hearing hq apr-jul 14

For all your hearing optionsHQhearing

Apr - Jul 2014

OLIVIA ANDERSEN The founder of an award-winning deaf teen mentoring program explains why she chose to have a cochlear implant at 30

TOP 15 MOST USEFUL HEARING AID FEATURES

Central Auditory Processing Disorders (in Children) explained

WHO INVENTED

THECOCHLEAR IMPLANT?

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THE TOP 15 HEARING AID FEATURESThe 15 most useful features to look for when choosing a hearing aid irrespective of the brand!

FEATURES10

16 WHO INVENTED THE COCHLEAR IMPLANT?'Success has many fathers, failure is an orphan'. This adage is certainly true of the cochlear implant. We went in search of the truth and found a very interesting and long history to the development of this miraculous technology.

SUBSCRIBEPersonal orders: for just $22 each year, receive 3 issuesMultiple copies - Small: $25/year for 3 issues (5 copies of each issue)Multiple copies - Large: $50/year for 3 issues (45 copies of each issue)

For all orders you can subscribe - online at www.hearingHQ.com.au - post the form on page 25 to the address below - email [email protected]

Hearing HQ, PO Box 649, Edgecliff NSW 2027

Hearing HQ Apr - Jul 2014 3

EditorHelen Lowy [email protected] EditorCelia TaylorContributorsMarion Williams, Prof Harvey Dillon, Sharon Cameron, Daniela AndrewsExpertsProfessor Bill Gibson AMAudiologists: Emma Scanlan, Roberta MarinoAdvertising Sales ExecutiveJulia Turner [email protected] 0414 525 516Magazine [email protected] PublisherLucinda Mitchell [email protected] by Offset Alpine

Sharan WestcottClinical Manager, SCIC

Adjunct Prof Harvey Dillon Director of Research, NALDr Dillon has researched many aspects of hearing aids, effectiveness of rehabilitation, auditory processing disorders and methods for preventing hearing loss. He has designed hearing aids, authored over 160 articles and his text on hearing aids is used worldwide.

Principal Research Fellow of Melbourne University, A/Prof Cowan has researched and published extensively in the fields of audiology, cochlear implants, sensory devices and biomedical management. He holds the '06 Denis Byrne Memorial Orator Award.

Former principal audiologist for Australian Hearing, Sharan Westcott has provided audiology services to children and adults for more than 40 years and now coordinates a team of surgeons, audiologists, speech pathologists and social workers at SCIC.

Assoc Prof Robert Cowan, CEO HEARing Cooperative Research Centre

The Editorial Advisory Board provides guidance and expertise on a voluntary basis. They may not review every article and make no warranty as to the scientific accuracy of the magazine. They are not responsible for any errors published and do not endorse advertised products. If you have any questions about editorial content, please direct them to [email protected]. If you have questions about product suitability for your specific needs, we recommend you consult an audiologist or doctor. Any person with health issues or medical concerns should first take advice from a health professional.

MAA focuses on identifying practical, real-world solutions for people with disabilities to access audiovisual content to empower people to be independent. They provide advice to government, industry, educators and individuals.

After 45 years of profound deafness Dr Lockhart received a cochlear implant in 2005. His involvement in the cochlear implant support group CICADA and his technology background (retired senior CSIRO scientist) led him to become editor of CICADA Magazine (now Hearing HQ).

Profoundly deaf from birth, Olivia Andersen started Hear For You, a not-for-profit organisation to help young deaf people achieve their life dreams. The birth of her first child prompted her decision to have a cochlear implant.

Alex Varley, Chief ExecutiveMedia Access Australia

Dr Neville Lockhart

Olivia Andersen, Founder/Director Hear for You

contentsHQhearing

Prof Gibson holds the Chair of Otolaryngology at The University of Sydney. He is Director of Sydney Cochlear Implant Centre and the author of 185 texts and scientific articles. His AM was received in recognition of his services to medicine.

Prof William Gibson AMHead of ENT Unit, University of Sydney

PUBLISHER'S LETTER

NEWSBITES Research, innovations and things you need to know.

