Minimization of cochlear implant stimulus artifact in cortical auditory evoked potentials. Clinical Neurophysiology, 117(8): 1772-1782. – Lightfoot G. & Kennedy V. (2006) Cortical electric response audiometry hearing threshold estimation: accuracy, speed and the effects of stimulus presentation features. Ear & Hearing, 27: 443-456. – Ostroff J.M. Martin B.A. & Boothroyd A. (1998) Cortical Evoked Response To Acoustic Change Within A Syllable. Ear & Hearing, 19(4): 290-297. – Polich (2007) Updating P300: an integrating theory of P3a and P3b. Clinical Neurophysiology, 118: 2128-2148. – Van Yper L.N., Vermeire K., Dhooge I.J.M., De Vel E.F.J. & Beynon A.J. (2015) Bimodal processing with AEP recordings. Part 1: Evidence from the cognitive P300 auditory event-related potential. Presentation at 9th International Conference on Objective Measures in Auditory Implants, Szeged, Hungary. – Wunderlich J & Cone-Wesson B (2006) Maturation of CAEP in infants and children. Hearing Research 12: 212-223.

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Newborn Hearing Screening in England: the first 10 years CD

Sally A Wood Clinical Advisor, NHS Newborn Hearing Screening Programme (NHSP), Public Health England, London, UK. E. Sally.wood@phe.gov.uk

Take home message The newborn hearing screening programme is successful. A key component of its success lies in achieving early entry into high quality audiology follow up for babies that refer on the screen. This requires a high level of expertise and commitment from paediatric audiology teams-what happens at these assessments can affect the rest of a childâ&#x20AC;&#x2122;s life.

Newborn Hearing Screening has been fully implemented in England for the last 10 years and all babies are now routinely offered the screen. Separate programmes cover Scotland, Wales, Northern Ireland and the Republic of Ireland. The aim is to screen babies within the first few weeks of life and to identify those with the target condition and commence appropriate intervention by 6 months of age. The target condition is moderate, severe or profound bilateral permanent childhood hearing loss (PCHL) i.e. 40 dB or more based on the average threshold (in dB HL) over the frequencies 0.5, 1.0, 2.0 and 4.0 kHz for the better hearing ear. This article summarizes progress to date and identifies the next set of challenges.

Why do we need a screening programme?

Newborn hearing screening is now considered to be standard of care in most of the developed world. The evidence base for the programme is summarized in Davis et al (1997).The benefits of early identification and intervention are known (Yoshinago-Itano et al (2003), Kennedy et al (2006), Pimperton et al (2014)). Parents and professionals are not good at identifying hearing loss in newborns and infants and without newborn screening, identification before 6 months of age is rare. Let us not forget that typically before the introduction of NHSP the median age at confirmation of PCHL was 18.1 months (Fortnum & Davis, 1997) and this was similar in most western developed countries.

tocols and pathways are available at https:// www.gov.uk/government/publications/ newborn-hearing-screening-care-pathways. Well babies follow a two-technology protocol; the first stage is a transient automated otoacoustic emission (AOAE) screen, with a maximum of two attempts, followed by an automated auditory brainstem response (AABR) screen if required. A pass in both ears using AOAE, or a pass in both ears on AABR constitutes an overall screen pass. Babies cared for in NICU or SCBU for more than 48 hours undergo an otoacoustic emission (AOAE) screen and an automated auditory brainstem response (AABR). Babies that fail the AABR screen in one or both ears are considered to be screen referrals and are referred for audiological assessment. These protocols will detect auditory neuropathy spectrum disorder (ANSD) as target cases in the NICU population but not in the well-baby population. Babies with microtia/atresia in one or both ears and babies that recover from neonatal meningitis are considered to be automatic screen referrals. They do not undergo screening tests as they have unequivocal evidence of hearing loss (in the case of microtia/atresia) or a very high risk of hearing loss (neonatal meningitis) but are referred directly for audiological assessment. The majority of NHS screening programmes operate a hospital based programme; babies are screened by dedicated hearing screeners in hospital before discharge or in outpatient screening clinics for those babies that do not complete screening before discharge. A minority operate a community-based model; well

How do we do it screening protocols

Screening is carried out using standard techniques and protocols that have been developed for use within NHSP. The screening equipment uses in-built detection algorithms to judge whether a response has been detected; thus there is no human judgement, with all its associated variability, about presence/absence of a response. Detailed pro-

Figure 1: an AABR screening test in progress

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22 babies are screened at home by Health Visitors or Health Professionals at age 10 days or later. In both models babies screened under the NICU protocol are screened in hospital before discharge.

Coverage and follow up rates

In order to identify PCHL and initiate intervention by 6 months of age it is important to achieve a high coverage for screening and high rate of entry into follow up and to complete both screening and assessment early. This facilitates completion of diagnostic testing – it’s easier in babies who are a few weeks of age compared with babies a few months of age - and minimises the period of uncertainty for parents that follows a referral from newborn hearing screening. Coverage and entry into follow up are key performance measures for NHSP and comprise two of the programme standards against which performance is measured. Full details of programme standards are available at https://www.gov. uk/government/publications/newborn-hearing-screening-programme-quality-standards. The combination of coverage and follow up will determine the percentage of the target population identified by the screen. Newborn Hearing screening coverage is very high - 98.1 % of the 2015/2016 birth cohort completed screening by 4/5 weeks of age and 99.1 % by 3 months of age.This is an excellent result and is achieved by much hard work on the part of local screening teams- using multiple strategies to maximise coverage by adopting family-friendly practices, implementing initiatives to organise screening appointments for babies that do not complete the screen in hospital and enlisting the support and input of primary care professionals for “hard to reach” families. About 3 % of babies are referred from the screen in one or both ears and require follow up in audiology. Achieving early entry into follow up for these babies requires good teamwork and communication between the screening and the audiology teams, good communication with parents and a smooth process that (ideally) allows direct booking of follow up audiology appointments by screeners at the point of screen completion. Performance early in the programme

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Figure 2: Bilateral PCHI in screen referred group: Median age (with 95% CI) at screening (N=6235), first assessment (N=6235), confirmation (N=6216), referral to early intervention (N=6073) and hearing aid fitting (N=5332).

was poor but has improved considerably and reached 87.2 % for the 2015/2016 birth cohort-just short of the target of 90% for babies receiving an audiological assessment within 4 weeks. This national data masks considerable inter programme variability; the challenge is to ensure that the worst performing programmes that only follow up 60 % within 4 weeks improve to the level of the best performing programmes that follow up 100 % within this time scale. Paediatric audiology teams need to take ownership of this issue to ensure the standard is met.

Outcomes

Figure 2 above shows the median age at screening, assessment, confirmation of PCHI (permanent childhood hearing impairment), referral to Early Intervention and initial hearing aid fitting for screen referrals for birth cohorts 2006/2007 onwards as measured in September 2016. It is clear that the median age at confirmation and referral to Early Intervention for these babies is well within the first 6 months of life and for most is within the first 3 months. This represents an enormous improvement that can be attributed to universal newborn hearing screening. Parents and services now have the opportunity for early intervention including decisions about management, fitting of appropriate

hearing aids, referral for cochlear implant, choice of communication methodology and provision of family support. References Davis A, Bamford J, Wilson I, Ramkalawan T, Forsaw M, Wright S. 1997. A critical review of the role of neonatal hearing screening in the detection of congenital hearing impairment. Health Technol Assessment 1(10). Pimperton H, Blythe H, Kreppner J, et al. The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study. Arch Dis Child Published Online First: 25 Nov 2014. doi:10.1136/archdischild-2014-307516. Kennedy CB, McCann DC, Campbell MJ, et al. Language ability after early detection of permanent childhood hearing impairment. N Engl J Med 2006;354:2131–41. Fortnum H, Davis A. Epidemiology of permanent childhood hearing impairment in Trent Region, 1985–1993. Br J Audiol 1997;31:409–46. Yoshinage-Itano, C. From screening to early identification and intervention: discovering predictors to successful outcomes for children with significant hearing loss. J Deaf Stud Deaf Educ 2003;8:11–30.

hearsay

The Be one of the 300 Project Help us reach a further 300 new members by the end of this financial year (31st March 2017). All societies lose members over time - it’s a natural thing and unless we bring in new members we face the risk of losing influence. Why does the BSA need more members? With more members we are likely to get new and better ideas, more skills and more power to become a stronger, more influential Audiology organisation in the UK. Laura Turton BSA Operations Manager

Last year we had an increase of 17% in our membership. Most people report joining the BSA because someone who they respect told them it would be good for their career. We need every member of the BSA to help engage your contacts and encourage them towards joining. We are confident with your help we can do this. If every member persuaded just one person to join we would far exceed our goal. Our elevator pitch – what to say to people about the BSA An elevator pitch is a short summary used to quickly and simply define a service or organisation and its proposition – it helps get the conversation started. Please feel free to use / alter the below in your efforts to market your society. The BSA needs you, to help us grow into the strongest and most effective society in the field. Our vision is building knowledge and empowering professionals to improve the lives of people with hearing and balance problems. Join us today and let’s make this vision real.

Why do we exist?

For whom?

What’s in it for me?

hearsay

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• You should be in the BSA because it is the leading organisation that is devoted to the latest science within audiology • We are a Learned Society, not a professional body. As such we focus on clinical and patient experience, whilst maintaining an interest in professional matters • We make your life easier by giving you easy access to the latest research • You will be invlolved in a leading healthcare movement that shapes and alters clinical practice

• Anyone with an interest in hearing and balance science • This mix of professionals provides opportunities for dialogue which can be a catalyst for exciting scientific and clinical change • We work with agencies to promote high quality research which influences changes in clinical practice and overall health policy

• Inspire others to be the best they can be • Be a leader and make things happen • Influence local and national agendas • Up to date evidence based science, to develop your competencies as a practitioner • On-line access to the International Journal of Audiology - current and past editions • Consult on Practice guidance for Audiology • Access to 8 groups dedicated to areas of special Interest within audiology • Research projects and access to funding • Access to essential learning resources for your CPD

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25 Call to action – how to join Wherever possible, we need to inspire action – and make it easy for people to know what to do next. We are trying to make it as easy as possible. If you would like some membership forms to distribute, please contact bsa@thebsa.org.uk / 0118 9660622. Alternatively, you can direct people to the website: www.thebsa.org.uk/contact/join-british-society-audiology as an online payment system is available. We also have the following tools: Posters about the BSA, we can send these to you if requested A webinar on why you should join: https://connect.sonova.com/p1c7hrj4ksh?launcher=false&fcsContent=true&pbMode=normal Membership profiles on why others have joined and what membership means to them www.thebsa.org.uk/contact/join-british-society-audiology/ be-a-member-like-me/ We can all work together to help the BSA grow. Whether we convince members who have lapsed to re-join, or encourage new people - our next generation of audiology professionals, all of this will ensure our society is better placed to achieve our vision. Incentives For the referrer – for each successful, new full member referral to the BSA you will get a £5 Amazon voucher – which will be collated during April. For the new full member – For the first year, join the direct debit scheme and receive 12 months’ membership for the price of 10.

Adult Rehabilitation Interest Group (ARIG) study day: Complex Matters: going beyond the routine 5th September 2016 Darren Cordon, Chief Audiologist Hearing Services, University Hospitals of Leicester. The ARIG held a one day conference on the theme of ‘Complex Matters’ at the De Montfort University in early September 2016. The meeting was opened and chaired by Dr Melanie Ferguson (Chair of ARIG).

Laura Turton (BSA Operations Manager & South Warwickshire NHS Foundation Trust) started the morning’s lectures with an informative discussion on ‘the fundamentals of managing complex patients’ titled “I’m not complex! I’m me!” Laura offered some excellent, practical advice about individualising care in our clinics for patients perceived as ‘complex’. Dr Lynzee McShea (City Hospitals Sunderland NHS Founda-

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26 tion Trust) followed Laura by discussing her work on improving audiological care for people with learning disabilities. Lynzee highlighted a significant national unmet need in this population and spoke about her work to improve referral rates and her work training ‘Hearing Champions’.

