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feedback The Official Publication of The Academy of Doctors of Audiology® 7 10 18 Tinnitus overview: Hope! Human brain imaging of tinnitus and animal models. Officer nomination position statements. 12 Evolving Counseling and Sound Therapies for Tinnitus President’s Message: Embracing Change for a Better Future Professional Update: AAA Update, AFA Update, ASHA and HCEC Update, HIA Update ADA 2007 Convention: Pre-Conference Workshop Registration VOLUME 18, NUMBER 2 ■ SUMMER 2007 feedback The Official Publication of The Academy of Doctors of Audiology® C O 5 N T President’s Message Larry Engelmann, Au.D. 6 Editor’s Note E N 16 18 9 10 Tinnitus Overview: Hope! Amy Harris Catherine Nelson, Au.D. Officer Nomination Position Statements 22 My Life Is… C. Joseph Hibbert, Au.D. Human Brain Imaging of Tinnitus and Animal Models Evolving Counseling and Sound Therapies for Tinnitus Richard S. Tyler, Ph.D. 14 Tinnitus Prevalence Reduced by Prevention Nancy N. Green, Au.D. 24 26 Richard Salvi, Ph.D., Edward Lobarinas, Ph.D. and Wei Sun, Ph.D. 12 S My Life Is… Nancy Gilliom, Ph.D. 7 T Tinnitus Retraining Therapy Nancy Gilliom, Ph.D. Advertisers Index Oticon...........................................Inside Front Cover Siemens CENTRA Active™.......................................4 Arches Tinnitus Formula.........................................8 Professional Update Preceptor Training: Concepts to Consider and Helpful Tips Tabitha Parent-Buck, Au.D. 29 30 31 ADA News My Life Is… Kathy Landau Goodman, Au.D. ADA Convention 2007: Pre-Conference Workshops Registration Discovery Hearing Aid Warranties.......................21 Hal-Hen Company, Inc. ...........................................21 Widex ............................................Inside Back Cover Phonak .....................................................Back Cover All advertisements sent to Feedback and the Academy of Doctors of Audiology for publication must comply with all applicable laws and regulations. The appearance of advertisements in Feedback magazine is not an endorsement of the advertiser or its products or services. Neither Feedback nor the ADA board investigates the claims made by advertisers and is not responsible for their claims. FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 3 President’s Message ADA Larry Engelmann, Au.D. President’s Message Embracing Change For A Better Future… DA, and its members, infused hearing aid dispensing into audiology’s standard of care 30 years ago.Without ADA, there would be no Au.D. degree or Au.D. movement. In the words of Eric Hoffer,“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.” A One of the many strengths I have appreciated and respected about all of you, and ADA as an organization, is how resilient you are when it comes to change. Not only that; you are often the catalyst for change. ADA does not settle for the status quo.You embrace change, adapt,and constantly create new and better futures for yourselves and for our profession. In April, it was a joy and a pleasure for me to address a large group of third-year audiology students at NAFDA’s 2007 convention in Denver, Colo. They are vibrant and energetic! They listened intently while I proudly spoke to them about audiology and ADA’s history as well as provided them words of encouragement about audiology’s future and their future! They were excited about the birdseye view given to them on the white paper that ADA’s Task Force is developing about audiology’s practice models. A few excerpts of that presentation follow below: Currently, only about 20 percent of all audiologists in the U.S. are practice owners. However, over 90 percent of dentists, podiatrists and optometrists select some form of private practice as their career choice. Private practice is their “rule”rather than the “exception.” If we truly desire ownership of our profession through independence and autonomy, then our next step to fully becoming a healing arts doctoring profession is to establish ownership of the clinical practice side of the profession as well. The private, or autonomous, model of practice pays public, private, and professional dividends. Professional care is dictated by patient need rather than employer dictate. Practitioner earnings are substantially higher:a) allowing for higher standards of living throughout one’s career and better retirement conditions and b) enabling the profession to be better positioned to influence legislative,regulatory and policy matters to benefit the patients it serves. In 1993,Dr.Earl Harford said, “As long as we are a ‘kept profession’, we will never enjoy true professional independence. Our professional autonomy is directly dependent upon our financial independence. The key to financial independence is a viable private practice structure.” Well, here it is 2007; audiology cannot continue to expect a new practice model to occur by chance. It is imperative and essential for audiolo- gy to direct its destiny and own the profession rather than being defined and regulated by outside entities whose interests are not necessarily compatible with audiology’s best interests.It is time for this generation of audiologists to intentionally restructure the profession, unify it and literally take ownership of audiology for the benefit of the next and future generations of audiologists. It has been said that,“The best way to predict the future is to create it.” Later this year, the Academy of Doctors of Audiology will publish a white paper for peer review that will comprehensively lay out a Vision.This whole process reflects a maturing profession; a profession that takes care of itself. With the proper planning and implementation, the proposed ADA Vision is achievable! Thank You I would like to express ADA’s appreciation to Carole Rogin and HIA for inviting ADA to participate in the Hearing on the Hill on May 16. ADA thanks Drs. Melissa Clark and Craig Johnson who were ADA’s representatives. I would also like to thank Dr. David Citron in advance for volunteering to represent ADA in November at ASHA’s Health Larry Engelmann, Au.D. ADA President Care Economics Committee (HCEC) meeting. Issues addressed at this meeting are related to procedural and diagnostic coding and relative values for audiology. The nominations committee, comprised of Drs. Craig Johnson (Chair),Mary Caccavo and Jim Rippy, has fulfilled its extremely important duty of providing ADA’s members with a great slate of candidates for this year’s Board elections.You can read the backgrounds and position statements of Drs. Charlie Stone, Susan Parr and Nancy Dunkin in this issue of Feedback.Thank you all for your willingness to serve ADA and its members! Dr. David Berkey and his entire convention committee and headquarters’ staff are preparing one of the most dynamic conventions in ADA’s history just for you! I encourage you to take advantage of the CEU and networking opportunities at the first convention of the Academy of Doctors of Audiology! This is one of the best investments you will make for your future success. ■ Kindest personal regards, Larry Engelmann,Au.D. FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 5 ADA Editor’s Note Editor’s Note President Larry Engelmann, Au.D. [email protected] President Elect David Berkey, Au.D. [email protected] Past President Craig Johnson, Au.D. [email protected] Treasurer Tabitha Parent-Buck, Au.D. [email protected] Secretary Susan J. Williamson, Au.D. [email protected] Directors At Large Gail B. Brenner, Au.D. [email protected] C. Joseph Hibbert, Au.D. [email protected] Gretchen Syfert, Au.D. [email protected] Feedback Editor Nancy Gilliom, Ph.D. 2051 Art Museum Drive, Suite 130 Jacksonville, FL 32207 Phone: (904) 399-3323 [email protected] Publisher Jay Strother [email protected] Managing Editor Theresa Rubinas [email protected] Advertising M.J. Mrvica Associates (856) 768-9360 [email protected] Executive Director Kevin Hacke Association Manager Erin Butler Association Coordinator Alexis Bauer ADA Headquarters 401 North Michigan Avenue Chicago, IL 60611 (866) 493-5544 or (312) 527-6748 Fax: (312) 673-6725 Feedback is the official publication of the Academy of Doctors of Audiology ®. Feedback is published four times a year with deadlines of January 15, April 15, July 15, and October 15. Contributions are welcomed but the Editor reserves the right to accept or reject any material for publication. All articles published in this magazine represent solely the individual opinions of the writers and not necessarily those of the Academy of Doctors of Audiology®. 6 Nancy Gilliom, Ph.D. Construction 101 In October of last year, I accepted the position as Feedback editor for 2007. In January of this year, I began a renovation of my house … or more accurately, I am having “someone” rebuild my 43-year-old beach abode into a modernday home.That someone happens to be a multitude of people.So it is with most ideas that come to fruition,one person or group may have an idea,but ultimately it takes a collection of dedicated people to walk the journey. Nancy Gillion, Ph.D. The journey is not always easy and sometimes it seems quite frenetic,as many balls must be juggled at once: decisions must be made in an instant, ideas are challenged,strategies must change,budgets must be maintained,and deadlines must be met.As Feedback Editor preparing the next publication and as a homeowner living in an ever-changing environment, these tasks could be quite daunting if I stood alone. It really does take a village… At any given time at my house, there is a group of framers, plumbers, siding crews, stucco crews, electricians, pavers, carpenters, painters, tilers, etc., each playing a role in making this dream house a reality.The concrete crew knows that its job is the foundation of this entire project.The framers know that all future work is built around their construction. The plumbers and the electricians must connect the overall system in terms of infrastructure.This is the village within my house. However, as individuals,each contributes professionally and personally in different ways.Some take pride in every task they perform while others just show-up for “the job” (or in some case, don’t show-up at all); some share in the enthusiasm of the vision and are ready and able to take the lead; some wait for instructions; while others sit on the sidelines watching or occupying themselves with other things. For me, it has been exciting, yet stressful, frantic, demanding and inconvenient. Being a part of this process is a journey. It is, without a doubt, the way of all big endeavors. With each issue of Feedback, I work closely with our Managing Editor,Theresa Rubinas, as well as many other individuals working toward a common goal.When a ball is dropped, we share the burden of getting it back in play… that may mean, she or I may write an article because an author could not meet deadline, make calls to our advertising firm to get more revenue to produce an issue, outreach to our members to participate, change strategies with help from our publisher, or brainstorm ideas with committees, etc.The job can seem chaotic because of numerous balls in the air and the various jugglers involved, but that is the nature of the work. With our profession and our academy, a crew of individuals continues to strengthen our foundation, to build new framework, to navigate through the chaos, and to walk the journey for our future.A community of audiologists works together – from the eight individuals who in 1977 had a vision about our profession’s future and created the foundation for audiologists to dispense hearing aids, to our current-day visionaries framing our future to ensure autonomy,growth and security.The ADA has dedicated individuals like our current President,Dr.Larry Engelmann, working with ADA’s Task Force for doctors of audiology to develop a practice model of independence for our profession. Likewise, Dr. David Berkey works with a committee for the annual convention to provide valuable tools to launch our practices to further heights and to challenge our minds to new ways of thinking and new treatments.Academy members devote time and resources to enhance our profession, and