DEAFINING MOMENTSThe funny side of living with hearing loss.

ALL ABOUT… Central Auditory Processing Disorders in Children.

ASK THE EXPERTS Professional advice on reader questions and concerns.

REGULARS4

26

REAL PEOPLE REAL STORIES The founder of awarding winning Hear For You mentoring program explains why she had a cochlear implant.

HERE TO HELP Organisations providing advice and support.

PRODUCTS & SERVICES Information at your fingertips.

BOOKS ETC...Book reviews.28

30

33

34

EDITORIAL ADVISORY BOARD

Cover image: Photo by Dean McCartney, Styling by Emily Brunette.

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4 Hearing HQ Apr - Jul 2014

Lucinda MitchellPublisher To have your say contact:

[email protected] or PO Box 649, Edgecliff NSW 2027

Hearing HQ Magazine is published by The Tangello Group Pty Limited 'The Tangello Group' (ABN 38 155 438 574) PO Box 649 Edgecliff NSW 2027 and is subject to copyright in its entirety. The contents may not be reproduced in any form, either in whole or part, without written permission from the publisher. All rights reserved in material accepted for publication unless specified otherwise. All letters and other material forwarded to the magazine will be assumed intended for publication unless clearly labelled “not for publication”. Text, photographs and illustrations received in hard copy must be accompanied by a self-addressed envelope stamped to the appropriate value (including registered or certified mail if required) if return required. The Tangello Group does not accept responsibility for damage to, or loss of, submitted material. Opinions expressed in Hearing HQ Magazine are those of the contributors and not necessarily those of The Tangello Group. No responsibility is accepted for unsolicited material. No liability is accepted by the publisher, the authors or members of the editorial advisory board for any information contained herein. All endeavours are made to ensure accuracy and veracity of all content and advice herein but neither Hearing HQ Magazine, its publisher, contributors or editorial advisory board members is responsible for damage or harm, of whatever description, resulting from persons undertaking any advice or purchasing any products mentioned or advertised in Hearing HQ Magazine or its website.

letterfrom the publisher

newsbites

In August 2009 I made a pact with myself.

It was while I was having my toenails painted and sipping a heartwarming cup of hot tea. It was also while

I was slowly feeling worse and worse as the chemo drug I was hooked up to was taking effect.

The thing that helped me stay positive during those two hour sessions when I'd walk in feeling good and walk out feeling like death warmed up were the volunteers who managed to appear at the very moment you needed a boost with a smile on their face and their only agenda - to help.

It was at that moment I realised I finally had to get myself into gear and do what I'd been promising myself for years: "When I have more time I'll give back". Of course there is never more time - you swap nappies for play dates then sporting events and one 'full-on' job for another.

As I contemplated how I could give back, I decided the area of cancer was well supported and I could add more value somewhere where I could apply my extensive consumer magazine publishing skills.

Having seen my stepfather Neville Lockhart go through the frustration of researching to find information and the right path to get a cochlear implant after 45 years of profound deafness, I realised this was where I could really help. I was stunned at the lack of independent information available and I felt there was a real need for someone to pull all the information together in one easily accessible place.

Working with CICADA we created CICADA magazine and website which subsequently became HearingHQ. And of course I learned a great deal about cochlear implants during Neville's journey. My fascination with cochlear technology has resulted in the feature article on page 16 which follows the development of the technology from the very earliest days to the sophisticated devices today, which are the result of many brilliant scientists and companies globally.

I am immensely proud of what we've achieved. And when I say 'we' I mean CICADA who took a leap of faith with my plan; Neville who was our first editor and inspiration; Helen Lowy our current editor; our-long term contributors, experts and advisory board members who keep us interesting, up to date and accurate; and of course, our advertisers without whom we could not produce a magazine that is available for free.