During the mid-afternoon break, posters submitted before the study day were judged by attendees in two categories, the ‘Most likely to change my clinical practice’ and ‘Best innovation’. There was a very high standard of entries and topics to choose from.

Following a short break to view the sponsor stalls and displays, Dr Sarah Bent (Besi Cadwaladr University Health Board) spoke at length about the differing types of dementia we commonly encounter in our clinics and offered practical suggestions for dealing with those patients who have memory problems.

The afternoon and meeting closed with ‘interactive case studies’ where attendees were encouraged to apply the learning from the day to real life, anonymised situations presented by the complex needs presenters.

Donna Corrigan (Sense) rounded off the morning’s presentations by identifying some of the common communication difficulties dual impaired people may encounter in our clinics and offered practical ideas and advice to overcome them. Donna’s presentation was then followed by the BSA annual general meeting. Following lunch Jane Wild (Vice Chair of ARIG) introduced Keith Stiff from Oticon (the meeting’s sponsor) who presented about Oticon’s new super powered hearing instruments. Judith Bird (Cambridge University Hospitals) then discussed the role and approach of Audiologists as agents of change when dealing with severe and profound patients highlighting the challenging nature of change for this patient population.

Finally Mel closed the meeting by announcing the winning posters: The ‘Most likely to change my clinical practice’ winner was Lynzee McShea for ‘Hearing Champion Training’ (Lynzee won a £50 Amazon voucher kindly sponsored by Oticon) and the ‘Best innovation’ winner went to Ann-Marie Hawkins for “You REM’ed what! – verification of a communicator” (Ann-Marie won a free place for one day at the BSA Annual Conference 2017). The meeting was a timely reminder of the need for individualised care and the many practical suggestions and ideas will no doubt prove valuable within my own Department. In summary the day was an excellent opportunity to learn and share good practice when dealing with ‘complex patients’.

Review of British Society of Audiology (BSA) Balance Interest Group (BIG) Conference. Dr Andrew Wilkinson Principal Clinical Scientist & Vice Chair, BSA Balance Interest Group University Hospitals Bristol NHS Foundation Trust

Ear Institute, London. 16th September 2016. I am writing to you now, enthused and motivated by the latest biennial Balance Interest Group (BIG) Conference, held at the Ear Institute in London. Attendees of the Conference were very fortunate to gain the wisdom of renowned speakers from UK Universities and Hospitals, with an additional talk by Joanna Remenyi from Australia via Skype (online support tools for vertigo). The breadth and depth of material was outstanding: we covered material that encompassed ground-breaking scien-

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tific research into biomechanics (nystagmus in magnetic fields), vision science/ visual vertigo, and importantly also from physiotherapy and psychology. It is always fascinating and humbling to gain such expert academic knowledge. However, the focus was very much applied, as demonstrated by Dr Jess Tyrrel’s (University of Exeter) insightful app for self-monitoring of Meniere’s patients, as part of her work on causal relationships with ‘big’ data. There was the opportunity to hear some case studies from committee members Dr Peter West and Vicki Kennedy, on BPPV (mis)diagnosis and symptom longevity (anyone out there who can beat 49 years??), and hyperventilation.The BPPV cases contrasted well with Donncha Lane’s experiences with cases of BPPV resulting from head trauma. Also on a practical note, and given the increase in popularity in recent years with new equipment techniques such as video head impulse testing (v-HIT), it was very informative to hear Dr

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27 Paul Bacon’s finer points on the application of this in the clinical setting. Clinicians involved with the diagnostic assessment of vestibular function are often challenged by many of the limitations of test techniques and some of the fraught complications associated with interpreting tests, but Helen Brough shared with us the even greater difficulties associated with trying to develop balance services in developing countries.

also ENT and AVP clinicians, scientists, academics and lecturers.

It was also pleasing that there was good representation in the audience from not only the discipline of audiology itself, but

sincerely hope that we can hold many more such events like

All in all, I think days like this are a reminder that there is still a great deal which needs to be understood in this field, but also that there is already an immense wealth of knowledge and talent with all professionals working within the vestibular/ balance assessment and rehabilitation community. I, for one, this in the future.

Regulation Rethought Paul Sharpe Chief Executive Registration Council for Clinical Physiologists, City Wharf, Davidson Road, Lichfield, Staffs, WS14 9DZ E: chiefexec@rccp.org.uk

There was huge support for identifying areas that both AHCS and RCCP currently do the same or similar and doing that together and while both organisations continue to do what they do differently. ards set by different regulators for the same or similar pieces of work.

Take home message The Professional Standards Agency (PSA) have been having a think about how the Healthcare sector might be better regulated and that could influence how Audiologists are regulated. ‘Regulation rethought’ is a paper published by the Professional Standards Agency (PSA) in October 2016. Paul Sharpe, Chief Executive of the Registration Council for Clinical Physiologists (RCCP) highlights some of the points made by the PSA and looks at how the regulatory regime for Audiologists might be better delivered. The PSA run an oversight regime of the statutory regulators in healthcare and also provide a voluntary accreditation of the voluntary regulators. The paper ‘Regulation rethought’ can be viewed here: www.professionalstandards.org.uk/publications/ detail/regulation-rethought It is a follow up to a paper called ‘Rethinking Regulation’ published by the PSA in August 2015 which can be reviewed here: www.professionalstandards.org.uk/publications/detail/rethink ing-regulation

• Educators are affected by multiple regulators with different standards and quality assurance mechanisms. • Regulators should shift their focus and expenditure to the prevention of harm and the maintenance of standards – so should look to save costs and work done elsewhere. • Working in silos with separate objectives dilutes regulatory impact. • There would be merit in merging regulators to simplify access, improve efficiency and reduce costs. • Regulation should not be applied by job title but on the basis of risk to service users. • Risk is a function of the type of work done, the level of supervision under which the work is carried out and the vulnerability of service users and their ability to understand and measure the type of work delivered to them. PSA have proposed a risk measuring tool which can be reviewed here: www.professionalstandards.org.uk/publications/detail/ right-touch-assurance-a-methodology-for-assessing-and-assuring-occupational-risk-of-harm

What are the issues that the PSA have identified? • Employers have to engage with multiple regulators in order to check their worker’s registration, report concerns, support revalidation and continued professional development. • People in multi-disciplinary teams work to different stand-

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28 mination” to better deliver regulatory outcomes for Audiologists and the people who use the services that they provide? This is a question that has been asked many times over the years and most recently in May 2015 when representatives from AHCS and RCCP met to discuss the imperfect solution that AHCS and RCCP currently are to the regulatory regime required in Audiology, Clinical Physiology and in Healthcare Science. • The risk from some activities which are currently statutorily regulated could probably be adequately mitigated by forms of non statutory regulation and the risk from some activities which are not currently statutorily regulated is such that they probably should be statutorily regulated. • Improvements can be achieved through collaboration, innovation, imagination and determination. What does this mean for Audiologists? It is true that many of the observations made by the PSA in their documents apply to the statutory regulators, but they can equally be applied to the regulatory regimes which exist in the voluntary regulatory framework that Clinical Physiologists and Audiologists operate under. Two regulatory regimes currently exist, one operated by the Academy of Healthcare Science (AHCS) – who have a register accredited by PSA and another, a longer established and larger register operated by the Registrant Council for Clinical Physiologists (RCCP). In my short time sitting on the Council of RCCP, and even shorter time as its Chief Executive, I’ve witnessed: • Confusion amongst patients about where to go with concerns that they have. • Confusion amongst employers about which organisation(s) to suggest for registration requirements in job adverts – if any at all. • Confusion amongst educators about which organisation to apply for course accreditation, if any at all. • Confusion amongst registrants about which organisation to register with – if any at all. • Regulatory shortcomings arising from problem practitioners jumping from one register to another and into the gap which exists between both. • A likely cost burden on practitioners as two organisations duplicate what the other is doing Furthermore, both organisations do other things apart from offering voluntary regulation – RCCP campaigns for statutory regulation in the Clinical Physiology sector and accredits education courses, while AHCS provides equivalence, quality assurance and commissioned consultancy type work. What can be done about a solution? Can we use “collaboration, innovation, imagination and deter-

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The process has been like a journey where we have some idea of the direction of where the destination is, but we don’t know exactly where it is and we don’t have a map to show us how to get there. We’ve inevitably made some wrong turns and gone down a few cul-de-sacs. And we’re still not at the destination – but we are a lot closer to it. A meeting in November 2016 between representatives of the RCCP, its professional bodies (including the BAA President) and AHCS Board members determined that: • Doing nothing and maintaining the status quo was not an option. • An option of combining all of the services that both organisations currently do into one organisation was equally unappealing. Both organisations have history and standing and there is value in their names and what they do and it would be a shame to lose that by losing one or both of the names or brands. • There was huge support for identifying areas that both AHCS and RCCP currently do the same or similar and doing that together and while both organisations continue to do what they do differently. What that solution will look like in detail is the challenge ahead and a working group made up of representatives from RCCP (including professional bodies) and AHCS starts work in January 2017 with a goal of finalising the solution in the first quarter of 2017 for launch and delivery later in the year. What does this mean for RCCP? It’s too early to say what RCCP will look like in the future if it ceases to have a regulation/register function to operate. For years RCCP has campaigned for statutory regulation for Clinical Physiologists and the reasons for that have not gone away - and won’t go away once a new regulatory solution has been developed. The new regulatory solution should be better placed to deliver greater safety for service users, not least because it will be less easy for practitioners to hide. But any solution will still be voluntary and problem practitioners will still have the option to not be part of any of it and that is a risk to service users. So the campaign for statutory regulation must continue, though it will probably change to be more responsive to the rethinking of regulation outlined by PSA and the risk measurement model that PSA have published.

lunch and learn

Lunch and Learn CD

Facilitators and Correspondence

Shahad Howe Clinical Lead (Auditory Implants) North East Regional Cochlear Implant Programme E: Shahad.Howe@stees.nhs.uk

Christopher Cartwright Professional Marketing Manager, Phonak

Gemma Crundwell Audiologist Addenbrookes, Cambridge

E: Chris.Cartwright@phonak.com

E: Gemma.Crundwell@addenbrookes.nhs.uk

BSA Lunch and Learn eSeminars

An exciting Series of online presentations covering current topics of interest and clinically relevant research findings in Audiology and related professions, free of charge to all BSA members.

Recent bites

Coming up on the menu

These and other earlier seminars are available to access at www.thebsa.org.uk (please note these are no longer available to non-BSA members). You may need to request connection through firewalls from your local IT department for your first eLearning experience.

To go live on the first Monday of every month for access by the emailed link, or archived at www.thebsa.org.uk (please note these are no longer available to non-BSA members).You may need to request connection through firewalls with your local IT department for your first eLearning experience.

May 2016

Issues in diagnosis and management of auditory processing disorders – including spatial processing disorder › Professor Harvey Dillon

Online interventions for Tinnitus > Hidden Hearing Loss > Progressive loss/genetics of deafness

June 2016

Hearing Aids for Music: Exploring the music listening behaviour of people with hearing impairments › Dr Alinka Greasley

> Hearing aids in the paediatric population

> Preparing an article for IJA > Basic hearing science research > Update on Clinical Commissioning Policy for

July 2016

bone conducting hearing implants

Personalised Audiology › Professor Dave Moore

> Tinnitus in the media

September 2016

If you would like to contribute a seminar, have any queries or would like regular email updates, please email:

Changing caregiver and primary care perceptions of Audiology › Dr Lynzee McShea

lunch and learn

Chris.cartwright@phonak.com or Gemma.Crundwell@addenbrookes.nhs uk

lunch and learn

Changing caregiver and primary care perceptions of Audiology This short communication is based on the on-line BSA Lunch and Learn seminar by Dr Lynzee McShea, September 2016.The recording is available on www.thebsa.org.uk People with learning disabilities are more likely to have a hearing loss than the general population, but are less likely to receive diagnosis or management of their hearing loss1. The reasons for this are varied, but the support people with learning disabilities receive is relevant2. This seminar details a qualitative action research study designed to improve audiological issues for adults with learning disabilities and hearing loss, who are supported by paid caregivers. Previous research3 demonstrated that increasing caregiver knowledge alone was not sufficient to evoke a change in practice with regards to hearing loss. An understanding of caregiver attitudes and experiences was lacking in previous studies and was therefore incorporated into this research. The overall research questions aimed to explore whether it would be possible to engage with paid caregivers to improve their awareness of audiological issues and to influence their working practice and if so, what the key elements would be in achieving this. The study comprised of four action research cycles, each theoretically underpinned. The first cycle involved interviewing paid caregivers in their workplaces to explore their knowledge and experiences. Findings indicated that the majority of participants underestimated the prevalence of hearing loss and had inaccurate knowledge regarding assessment and hearing aids. Symbolic interactionism was used as a theoretical tool to account for their perspectives4.