individual practitioners model best practices and serve the hearingimpaired community with knowledge, compassion and integrity.They are not alone. We are a professional community, and the role each of us takes part in, however big or small, affects us as a whole.ADA is a community of strength and growth.Individually,take the roof off and examine your practices and the profession.Then, ask yourself,“Am I just showing up or am I part of the crew?” Nancy Gilliom, Ph.D., Feedback Editor [email protected] MISSION STATEMENT It is the mission of Feedback to provide doctoral-level technical, professional, business, and Academy information in a way that prepares the ADA membership to achieve professional success, and ensure that Audiologists have the choice of practicing autonomously as the recognized leaders in hearing and balance care and dispensing hearing instruments. FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Tinnitus Overview: hope! By Amy Harris, American Tinnitus Association (ATA) Director of Research What is tinnitus? Tinnitus is defined as the perception of sound where no external source is present. Those who are affected often describe tinnitus as ringing, hissing, roaring, buzzing or whooshing, perceived in one or both ears. Nearly 50 million Americans experience tinnitus to some degree, 10-12 million have tinnitus chronically and seek medical attention for their condition and 1-2 million Americans are debilitated by their tinnitus.For these people,cognitive abilities are compromised and quality of life is ruthlessly reduced by their tinnitus.They often become depressed and anxious, have trouble sleeping or concentrating, and find that their personal and professional lives are severely affected. Causes and treatments Tinnitus is most commonly caused by noise exposure. Other causes can include ototoxic medications, head, neck or jaw problems, certain conditions such as hyperFEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 7 Feature Tinnitus Overview: Hope! thyroidism or lyme disease.There is no cure for tinnitus; however, many treatments and management techniques exist to help people live with this condition.Masking – using a sound to cover up the tinnitus noise so that it can no longer be heard – provides immediate, though temporary, relief. Therapies such as Tinnitus Retraining Therapy and Neuromonics allow tinnitus sufferers to habituate to their tinnitus so that they no longer listen to the tinnitus sound, even if it is still present. Medications, such as antianxiety and anti-depressants, are often very helpful in not only helping to quiet tinnitus, but also to relieve its associated emotional symptoms. Counseling, notably cognitivebehavioral therapy, can help break negative thought patterns associated with tinnitus. For those with hearing loss,hearing aids can be extremely helpful to alleviate tinnitus. Though few studies have demonstrated the efficacy of herbal or homeopathic remedies, such as ginkgo biloba or acupuncture,some people find them helpful. Research Between all public and private funding in the United States a mere $2-3 million exists for tinnitus research annually. By comparison, the following public funding 8 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 exists for these conditions : Fibromyalgia ($10M), Anorexia ($14M), Fragile X Syndrome ($22M) Homelessness ($24M). The National Institutes of Health (NIH) alone allocate about $1.5 million for tinnitus research but don’t always award it.The Centers of Disease Control report that 5 million children and young adults between the ages of 6-19 have some form of noise-induced hearing loss that can substantially worsen with increased noise exposures and lead to tinnitus. In 2005, the Amer ican Tinnitus Association (ATA) developed the Roadmap to a Cure.The Roadmap identifies what we know about tinnitus right now and what additional information we need so that we can make progress in developing a cure for tinnitus. The four paths focus on where and how tinnitus is generated, how tinnitus can best be treated and how to optimize treatment for each person. ATA funds $500,000 of research annually. Currently funded projects include imaging studies that use functional Magnetic Resonance Imaging (fMRI) and other technologies to allow researchers to “see” the tinnitus.This helps to determine where in the brain tinnitus is generated. Other ATA-funded studies focus on how tinnitus is generated. For example, some researchers are examining the brain’s auditory system for hyperactivity and other abnormalities. On the treatment side,ATA has funded research projects about how to best cover up tinnitus sound, also known as masking, tinnitus therapies such as cognitive behavioral therapy, and residual inhibition (when tinnitus is silenced after an external sound is introduced to the ear). What you can do for your tinnitus patients Although there is no cure for tinnitus, there are many treatments and management strategies that allow people to reclaim their lives from the intrusive sound in their head. Sound therapy treatment may be implemented in audiology practices.Also, tell your patients about the American Tinnitus Association.You are the one that they turn to for audiological advice and treatment. For tinnitus support and education, tell your patients about the ATA (www.ata.org) and give them access to other tinnitus-related resources, such as information about local chapters and selfhelp groups. Most importantly, let them know that there is hope! ■ C. Joseph Hibbert,Au .D. partners with his father in private practic Mississippi. He curren e in tly serves on ADA's Boa rd of Directors. My Life Is… ADA My Life Is… FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 9 By Richard Salvi, Ph.D., Edward Lobarinas, Ph.D. and Wei Sun, Ph.D. Center for Hearing & Deafness, University of Buffalo and Dept. of Communicative Disorders & Sciences, Buffalo, NY ([email protected]) 10 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Human Brain Imaging of Tinnitus and Animal Models Feature hen asked to report on the source of their tinnitus, patients often state that the phantom sound is coming from the ear in which they have hearing loss and a cochlear hair cell lesion.Thus, the phantom sound of tinnitus is similar to an amputee’s report of phantom limb pain. Researchers and scientists initially believed that the phantom sound of tinnitus originated from abnormally high rates of spontaneous activity (hyperactivity) in the auditory nerve. However, the neural activity in damaged ears is generally reduced (hypoactive) due to the degeneration of the hair cells and the loss of auditory nerve fibers. Although the neural output from a damaged ear is generally reduced, the sound-evoked neural activity in the central auditory system is often greater than normal (Salvi et al., 2000). Researchers speculate that the phantom sound of tinnitus might reside in the central auditory pathway. We have used a brain imaging technique, positron emission tomography (PET), to identify the regions of the human auditory brain activated by the real sounds and the phantom sounds of tinnitus.When a pure tone is presented to the right ear of a normal hearing listener, the unilateral sound produces bilateral activation in both the left and the right auditory cortex as well as more peripheral sites in the auditory pathway (Lockwood et al., 1999). To identify the regions of the brain activated by the phantom sound of tinnitus,we studied a special group of tinnitus patients who were able to change the loudness of their tinnitus by making an oral-facial movement (OFM) such as a jaw clench. When the tinnitus patients produced an OFM that caused a significant change in tinnitus loudness,there was a significant change in neural activity only in the auditory cortex contralateral to the ear with the perceived tinnitus.Thus,the change in tinnitus loudness only activated one side of the brain. Since the phantom sound of tinnitus produced unilateral activation of the auditory cortex,in contrast to the bilateral activation caused by a real sound, we concluded that the tinnitus generator must reside in the central auditory pathway rather than the inner ear. Patients who undergo surgery to remove W an acoustic neuroma generally lose their hearing because the auditory nerve is severed, thereby disconnecting the ear from the brain. Although the auditory nerve is severed, these patients often report hearing tinnitus in their deaf ear (Coad et al.,2001). Interestingly, some acoustic neuroma patients develop gaze evoked tinnitus (GET) such that eye movements to the left or right cause tinnitus loudness or pitch to increase or decrease significantly.When PET imaging was carried out on subjects with GET, lateral eye gaze caused significant changes in neural activity either in the auditory brainstem or in regions of the brain adjacent to auditory cortex (Lockwood et al., 1998). Lidocaine, a sodium channel blocker, is reported to transiently suppress tinnitus,but the cardiology literature also suggests that lidocaine can induce tinnitus.We used PET to identify regions of the brain affected by lidocaine. We found that when administered to normal subjects or to tinnitus patients, lidocaine induced bidirectional effects.In some cases,lidocaine induced tinnitus or made it louder; we associated the increase in tinnitus loudness with increased activity in the right auditory cortex.In contrast,when lidocaine made the tinnitus quieter; activity in the right auditory cortex decreased. Collectively, these three studies suggest that many forms of tinnitus must originate from aberrant neural activity in the brain rather than the ear. To begin to investigate the biological mechanisms underlying tinnitus, we developed a behavioral technique — schedule induce polydipsia avoidance conditioning (SIPAC) — to measure salicylate, quinine and noise-induced tinnitus in individual rats (Lobarinas et al., 2004). Rats reliably developed behavioral evidence of temporary tinnitus when treated with high doses of salicylate and quinine, but not with low doses of these drugs or with a placebo (Lobarinas et al., 2006).When monaurally exposed to high level noise,some rats developed transient or persistent tinnitus immediately after the exposure,while others failed to develop tinnitus. To identify the neural correlates of tinnitus, we implanted electrodes in the auditory cortex to measure the local field potentials from awake rats before and after treatment with a high dose of salicylate.The local field potentials from the auditory cortex increased in amplitude (hyperactive) after salicylate (Lobarinas et al., 2006).We did not observe this salicylate-induced enhancement of neural activity in anesthetized animals.We also saw hyperactivity in the auditory cortex after unilateral acoustic over-stimulation. Over the past decade, rapid advances in brain imaging, behavioral models and electrophysiology have significantly advanced our understanding of the once considered difficult to near impossible scientific investigation of subjective tinnitus and its neural origins. We expect significant progress in understanding and treating tinnitus is expected to occur in the next decade. Acknowledgments: Research supported in part by grants from NIH, the American Tinnitus Association and the Tinnitus Research Consortium. ■ References Coad, M.L., Lockwood, A., Salvi, R., Burkard, R. 2001. Characteristics of patients with gaze-evoked tinnitus. Otol Neurotol 22, 650-4. Lobarinas,E.,Sun,W.,Cushing,R.,Salvi,R. 2004. A novel behavioral paradigm for assessing tinnitus using schedule-induced polydipsia avoidance conditioning (SIPAC). Hear Res 190, 109-14. Lobarinas, E.,Yang, G., Sun, W., Ding, D., Mirza,N.,Dalby-Brown,W.,Hilczmayer, E.,Fitzgerald,S.,Zhang,L.,Salvi,R.2006. Salicylate- and quinine-induced tinnitus and effects of memantine. Acta oto-laryngologica, 13-9. Lockwood, A.H., Salvi, R.J., Coad, M.L., Towsley, M.L.,Wack, D.S., Murphy, B.W. 1998.The functional neuroanatomy of tinnitus: evidence for limbic system links and neural plasticity. Neurology 50, 114-120. Lockwood, A.H., Salvi, R.J., Coad, M.L., Arnold, S.A.,Wack, D.S., Murphy, B.W., Burkard,R.F.1999.The functional anatomy of the normal