The bass player of Dire Straits John Illsley has revealed he struggles to dine out in restaurants playing music these days. He admits he can no longer listen to loud music and much of what he once enjoyed is now little more than noise. He's urging music industry boffins to look at the apparent rise in hearing troubles among people of his generation and younger, and turn the volume down.Illsley, 64 told the BBC, "My son went to a club in London about seven or eight years ago and he had tinnitus for three years after it. I've noticed a lot more people my age and younger wearing hearing aids... There's just a problem... It really needs looking at." Illsley is not the only British rocker experiencing

hearing problems. Noel Gallagher, Coldplay's Chris Martin, Phil Collins and Pete Townshend have also previously spoken out about their troubles. He adds, "It's an occupational hazard... It's difficult to play a gig quietly... You just get damaged; it's one of those things... It really needs looking at pretty seriously."

This post-XXXII World Congress of Audiology symposium hosted by Sydney Cochlear Implant Centre (SCIC) is the first of its kind in the Asia-Pacific.

Titled In Tune with Technology, the emphasis will be on improving music enjoyment for recipients with current cochlear devices.

The two-day symposium will be held at the Australian Hearing Hub in the grounds of Macquarie University, feature international speakers. The Sunday 11 May half-day session is open to professionals, implant recipients and their families and will share practical ideas on how to improve music listening and enjoyment. The Monday 12 May full day session is open to professionals only. For full details and to register go to www.scic.org.au

INAUGURAL INTERNATIONAL

SYMPOSIUM ON MUSIC AND

COCHLEAR IMPLANTS

HEARING IN DIRE STRAITS



newsbites

Researchers at Washington University School of Medicine have identified the specific genes involved in regenerating cochlear hair cells in chicks - a significant step in the quest to reverse hearing loss in humans after inner ear hair cell damage.

Studies of avian species have shown that damaged cochlear hair cells can be replaced in as few as two to three days, with full auditory function restored within a few weeks. Mark Warchol PhD, a professor of otolaryngology, has spent more than 20 years investigating how they do it.

“Given that regenerative ability is widespread among vertebrates and absent only in mammals, it’s likely that regeneration is probably the “default” condition of the vertebrate ear that was lost during the course of mammalian evolution,” said Warchol.

Warchol and others believe that it may be possible to induce some amount of cochlear repair through genetic or pharmacological manipulation of key molecular targets. Using RNA sequencing (an advanced genetic screening technique), the researchers have been able to identify the specific genes that are expressed (or repressed) in the regenerating cochlea.

“We compared RNA from a damaged (with antibiotic) and an undamaged chick ear at 24-hour intervals to understand what genes are turned off or on,“ said Warchol. “We now have a blueprint of the pathways involved in chick regeneration of both vestibular and cochlear hair cells.”

The work by Warchol and his colleagues has moved the field toward a more complete representation of the regulatory network involved in regeneration of inner ear hair cells. This level of understanding is essential to development of therapeutic repair or regeneration of lost or damaged sensory receptors in the inner ear.Source: http://medschool.wustl.edu/news/patient_care/haircells2013

CHICKS BRING US A STEP CLOSER

If you have hearing difficulties but only occasionally and don't feel you need a hearing aid quite yet, perhaps this iPhone app can help on the odd occasion you need a little boost.

With Ear Machine's iPhone app you can adjust the quality of the sound to suit your needs. The iPhone microphone picks up sounds, adjusts them based on your profile and then feeds them to your earbuds. Over time the app, which is free, learns your preferences for audio settings. Currently you can only access the app on iPhone because Android smartphones have a time lag for processing sounds.

In January Ear Machine, run by founder Andy Sabin with hearing scientists Dianne Van Tasell and Kevin Franck, began testing a wireless earpiece for use with the app although it is not known when this will become available.

Bob Cowan, CEO of Australia's HearingCRC, says "While this is a good innovation it is definitely not a replacement for a hearing aid for those with more than mild hearing loss as it doesn't have the same features or processing capabilities. It relies on the microphone of the phone to pick up sound and as an omnidirectional microphone it is not particularly useful in background noise."

Need an occasional boost?

EarMachine picks upthe sounds around you...

enhances them... and sends them to your ears.