The second cycle involved designing and piloting a training package for a wider group of caregivers. The content and delivery of the training was informed by suggestions from participants and other key stakeholders. Situated learning5 and experiential learning theory6 were the theoretical basis for the training design. Forty-four individuals were trained across six homes and constant refinement of the training occurred throughout the pilot phase. Early indications were positive; participants’ knowledge and confidence increased post training and pledges were made to continue the change process. The third cycle was concerned with further evaluation of the effectiveness of the training. Follow up visits were made to each home and a reassessment of knowledge and confidence suggested the improvements had largely persisted. Within six months, 96% of all pledges made had been achieved and the estimated prevalence of hearing loss in those supported by staff increased from 23 to 54%, with several new confirmed diagnoses of hearing loss. Focus group discussions were held with staff to explore their experiences post training. Many described “new chapters” in their working lives, suggesting they had completed their own cycle of experiential learning. These discussions also revealed barriers to audiology within primary care which necessitated investigation in a further cycle. The fourth cycle involved visiting and interviewing primary care practitioners in their workplace in order to explore their experiences, in a similar manner to cycle one. Findings from this group suggested a significant underestimation of hearing loss in people with learning disabilities and negative attitudes around the worth and benefit of referral. This study has shown that training in audiological issues can evoke a change in working practice, which has not been demonstrated in the literature in this area to date. Contact between caregivers and audiology was also important and the need to develop the role of audiology within the community transpired as one of the key findings of this research. Theoretical development of the findings has led to modification of an existing conceptual model (the 3As model) into a 5As model, which further acknowledges the need for multidisciplinary engagement and greater visibility of audiology in the community. References

Figure 1 – The 5As model for multidisciplinary engagement

1. McClimens A, Brennan S & Hargreaves P (2014) Hearing Problems in the Learning Disability Population: is Anybody Listening? British Journal of Learning Disabilities doi: 10.1111/ bld.12090 2. McCracken W, Lumm J & Laoide-Kemp S (2011) Hearing

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32 in Athletes with Intellectual Disabilities: The Need for Improved Ear Care. Journal of Applied Research in Intellectual Disabilities 24(1): 86–93. 3. McMillan L, Bunning K & Pring T (2000) The Development and Evaluation of a Deaf Awareness Training Course for Support Staff. Journal of Applied Research in Intellectual Disabilities 13: 283 - 291.

4. Denzin NK (1992) Symbolic Interactionism and Cultural Studies. The Politics of Interpretation. Oxford: Blackwell. 5. Lave J & Wenger E (1990). Situated Learning: Legitimate Peripheral Participation. Cambridge: University Press. 6. Kolb DA (1984) Experiential Learning. Experience as the Source of Learning and Development. New Jersey: Prentice Hall.

Considering music in routine fittings: evidence from hearing aid users’ music listening experiences This short communication is based on the on-line BSA Lunch and Learn seminar by Dr Alinka Greasley on 5th June 2016. The recording is available on www.thebsa.org. uk. Love it or hate it, music is all around us these days, and although sometimes we might have it forced upon us as well as choosing to listen, music can have significant health and well-being benefits (MacDonald, Kreutz & Mitchell, 2012). Whilst there is growing evidence on adults’ music listening behaviour in the field of music psychology, far less is known about music listening of people with hearing impairments, and in particular, those with presbycusis (the largest single cause of deafness in the UK, AoHL, 2016). This demographic contains those for whom music listening precedes the onset of deafness, and encompasses a large proportion of hearing aid (HA) users in the UK. HAs are increasingly effective for speech perception, but there is some evidence that they can negatively affect music perception. Musical acoustics are significantly different from those of speech (e.g. frequency range, dynamic range, crest factors) (Chasin, 2012) and studies have shown that HAs can cause distortions to pitch and volume in listening and performance contexts (Fulford, 2013; Madsen & Moore, 2014). The ‘Hearing Aids for Music’ project is a large-scale investigation exploring the ways in which hearing impairments and the use of HAs affect music listening. Several studies have been implemented (see Figure 1). In the first study, a clinical survey, patients attending two clinics (Sheffield Teaching Hospitals, NHS Foundation Trust and Harley Street Hearing, London) were asked about frequency of music listening problems and discussions with audiologists about music to identify general prevalence of problems within routine clinic settings. Data from 176 HA users, aged 21–93 years, showed that challenges with music listening were often experienced and almost half reported that this negatively affects their quality of life. Participants described issues in live

lunch and learn

Figure 1. Overview of Hearing Aids for Music project studies and outputs

performance contexts, hearing words in songs, the loss of music from their lives and associated social exclusion. The majority had not discussed music with their audiologist. For those who had, some positive experiences were reported wherein increased HA tailoring had enhanced music appreciation. Other experiences were reported to be less positive with no improvements. Results suggest that more could be done to help audiologists fit HAs for music and to inform HA users of their options. In the second study, we conducted in-depth interviews with the collection of audiometry to facilitate interpretation of the accounts. Data from 22 HA users aged 24-82 years, with varying levels of hearing impairment (10 mild, 10 moderate, 2 severe), highlighted the complexities of listening to music with HAs. Problems such as distortion (particularly at higher frequencies), a reduction in tone quality, and challenges with listening to music in live contexts were reported. Across all participants, less distortion and feedback was reported than we had expected, and pleasingly several interviewees did not experience any difficulties. One challenge that was described by numerous interviewees was switching between music and speech in a range of con-

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texts; for example, talking to friends in a bar where music is playing, attending a concert and not being able to hear the artist talk between songs, and being in a rehearsal and having to switch between music and the speech of the conductor. Those who had the ability to control the volume on their hearing aids through a phone application or remote were able to manage these situations more successfully than those without such control. Differences between success of listening in live versus recorded contexts were highlighted, and also the results confirmed the wide range of variables that need to be considered given the breadth of styles and contexts of music that are encompassed by musicians, non-musicians, listeners, performers and singers. Data show differences in HA use according to level of hearing impairment, level of engagement and training, musical styles, and listening contexts. There were also differences in interviewees’ understanding of their HA technology and in the process of acclimatising to the auditory input provided by the HAs. Some took an active role in adjusting, adapting, and experimenting, whereas others were less inclined to explore the possibilities. The use of Assistive Listening Devices (ALDs) was low which suggests that HA users are not as aware as they could be about tools that could help. Better understanding of their own hearing loss and HAs may help to align expectations appropriately.

ogists or HA dispensers, and which will help audiologists, HA fitters, and care workers to provide the best technology and environments for improving access to music. The leaflets will be distributed in clinics and dispensaries throughout the UK and will be available for download via the project website. We will also prepare a stakeholder report outlining existing processes and protocols in both public (NHS) and private sectors and highlighting where change to practice would be beneficial. References 1. Action on Hearing Loss (2016). Latest statistics on deafness and hearing loss. https://www.actiononhearingloss.org.uk/ your-hearing/about-deafness-and-hearing-loss/statistics.aspx 2. Chasin, M. (2010). Six ways to improve listening to music through hearing aids. The Hearing Journal, 63(9), 27-30. 3. Chasin, M. (2012). Music and Hearing Aids: An Introduction. Trends in Amplification, 16(3), 136-139. 4. Fulford, R. J. (2013). Interactive Performance for Musicians with a Hearing Impairment. Unpublished doctoral thesis. RNCM, UK. 5. MacDonald, R. A. R., Kreutz, G. & Mitchell, L. A. (2012). Music, Health and Wellbeing. Oxford: Oxford University Press. 6. Madsen, S. M., & Moore, B. C. J. (2014). Music and hearing aids. Trends in Hearing, 18, doi:10.1177/2331216514558271

The findings of these studies were used to inform the design of an online survey which is currently live (www.musicandhearingaids.org) and which will explore trends in the music listening behaviour of a larger sample of HA users than has been achieved in previous studies.The survey, which is available in BSL, asks HA users about their hearing, type of HAs, musical preferences and uses of music, levels of musical training, and their experiences of listening to music in different settings. In the UK, audiologists do not receive formal training in fitting HAs for music listening and may not cover the acoustics of musical signals in depth. A range of strategies have been described that might be applied to optimise digital aid fittings (Chasin, 2010), but there is a need to provide evidence of the problems listeners experience so that technical improvements can be targeted appropriately at particular difficulties and listening settings. We will use the findings to develop patient and practitioner advice leaflets which will provide useful facts and information directly benefiting HA users in their engagement with audiol-

If you would like to be added to a list to be kept informed of the project findings, and/or would like to attend the project conference, please email us, and keep an eye on our website for updates. Email: musicandhearingaids@leeds.ac.uk Twitter: @musicndeafness

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www.thebsa.org.uk lunch and learn

The benefits of SoundRecover2 Compressed output with signficiant high frequency energy Level (dB)

What is it? The next generation of Phonak’s frequency lowering technology, SoundRecover2, restores access to high frequency information and also protects low and mid frequency information while maintaining overall sound quality. It utilises an adaptive frequency lowering algorithm allowing for instantaneous adjustments in the starting point of frequency compression, between a lower and an upper cut-off frequency, based on the distribution of energy in the input signal.

fOut Max

0.5

CT1

How to use it? SoundRecover2 is available on all Phonak Sky™ V and Naida™ V hearing aids and is activated by default for most moderate to profound hearing losses. The pre-calculation is based on a patient’s audiogram and expected audible bandwidth. SoundRecover2 can be further adjusted in Phonak Target, using two sliders for optimizing the balance between audibility and distinction of high frequency information and sound quality.

For your chance to evaluate Phonak Sky™ V or Naida™ V within your department, please contact your Regional Sales Manager.

For more detailed information on SoundRecover2, Sky V and Naida V please go to www.phonakpro.com

CT2

10 Frequency (kHz) Frequency (kHz) Logarithmic scale Logarithmic scale

Compressed output with significant low and mid frequency energy Level (dB)

Why use it? Achieving audibility of high frequency sounds can be difficult or impossible with conventional hearing aids particularly for those with moderate to profound hearing loss, including sharply sloping and corner audiograms. SoundRecover2 provides access to high frequency information without compromising sound quality and naturalness. It gives more children and adults access to all the important sounds for speech development and communication as well as the everyday sounds of their environment.

fOutMax Max fOut

0.5

CT1

CT1: lower cut-off frequency CT2: upper cut-off frequency fOutMax: maximum output frequency

CT2

10 Frequency (kHz) Frequency (kHz) Logarithmic scale Logarithmic scale

ear to the ground

Ear to the ground

for all things ear-related in the media This issue of Ear to the Ground unsurprisingly begins with a summary of Breaking the Silence:Live, a rare opportunity to showcase our profession to a primetime audience. We also include coverage of a man who went deaf after eating too many chillies, another update on stem cell research and an interesting podcast on the subject of Hawaii Sign Language. There are two stories from Australia that do not shed the best light on the Australian establishment (which I almost certainly did not include as a backlash to the Australians thrashing Wales at rugby union last month!) and a video of a live maggot being removed from an ear canal. Amanda Hall’s Twitterarty section focuses on how the twittersphere reacted to Channel 4’s Breaking the Silence: Live show.