human auditory system: responses to 0.5 and 4.0 kHz tones at varied intensities. Cereb Cortex 9, 65-76. Salvi, R.J., Wang, J., Ding, D. 2000. Auditory plasticity and hyperactivity following cochlear damage. Hear.Res.147, 261-274. FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 11 Evolving Counseling and Sound Therapies for Tinnitus By Richard S. Tyler, Ph.D. The University of Iowa 12 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Evolving Counseling and Sound Therapies Feature the pioneer ing work in the 1980s of psychologist Richard Hallam and his Tinnitus Habituation Therapy, many counseling and sound therapies have emerged. The 1995 Paul Davis book Living with Tinnitus and the more recent Tinnitus:A self-management guide for ringing in your ears (2002) by Jane Henry and Peter Wilson, have benefited thousands of tinnitus sufferers worldwide. The approaches range from intensive psychology-based counseling approaches (such as Cognitive Behavior Therapy (Andersson et al, 2005; Caffier et al., 2006)) to approaches that focus primarily on providing information (such as Tinnitus Retraining Therapy (Bartnik & Skarzynski, 2006). The University of Iowa Department of Otolaryngology — Head and Neck Surgery — has a long history of tinnitus treatment and research,encompassing more than two decades of work in this area.The department’s treatment protocol, started in the 1980s, has evolved into Tinnitus Activities Treatment.This treatment – which depends on an individual’s needs – focuses on four areas: thoughts and emotions, hearing, sleep and concentration. There are actually many new counseling and sound therapies.Several clinicians favor taking a global perspective, considering the broader lifestyle of the patient (e.g. Folmer et al., 2006). Mohr and Hedelund (2006), with their Patient-Centered Therapy, nurture an acceptance of the tinnitus. Hearing aids can be adjusted to maximize tinnitus relief (e.g. Searchfield, 2006), and of course many patients prefer music to listening to broadband noise. Some treatments such as the “Scary Monsters and Waterfalls” by Kentish and Croker (2006) specifically focus on children with tinnitus. The University of Iowa approach starts with an individual assessment to understand what the needs are of each patient.As tinnitus often affects the patient’s emotional wellbeing,hearing,sleep and concentration abilities,we worked to develop strategies for each of these areas. Since Sound Therapy Various treatment strategies use sound to decrease the loudness or prominence of tin- nitus. Sound therapies include both wearable (hearing aid-like devices) and nonwearable devices (such as table-top sound machines or even a whirring fan). Often, sound is used to completely or partially cover the tinnitus.Some people refer to this covering of sound as masking. Sound therapies should always be combined with counseling. For those patients who want to mask the sounds, they report that the presence of background noise or music is helpful. These sounds can: • Partially mask the tinnitus – The background sound mixes with the tinnitus,but the patient is still able to hear the tinnitus. • Totally mask the tinnitus – The background sound completely covers up the tinnitus. Both of these partially and total masking approaches can: • Reduce the loudness of the tinnitus • Distract the patient from attending to the tinnitus. Successful Masking Sounds Masking is generally successful because the masking sound and the tinnitus sound are vastly different in quality.Tinnitus usually produces a shrill,high-pitched,unpleasant tone.In contrast,water,masking sounds and music are typically soothing. • Most individuals can and usually do “automatically” ignore certain external sounds. • These sounds are ignored if they are not too loud or harsh and if they are relatively constant and monotonous. Many patients report that it is easier to listen to broadband noise (heard as “sssshhhh”) than it is to listen to their tinnitus.Similarly, soft, light background music (e.g. classical baroque or simple piano music) is a great way to partially mask the tinnitus. Sound produced particularly for relaxation or distraction (e.g., waves lapping against the shore, raindrops falling on leaves— sometimes these are combined with light music) is another form of masking. Masking Devices So what types of devices producing these melodic sounds do patients use? It depends on the patient’s preference. Some patients prefer wearable devices with earphones or insert earphones (e.g. portable music players),while other patients favor non-wearable devices that include radios, compact disc players or sound generators specifically produced for relaxation or tinnitus.Some of the non-wearable devices were intended for use at the bedside with timers and can include many different sound types. Sound therapy is effective for many patients. People use sound therapy in different ways. For example,some people find that their tinnitus does not bother them except at night. Others require sound therapy during the entire day. Sound therapy does not have to be used all the time. Some people find that they require masking less as they use it for several months. They use the noise to decrease the prominence of the tinnitus and enable them to move forward and no-longer focus on the tinnitus. It is possible to obtain a noise generator and a hearing aid combined in one wearable device. Additional Therapies Hearing Aids Some patients with tinnitus also have a hearing loss and can benefit from a hearing aid. As tinnitus may be caused by stress, hearing and better communication may reduce stress and tinnitus at the same time. Hearing aids also amplify background noise, and many tinnitus patients report that their tinnitus is better when they listen to low levels of background noise (note the sound therapy above). Psychological Therapies Cognitive Behavior Modification. This approach helps you to talk about tinnitus in a reasonable fashion, and to plan and carry out trials to change the way you think about tinnitus and react to it. Relaxation Therapy. There are many relaxation techniques, for example using recorded soft music or biofeedback, which can help patients relax when they are particularly bothered by their tinnitus. Continued On Page 17 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 13 By Nancy Gilliom, Ph.D. Feedback Editor FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Tinnitus Retraining Therapy Feature The brain is complex and trainable (plasticity). It is common in our everyday practice to counsel hearing aid users regarding newly perceived “unwanted” ambient sounds that they may begin to hear after a long time of auditory deprivation (e.g. a refrigerator hum or an air handler), but few audiologists address treatment options for tinnitus suffers. Audiologists can easily provide examples about acclimation for new hearing aid users: I liken it to when I lived in an old house near a fire station. The first week or so, I heard every emergency vehicle as it rushed out of the station in the middle of the night. Although, they continued to make emergency runs with whaling sirens, eventually, I stopped having a conscious awareness of them. In order to acclimate to the sound, one must be able to hear it. I explain that our brain wants to know the meaning of sound to determine if it is a threat, a warning, a problem, or something that evokes an emotion, or even a learned response (like a mother awakening to the sound of her baby stirring or a physician to a soft pager). Typically, if an unknown or new sound is heard, the brain will be acutely aware of it regardless of its decibel level. Once the sound is identified or categorized by the brain as unimportant, the conscious awareness of that sound will diminish. For many individuals with tinnitus and a co-existing presence of hearing loss, a hearing aid may be all that is necessary to relieve the perception of the unwanted tinnitus. However, as the literature suggests, the prevalence of tinnitus is only two times greater in the hearing-impaired population than it is in a normal hearing population. Therefore, audiologists must seek more knowledge in order to be of service to these individuals that show up at our offices with normal hearing. Audiologists often fail in helping patients with tinnitus because of hard-held beliefs about tinnitus, i.e. being a peripheral problem with no cure or treatment. If the brain can habituate to ambient sounds, it stands to reason that the auditory cortex can also habituate to internal sounds such as subjective tinnitus.Often audiologists and oth- er professionals consider it a benign problem and minimize the impact it has on an individual’s quality of life that can lead to anxiety, depression, panic and isolation.To varying degrees, the tinnitus sufferers then may feel hopeless and angry, as many professionals have told them nothing can be done.Knowledge of treatment options and referral sources for tinnitus treatment offer patients solutions and offer patients hope. It imperative that providers do not continue to send the message of doom and Knowledge of treatment options and referral sources for tinnitus treatment offer patients solutions and offer patients hope. despair to tinnitus sufferers by simply saying: “there is nothing that can be done.” Although, it can be a heated topic for debate, there is much evidence that tinnitus is secondary to our peripheral auditory system;just as we work with our hearing aid patients to acclimate to their environment, there are techniques that can be used to help patients acclimate or habituate to their reaction to internal noise.Tinnitus is not a disease,but we can treat this symptom. In the 1980s,Dr.Pawell Jastreboff,a neuroscientist, and Dr. Margaret Jastreboff, molecular and biological scientist, proposed a neurophysiological model explaining the reason for tinnitus distress and developed a treatment method for subjective tinnitus called Tinnitus Retraining Therapy (TRT). Almost everyone can experience tinnitus in a quiet environment; it is a natural occurrence.While the majority of people easily habituate to tinnitus, about 15 to 25 percent with persistent tinnitus find it intrusive, disturbing or anxiety provoking, and it reduces their quality of life.The psychoacoustical characteristics (pitch, loudness, perception of location) of tinnitus are not the disconcerting factor; rather, it is the person’s limbic (emotional) reaction that perpetuates the perceived tinnitus. Many patients with persistent tinnitus may say, “I don’t pay attention to it.” “I only hear it if I listen for it.” “I only hear it when I am in a quiet environment.” Others, however, find that same tinnitus to be distressing. Tinnitus sufferers may perceive the sound as a threat of serious illness, believe that it will get louder, or that they have a mental disorder and are going “mad,” etc.The main theory of tinnitus based on these neurophysiological principals is that the limbic system (involved with emotions) and the autonomic nervous system (fight or flight reaction) are an essential part of “pathological tinnitus.”This attachment to negative emotions is the first barrier to break down in order for TRT to be successful. From the “The Origins of Tinnitus Retraining Therapy (TRT),” (Published in ATA Tinnitus Today, April 1998), Pawell J. Jastreboff writes:“TRT is a method aimed at habituating of reactions of the body induced by tinnitus, and habituation of perception of the tinnitus signal itself. … The method retrains reflexes involving connections of the auditory with the limbic and autonomic nervous systems, and retrains the subconscious part of the auditory pathway to block the tinnitus signal. TRT always consists of two components: intensive one-on-one directive counseling and sound therapy, most frequently with the use of sound generators (which emit low level of broad-band noise), following a specific habituation protocol.” Jastreboff and his colleagues believe that for patients to experience success with this model it is imperative that the tinnitus sufferer works with a therapist specifically trained in using this model. It is not simply cognitive behavior therapy, but rather a precise combination of techniques tailored for each individual patient including the following: 1) Otological and Audiological Testing and Diagnosis — rule out middle ear pathology, cerumen occlusion, acoustic neuroma, etc. 2) Identification of the effects of the tinnitus — each patient is categorized from 0-5 in terms of disturbance of tinnitus, duration, hyperacusis, and corresponding type of TRT treatment. 