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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®
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President’s Message
Larry Engelmann, Au.D.
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Editor’s Note
E N
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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.
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Tinnitus Prevalence Reduced
by Prevention
Nancy N. Green, Au.D.
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Richard Salvi, Ph.D., Edward Lobarinas,
Ph.D. and Wei Sun, Ph.D.
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My Life Is…
Nancy Gilliom, Ph.D.
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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
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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
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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…
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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!
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