Breaking the Silence

Arguably the media highlight of the year for the Audiology profession in the UK was Channel 4’s coverage of the live switch-on of 7 cochlear implants at Manchester Royal Infirmary. The programme featured CI audiologists from several departments, including a couple of members of the Audacity editorial team! The programme began on Channel 4 and continued on Facebook live to give enough time for each switch-on. It was enlightening to see the different reactions patients gave to the initial experience of hearing through a cochlear implant, and the narrator made it clear at several stages that this was only the first step of a long journey. There were a wide range of opinions shared on social media, and a fantastic opportunity to showcase the work our CI audiologists do on a daily basis. The programme can be watched on the all4 catch up service, with or without a BSL interpreter at http://www. channel4.com/programmes/breaking-the-silence-live.

Surgeon grows ear on arm

The Independent newspaper reported in November on a man who has had a human outer ear grown onto his arm, with the eventual hope that it will be attached to his head. The patient, known as Mr Ji, lost his right ear in a car accident. Subsequently, a surgeon has used a technique similar to that used by surgeons for ear reconstruction, using a piece of cartilage from the ribs, to shape a pinna on the forearm. Once this has grown, the surgeon will attempt to attach the newly formed ear to the patient’s face. You can read about the procedure in the article at http://www.independent.co.uk/ news/world/asia/chinese-doctor-grows-human-ear-arm-ripped-off-car-crash-a7416791. html

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Don’t forget that any piece that appears on a news website can be commented on or shared via social media, allowing the reader to add their voice to a debate and pass the story to friends and colleagues.

ear to the ground

36 Not for the faint hearted

This is by no means the first “foreign body” story to have made it onto the pages of Ear to the Ground, but it is the one which turned my stomach the most! The Mirror posted a video of a doctor removing a live maggot from a young boy’s ear. This was one of 14 live fly larvae to be removed in all. The boy’s father is quoted as saying he had looked in his ear but not seen anything – further proof, if any were needed, of the unquestionable necessity of otoscopes. The removal of the maggots may not be the most horrific part of this story. Take a look at the doctor’s lack of bracing technique when performing otoscopy. The video and accompanying article is available at http://www. mirror.co.uk/news/world-news/horror-doctors-pull-14-live-9140654.amp

Podcast: Hawaii Sign Language

The Guardian recently produced a Podcast detailing the discovery of Hawaii Sign Language in 2013, and the dangers it faces today. It explains the amazement that linguists felt on discovering the language, and discusses the chances of survival for a language that is used by fewer and fewer people. The main threats listed include globalisation and a split in the indigenous community. The podcast last only half an hour, and is an interesting look at sign language away from the British Isles. It can be downloaded at https://www.theguardian.com/news/audio/2016/oct/03/the-race-to-save-a-dying-languagepodcast.

Deaf footballers struggling for funding

The Independent reported in October on the difficulties facing Team GB’s men and women’s deaf football teams. They quote the Great Britain captain Claire Stancliffe that overall, £125,000 is required to cover the costs of training, kits travel and accommodation at next summer’s Deaflympics. If the teams are unable to raise the money, Team GB will be forced to withdraw from the tournament. The article highlights the intervention of footballers James Milner and Jack Butland, who made significant donations to allow the teams to compete at the Deaf World Cup. There is much more information available, and can be read in the article at http://www.independent.co.uk/sport/ football/britains-deaf-football-team-struggling-to-find-cash-to-attend-deaflympics-a7368276.html.

Progress reported on stem cell research

The Mirror reports on progress made by a lab in Tokyo in developing stem cells that can replace one of the mutations that cause abnormalities of the outer hair cells. Though the report is a little sensationalist and doesn’t exactly reflect the work of the researchers, it is nevertheless promising to read that stem cells may play a role in treating some forms of hereditary hearing loss in the next 10 years. However, the article claims that this research will lead to a cure for congenital deafness, a claim unsupported by the researcher quoted in the article. The article does provide a neat layman’s summary of stem cell research in the field of hearing loss, and is available at http://www.mirror.co.uk/science/scientists-believe-found-cure-deafness-9298845.

ear to the ground

37 Life as a deaf actor In September, actor Genevieve Barr wrote an insightful piece in the Guardian about the difficulties of being an actor with a disability in British theatre. She discusses her two most recent roles, and compliments the directors on their honesty about the inconvenience of an actor with hearing loss and willingness to disregard the norms of theatre. She mentions the “wall of fear” audiences feel at casually poking fun at everyday reactions to hearing loss. Her attack on the excuses currently used for why there are not more disabled actors is engaging and persuasive. Ms Barr gives an interesting view into the world she experiences as a deaf actor and shares her hope for a more inclusive future. Read the article at https://www.theguardian.com/stage/2016/sep/08/deaf-actor-theatre-roles.

Australian woman denied jury opportunity The Independent reported on the outcome of a High Court trial where judges have ruled that a deaf Australian woman may not serve jury duty, as she would need a sign language interpreter to communicate. Gaye Lyons was originally dismissed from jury duty in 2012, and has been trying to have this decision overturned for almost 5 years. Understandably disappointed with the outcome of the High Court ruling, Ms Lyons described it as “a smack in the face… for the Deaf community”. Interestingly, the article concluded by explaining that Deaf jury members have served in several other countries, including the UK, USA and New Zealand. The article can be read at http://www.independent.co.uk/news/world/australasia/deaf-woman-jury-bid-australia-highcourt-bid-gaye-lyons-a7348791.html

Criticism of transcript cuts The Guardian report on another story from Australia, with criticism of the Australian Broadcasting Corporation’s (ABC) decision to stop transcribing some of its’ news and current affairs programmes. The decision is likely to save ABC around $210,000, with a spokesman arguing that, “As audience needs shift to mobile consumption…the need for a focus on transcripts is reduced”. This provoked a reaction from Australia’s disability discrimination commissioner, who raised concerned that this would prevent content from being accessible to all Australians. The argument was discussed in the Australian Senate, with Senator Kim Carr questioning whether the change was justified, given the impact on the population and the relatively small cost saving to ABC. To read the full article, follow the link https://www.theguardian.com/media/2016/oct/22/disability-commissioner-criticises-abc-over-cuts-to-transcription-service

Noodle induced hearing loss The Mirror report on a British chef who reported temporarily losing his hearing after eating what is described as “the hottest noodle dish in the world”. Ben Sumadiwiria ate a dish which included 100 bird’s eye chillies crushed together, known as death noodles. After eating the dish in Jakarta, Indonesia, the chef reported sweating, dizziness, nausea and temporary hearing loss. According to Mr Sumadiwiria, the hearing loss lasted around 2 minutes before returning to normal. Unfortunately, the burning sensation in his mouth lasted a lot longer! The article is available at http://www.mirror.co.uk/news/weird-news/british-chef-went-temporarily-deaf-8742641

ear to the ground

Twitterarty @HallAmandJ introduces you to the audiology Twitter community The documentary #Breakingthesilence was the talk of the Audiology Twittersphere in November. Cochlear implant switch-ons were broadcast live on Channel 4. Holthearing&balance @holthearingltd . Nov 22 A truly moving documentary #breakingthesilence #hearingloss #hearing

Breaking the Silence Live: the TV show set to make deaf people hear... Viewers can tune in to watch people have cochlear implants switched on and hear for the first time. It should be heartwarming - but there are always ris... theguardian.com

This edition of Twitterarty looks at twitter’s promotion and reaction to Breaking the Silence: sLive. We look at reviews of the show, personal stories of other implant users and personal greetings to the Audiologists who took part in the programme.

Some familiar Audiology faces were seen on TV… Manchester Hospitals @CMFTNHS . Nov 23 Dr O’Driscoll on the @BBCBreakfast couch this morning talking #cochlearimplant and #breakingthesilence. Get it on @Channel4 catch up now!

Ed Cooper @EA_Cooper . Nov 23 Shout-out to my Uncle Huw for helping combat deafness on @Channel4’s #breakingthesilence

Cohclear UK & IE @CohclearUK . Nov 22 In 2 hrs @Channel4 show #CochlearImplant patients live switch-ons at 8pm #BreakingtheSilence bit.ly/2flpDXS

The programme generated lots of tweets, reviews and personal stories about #cochlear implants

In reply to Manchester Hopitals

Ed Rex @rexyedventures . Nov 22 From op to switch on, follow my #cochlearimplant journey in #breakingthesilence & how I rediscovered #sound: rexyedventures.com/cochlear-impla...

bridge@thethomashous @bridgethethoma1 . Nov 23 @CMFTNHS my daughter had an Implant at Manchester aged 2. She’s a student nurse at Manchester Uni now fabulous team! #breakingthesilence Emily Morritt @EmilyMorritt . Nov 24 Catching up on #breakingthesilence Amazing what they can do & how such a small device can change people lives! #cochlearimplant Dr Lynzee McShea @LynzeeMcShea . Nov 23 Just caught up on #breakingthesilence - great to see Audiology getting some airtime! Such an important, but often overlooked profession! Fiona Stewart @Mynameisnotfifi Nov 22 I’ve had my #cochlearimplant for almost 25 years & it’s hard work. I’ve had to do rehab & learn all new sournds. It’s not that simple!

ear to the ground

39 Laura Lowles @Laura_Lowles . Nov 22 My thoughts on @Channel4 documentary #breakingthesilencelive tonight theinvisibledisabilityandme.co.uk/breaking=the-s...#hearingloss #CochlearImplant @ActionOn Hearing

Join us on Twitter @BSAudiology1

Breaking The Silence Live: My thoughts on the Channel 4 Breaking the Silence: Live documentary. theinvisibledisabilityandme.wordpress.com Hazel Price @HazelLinguist . Nov 27 Really good review of #breakingthesilence and the reality of cochlear implant switch-ons by @Charlie_win -

Charlie Swinbourne: Review of Channel 4â&#x20AC;&#x2122;s Breaking the Silence: Liv... When I first found out about Breaking the Silence: Live - an hour of live primetime TV showing deaf people having their cochlear implants switche... limpingchicken.com Daddy Knott @DaddyKnott11 . Nov 22 @Limping_Chicken Charlie I think a #breakingthesilence programme following children is needed, fancy it?

CMFT CI @CMFTcochlear . Nov 25 Tune in to Channel 4 at 21:00 tonight to see some familiar faces waching #BreakingTheSilence Live #Gogglebox #cochlearimplants

Ruth MacMullen @thehearinglib . Nov 25 My post about going biateral with #cochlearimplants. Just need to watch #breakingthesilence MED-EL @medel Thinking of going bilateral? Ruth got her first implant at 13 and shares her experience of going bilateral as an adult bit.ly/2gB8JcEy

Find out about relevant events and conferences worldwide; as well as all the latest news from the world of audiology. Get involved by sharing meeting photos and contributing to regular discussion points and surveys.

Why not give twitter a try. A good place to start is by following the British Society of Audiology @ BSAudiology1

ear to the ground

clinical catch-up

The National Bone Conducting Hearing Implant Registry CD

Author and Correspondence Zheng Ng The Ear Foundation 83 Sherwin Road, NG7 2FB, Nottingham, UK. T: 0115 942 1985 E: info@earfoundation.org.uk W: www.earfoundation.org.uk

Take-home message The National BCHI Registry assembles national figures on BCHI users, providing evidence to drive policy and practice and to support BCHI users. Audiologists, ENT consultants, manufacturers and other BCHI professionals are key stakeholders in this, and therefore we would like to invite your BCHI centre to join the National BCHI Registry!