3) Teaching about the mechanics of tinnitus — including concepts of the neurophysiological model, and that it is natural, benign and has a fundamentally normal origin of perception. Once that is underContinued On Page 17 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 15 ADA My Life Is… zona School of Health .D. student at the Ari her fourth year as an Au spitals and Clinics. ing Ho a inn beg Iow is of son sity Nel Univer Catherine year externship at the rth fou her e plet com l Sciences. She wil My Life Is… 16 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Feature Evolving Therapies Medications There are no medications that are widely accepted (based on replications of controlled studies) to cure tinnitus. However, several medications can be helpful in reducing stress and in getting to sleep. Several studies are underway or being planned to test new medications, new applications of existing medications and even supplements. It is likely something will be found soon, at least to help some subgroups of tinnitus patients. Several studies are underway or being planned to test new medications, new applications of existing medications and even supplements. It is likely something will be found soon, at least to help some subgroups of tinnitus patients. In most cases, tinnitus remains the same throughout the person's life, but in some instances it can get worse, or even improve over time. Many studies now underway! Previous published research has focused on Cognitive Behavioral Therapy, and several studies have shown significant treatment effects. Hearing aids have also been shown to provide benefit. Worldwide,there are now currently several other studies underway on many of the other counseling and sound therapies. To learn more about the therapies currently underway at The University of Iowa Department of Otolaryngology visit www.uihealthcare. com/depts/med/otolaryngology/ clinics/tinnitus/index.html. The Department of Otolaryngology — Head and Neck Surgery and the Department of Speech Pathology and Audiology at The University of Iowa will be hosting the 15th Annual Conference on Management of the Tinnitus Patient. The conference, for patients and professionals takes place Thursday – Saturday,September 20-22, 2007 for patients and professionals. View the most up-to-date program on our Web site: uihealthcare.com/depts/ med/otolaryngology/conferences/. ■ Feature Retraining Therapy REFERENCES Andersson,G.,Porsaeus,D.,Wiklundm,M., Kaldo, V. & Larsen, H.C. (2005). “Treatment of tinnitus in the elderly: a controlled trial of cognitive behavior therapy.” Inter national Jour nal of Audiology 44(11): 671-675. Bartnik, G.M. & Skarzynski, H. (2006). Tinnitus Retraining Therapy. Tinnitus Treatment:Clinical Protocols.R.S.Tyler. New York,Thieme: 133-145. Caffier, P., Haupt, H., Scherer, H. & Mazurek,B.(2006)."Outcomes of LongTerm Outpatient Tinnitus-Coping Therapy: Psychometric Changes and Value of Tinnitus-Control Instruments." Ear and Hearing 27(6): 619-627. Folmer, R.L., Martin W.H., Shi, Y. & Edlefsen, L.L. (2006). Tinnitus sound therapies.Tinnitus treatment:clinical protocols. R.S. Tyler. New York, Thieme: 176-186. Henry,J.,Wilson,P.H.& Dragin,S.D.(2002). Tinnitus:A Self-Management Guide for the Ringing in Your Ears. Boston, MA, Allyn & Bacon. Kentish, R.C., Crocker, S.R. (2006). Scary Monsters and Waterfalls: Tinnitus Narrative Therapy for Children.Tinnitus Treatment:Clinical Protocols.R.S.Tyler. New York,Thieme: 217-229. Mohr, A., Hedelund, U. (2006). Tinnitus Person-Centered Therapy. Tinnitus Treatment:Clinical Protocols.R.S.Tyler. New York,Thieme: 198-216. Searchfield, G.D. (2006). Hearing Aids and Tinnitus. Tinnitus Treatment: Clinical Protocols.R.S.Tyler.NewYork,Thieme: 161-175. Richard S.Tyler, Ph.D. is professor specializing in audiology with The University of Iowa Department of Otolaryngology – Head and Neck Surgery. He has a B.S. in Communication Disorders; a M.Sc in Audiology; and a Ph.D. in Psychoacoustics.Tyler’s clinical specialty is Audiology and Tinnitus. For more information visit,www.uihealthcare.com/ depts/med/otolaryngology/clinics/ tinnitus/index.html. stood, the unpleasant psychological reactions can begin to disappear. 4) Sound enrichment — sound that does not completely mask tinnitus because one cannot habituate to a sound they cannot hear 5) Retraining Tactics — retraining reflexes to tinnitus by exercises that reduce the sound enrichment and evaluating reaction to the tinnitus There are more than 800 professionals around the world who have attended training courses on TRT and the success rate reported is nearly 80 percent. Pawel Jastreboff and Jonathan Hazell have established the Tinnitus Retraining Therapy Association (TRTA).The association helps maintain high standards in the proper utilization of TRT and provides a list of practioners by state. When working with patients with tinnitus, it behooves audiology as a profession to continue to expand our thinking, knowledge, and experience in areas that often have been a mystery for so many years. ■ REFERENCES Emory Center Helps Hyperacusis and Tinnitus Patients With A Unique Retraining Therapy, http://whsc. emory.edu/_releases/2003august/ hyperacusis.html Hazell, Jonathon, F.R.C.S. Tinnitus Retraining Therapy Implementing the Jastreboff Neurophysiological Model. Tinnitus and Hyperacusis Centre, London UK www.tinnitus.org Hazel, Jonathan F.R.C.S. Tinnitus Retraining Therapy from the Jastreboff Model. J Director, Tinnitus and Hyperacusis Centre, London UK, October 2002 Jastreboff, Pawell Ph.D. and Jastreboff, Margaret Ph.D. “Tinnitus Retraining Therapy: An Update.” Audiology Online, October 2000. Tinnitus Retraining Therapy by WCB Evidence Based Practice Group. Dr. Craig W. Martin, Senior Medical Advisor, January 2004 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 17 18 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 2007 Nominations ADA ★★★★★★★★★★★★★★★★★★★ Candidate for President-Elect ★★★★★★★★★★★★★★★ CHARLES R. STONE, Au.D. Candidate: President-Elect Owner/CEO ESCO, Plymouth Minnesota EDUCATION B.S. Communication Disorders, University of Wisconsin, Stevens Point, 1970 M.S. Communication Disorders, University of Wisconsin, Stevens Point, 1971 Au.D. Arizona School of Health Sciences,A.T. Still University, Mesa Arizona, 2001 PROFESSIONAL ACTIVITIES • • • • Private Practice, 1975-1997 Founder and CEO of ESCO, 1990-present Fellow – American Academy of Audiology Past President – Minnesota Academy of Audiology Academy of Dispensing Audiologists (ADA) • Fellow member (1978 – present) • Member of the Board of Directors (ADA) Secretary 1996-2002 • Participated in the 1995 Standards and Equivalency Conference. • Participated in ADA's last two Long Range Planning meetings. • Membership Committee • Convention Committee • Contributing Author to Feedback Magazine • Formal and informal presenter at ADA conventions POSITION STATEMENT We have finally arrived or have we? Many of us rabble rousers who helped found ADA knew from our first day on the job that we were the professionals to whom individuals would trust their hearing and now balance problems. Somehow we came away from our academic training with a different message and refused to be puretonettes or the guy or gal down the hall who will test your hearing. We felt there was room to practice with the ENT or be an equal staff member of the multi-disciplinary clinic or be totally independent practitioners. We knew no one else had our professional knowledge and expertise. We were just not trained to ask all the right questions. Like how do you set up a business plan or how do you read a balance sheet or profit loss statement or when to ask the billing department how reimbursements for billed services were going so we could make some calls to improve collections and the list goes on and on. By adding two more years of education and a doctoral degree we have definitely raised the bar. We now need to help guide the training programs to educate their students to know all the practice information or at least train these students to ask the right questions.And these new Doctors of Audiology will need a place that can mentor and support their growth. ADA was that kind of place for me and I would like to see it continue that tradition for all future practicing Doctors of Audiology Having served on committees with both ADA and AAA I view AAA as the umbrella organization representing the broad scope of the Audiology profession. ADA’s focus is on practitioners and autonomous professionals and on running a practice or being accountable for the business of Audiology even if it is a department within a clinic. We will continue to work cooperatively with AAA on initiatives to position Audiology in its rightful place in the health care arena. As more Doctors of Audiology enter independent private practice this is particularly true; for third party payers often treat independent Audiologists different than their colleagues in hospitals or clinic settings. ADA needs to reinforce its role as the home for practicing Doctors of Audiology. A place to go, at a place to belong if you’re thinking about private practice or need a private practice jump started. From basic courses in accounting 101 to advanced panel discussions on what’s working in the field. From cursory knowledge of marketing to implementation of new state of the art procedures for better patient services and potential professional referrals. I feel the largest potential for growth as a profession is in the area of private practice. I see ADA playing a big role in helping new audiologists start a practice or revitalizing existing practices. I would like to see ADA expand its mentor programs to provide regional mentors that can be easily accessed for support and council. Within ADA’s membership we have practitioners from every type of practice setting. From ENT’s offices and multi-disciplinary clinics to industrial noise, tinnitus clinics, balance centers and general practice settings. All these resources can be of great benefit to a new Doctor of Audiology. In addition, I would like to see ADA work more cooperatively with our manufacturers and suppliers to develop new models for future practices in order to meet the increasing demands for our services. I would also like to make our conventions more fun by having some participation between practitioners and manufacturers like the good old days of yester year.The awesome audiologists against the scruffy suppliers in fun competitive activities. And for you old folks, there could be a shuffleboard tournament or competition bingo. I think this will help bond a relationship with our industry colleagues and help to get new younger members more involved in the lighter side of this Academy. I couldn’t agree more with President-Elect Dr. David Berkey’s statement in his position statement of last year. David said “ADA has always been the professional home for entrepreneurial audiologists - a place where we can gather together, network, share, learn from each other, disagree and innovate head-to-head. I would like to see us capitalize on that historic strength and build upon this networking.” I promise to follow Dr. Berkey’s footsteps and continue to make ADA the place that welcomes with open arms practicing Doctors of Audiology and helps new and old members develop their professional skills to the utmost for the betterment of themselves and the patients they serve. Charlie Stone Statements Continue On Next Page FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 19 ADA 2007 Nominations ★★★★★★★★★★★★★★★★ Candidates for Member At Large ★★★★★★★★★★★★★★★ NANCY A. DUNCAN, Au.D. Candidate: Member At Large Owner/Duncan Hearing Healthcare, Inc., Fall River, Mass. SUSAN J. PARR, Au.D. Candidate: Member At Large Owner/Director, Parr's Pro Hearing Services