The National BCHI Registry The National Bone Conducting Hearing Implant (BCHI) Registry is a national registry collecting information on BCHI demographics and fittings in children and adults. It has been set up through collaboration with professionals from multiple disciplines (including audiologists, ENT consultants, researchers and educators) in different organisations and major centres across the United Kingdom, and provides information relevant to (potential) BCHI users, professionals including audiologists, and funders. It collects data including numbers implanted, hearing loss (unilateral/bilateral), ages, indications for fitting, and usage rates. Clear advice on

ethics has been obtained from our local ethics committee and guidance issued to ensure that only group data is sent, no patient data is identifiable, and data entry is robust and secure. The National BCHI Registry is hosted by The Ear Foundation, as an independent body, and supported by Cochlear Europe and Oticon Medical. Why a registry is needed Currently there is hardly any robust information about the number of BCHI users in the UK, to enable planning of services and ensure effectiveness and efficiency. In addition, funding for these devices varies greatly across the country. The BCHI Registry can provide the relevant information needed to drive policy and practice and the support of BCHI users. This information is vital to provide evidence which can be used to secure the future funding of bone conducting hearing implants around the country. Following discussions with leaders in the field, the National BCHI Registry was developed; to quantify the number of BCHI users in the country and to gain an understanding of the reasons why people are fitted with the devices, the demographics of the group, and their use of the BCHI(s). This registry provides information for patients, professionals and commissioners of health care services. Aims of the National BCHI registry The aims of the BCHI Registry are: • To increase awareness on the use of bone conducting hearing implants. It aims to facilitate accessibility to BCHI users’ information, keeping a record of the numbers of implanted users, their demographics and their use of the BCHIs, and disseminate the appropriate findings on BCHI users as widely as possible. • To increase evidence on the use of a bone conducting hearing implant for users, their families and professionals.

In order to collect more robust national figures for the benefit of BCHI candidates, users and professionals, centres are invited to participate in the BCHI registry. Existing and potential BCHI users, their families, and professionals including clinicians, manufacturers and researchers could benefit through being able to use the findings. For instance, they could use the evidence as support for BCHI candidates who are thinking about implantation, in applications for funding and to improve robustness of research outcomes. • To inform policy and practice. The aim is to inform policy and clinical and teaching practice, and provide more highly needed information in terms of both quantitative and qualitative evidence on this population of users. It may also benefit professional teams: in service planning, discussion with patients, for discussion with patients, referrers and funders. The aim is also to give individual centres access to figures for the UK (at present), and to be able to use and report their own figures. Participating centres Currently, there are 21 centres involved in gathering data for the National BCHI Registry: Addenbrooke’s Hospital (Cambridge UH), Alder Hey Children’s Hospital (Liverpool), Birmingham Children’s Hospital, Heartlands Hospital (Heart of England NHSFT, Birmingham), Brighton & Sussex UH NHS T, Countess of Chester Hospital (Chester), Derriford Hospital (Plymouth H NHS T), East Kent Hospitals U NHS T, Frimley Park Hospital (Camberley), Leeds Teaching Hospitals NHS T,

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42 adults. Figure 1 shows the numbers of BCHI users with unilateral and bilateral hearing loss for children, adults, and both groups (all ages). Table 1 shows the causes of hearing loss and the proportion of people (%) in each category for children, adults, and both groups (all ages). The most common cause of hearing loss for children is syndrome with associated hearing loss, and for adults it is Chronic Suppurative Otitis Media (CSOM). Figure 1. Number (%) of BCHI users with unilateral and bilateral hearing loss.

Both groups

Children

Adults

CSOM

48%

17%

50%

Downs syndrome

13%

Isolated Atresia

20%

OME

Otitis Externa

Otosclerosis

Syndrome with associated hearing loss

22%

Trauma

Other

26%

21%

26%

Table 1. Aetiology of both groups (all ages), children and adults.

With regard to the BCHI users with bilateral hearing loss clinicians have reported (n=1738), 10% (n=167) are children and 90% (n=1571) adults fitted with a BCHI. Figure 2 illustrates the current amount of usage of their BCHI. With regard to the BCHI users with unilateral hearing loss clinicians have reported (n=550), there are 16% (n=88) are children and 84% (n=462) adults fitted with a BCHI. Figure 3 illustrates the current amount of usage of their BCHI. Quarterly results in the form of an infographic and presentation slides are posted on The Ear Foundation website: http:// www.earfoundation.org.uk/hearing-technologies/bone-conducting-hearing-implants/national-bone-conducting-hearing-implant-registry. Continuous work will be done to raise awareness of BCHI, the registry and to expand the number of centres participating to gain a clearer national picture of BCHI users. The results of the Registry will continue to be updated, and aims to be presented further through the website, meetings and publications.

Figure 2. Current amount of usage of BCHI by those with bilateral hearing loss (n=1738).

Mid Chesire H NHS FT (Crewe), North Manchester General Hospital, Freeman Hospital (Newcastle Hospitals, Newcastle Upon Tyne), Norfolk and Norwich UH NHS FT, Ropewalk House (Nottingham UH NHS T), Queen Elizabeth Hospital Birmingham, Shrewsbury & Telford H NHS Trust, Rotherham NHS FT, Royal Stoke University Hospital (UHNM, Stoke on Trent), South Tees NHS T (Mid-

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dlesbrough), and University College Hospital (UCLH, London). Each centre has a professional responsible for data input. Results so far Data has been collected over a period of 5 years so far.The BCHI Registry currently has a large dataset including information from 3530 BCHI users, of which 9% (n=313) are children, and 91% (n=3217)

Please join the BCHI Registry In order to collect more robust national figures for the benefit of BCHI candidates, users and professionals, centres are invited to participate in the BCHI registry. Centres can freely join by requesting a BCHI package from The Ear Foundation which includes software, an e-guide and usable charts. They can demonstrate their own data on charts, and are asked to send in their data quarterly to The Ear Foundation to be included in the national dataset. The entry sheet asks for details

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43 to learn more about the BCHI pathway and outcomes, with expertise from relevant professionals. • Research outcomes, available at: http:// www.earfoundation.org.uk/research see particularly Young people (11-17 years) & Adults (26+ years).

Figure 3. Current amount of usage of BCHI by those with unilateral hearing loss (n=542).

such as unilateral/bilateral hearing loss and fitting, aetiology, current usage, possible reasons for non-use, etc. The aim has been to make the data entry and collection short enough to ensure compliance, but broad enough to collect useful data. It takes a few minutes to input data per patient, and once a patient’s information is entered, the software will retain all details to present them back on the next occasion the patient’s details are opened. In doing so, further entries require less work. All patient data sent from the centres to The Ear Foundation will be received anonymously, and the data is safely stored. In addition, professionals from centres are invited to a bi-annual meeting held with professionals from the centres, manufacturer representatives and The Ear Foundation. Here, the latest figures are presented, discussions held, and appropriate tasks set. To request a BCHI package, please contact: zheng@ earfoundation.org.uk.

Useful events and resources • Facebook group for BCHI candidates and users: https://www.facebook.com/ groups/BAHA.UK/. • Accessories and technology from various BCHI manufacturers: http://www. earfoundation.org.uk/hearing-technologies/bone-conducting-hearing-implants/bone-conducting-hearing-implant-accessories. • Technical support on assistive listening devices: http://www.earfoundation. org.uk/sound-advice-for-adults/technical-sessions. • Free information booklets on children and adults from The Ear Foundation and partners: http://www.earfoundation.org.uk/hearing-technologies/ bone-conducting-hearing-implants/ bone-conducting-hearing-implant-information-sheet.

Acknowledgements The BCHI Registry is supported by Cochlear Europe Ltd. and Oticon Medical. We would like to thank the participating centres listed above, and the professionals involved, including Marion Atkin, for all their continuous input, advice and support. This registry is coordinated by Zheng Yen Ng, Imran Mulla, Arti Patel, Sue Archbold and Melanie Gregory. The Ear Foundation is very grateful to be able to host the BCHI Registry. About The Ear Foundation The Ear Foundation is an independent non-profit charity supporting those with hearing loss of all ages with different hearing technologies such as hearing aids, bone conducting hearing implants, cochlear implants and assistive listening devices. It aims to bridge the gap between clinic-based services, where the technology is fitted, and home, school, work and socially where they are used in daily life, as well as to inform policy, practice and to encourage public engagement.

• BCHI Information Day for candidates

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Tinnitus and Hyperacusis Rehabilitation at the Royal Surrey County Hospital: Patients’ evaluations of the effectiveness of treatments CD

Author and Correspondence

This report is based on the publication cited below with permission of the copyright holder. Hashir Aazh, Brian C. J. Moore, Karen Lammaing & Mark Cropley (2016): Tinnitus and hyperacusis therapy in a UK National Health Service audiology department: Patients’ evaluations of the effectiveness of treatments, International Journal of Audiology, DOI: 10.1080/14992027.2016.1178400

Dr. Hashir Aazh Tinnitus & Hyperacusis Therapy Specialist Clinic, Audiology Department, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK E: hashir.aazh@nhs.net Take-home message

• From the patients’ perspectives,

counselling was the most effective treatment in helping them to manage their tinnitus and hyperacusis, followed by education and cognitive behavioural therapy (CBT). Therefore, audiologists may need further training in the application of counselling skills in order to help them in offering therapies for patients with tinnitus and hyperacusis.

• The majority of responders who

found the bedside sound generators (SGs), wideband noise generators (WNGs) and hearing aids to be effective also found counselling and education to be effective. Therefore, it is not clear whether bedside SGs, WNGs and hearing aids were important components of the treatment package

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Introduction Audiology departments in the NHS play a major role in offering therapy and support for patients experiencing tinnitus and hyperacusis. Recently, the American Academy of Otolaryngology - Head and Neck Surgery published a Clinical Practice Guideline for tinnitus (Tunkel et al, 2014). They recommend history taking, audiological examinations, education about management strategies, hearing aid evaluation and cognitive behavioural therapy (CBT). Sound therapy was not recommended, but was suggested as an optional treatment. To the authors’ knowledge there is no widely agreed guideline developed for management of hyperacusis. A conference report suggests that various forms of counselling and sound therapy seem beneficial in the management of hyperacusis, but the evidence base for these remain poor (Aazh et al, 2014). The Tinnitus & Hyperacusis Therapy Specialist Clinic (THTSC) at the Royal Surrey County Hospital (RSCH) is an audiologist-led service. THTSC offers a mixture of interventions comprising: (1) education, (2) CBT, (3) hearing aids (4) sound therapy, and (5) client-centred counselling. Although most of these tinnitus management interventions are included in the above-mentioned guideline, the strength of their evidence base is not equal. A brief description of each intervention and its evidence base is given below.

1. Education The content of the educational sessions at THTSC is informed by Tinnitus Retraining Therapy (TRT; Jastreboff & Hazell, 2004). There are two systematic reviews supporting the efficacy of educational sessions based on the TRT approach in combination with sound therapy in the management of tinnitus (Grewal et al, 2014; Phillips & McFerran, 2010). However, the evidence base for the efficacy of education alone in management of tinnitus or hyperacusis is poor. 2. Cognitive Behavioural Therapy (CBT) CBT is a psychological intervention that aims to help the patient to modify their unhelpful, erroneous cognitions and safety-seeking behaviours (Beck, 1976; Clark et al, 1999). CBT involves helping the patient to identify, challenge and modify their unhelpful thoughts in response to tinnitus or environmental sounds. The CBT techniques at THTSC comprised: Socratic questioning, guided discovery, behavioural experiments, education and filling in diaries of thoughts and feelings between the sessions. There is a wide range of research supporting the efficacy of CBT in the management of tinnitus (Hesser et al, 2011; Grewal et al, 2014). The authors are aware of only one published research study on hyperacusis management that reports some benefits from CBT (Juris et al, 2014).

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45 From the patients’ perspectives, counselling (i.e., audiologist listening empathically to patient’s concerns) was the most effective treatment in helping them to manage their tinnitus and hyperacusis, followed by education and CBT.