Inc., Pennsylvania EDUCATION EDUCATION B.S. Worcester State College (1995) M.S. University of Arkansas for Medical Sciences (1997) Au.D. Pennsylvania College of Optometry (2005) B.A. West Virginia Wesleyan College (1971) M.S. The Pennsylvania State University (1984) Au.D. The University of Florida (2001) PROFESSIONAL ACTIVITIES PROFESSIONAL ACTIVITIES • 2006 to present Board of Directors Fall River Chamber of Commerce • 2006 to present Board of Directors Fall River Rotary Club • 2004 to present Board of Directors Fall River Symphony • 2005 to present Charlton Memorial Hospital Woman's Auxilliary • 2003 to present BNI Hilltoppers - Past President POSITION STATEMENT I am honored to be nominated to serve my fellow audiologists in ADA. As audiologists we have many choices as to which groups and organizations we choose to be a part of, and I choose ADA. When I attended my first ADA convention in October 2002 I was at a point where I was frustrated with my audiology career and considering a change. I left that conference with the beginnings of my business plan and the knowledge of where my future would be heading. In September 2003 I opened the doors of my practice and in May 2005 graduated with my Au.D. as a direct result of my ADA experiences. At that first convention I finally felt at “home”within my profession,finally a place with likeminded individuals who love helping people but also love the freedom of having their own practices and controlling their own destinies. There are no other organizations that provide us with real world, practical information on how to run and manage a practice while providing a better way to care for our patients. While trying to grow my practice, one of the biggest assets to me has been asking questions of the experienced ADA members and having an open line of communication with the “movers and shakers” in our field. I hope in the future I can be as helpful to the new generation of audiologists as these individuals have been to me. Looking toward the future with our new designation as The Academy of Doctors of Audiology, I see an exclusive group promoting us as the Doctors of Audiology as well as direct access to hearing health care for all. I look forward to the evolution of our academy while still maintaining those qualities that make ADA a valuable tool to anyone considering the independence of private practice. • Own,operate and manage a private audiology practice,Parr's Pro Hearing Services Inc. – 1991 to the present • CAOHC Course Director,March 2003 to the present;Industrial Audiology (Hearing Conservation Programs for 25 Industries) • Board Certification in Audiology, March, 1999 to the present • Allied Health Professional/ With Privileges in Audiology @ J. C. Blair Memorial Hospital 1986 to the present • Fellow ADA,Academy of Doctors of Audiology since 1997 • Fellow American Academy of Audiology since 1988 serving as Regional 2 Captain • Fellow Pennsylvania Academy of Audiology since 1996 served as Treasurer, President Elect, President and Past President • Member,National Hearing Conservation Association since 1990 • Fellow, Audiology Foundation of America • Fellow, Educational Audiology Association • Fellow, American Speech – Language – Hearing Association • Adjunct Professor University of Pittsburgh 2003 to the present • Adjunct Professor Bloomsburg University 2004 to the present • Adjunct Professor Towson University-2005 • Presenter PAA Workshop; Private Practice Audiology • Presenter: International Symposium for Audiology UNCISAL Maceio, Brasil May 2005 • AFA PresenterWhite Coat Ceremony for students of Bloomsburg University August 2006 & 2007 POSITION STATEMENT I consider it an honor to be selected as a candidate to serve our profession of Audiology on the ADA Board of Directors. ADA has always offered practical business management advice for success in our mission to help those with hearing loss and balance problems. I would like the opportunity to give back to the organization that has helped me grow my practice. As a private practicing audiologist for seventeen years, I have seen our profession advance in Continued On Next Page 20 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Susan J. Parr, Au.D. – 2007 Nominations ADA access and reimbursement.While we have made great strides, we still have more to accomplish. A personal goal of mine is to work diligently,enthusiastically,and relentlessly to obtain direct access for audiologists. I will dedicate my time to the passage of the Medicare Hearing Health Care Enhancement Act of 2007. This legislation would give Medicare beneficiaries the option of going directly to a qualified audiologist or physician for much needed hearing and balance testing. HR 1665 removes the physician referral requirement for Medicare beneficiaries.We need a continued presence on Capitol Hill to move this legislation forward. Direct access would improve Medicare beneficiaries’ access to hearing care. I have gained Board of Director experience at the state and local level while serving on the Pennsylvania Academy of Audiology Board for seven years as treasurer, president elect, president and past president; the Huntingdon County Community Center Board; and our local Rotary Board of Directors. I am part of the state leaders’ network of AAA serving as Regional Captain for Region 2 encompassing Pennsylvania, New York, Maryland, Delaware, D.C., and Virginia. I enjoy mentoring our future Doctors of Audiology at our national conventions. If elected, I would be receptive to your input and act as your voice at the Board of Directors’ meetings. Together we can make a difference! I see a bright future for the profession of Audiology with no limits on its success. I am dedicated and driven personally and professionally to accomplish our goals, to advance our profession, and to exceed our vision. ■ FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 21 By Nancy N. Green, Au.D., Industrial Audiologist, Jacksonville, Fla. 22 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Tinnitus Prevalence Reduced by Prevention Feature should come as no huge surprise to any audiologist that tinnitus and noise-induced hearing loss frequently occur together. Likewise, it would not surprise anyone that tinnitus is often the more annoying of the two problems, especially if the hearing loss is mild and the tinnitus is severe. In 1996, the National Institute of Occupational Safety and Health (NIOSH) estimated that approximately 30 million employees in the United States are exposed to at least some amount of hazardous occupational noise (NIOSH, 1996). OSHA reports that more than five million of those employees are exposed to daily average levels of 85 dBA and above, with three million of them exposed to average levels of 90 and higher (OSHA, 1981). While the hearing loss that this group typically exhibits is certainly not the only type associated with tinnitus, it occurs frequently enough in the working noiseexposed population to make it an additional concer n both from a clinical/rehabilitation perspective and from a workers’ compensation/liability perspective. Some state workers’ compensation statutes award compensation for occupation-related tinnitus, just as the Veteran’s Administration does for federal military service-related tinnitus. Tinnitus is often difficult to clinically quantify and treat, especially when a professional has determined that the patient’s primary need is for appropriate amplification. Diagnosis and treatment of the tinnitus then becomes secondary to the fitting of a hearing aid or hearing aids. Fortunately, it is not unusual for the extra sound created by amplification devices to mask the annoying effects of the patient’s tinnitus. In those cases where amplification does not mask those effects, or in cases where the hearing loss is only slight and amplification is not likely to be beneficial or is contra-indicated, the tinnitus may be the main issue for the patient, and will require additional time and attention from the audiologist. It Work-Induced Hearing Loss Because of its close relationship to noiseinduced hearing loss and because noise- producing industries increasingly recognize the need to protect their employees from excessive noise exposures, it follows that the more effective industry is at reducing exposures to noise, the less likely the exposed population will be to develop the tinnitus that often accompanies the noise- The elimination of occupational noise-induced hearing loss wouldn’t necessarily eliminate all occurrences of tinnitus; however, if tinnitus is indeed a by-product of cochlear hair cell damage (either physical damage or as a result of destructive metabolic processes), then the less hearing loss an employee sustains over a working lifetime, the less tinnitus for which he or she is likely to need treatment after the fact. induced hearing loss. By reducing the number and severity of work-related hearing losses, industries can reduce the number and severity of employees experiencing tinnitus.This principle applies to military and recreational exposures as well. The elimination of occupational noiseinduced hearing loss wouldn’t necessarily eliminate all occurrences of tinnitus; however, if tinnitus is indeed a by-product of cochlear hair cell damage (either physical damage or as a result of destructive metabolic processes), then the less hearing loss an employee sustains over a working lifetime, the less tinnitus for which he or she is likely to need treatment after the fact. Financial Implications The Office of Management and Budget (OMB) reported that the financial impact on American industry of the implementation of the requirements of the Hearing Conservation Amendment (29 CFR 1910.95 c-p, 1983) would be $2.6 billion per year (expressed in 1976 dollars). Collectively,industry currently spends only $180 million annually on providing hearing protection devices for employees and only $120 million annually on audiometric services (Hager, 2004).These numbers indicate that industry is spending only about 11 percent of the costs originally predicted to be associated with the program. The OMB determined that those costs do not have the potential for significant impact on the American industrial machine’s bottom line. What services and/or products are not being provided that the OMB anticipated would be necessary for proper implementation of the regulation? At the very least, the answer is hearing tests and hearing protection devices. Either those employees with known exposures who should be tested aren’t being included in hearing conservation programs, or there are significant numbers of employees whose exposures are unknown or undocumented. Additionally, many employers provide the bare minimum variety of hearing protection devices required by OSHA (two) and many employees prefer to wear nothing rather than devices which are uncomfortable or inconvenient to obtain. Either way, there is at least $2.3 billion that should have been spent annually on hearing conservation programs since 1983, and it wasn’t. Imagine how much noise-induced hearing loss and tinnitus could have been prevented if the $55.2 billion that wasn’t spent over the past 24 years had actually been put to good use by improving the effectiveness of hearing conservation programs! Enhancing Current Programs Certainly, there is significant room for improvement in occupational hearing conservation programs.There is also room for improvement in other areas of hearing preservation. Significant research is in progress regarding the potential otoprotective properties of certain antioxidant pharmaceuticals (N-acetylcysteine, Dmethionine, etc.) when administered prior to, during, and for a short time after noise exposure. Additionally, there is Continued On Page 34 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 23 ADA Professional Update Professional Update AFA Offers Student Grants to Attend ADA Convention, AFA Awards Audiology Practitioner Scholarships, AFA Presents Student Award at University of Texas at Dallas, ASHS Bestows AFA Endowed Student Excellence Award, ASHS Graduates Honored with Professional Leadership Awards, Hearing Aid Companies Host “Hearing On The Hill.” AFA Update AFA Offers Student Grants to Attend ADA Convention The AFA is accepting applications for student grants to attend the Academy of Doctors of Audiology (ADA) convention as part of the AFA’s Student Mentoring Program. The convention will be held this year in Orlando, Fla., from Oct. 10-13, 2007. The grants are available to 3rd or 4th year students (as of Fall 2007) in four-year Au.D. programs. To be eligible, submit a Student Mentoring Grant application form and accompanying materials to the AFA by August 3,2007.Grant winners will participate in onsite mentoring program activities and receive paid convention registration and sleeping rooms at The Peabody Hotel in Orlando. Most meals will also be provided. “This is a great opportunity for Au.D. students to meet some of the country’s most successful private practitioners,” said AFA Executive Director Susan Paarlberg.