3. Hearing aids Patients are offered hearing aids if they have tinnitus combined with self-reported hearing difficulties and a hearing loss that could be helped with hearing aids. Despite their widespread use, there seem to be conflicting results with regard to the effectiveness of hearing aids in the management of tinnitus. While several authors have recommended the use of hearing aids in tinnitus management (Henry et al, 2015; Moffat et al, 2009), a recent Cochrane systematic review concluded that there is currently no evidence to support or refute their use as a routine intervention for tinnitus (Hoare et al, 2014). 4. Sound therapy All patients were offered bedside sound generators (SGs) to use at night. For use during the day, patients were offered the combination devices. Research supporting the effectiveness of sound therapy for tinnitus or hyperacusis is limited, as in most studies sound therapy has been offered in combination with educational sessions (Hobson et al, 2012; McKenna & Irwin, 2008; Pienkowski et al, 2014). 5. Client-centred counselling: Client-centred counselling was developed by Carl Rogers (Rogers, 1951) and emphasises respecting and trusting the patient’s capacity for growth, development and creativity (Rogers, 1959). Empathic listening is a key counselling skill that is used throughout the therapy sessions to build a good patient-clinician relationship and offer emotional

support to patients. Empathy means to understand and feel another person’s perspectives (Rogers, 1959). Use of client-centred counselling in the management of tinnitus and hyperacusis has been recommended by several authors (Pienkowski et al, 2014; Tyler et al, 2001). However, to the author’s knowledge there is no study in the literature that assesses the effectiveness of client-centred counselling in the management of tinnitus or hyperacusis. The aim of the present service evaluation study was to obtain patients’ feedback on the effectiveness of the treatment they received for tinnitus and hyperacusis at THTSC. The information was intended to complement research findings and guide the provision of care for patients with tinnitus and hyperacusis. Method A survey questionnaire was sent to all patients who were initially seen between January and March, 2014 (n=200). The questionnaire included nine items assessing patients’ opinions of the effectiveness of the therapies that they received. Patients were asked to rate the effectiveness of each therapy on a scale from 1 to 5 (1=no effect, 5=very effective). They were instructed to leave the form blank if they had not received a specific therapy. The questionnaire items were concerned with: (1) Hearing tests, (2) Completing the tinnitus/hyperacusis questionnaires, (3) Education and information about tinnitus/hyperacusis, (4) Counselling, (5) CBT, (6) Bedside sound generator (SG), (7) Wideband noise generator (WNG), (8) Hearing Aids, (9) Overall satisfaction with the tinnitus/hyperacusis clinic. In addition, patients were asked whether they had tinnitus (yes/ no), hearing loss (yes/no) or hyperacusis (yes/no), and to specify the duration of their tinnitus. Patients were asked to return the questionnaire within two weeks, using the pre-paid envelope provided. Results A total of 92/200 questionnaires were returned, a response rate of 46%. The mean duration of tinnitus for the responders was 10 years (SD=10). Ninety

six percent (89/92) of the responders reported having tinnitus, 39% (36/92) reported having hyperacusis and 72% (66/92) had hearing loss. Forty eight percent of the responders (44/92) had received bedside SGs, 64% (59/92) ear level devices (GN ReSound i-fits) incorporating a WNG and 60% (55/92) had received i-fits incorporating amplification. Effect of the treatments from the patients’ perspective Each item on the questionnaire was rated as 4/5 or 5/5 (very effective) by over 50% of the responders. The mean score was greatest for counselling, followed by education, CBT and hearing tests. Only 6% of responders rated counselling as 3/5 or below. This was followed by education, hearing tests, and CBT, which only 9%, 12% and 15% of responders rated as 3/5 or below, respectively. This is in contrast with the bedside SGs, hearing aids and WNGs, which 25%, 36% and 47% of responders rated as 3/5 or below, respectively (Figure 1). There was no significant difference between the scores for education and counselling (p=0.06) or education and CBT (p=0.24). However, scores for education were significantly greater than scores for WNGs (p<0.001) and hearing aids (p<0.001). Scores for counselling were significantly higher than scores for CBT (p<0.001), WNGs (p<0.001) and hearing aids (p<0.001), and scores for CBT were significantly higher than scores for WNGs (p<0.001) and hearing aids (p<0.005). The scores for the bedside SGs were lower, but not significantly so, than scores for counselling (p=0.007), education (p=0.03) or CBT (p=0.06). A comparison of scores for responders with tinnitus only and those with hyperacusis (with or without tinnitus) showed that there were no significant differences for education (p=0.32), counselling (p=0.14), CBT (p=0.05), bedside SGs (p=0.16), WNGs (p=0.29) or hearing aids (p=0.26).

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46 most all of the patients who found SGs, WNGs and hearing aids to be effective, also rated counselling or education as effective (4 or 5). This makes it difficult to determine whether the bedside SGs, hearing aids or WNGs were effective components of the treatment package.

References • Aazh, H., McFerran, D., Salvi, R., Prasher, D., Jastreboff, M. et al 2014. Insights from the First International Conference on Hyperacusis: causes, evaluation, diagnosis and treatment. Noise Health, 16, 123-6. Fig 1: The percentage of respondents who ranked each intervention as 3/5 or below i.e., “non-effective”.

Conclusion Counselling, CBT and education Responders rated counselling, education and CBT as more effective than hearing aids and WNGs. This is consistent with previous reports suggesting that CBT and education have a stronger evidence base for the management of tinnitus and hyperacusis than sound therapy and hearing aids (Tunkel et al, 2014; Hesser et al, 2011). However, to the authors’ knowledge no previous study has assessed the effectiveness of client-centred counselling in management of tinnitus and hyperacusis. Our study showed that client-centred counselling was rated as slightly better than CBT and as much more effective than education. Although the Good Practice Guide in the UK recommends that “all members of teams working with patients with tinnitus need to be competent in counselling and psychological support skills” (p.14, line 12), the document did not define exactly what was meant by counselling and psychological support. This could range from providing reassurance and information to the use of client-centred counselling skills.There is a discrepancy between audiologists’ perception of counselling and the client-centred counselling approach. In many audiology textbooks and research papers, counselling is described as explaining and providing technical information to the patient (English

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et al, 2000). However, in the context of a client-centred approach, counselling is a process that should allow the patient, not the clinician, to talk about their concerns and emotions (Rogers, 1962). A clinical implication is that audiologists may need further training in the application of counselling skills to help them in offering therapies for patients with tinnitus and hyperacusis. However, further research is needed to systematically assess the effectiveness of client-centred counselling (as opposed to just listening sympathetically and giving advice to the patient) in the management of tinnitus and hyperacusis. Bedside SGs, hearing aids, and WNGs More than 50% of the responders rated the bedside SGs, hearing aids and WNGs as 4/5 or 5/5. However, as sound therapy devices were always offered together with counselling and education, it is not clear whether the high satisfaction of this 50% was directly related to the effectiveness of the devices or to satisfaction with the overall therapy. Between 20% and 46% of responders who found education or counselling to be effective, rated the bedside SGs, WNGs and hearing aids as 3/5 or below. This indicates that many patients who did not benefit from the SGs, hearing aids or WNGs still benefited from the educational and counselling components. However, al-

• Beck, A.T. 1976. Cognitive therapy and the emotional disorders. New York: International Universities Press. • Clark, D.A., Beck, A.T. & Alford, B.A. 1999. Scientific Foundations of Cognitive Theory and Therapy of Depression. New York: Wiley. • English, K., Rojeski, T. & Branham, K. 2000. Acquiring counseling skills in mid-career: outcomes of a distance education course for practicing audiologists. J Am Acad Audiol, 11, 84-90. • Grewal, R., Spielmann, P.M., Jones, S.E. & Hussain, S.S. 2014. Clinical efficacy of tinnitus retraining therapy and cognitive behavioural therapy in the treatment of subjective tinnitus: a systematic review. J Laryngol Otol, 128, 1028-33. • Henry, J.A., Frederick, M., Sell, S., Griest, S. & Abrams, H. 2015. Validation of a novel combination hearing aid and tinnitus therapy device. Ear Hear, 36, 42-52. • Hesser, H., Weise, C., Westin, V.Z. & Andersson, G. 2011. A systematic review and meta-analysis of randomized controlled trials of cognitive-behavioral therapy for tinnitus distress. Clin Psychol Rev, 31, 545-53. • Hoare, D.J., Edmondson-Jones, M., Sereda, M., Akeroyd, M.A. & Hall, D. 2014. Amplification with hearing aids for patients with tinnitus and co-existing hearing loss. Cochrane Data-

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47 Thai-Van, H., Collet, L. et al 2009. Effects of hearing aid fitting on the perceptual characteristics of tinnitus. Hear Res, 254, 82-91.

base Syst Rev, 1, Cd010151. • Hobson, J., Chisholm, E. & El Refaie, A. 2012. Sound therapy (masking) in the management of tinnitus in adults. Cochrane Database Syst Rev, 11, Cd006371. • Jastreboff, P.J. & Hazell, J.W. 2004. Tinnitus retraining therapy: implementing the neurophysiological model. UK: Cambridge University Press. • Juris, L., Andersson, G., Larsen, H.C. & Ekselius, L. 2014. Cognitive behaviour therapy for hyperacusis: A randomized controlled trial. Behav Res Ther, 54c, 30-37.

• Phillips, J.S. & McFerran, D. 2010. Tinnitus Retraining Therapy (TRT) for tinnitus. Cochrane Database Syst Rev, 3, Cd007330. • Pienkowski, M., Tyler, R.S., Roncancio, E.R., Jun, H.J., Brozoski, T. et al 2014. A review of hyperacusis and future directions: part II. measurement, mechanisms, and treatment. Am J Audiol, 23, 420-36.

ENT & audiology • McKenna, L. & Irwin, R. 2008. Sound therapy for tinnitus – sacred cow or idol worship?: An investigation of the evidence Audiol Med, 6, 16-24.

• Moffat, G., Adjout, K., Gallego, S.,

• Rogers, C. 1951. Client-Centered Therapy. UK: Constable and Company Limited.

• Rogers, C.R. 1962. The nature of man. In: S. Doniger (ed.) The nature of man in theological and psychological perspective New York: Harper & Brothers, pp. 91-96. • Tunkel, D.E., Bauer, C.A., Sun, G.H., Rosenfeld, R.M., Chandrasekhar, S.S. et al 2014. Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg, ISSN 2042-2156 151, S1-S40.

R.S., Haskell, G., Preece, J. & Special• Tyler, Focus Bergan,Care C. 2001. Nurturing Patient-centred – Page 43patient

• Rogers, C.R. 1959. A theory of therapy, personality, and interpersonal relationships as developed in the

news

client-centered framework. In: S. Koch (ed.) Psychology: The study of a science Vol 3 Formulations of the person and the social context, New York: McGraw-Hill, pp. 184-256.

expectations to enhance the treatment of tinnitus. Seminars in Hearing, 22, 15-21.

AUDIOLOGY MATTERS European Tinnitus Research Network (TINNET) – Page 71

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49 So the World May Hear: Switch on the Sound/Lions Used Hearing Equipment Programmes Your support can help underprivileged children and adults around the world hear the Sounds of Life we take for granted Now he has no excuse for not doing what ‘big sis’ tells him. Brazzaville 2015

Little did I know the impact that that first project in fitting 230 children with binaural hearing aids would have on my life. I subsequently met a Lion called Vic, a French Canadian priest called Papa Gagion, the Founder of the World’s largest hearing aid manufacturer – Bill Austin and his wife Tani, various Governors of HM Prisons Service and their excellent staff, the Inside Out Trust, Sound Seekers and many more people and organisations all with the belief that it was possible to make a difference to the life quality of underprivileged hearing impaired people by establishing sustainable programmes, underpinned by local skilled people with ongoing support and training from organisations dedicated to the goal – So the World May Hear. The service was to be free at the point of delivery. The prisons aspect was one of Restorative Justice with the establishment of workshops within prisons where supervised prisoners process donated aids - sorted, cleaned, refurbished or identified as needing sophisticated electronic attention.

It’s 1983 and I am in Ethiopia a country that was about to be ravaged by famine, having flown there in a RAF Hercules transport plane (fully loaded). The main instructions from Sister Barbara Walsh who was establishing the first Oral school for Hearing Impaired children in the country was “bring hearing aids for the children and some custard powder if you have room in your luggage” - the nuns had a sweet tooth and loved Bird’s

custard. That was my first experience of collecting unwanted hearing aids, refurbishing them, organising for appropriate cords, receivers (for the body worn aids), batteries for both body worn and BTEs and ear mould making kit. I cadged and cajoled everything because I hadn’t the money to buy stuff. Everything was shipped free by TNT to RAF Lyneham and then on by Hercules to Addis Ababa.