“The Student Mentoring Program is set up to encourage networking and allow students to make personal connections with practitioners who have already begun the professional journey the students are about to begin. The courses offered at the ADA convention will broaden the 24 students’ education, with a strong emphasis on private practice development and management.” The AFA has developed this program, in conjunction with the ADA (“Home of the Au.D.”), to further its commitment to fostering the education and training of future audiologists. For more information on this program, or to download the application, please visit the AFA’s scholarship page at http://www.audfound.org/ files/StudentMentor ing Application2007.pdf. AFA Awards Audiology Practitioner Scholarships The Audiology Foundation of America (AFA) announced 10 recipients of its Practitioner Scholarship awards.Each recipient won $1,000 in support of distance Au.D. education. Donations to the AFA funded the scholarships; the AFA will continue to support practitioners in their upgrade with additional scholarship opportunities throughout 2007.Visit the AFA Web site (www.audfound.org) often to check for new practitioner scholarship announcements. The scholarship winners are: Sarah Bretz – an audiologist for five years who is currently employed by Colorado ENT Specialists in Parker,Colo.She is pursuing her Au.D. from the Pennsylvania College of Optometry, School of Audiology (PCO). Patti Ann St. John – Director of Audiology at FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Louisiana State University’s Health Sciences Center and a practicing audiologist since 1993.She is pursuing her Au.D. from A.T. Still University/ Ar izona School of Health Sciences (ASHS). Jennifer Christo – an audiologist since 1999 and currently employed as a school-based audiologist at Omaha Hearing School in Omaha, Neb. She is pursuing her Au.D.from ASHS. Jennifer Hall – an employee of Orlando Regional Healthcare System in Orlando, Fla, and a practicing audiologist since 1990. She is pursuing her Au.D. from ASHS. Donna Lauschke – an audiologist for five years and currently employed by Otolaryngology Group, Ltd. in Glenview, Ill., and Children’s Memorial Outpatient Center in Westchester, Ill. She is pursuing her Au.D. from ASHS. Jennifer Gutzwiller – an educational audiologist since 1998 who is currently employed in Kearney, Neb. She will earn her Au.D. from PCO. Joni Johnson – an audiologist for more than 20 years who Professional Update is currently employed by Columbia Regional Program in Portland,Ore.She will earn her Au.D. from ASHS. Bridget Kane – an audiologist since 1981 who currently owns Professional Audiology and Hearing Aid Services in Woodridge, Ill., and is also employed as head audiologist in an otologist’s office in Chicago, Ill. She is pursuing her Au.D. from ASHS. Kristin Lillie – an audiologist since 2003 who is currently employed in an educational setting in Salem, Ore. She will earn her Au.D. from PCO. Kellen Rogan – an audiologist since 1999 who is currently employed in an ENT office in Chicago,Ill.She is pursuing her Au.D. from ASHS. AFA Presents Student Award at University of Texas at Dallas In January a third-year student at the University of Texas at Dallas (UTD), Mar issa Mendrygal, received an AFA Outstanding Au.D. Student Sarah Bretz Patti Ann St. John Jennifer Christo Jennifer Hall Donna Lauschke Jennifer Gutzwiller Kristin Lillie Kellen Rogan Professional Update ADA Scholarship — $4,500 in support of her academic endeavors. AFA established the Outstanding Au.D. Student Scholarships to recognize and support the “best and brightest” Au.D. students. The Oticon Foundation, also known as the William Emant and Wife Ida Emilie Foundation, provides a grant for these scholarships. ASHS Bestows AFA Endowed Student Excellence Award In a recent ceremony, the Ar izona School of Health Sciences ( A S H S ) awarded its AFA Student Excellence Award scholarship to one Michelle Pollihan of its most outstanding residential students. The annual scholarship provides $1,000 to a winning student based on clinical skills, academic standing,demonstrated commitment to professional organizations and an essay on professionalism.This year’s winner was Michelle Pollihan. Pollihan is a third-year student at ASHS. She holds a perfect GPA, has perfor med professionally at numerous and varied clinical externship sites, and has also participated in Rotary Club missions to Mexico to perform audiological evaluations for Spanish-speaking children and adults. She is a student member of several pro- fessional organizations, including NAFDA and AAA, and has also offered presentations on professional topics throughout her academic career. "Academically,Ms.Pollihan is an excellent student, but she stands out even more because of her positive attitude,professional behaviors, and motivation to get involved in service and leadership activities,”said Dr.Tabitha Buck, ASHS Audiology Chair. “She will be an outstanding Doctor of Audiology and an active professional, representing audiology well in all of her endeavors." ASHS Graduates Honored with Professional Leadership Awards During March graduation exercises at ASHS, Joan Marttila, Au.D. (left), and Mary McDaniel,Au.D. (right), both received AFA Professional Leadership Awards. These awards honor graduating dis- tance education students. Winners are recognized for their positive attitude and strong work ethic throughout their Au.D. program, their involvement in professional activities to promote the profession and patient care,and their dedication to public service. Dr. Marttila was recognized for her leadership in ensuring that assistive devices are provided for Iowa school students,her work with the Iowa EHDI Advisory Committee, her contributions to the profession via authoring articles,and in particular for serving as principal author for the “Knowledge is Power” program to teach students about their hearing loss. Dr. McDaniel was honored for her efforts to protect the hearing of industrial workers in the state of Washington, her national contributions as an officer and member of the National Hearing Conservation Association,and her collaborative work with OSHA and CAOHC. McDaniel has owned her own hearing conservation company, Pacific Hearing Conservation, in Seattle,Wash., since 1995. ASHA and HCEC Update Similar to its annual convention in San Diego last November, ASHA hopes to gather advisors from several organizations to continue the collaboration and exchange of ideas next November. The Health Care Economics Committee (HCEC) extended an invitation to ADA President Larry Engelmann or a representative from ADA to attend the meet with them during the upcoming November meeting in Boston, Mass. The meeting takes place one day prior to the ASHA Annual Convention. ADA Past-President David Citron, Ph.D. has agreed to be ADA's representative in Boston at the Amer ican SpeechLanguage-Hearing Association’s (ASHA's) Healthcare Economics meeting. The HCEC is charged with developing recommendations for procedural and diagnostic coding and relative values of audiology and speech-language pathology procedures. The committee also considers coverage of services by all payers and anticipates further socioeconomic needs of the professions and consumers. Issues addressed at this meeting are related to procedural and diagnostic coding and relative values for audiology. For more information, www.asha.org. Hearing Aid Companies Host “Hearing On The Hill,” Brief Legislators On Hearing Health Issues The Hear ing Industr ies Association (HIA) hosted its biennial “Hearing on the Hill” to spotlight hearing loss and treatment and the importance of hearing health May 16 for Senators, Representatives, House and Senate staff, agency staff and others with an interest in hear ing health. Senator Norm Coleman (R-Minn.) and Representatives Carolyn McCarthy and Vern Ehlers cooperated on the event held at the Library of Congress. HIA represents manufacturers of hearing aids and related devices, and the association has hosted “Hearing on the Hill”as an educational event at the start of each Congressional session for the past decade. Our Academy’s Melissa Clark,Au.D. organized ADA’s participation in this event. As part of the event, hearing health professionals from around the country provided confidential hearing screenings, which take a maximum of 10 minutes. Hearing Continued On Page 29 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 25 26 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Preceptor Training Feature remember the first time I supervised an audiology student during a clinical rotation. I relied on all of my memories of being a student and being supervised by someone else. I utilized the interpersonal communication skills I had developed as a student,teacher and clinician.I tried to pull out some vague memories of lessons taught to me in graduate school about “being a supervisor.” I believe the experience was an educational one for the student and for me, and the term progressed rather smoothly. However,formal training in aspects of being an excellent clinical preceptor, providing clinical instruction, determining appropriate clinical learning objectives,being a mentor and role model for professional behaviors, and evaluating student performance definitely would have been helpful. I wish I would have had preceptor training back then. Preceptor or clinical instructor training provides an educational process (i.e. workshop,class,workbook) designed for experienced care providers that work with students (preceptees) during clinical rotations. The training may cover the aspects mentioned above as well as additional detailed topics such as, developing critical thinking skills in the preceptee,implications of generational differences between preceptor and preceptee,how to deal with conflict,learning styles,providing feedback and more.Ultimately,the aim of preceptor training is to improve the skills of the preceptor in areas important to facilitating student learning and helping the students to become competent,productive and enthusiastic professionals. Providing patient care involves a specific set of clinical and decision-making skills for which I had been trained, but being a clinical preceptor – teaching students how to manage patient care – takes a different set of skills.Raoul A.Arreola (2007) refers to college teaching as a meta-profession. This meta-profession model explores how faculty must be involved in activities that require not only expertise in a given content area or professional discipline, but that require skills “in a host of other sophisticated psychological, technical, organizational, and group processes” (Raoul, 2007, p.xix).The meta-professional skill set described by I Raoul (2007) for college faculty also appropriately addresses the skill set needed by clinical preceptors. Some meta-professional skills that apply to preceptors include areas such as knowledge and application of instructional design, instructional delivery, instructional assessment, learning theory, communication styles, conflict management, group process/team building, and personnel management.Therefore, serving as a preceptor can be viewed as a meta-profession built on the foundation of the audiology profession and requiring application of many elements that go beyond the practice