In the early days our own Government was donating new hearing aids to support projects, the problem was making sure what was donated was usable – it’s no use sending brand new body aids without cord and receiver, or forgetting that hearing aids need batteries and in developing countries they are unaffordable to many people. Slowly but surely however things began to click and when I look at where we are today with inter country training and resource, local programmes with Government support, effective sorting and refurbishing of donated hearing aids

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It’s good to hear Liberia

and equipment, battery programmes, weekly troubleshooting clinics and effective Primary Ear Care with medication where necessary for the 25-30% of patients who attend Hearing Missions with hearing loss that is amenable to treatment, I think it is fair to say we are making progress in achieving the goal – So the World May Hear. However, without the basic tools of hearing aids and associated hard and soft ware it will not be possible to continue the work of providing FREE at the point of delivery, a sustainable service that gives the joy of hearing to underprivileged hearing impaired kids and adults. We have a sustainable supply of batteries, of efficient earmoulds, of skills necessary to support the patients –

the primary need is donated unwanted hearing aids working or broken and any bits and bobs such as ear hooks, plastic parts for which you no longer have a need.

Africa, Uganda, Tanzania, Malawi, Kenya,

As we enter a New Year please think of the work being done across the world So the World May Hear and drop in the post any unwanted hearing aids to help feed the huge appetite of people for good hearing.

West Bank, Afghanistan, Jordan, British

During the past 18 months Lions International and Switch on the Sound Campaign have collected and shipped hearing aids and associated equipment that has been used in Hearing Missions in countries including; Ethiopia, Congo, Peru, Mexico, Colombia, South

Zanzibar, Madagascar, Ukraine, India, Nepal, Sri Lanka, Democratic Republic of Congo, Bangladesh, Burma, Cambodia, China, Philippines, Vietnam, Zimbabwe, Guyana, Caribbean countries, Indonesia.

Please direct any unwanted hearing aids and associated equipment to: Dr Michael Nolan Lumb Gaps Barn Haslingden Old Road Rossendale BB4 8TT

Submit an article We welcome the submission of articles on relevant clinical, research and academic or other themes within Audiology. The reader may not always be an expert or have previous interest in your specialist area and the article is an opportunity to increase the knowledge base and interest in new areas of audiology. We are keen to publish articles that present alternative or challenging themes that will encourage and provoke debate. www.thebsa.org.uk/audacity/submit-article

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Essentials Council Members / Meeting Dates Officers Mrs Elizabeth Midgley – Chair Dr Ted Killan – Vice Chair Dr Huw Cooper – Immediate Past Chair Dr Gareth Smith – Secretary Mr Barry Downes – Treasurer Elected Trustees

BSA COUNCIL MEETNGS Boardroom, Post Graduate Centre, QE, Birmingham, unless otherwise stated 11am – 4.30pm 21st March 2017 - IM&T, University Hospitals Bristol 20th June 2017 19th September 2017 5th December 2017

Dr Peyman Adjamian Ms Siobhan Brennan

Meeting dates and venues may be liable to change and new dates for 2017 will be released imminently.

Dr Nicci Campbell Dr Carmel Capewell Dr Piers Dawes Mr John Day Dr David Greenburg Michael Joseph Dr Imran Mulla Yvonne Noon Dr Sudhira Ratnayake Council Advisors Prof. Kevin Munro (International Journal of Audiology) Dr Michael Akeroyd (International Journal of Audiology & Chair of the Research Funding Steering Committee)

Dr Peter West (International Journal of Audiology) Dr Mel Ferguson (Adult Rehabilitation Interest Group) Donna Corrigan (Professional Guidance Group) Pauline Grant (Auditory Processing Disorder Special Interest Group) Charlotte Turtle (Social Media) Belinda Baldwin (Social Media) Katy Morgan (Balance Interest Group) Dr Martin O’Driscoll (Audacity Editor) Jane Wild (Incoming Audacity Editor) Dr Derek Hoare (Tinnitus & Hyperacusis Special Interest Group) Lauren Smalley (Paeditric Audiology Interest Group) Gemma Twitchen (Global Outreach Special Interest Group) Carolyn Dando (Events Representative) Nathan Clarke (Student Representative)

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For more information, please contact BSA Tel: 0118 966 0622 Fax: 01506 811477 Email: bsa@thebsa.org.uk Web: www.thebsa.org.uk British Society of Audiology Blackburn House Redhouse Road Seafield, Bathgate, EH47 7AQ

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Essentials Examination Passes The following students have passed accredited BSA courses over recent months: May 2016

BSA Certificate in Industrial Audiometry (Albacare) Sarah Davidson

Louise Porter

Billie Butler

Joanne Doran

Susan Broadhurst

Ella Tidswell

Anna Quary

Sarah Skellon

Nick Scoffield

Pedro Meha

Kyle Marshall

Mark Bell

Gabrielle Larkin

Gayle Currie

Agatha Lyons

Marian McKenna

Helen McClelland

Shona Anderson

Vivienne Costley

Roisin MacCann

Joseph McCloskey

Marguerite Browne

Christine Connor

Claire McLeod

Valantine Lawson

Lynsay Boyle

Elspeth Chalmers

Julie Falconer

Elaine O’Neil

David Sim

Samantha Eastcroft

Wendy Meldrum

Virginija Kuizinaite

Jason Weightman

Gus Colville

Andy Heslop

Cliff Purvis

Vivien Coltherd

Gary Scott

Elesha Sopel

Angela McCallum

Abbigail Welsh

Joanna Elliott

Arlene Donnelly

Paulo Alexandre Dos Santos

Jane Walder

Christopher Fazakerley

Oonagh Always

Anne Dempsey

Penelope Callan

Graham Larmour

Hilary Best

Lynn Minter

Gill Corner

Nicola Street

Elizabeth Wakeling

Kathryn Gallagher

Sue Carroll

Kerri Tyler

Mary Goves

Lesley Tindale

Sally Hobson

Adele Martin

Anne McGee

Elizabeth Weir

Chris Simpson

Sara Annau

Catriona Heath

Kelly Ireland

Mhairi Deas

Gillian Marelic

Jade Welch

Phillip Sparks

Cathy McDowall

Sharon Wilkinson

Stella Tomkinson

Claudia Santos

Ruby Thibeault

Gerry Smith

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (Audio-Training) Earl Panagi

Joy Williams

Neil Bennett

Danielle Boyle

Jerrin Johny

Joe Morphew

Joanne Snelling

Daniel Bennett

Richard Glover

Bruce Marks

Ashley Small

Mark Skinner

Paris Walker

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (T J Audiology) Roger Williams

Darren Williams

Anna Budwisz

Toni Formoy

BSA Certificate in Basic Audiometry and Tympanometry (T J Audiology) Ciara O’Connor

Lauren Darvall

Anna Budwisz

Abigail Sisson

Eileen Morgan

Masa Klubicka-Herdics

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Essentials Examination Passes The following students have passed accredited BSA courses over recent months: November 2016

BSA Certificate in Industrial Audiometry (Albacare) Grace Brady

Eileen M O’Connor

Karen McCabe

Joan Lockheart

Claire Cunningham

Carolyn Gill

Madalene Magee

Jolene O’Malley

Rebecca Thomas

Haf Ward-Williams

Elena Pattinson-Thomas

Terry Pease

David Barber

Kate Franklin

Anna Barton

Paula Wilson

James Shuttleworth

Paul Willis

Hayley Drake

Trudy Davies

Delia Harrop

Lynda May

Sam Laird

Joanne Prenter

Amanda Lindsay

Natalie Smith

Sharon Gilmour

Maureen Callaghan

Liz Bryson

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (Audio-Training) Mark Chase

Charlote Crowe

Lee Jenkins

Rebekka Jones

Daniel Wright

BSA Certificate in Industrial Audiometry (Insight Health Screening) Rachel Godfrey

Wayne Cullis

Bethan Roberts

BSA Certificate in Basic Audiometry and Tympanometry (Mary Hare Training School) Nicola Green

Tahir Khan

Ella Malenchini

Jon McCarthy

Amanda McGilligan

Seamus McKenna

Jane Peyton

Annette Stege-Dean

Renee Van Ohlsen

Graham Warner

Alex Eaves

Kim Hiett

Lynne O’Mahony

Joanne Dale

BSA Certificate in Industrial Audiometry (Sheffield Teaching Hospital NHS Trust - Harriet Crook) Debbie Farrow

Tracey Froggatt

Natasha Rollitt

Justin Wilkinson

Sarah Wood

Michael Morrell

Jack Latus

William Latus

Joanne Meadows

Thomas Fairey

BSA Certificate in Otoscopy & Impression Taking (Adults & over 5’s) (*Starkey) Elizabeth Heuston*

Sharon McVey

Michael Diamond

Lori Ross

Alison Orr

Danielle Randall

Kylie Hodge

Payton Williams*

Alison Williams

Christine Sawyer

Kathryn Howard

Deborah Chapman

Wendy Gregory

Mary Peters*

Gemma Green

Pamela Tokely

Daniel Mallin

Fiona Haughie

Anne Crosland

Claire Marshall

Jay Campbell

Fiona McGarry*

Conor Ryan

Richard D’Adamo

Rachael Barnett

Jakub Wiatr

Lyndsey Green

Francesca Yaxley

Rebecca Odlin

Katie Mills

Mark Ellis

Suzanne Moore

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55 BSA Certificate in Otoscopy & Impression Taking (Adults & over 5â&#x20AC;&#x2122;s) (T J Audiology) Mr Hicham El-kaissi

Natasha Greenhough

Marie Parker

Wioletta Krukowska

Man Yui Pat Chow

Louie Ruck

Ausra Karunaite

Adam Johnson

Joy Monaghan

Steven Wall

Jake Corns

Sean Horsman

Emma Milam

Josh Shires

Charles Densham

Casey Rowlings

Jo Collier

Adrian Heap

BSA Certificate in Otoscopy & Impression Taking (Paediatrics) (T J Audiology) Caroline Pocock

Sandra Sharratt

Juliet Morely

Jackie Creese

BSA Certificate in Industrial Audiometry (T J Audiology) Michelle Gluck Vicky James

Gillian Gluck

Patrick Thornton

Anthony Gregori

BSA Certificate in Basic Audiometry and Tympanometry (T J Audiology) Kalev Rabi

Lina Staroselets

Madis Pruler

Sandra Verk

Michelle Turnbull

Pat Chow

Merike Rabi

Congratulations to all candidates Details of all accredited course providers, together with information on providing accredited courses, are available from the BSA office and via the BSA website www.thebsa.org.uk. The BSA also retains a list of delegates who have completed accredited courses.