of audiology. Many health professions have been involved in extensive analysis and development of clinical education training programs that have incorporated training in the above meta-professional areas. For example, the American Physical Therapy Association (APTA) introduced a Clinical Instructor Education and Credentialing Program (CIECP) in 1996 (www. apta.org). To date, there are more than 15,000 credentialed clinical instructors who have participated in the two-day training program and approximately 130 individuals trained to deliver the clinical instructor curriculum to other.When reading the history of the clinical instructor program development in physical therapy, it is easy to see that the assumptions and rationales central to the CIECP are also true for audiology. The importance of clinical education as a critical component for students in first professional degree programs and the need for practitioners to provide quality learning opportunities is very evident in audiology today. Audiology professionals,professional associations and universities should further examine the concept of being a preceptor as a meta-profession and the models of preceptor training used by other professions. Benefits of preceptor training would not only increase the effective positive learning experiences for students,but could also serve to increase the benefits to the clinical preceptors and the rewards of choosing to be a preceptor.This article will serve only to introduce those concepts and not to provide a comprehensive description or tutorial on preceptor training. As a basic starting point for building a pre- ceptor toolbox,audiologists who choose to host Doctor of Audiology (Au.D.) students for rotations,should follow two simple tasks: 1) mentoring professional behaviors and 2) establishing clinical learning objectives for the rotation. Activity – Mentoring Professional Behaviors Students are learning professional behaviors from us even when we are not actively trying to “teach” and when we are not aware that they are paying attention.When students are on a clinical rotation, they should be soaking in knowledge from their preceptor/mentors all day long.Many practicing audiologists have been working with students for decades using their own experiences, good judgment and highly developed interpersonal skills.However,students and preceptors alike should reflect on professional behavior outcomes. Consider your own professional behaviors in the following areas and reflect throughout a one to two week period on how you handle situations.Write down the areas in which you excel, even if these areas may seem like second nature to you.Write down an action plan to improve on one or two selected areas.After you have gone through this exercise,you can also engage students in discussions and reflections on their behaviors using the same process. Clinical Competence (Knowledge of Audiology): Mastery of current knowledge and skills out of the concern for the well-being of patients,not just to pass exams, classes or clinical rotations. Lifelong learning. Consistently supporting professional decisions with evidence (evidence-based practice). Recognizing limits of one’s competence. Honesty/Integrity: Being honest in work with patients and colleagues.Integrity in academic performance, clinical interactions and documentation,and research.This includes abiding by rules, regulations, laws, and high ethical principles.Incorruptibility. Altruism: Devotion to the needs of the patient before one’s own self-interests. The unselfish regard for the welfare of others. Providing care that goes beyond the expected standards of audiology practice. Compassion/Caring: Using empathy Continued On Next Page FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 27 Feature Preceptor Training and responding to others’(patients and colspend time to make sure that we provide clearly communicated objective expectaleagues) experiences, concerns, suffering patients information that will help them tions at the start of a rotation makes the and fears in a humane and healing manner. establish realistic expectations. Goals that process of feedback and evaluation of the Respect for Others: Respecting the we set for our patients can be compared to student easier and can make the value and dignity of others in all situations. rotation more satisfying and sucAppreciating diversity and maintaining atticessful from the perspective of tudes and behaviors that communiboth the student and preceptor. e nc rie pe l Ex es for Clinica ning Objectiv ____ cate respect. During an initial meeting with __ __ Student Lear __ __ ______ Preceptor__ ________ __________ __ __ __ Professional Responsibility/ a student, I use a specific form __ __ te_ __ Si __________ tions Student Name ______________ levels/expecta ific cy en __ r_ ici Accountability: Responsibility to (see sidebar) or a modified ea of pr /Y ec versity the sp Quarter quarter? (Uni clinical opportunities of tives for this the jec th ob wi ing ng work toward meeting professional version to facilitate interacrn alo lea re What are the considered he nt should be for the stude goals in all settings. Responding to tion and discussions of objecsite.) patients’ goals and needs. Not abusing tives, even in addition to 1. 2. the power that society has granted a more standardized docu3. 4. profession (such as substance abuse,sexments from the university. ur strengths? What are yo ual overtures or other abuses). I hope the concepts pre1. Conducting oneself in a manner that sented and the two items 2. 3. contributes to a positive environment for for your clinical preceptor 4. 5. learning and delivery of patient care. toolbox will be helpful and es? ur weakness What are yo This includes attendance, punctuality, will generate continued 1. 2. balancing professional and personal interest in learning about 3. demands, and willingness to identify and and developing preceptor 4. 5. eas? ar confront one’s own problematic behaviors training for audiology. ak we ur t yo done to targe What can be and those involving colleagues. Let’s work toward having 1. 2. Acknowledging and accepting the consepreceptors who are 3. quences of one’s actions. delighted to be involved 4. 5. ? tor Social Responsibility: Addressing in clinical education, ep ec your pr expect from What do you social factors that adversely affect patients’ rather than simply toler1. 2. health. Responding to societal needs for ating involvement! 3. _________ health and wellness. Community volunBeing a preceptor is an 4. __ __ te? __ da __ to y ____ ct of Audiolog ____________________ ___________________ favorite aspe ___ ______ ______ teerism and leadership. Political activism. important responsibili__ __ __ __ __ __ __ __ __ What is your __ __ __ __________ __________ __________ _________ __________ __________ __________ __________ __________ __________ As you review the list above,identify why ty for audiologists to __ __ __ __ __ __ __ __ __ __ __ __ ____ ______ ________ __________ __________ __________ __________ __ __ you think improvement is needed in an area undertake for the __ __ __ __________ and what you will do to improve by using future of our profesThis form can be downloaded at sion. It’s rewarding the two summary questions below. www.audiologist.org/feedback/studentlearningobjectives.pdf beyond the obvious of objectives that we set for our students. Professional Behavior helping another colleague.Inherent in being Establishing clinical rotation objectives at the Action Summary a clinical preceptor, the preceptor will beginning of the clinical rotation with Au.D. 1. Description of Area:Why do you think enhance his or her knowledge base providstudents and updating the goals as needed, improvement is needed? ing better services to the hearing-impaired can be valuable to both the preceptor and 2. Plan for Improvement:What will you population and becomes a partner in lifethe student.Universities should provide the do to demonstrate improvement? long learning. ■ clinical site with learning objectives for the rotation that can be used as a starting point. Activity – Establishing Clinical REFERENCES The learning objectives can then be taiLearning Objectives Arreola,R.Developing a Comprehensive Faculty lored by the preceptor,in conjunction with At the beginning of a clinical rotation, a Evaluation System: A Guide to Designing, the student and university clinical coordibrief session between the preceptor and stuBuilding, and Operating Large-Scale Faculty nator or liaison to be more specific to the dent to establish clinical learning objectives Evaluation Systems. Bolton, MA: Anker individual clinical setting. Since university for the clinical experiences can be extremePublishing Company Inc. learning objectives should be fairly consisly valuable. As practitioners, we are well SteinertY., Cruess, S., Cruess, R. & Snell, L. tent across programs, once you have estabaware of the importance of realistic goals (2005).Faculty development for teaching lished a set of objectives for your site, you and expectations.We know that a patient’s and evaluating professionalism: from promay be able to use them with students from expectations regarding amplification or othgramme design to curriculum change. any university by matching them with er remediation processes will have a bearing Medical Education 2005; 39: 127–136 objectives sent by each institution. Having on her or his success and satisfaction. We 28 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Professional Update ADA loss affects one in 10 Americans, and is the third most common chronic health condition facing seniors today. At the opposite end of the age spectrum, hearing loss is also the most prevalent birth defect in America,and the sensory deficit affects 1.2 million children under the age of 18. The day's events focused on the bipartisan Hear ing Aid Assistance Tax Credit Act that would provide a $500 tax credit for the purchase of a hearing aid by those 55 and older and dependent children. Hearing aids are expressly excluded from Medicare coverage and from most health insurance policies, while financial constraints are cited as a core reason why 30 percent of those with a hearing loss do not use hearing aids.The tax credit is designed to address this problem. HIA is the trade association of the companies that manufacture hearing aids, hearing aid components and batter ies. Headquartered in Alexandria, Va., HIA represents the majority of hearing aids purchased in the U.S. on an annual basis. For more information, visit www.hearing.org. AAA Update “Turn it to the Left” rocks… and raps at AudiologyNOW! The American Academy of Audiology and the AAA Foundation have joined efforts to promote public awareness about noise-induced hearing loss. This initiative developed when “Hearing Loss Prevention” was selected as the theme for AudiologyNOW! 