BSA Connections and Collaborations where we represent you March 2017 4th March, London, NICE scoping workshop on Hearing Loss 22nd March, London, UCL Student Careers day April 2017 11th April, Edinburgh Meeting with PinPoint to discuss BSA Media Clips 22nd April, Leicester Meeting with De Montfort University May 2017 13th May, Nottingham British Society of Hearing Aid Audiologist Annual Congress

June 2016 7th June, London Hearing and Deafness Alliance 27th June, Leicester Meeting with Leicester Royal Infirmary July 2016 8th July, Online Virtual Meeting with the Ida Institute

22nd September, Manchester The British Tinnitus Association Annual Conference 30th September, Westminster The Foundation for Science and Technology at the House of Lords October 2016 4th October, Derby

19th July, Westminster, London Launch of the National Commissioning Framework for Hearing Loss Services at the House of Commons

British Tinnitus Association

August 2016

Virtual meeting with the British Society

4th August, Birmingham Developing a population for a System of Care & the BSA Meeting,

November 2016

September 2016

16th May, Derby Meeting with the British Academy of Audiology

13th September, London Hearing and Deafness Alliance

18th May, Birmingham Hearing and Learning Disabilities Annual Meeting

15th - 16th September, Cork, Ireland European Federation of Audiological Societies Meeting

Meeting with the

31st October of Hearing Aid Audiologists

10th & 11th November, Glasgow The British Academy of Audiologyâ&#x20AC;&#x2122;s Annual Conference 22nd November, Leicester Meeting with the British Academy of Audiologys

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Essentials Organisational Members

Corporates Third and Public Sector Departmental

The partnership with Organisational Members of the British Society of Audiology (BSA) is of fundamental importance to the Society. As the largest multidisciplinary society concerned with hearing and balance in the UK, the BSA seeks to include commercial colleagues and organisations in its mission to promote knowledge, research and clinical practice in these areas. Being an Organisational Member places an organisation in close dialogue with senior members of the BSA, supporting meetings and publications. The outworking of this are yearly meetings between the Officers of the BSA and the Organisational Members to share information and perspectives on the strategic direction of the BSA. Organisational Members have direct input to the Learning Events Group, and their input is especially valued in the organisation of meetings and supporting exhibitions, these being a crucial element of successful events. ACOUSTIC METROLOGY LIMITED Manufacturers of VRA systems. Repair service of Audiometers, tympanometers and acoustics instruments. E: info@a-met.com W: www.a-met.com

INDUSTRIAL ACOUSTICS COMPANY LTD World leader in the design, supply and installation of high performance, state-of-the-art of Audiometric Rooms. E: info@iac-acoustics.com W: www.industrialacoustics.com/uk

PHONAK UK Phonak offers latest product information, an interactive content about hearing and a specific children section W: www.phonak.com

ADVANCED BIONICS A Sonova Brand – is a global leader in developing the most advanced cochlear implant systems in the world. Founded in 1993 and a subsidiary of the Sonova Group since 2009, AB develops cuttingedge cochlear implant technology that allows recipients to hear their best. E: info.uk@advancedbionics.com W: www.advancedbionics.com

INTERACOUSTICS

PURETONE LIMITED Manufacturers of quality digital and analogue hearing aids, tinnitus management systems. E: info@puretone.net W: www.puretone.net

AUDITDATA LIMITED Auditdata provides office management systems for hearing clinics, innovative audiometry fitting systems, and hearing instrument testing. E: uksupport@auditdata.com W: www.auditdata.com

OTICON LIMITED Oticon designs and manufactures both hearing solutions for adults, and specialized paediatric instruments. E: info@oticon.co.uk W: www.oticon.co.uk

QUIETSTAR With over 100 years collective experience within the design, manufacture, delivery and installation of noise control products and services, QuietStar Limited is fast becoming the UK’s leading noise control provider. E: info@quietstar.co.uk W: www.quietstar.co.uk

BIOSENSE MEDICAL LIMITED Biosense Medical supply specialist equipment for use in Audiology, Vestibular and Balance, Neurophysiology, Pressure Measurement, Human Movement and Biomechanics W: www.biosensemedical.com

OTICON MEDICAL

SIVANTOS LIMITED Leader in the provision of digital hearing systems to the NHS and private hearing aids dispensers. E: info-hearingaids.shi.ukhealthcare@siemens.com

OTODYNAMICS LIMITED Otodynamics Ltd. pioneered OAE screening 25 years ago and sells a wide range of OAE screening and diagnostic instruments and makes in-house research and development its top priority E: sales@otodynamics.com W: www.otodynamics.com

SPECSAVERS Specsavers is largest provider of the free NHS digital hearing aids and 60% of its 17.3m customers in the UK are from the NHS. W: www.specsavers.co.uk

P C WERTH LIMITED PC Werth supplies calibrate and service the UK’s leading range of instruments for every diagnostic and audiology need. E: sales@pcwerth.co.uk W: www.pcwerth.co.uk

THE TINNITUS CLINIC The Tinnitus Clinic is the leading provider of the latest evidence-based tinnitus treatments in the UK. W: www.thetinnitusclinic.co.uk

ECKEL

From product testing to research laboratory, Eckel noise control has played an integral role in technological advances in science, industry and commerce. Today, engineers and scientists utilise Eckel anechoic chambers and noise control products to improve the technology that affects our lives and the environment for our future. E: info@eckeleurope.co.uk T: +44 (0)1276 471199 W: http://eckeleurope.com

GUYMARK UK LIMITED Guymark is a distributor of GSI audiological equipment, Vivosonic ABR equipment and Micromedical Technologies balance equipment E: sales@guymark.com W: www.guymark.com

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Interacoustics is the world’s leading provider of solutions for measurement and diagnosis within hearing and balance. With more than 45 years’ experience, Interacoustics prides itself on listening to and supporting its customers to deliver the very best diagnostic solutions for their patients. This is accomplished by maintaining a continuous dialogue with healthcare professionals working in all sectors of audiology, neurology and physiotherapy.

W: www.interacoustics.com

Oticon Medical is a global company in implantable hearing solutions, dedicated to bringing the magical world of sound to people at every stage of life. As a member of one of the world’s largest groups of hearing health care companies, we share a close link with Oticon and direct access to the latest advancements in hearing research and technologies. E: info@oticonmedical.com W: www.oticonmedical.com

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57 WIDEX

Widex is a family owned company founded in Denmark in 1956. Today, it is one of the world’s largest manufacturers of hearing aids. Widex hearing aids are sold in more than 100 countries around the world, and the company employs over 4,000 people worldwide. We develop digital technology at a level of quality that few can match, and this has forged our reputation as one of the most innovative manufacturers in the industry. W: www.widex.co.uk

NATIONAL COMMUNITY HEARING ASSOCIATION We are the voice of community hearing care throughout the UK and are committed to better hearing care for all. E: info@the-ncha.com W: www.the-ncha.com

THE EAR FOUNDATION The Ear Foundation – bridging the gap between clinic-based services, where today’s exciting hearing technologies, such as cochlear implants & bone conducting hearing implants are fitted, and home, school and work where they are used in daily life. E: info@earfoundation.org.uk W: www.earfoundation.org.uk

AUDIOLOGY, NHS FREEMAN HOSPITAL

ACTION ON HEARING LOSS

DEAF EDUCATION THROUGH LISTENING AND TALKING (DELTA)

THE BRITISH TINNITUS ASSOCIATION The British Tinnitus Association (BTA) is a world leader, with a trained team of friendly and experienced advisers for anyone who experiences tinnitus or those simply seeking guidance or information about the condition. E: info@tinnitus.org.uk W: www.tinnitus.org.uk

Our highly skilled and experienced Audiologists provide a comprehensive Audiology and Hearing Aid Service for the Newcastle, North Tyneside and Northumberland region. We provide a range of specialist tests and individual management plans W: www.newcastle-hospitals.org.uk/services/ent_ services_audiology-and-hearing-aid.aspx

DELTA is a voluntary association of young deaf adults, the families and teachers of deaf children and is a national charity which supports and develops the Natural Aural Approach to the education of deaf children. Both the Approach and the Association trace their origins back to a group of teachers of the deaf working together from 1980 to improve the outcomes for deaf children. W: www.deafeducation.org.uk

INSTITUTE OF HEARING RESEARCH, THE MEDICAL RESEARCH COUNCIL (MRC) MRC improves the health of people in the UK – and around the world – by supporting excellent science, and training the very best scientists. We are a non-departmental public body funded through the government’s science and research budget. W: www.mrc.ac.uk

Action on Hearing Loss is the largest UK charity helping people confronting deafness, tinnitus and hearing loss to live the life they choose. Action on Hearing Loss enables them to take control of their lives and remove the barriers in their way, giving people support and care, developing technology and treatments, and campaigning for equality. W: www.actiononhearingloss.org.uk

AUDIOLOGY, NHS TAYSIDE

Our aim is to provide a high quality, patient focused, comprehensive service for Audiological and Vestibular impairments. Using the most up to date equipment our specialist teams provide a wide range of assessments, rehabilitation and habilitation in Adults and Children with various Audiological and Balance disorders. W: www.nhstayside.scot.nhs.uk/ OurServicesA-Z/AudiologyandBalanceServices/ index.htm

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Essentials Audacity Advertising rates THE BSA ADVERTISING RATES : 2016 / 17 The following rates are in to force on 1st June 2016 and will be in place for 12 months. The British Society of Audiology provides different methods of advertising opportunities which are listed below. All prices are subject to VAT Website Advertising (up to 2months) Cost (£) Jobs listing x 1* £ 355 Each additional job advertised* £ 225 Commercial courses/events £ 100 Non-commercial external events/courses £ 55 *

includes entry to that months e-Update

All courses are listed on our events page in day order and can be found here www.thebsa.org.uk/events/event The website has on average 3,600 users each month and 14,500 unique page views. We collate statistics on the website on a quarterly basis which we can share with you.

Website Advertising (up to 12months) Commercial courses/events Non-commercial external events/courses

£ 955 £ 205

Mailshot to BSA members (in the BSA e-Update email) Job listings* £ 355 Each additional job advertised* £ 225 Commercial courses/events £ 105 Non-commercial courses/events £ 65 *

Technology Update per issue - advertisers can focus on industry update on new products or features. Your advert should be 200300 words and can include images £ 240 Single A4 sheet (flyer provided by the customer) £ 675 Single A4 sheet (B/W printed by BSA) £ 940

includes a 2-month website advert

The email is sent out on the 15th of each month to 1,300 contacts. The newsletter has an open rate of 35% in the first 6 months of running this. We can provide further statistics to you if required.

COMBINED ADVERT (Website for 2-month + one e-Update email) - 15% discount Commercial courses/events £ 175 Non-commercial external events/courses £ 100 Audacity Magazine: (per issue) - sponsors receive around 35% discount 1/2 Page (sponsors) colour £ 340 1/2 Page (non-sponsors) colour £ 520 Full A4 Page (sponsors) colour £ 570 Full A4 Page (non-sponsors) colour £ 890 Full page colour inside front or back cover (non-sponsor) £ 970 Full page colour inside front or back cover (sponsor) £ 630

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Audacity Magazine - Special Rates (annually in both publications) - 15% discount Full page colour 2 issues (sponsor) 1/2 page colour 2 issues (sponsor) Full page colour 2 issues (non-sponsor) 1/2 page colour 2 issues (non-sponsor)

£ 970 £ 580 £ 1,780 £ 885

Print ready artwork Pass4Press PDF – Adverts must be supplied as Pass4press PDFs. To download settings for InDesign & QuarkXpress please visit www.pass4press.com. PDFs generated with these settings will be compatible with our commercial printer. Please note that we do not accept the following: RGB, colour-managed or ICC profiles, non-embedded fonts, images lower that 150dpi and transparency. If any of these elements are in the artwork then a report will be generated, sent to the client and a replacement must be sent. Adverts to be typeset by publisher Word document - Please supply the raw text as a word document and supply any images and EPS, TIFF or JPG files separately. Production charges will be applied to adverts typeset by the publisher. For further information please see www.thebsa.org.uk/ wp-content/uploads/2015/12/Audacity-Advert-Spec.pdf

2016 - 17 AUDACITY PUBLICATION SCHEDULE Advertisements (copy date deadline)

Audacity (dispatch date)

30th December 2016 1st July 2017

15th February 2017 15th August 2017

For more information please contact the BSA Administration Team by: Email: bsa@thebsa.org.uk or Tel: 0118 966 0622

Save the Date! 16th and 17th

NOVEMBER

2017

14th Annual Conference Bournemouth International Centre Highlights to include: The latest in Audiology research, education and expertise, with inspiring speakers and informative sessions Awards programme to acknowledge individuals and teams who have excelled in the Audiology profession Free paper and poster submission Dedicated tracks for students and associate Audiologists The largest UK Audiology exhibition Exciting social events and networking opportunities

@BAAudiology | #BAAConf British Academy of Audiology

Further information will be available at www.baaudiology.org/conference To add yourself to the event mailing list email events@baaudiology.org