2007,and efforts hit a “high note” during General Assembly in Denver! It was there that we debuted our “Turn it to the Left” campaign! The audiologists at General Assembly were on their feet as Ben Jackson performed the rap single for the crowd.The Academy leadership joined him on stage for an encore which “raised the roof ” of the convention center. Following his rousing performance, Jackson autographed CDs for audiologists and performed an encore performance for the Denver youth who were visiting the DiscovEARy Zone. Academy members were thrilled to hear that “Turn it to the Left”is available on CD and immediately began thinking of opportunities for its use to educate patients and family members about noise-induced hearing loss. The first delivery of CD’s sold out in one day… but we’ve ordered more and copies are now available.The CD is a thank you gift with each donation of $20 or more to the AAA Foundation’s “Turn it to the Left”Fund for research in noiseinduced hearing loss. Make your contribution to the AAA Foundation at www.audiologyfoundation.org to receive your complimentary copy. ■ ADA News Annual Convention Early Hearing Detection and Intervention Act ADA Meets In Orlando ADA Joins with Industry Leadership Groups DA's annual convention will be held in Orlando, Fla., October 10-13,2007. ADA's annual convention is known for facilitating close interaction with faculty and peers in an informal and fun resort environment. Convention programming is developing to focus on many areas of interest to young, mid– and late-career audiologists, as well as for students. Some of the exciting content areas tentatively include: • All-day reimbursement workshop (bring your office staff!) • Build a custom marketing plan • Incorporating tinnitus rehabilitation into your practice • Internet marketing • New Open Fitting strategies • The ABC's of negotiation • Marketing to the mature marketplace he Academy of Doctors of Audiology recently joined with several other hearing industry leadership groups to voice their support of The Early Hearing Detection and Intervention Act of 2007, which urges Congress to support the following funding amounts for health programs in the FY 2008 Labor, HHS, Education Appropriations bill, including: • $11 million for the Early Hearing Detection and Intervention (EHDI) program of the Health Resources Services Administration (HRSA) to assist states in screening,family support,follow-up and early intervention services; • $11 million for the National Center on Birth Defects and Developmental Disabilities (NCBDDD) under the Centers for Disease Control (CDC) to assist states with the tracking, surveillance, quality assurance and cost effectiveness in EHDI programs; and The bill also encourages the National A T Institute on Deafness and Other Communication Disorders (NIDCD) to expand its EHDI clinical research program. Introduction of H.R. 1198 On February 27, Representative Lois Capps (D-CA) introduced H.R. 1198, the Early Hearing Detection and Intervention Act of 2007.The bill would amend the PHS Act to expand the newborns and infants hearing loss program. Of interest to NIH is a provision that would require NIDCD to establish a postdoctoral fellowship program to foster research and development in the area of early hearing detection and intervention. It would also reauthorize NIDCD to continue a program of research and development on the efficacy of new screening techniques and technology.The bill would authorize such sums as necessary for FY2008 through FY2013 for both of these initiatives. H.R. 1198 was referred to the House Committee on Energy and Commerce. Energy and Commerce. FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 29 ADA My Life Is… ia. ctitioner in Pennsylvan an, Au.D., a private pra ess Campaign. aren Kathy Landau Goodm Aw logy dio Au the of She is also the Chair My Life Is… 30 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 Convention 2007 ADA ADA 2007 Convention: LAUNCH YOUR PRACTICE FOR SUCCESS! J oin ADA at the 2007 Convention to send your practice soaring! ADA's annual conventions are well-known for providing top notch education,business practice guidance and important networking opportunities.The 2007 Convention promises to be among the best ever with information on the latest technologies and practice setting applications.This is one conference you won't want to miss! The concurrent sessions for convention will cover four main categories. Experts will present on these topics. 1. Practice Development & Business Tools 2. Amplification/Technology/Rehabilitation 3. Diagnostic/Biomedical/Research 4. Professional/Advocacy/Legal/Ethical Look for the expanded convention line up in the next Q3 issue of Feedback! Attend these pre-conference workshops to get a head start on networking and learning opportunities! Pre-Conference Workshops Note: Separate Registration fee is required Audiology Practice Operations: From Appointment to Payment (A How to Guide to Productivity and Profitability) Kim Cavitt,Au.D.,Audiology Resources, Inc. This all day tutorial will focus on everything a practice needs to know to maximize their productivity,profitability and efficiency in their day to day interactions with patients, referrals, staff and insurance carriers.We will discuss the importance of office policies, procedures, forms and documents, coding and third-party reimbursement issues, Medicare, Medicaid, third-party insurance contracting, hearing aid coverage and verification, hearing aid and diagnostic procedure pricing, practice management issues and opportunities, and documentation. A major goal of this workshop is to make the reimbursement maze more understandable, and for each participant to be able to walk away with information that will have an immediate impact on their practice. Cerumen Management Workshop Dr. Rita Chaiken,Atlanta Audiology Services, Inc. This workshop, both educational and practical,will include a review of the anatomy and physiology of the outer ear and conditions of the ear canal,otoscopic examinations, properties and characteristics of cerumen, methods of cerumen management, and related issues such as liability, reimbursement,and state licensure.The final hours of this workshop will allow the participants to actually use a variety of cerumen removal instruments and equipment. Your Pathway to a Bigger Future: Developing the Audiology Practice Marketing Plan Steve Henson,Associate Professor of Marketing, Wester n Carolina University; Susan Williamson, Au.D., Healthcare Business Education; Lar ry Englemann, Au.D., Audiology Clinic; Gretchen Syfert, Au.D., Audiology Consulting Services More than ninety percent of all audiologists think that they should have high or Continued On Next Page FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 31 ADA Convention 2007 very high levels of knowledge about marketing. Unfortunately, only around 5 percent of all audiologists actually have such knowledge.This course is designed to assist participants in developing the most basic building block of marketing, the marketing plan. Students will complete an outline of a marketing plan including a situation analysis,marketing strategy,marketing goals and objectives, and key marketing pro- Register online; it’s that easy! Visit www.audiologist.org/news/convention/index.cfm to register online today! grams designed to achieve marketing objectives. Emphasis will be placed on developing marketing strategies that allow audiologists to flourish in increasingly competitive markets. ADA 2007 Convention Online Hotel Reservations Hotel Information The Peabody Orlando 9801 International Drive Orlando, FL 32819 Hotel Rate/Reservations Single/Double Room: $193* *Rates do not include 13.5% tax plus a $10.65 per night service charge (subject to change). The hotel service fee entitles the registered guest to unlimited local and 800 calls,two bottles of water per day, two I-Ride tickets per room per day, overnight shoeshine, morning lobby coffee, and access for one guest to the hotels wireless high speed internet service. Travel Information Transportation to and from the Orlando International Airport (MCO) - time approx. 20 minutes. Taxi fare is more than $36; shuttles are $16–$25. Orlando Highlights Learn more about the wonderful city of Orlando and its highlights. Visit www.orlandoinfo.com for more information! 32 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 33 Feature Tinnitus Prevalence Reduced by Prevention research being done on the regeneration of cochlear hair cells, as well as significant improvements in our understanding of the genetics underlying certain syndromes and disease processes associated with hearing loss and tinnitus. In spite of this research and advancement, it is the improvement in occupational hearing conservation programs that has the highest potential to reduce the incidence of the tinnitus-associated hearing loss in large numbers. In 1998, NIOSH published a new criteria document Criteria for a Recommended Standard for Occupational Noise Exposure (NIOSH, 1998, Publication 98-126, available free from NIOSH at www. cdc.gov/niosh). The previous criteria document from 1972 (NIOSH, 1972) formed much of the basis of the original OSHA Hear ing Conservation Amendment (OSHA,1981),but since then NIOSH collected audiometric data that has revealed some inadequacies. It is NIOSH’s position that it is necessary to create “Hear ing Loss Prevention Programs” based upon “best practice” in hearing preservation, since under the older NIOSH criteria as much as 25 percent their professional skills to address these problems before they happen, audiologists can and should play a pivotal role in maintaining the quality of life for those who spend their lifetimes providing the manpower that keeps the American economy competitive in a global marketplace. REFERENCES Council for Accreditation in Occupational Hear ing Conservation, “Hear ing Conservation Manual, 4th Ed., 2002, p7. Hagar, Lee, platform presentation at National Hear ing Conservation Association Annual Meeting, February, 2004. to absorb them. Given the current population of approximately 30 million noiseexposed workers, each industr ial audiologist would need to be able to serve 60,000 employees, which would clearly be impossible, even if the audiologists were All audiologists’ efforts to improve the frequency and effectiveness of occupational, military and recreational hearing loss prevention activities are necessary and overdue. Currently, the numbers of audiologists exclusively serving the industrial noise-exposed population are extremely small… of the noise-exposed population would still sustain disabling work-related hearing loss after a working lifetime even if employers and employees followed the OSHA regulation to the letter (NIOSH, 1998). Increasing Prevention All audiologists’ efforts to improve the frequency and effectiveness of occupational, military and recreational hearing loss prevention activities are necessary and overdue. Currently, the numbers of audiologists exclusively serving the industrial noise-exposed population are extremely small (estimated to be fewer than 500 of the 16,000 active audiologists) and more are likely to be required as the 78 million Baby-boomers reach retirement age and the workers’ compensation system begins 34 FEEDBACK • VOLUME 18, NUMBER 2 • SUMMER 2007 geographically and demographically distributed in the same manner as the working population, which they aren’t. Audiologists both in clinical and academic settings need to focus more on assessing noise hazards, the quality and quantity of protection devices available, and methods to evaluate and track their effectiveness as well as that of hearing loss prevention programs. By preparing audiology students to deal with industrial populations,by making such training a priority within student training programs, and by teaching students about the special nature of noise-induced hearing loss and the tinnitus that often accompanies it, professionals will strengthen hear ing loss prevention and reduce the prevalence of both hearing loss and tinnitus. By using National Institute for Occupational Safety and Health, “Cr iter ia for a Recommended Standard: Occupational Noise Exposure,Revised Criteria,1998,” NIOSH, DHHS, Publication 98-126, Cincinnati, Ohio. National Institute for Occupational Safety and Health, “Cr iter ia for a Recommended Standard: Occupational Exposure to Noise, 1972,” NIOSH, DHEW, Publication HSM 73-11001, Cincinnati, Ohio. National Institute for Occupational Safety and Health, “National Occupational Research Agenda,” DHHS, NIOSH Publication 96-115, Cincinnati, Ohio Occupational Safety and Health Administration, “Occupational Noise Exposure: Hear ing Conservation Amendment,1981,”46 Federal Register, 4078-4179. Nancy N.Green,Au.D.is an industrial audiologist and has been in private practice in Jacksonville,Fla.for more than 25 years,providing hearing conservation consultation services for industries in Florida, Georgia and the Caribbean. She also teaches Prevention of Hearing Loss and Disability as Associate Professor (Adjunct) of Audiology at A.T.Still University of Health Sciences. Join the largest student education program in the industry. August 8th-11th, 2007 Call Suzanne Smoak at 1-800-777-7333 x5114 or visit www.phonakpro.com to register for Phonak U 2007. Be a part of the program selected most frequently by your peers! Academy of Doctors of Audiology® 401 N. Michigan Avenue, Suite 2200 Chicago, IL 60611 Return Service Requested PRSRT STD U.S. POSTAGE PAID Columbia SC PERMIT 535