The bass player of Dire Straits John Illsley has revealed he struggles to dine out in restaurants playing music these days. He admits he can no longer listen to loud music and much of what he once enjoyed is now little more than noise. He's urging music industry boffins to look at the apparent rise in hearing troubles among people of his generation and younger, and turn the volume down.Illsley, 64 told the BBC, "My son went to a club in London about seven or eight years ago and he had tinnitus for three years after it. I've noticed a lot more people my age and younger wearing hearing aids... There's just a problem... It really needs looking at." Illsley is not the only British rocker experiencing

hearing problems. Noel Gallagher, Coldplay's Chris Martin, Phil Collins and Pete Townshend have also previously spoken out about their troubles. He adds, "It's an occupational hazard... It's difficult to play a gig quietly... You just get damaged; it's one of those things... It really needs looking at pretty seriously."

Drisana Levitzke-Gray from Perth, WA is the fifth generation of deaf people in her family but the first Australian deaf Auslan user to be allowed to fulfil her civil service to do jury duty."I felt really proud to have been chosen to be involved," Drisana said via an Auslan interpreter during an interview on Channel 10's Wake Up morning show.US and NZ courts already have deaf citizens participating in jury duty service however in Australia people who had asked for an Auslan interpreter were refused and not allowed to be on the jury.Common law states a jury cannot have a 13th person involved in jury deliberations. Until now an interpreter has been viewed as a 13th person revealing the lack of understanding of the role, professionalism and code of conduct for impartiality and confidentiality.To watch the full interview with captions visit http://www.youtube.com/watch?v=cg8rcuiAjJk

Australia FINALLY catches up with the US and NZ

This post-XXXII World Congress of Audiology symposium hosted by Sydney Cochlear Implant Centre (SCIC) is the first of its kind in the Asia-Pacific.

Titled In Tune with Technology, the emphasis will be on improving music enjoyment for recipients with current cochlear devices.

The two-day symposium will be held at the Australian Hearing Hub in the grounds of Macquarie University, feature international speakers. The Sunday 11 May half-day session is open to professionals, implant recipients and their families and will share practical ideas on how to improve music listening and enjoyment. The Monday 12 May full day session is open to professionals only. For full details and to register go to www.scic.org.au

HEARING IN DIRE STRAITS



newsbites

Researches at the Johns Hopkins University and the National Institute on Aging (NIA) have reported the loss of brain volume in humans seems to be fast-

tracked in older adults with hearing loss.The discovery adds to a growing list of health consequences associated with

hearing problems including increased risk of dementia, falls, hospitalizations, and diminished overall physical and mental health.

For the study, Frank Lin MD PhD and his colleagues used information from the ongoing Baltimore Longitudinal Study of Aging to compare brain changes over time between adults with

normal hearing and adults with impaired hearing. In the Longitudinal Study 126 people underwent yearly magnetic resonance imaging to track brain changes for up to 10 years. Each also had complete physicals at the time of the first MRI in 1994, including hearing tests. At the start, 75 had

normal hearing, and 51 had impaired hearing with at least a 25-decibel loss.After analysing their MRIs from the following years, Lin and his colleagues determined those whose

hearing was already impaired had accelerated rates of brain atrophy (loss) compared to those with normal hearing. Overall, the scientists report those with impaired hearing lost more than an additional

cubic centimeter of brain tissue each year compared with those with normal hearing.Those with impaired hearing also had significantly more shrinkage in particular regions including the

superior, middle and inferior temporal gyri, brain structures responsible for processing sound and speech. These findings suggests it may be even more important than previously thought to treat

hearing loss rather than ignore it.Source: www.hopkinsmedicine.org

WHY IT IS SO IMPORTANT TO TREAT HEARING LOSS!

COCHLEAR IMPROVES SOUND

The HEARing CRC has been granted an extention to their program funding with an additional $28m

from the Commonwealth Government over 5 years.The HEARing CRC, a collaboration of 23 organisations who

are contributing a further $95m, will lay the foundation for a new era of hearing healthcare delivering:

It is hoped these innovations will increase the take-up and use of hearing technology and services, provide hearing healthcare targeted to needs and encourage life-long hearing preservation. By better addressing hearing disability, the lives of hundreds of thousands of Australians will be improved through enhanced education outcomes in children, increased productivity for adults and reduced cognitive decline in the elderly.

$28m grant awarded

• new insights into the brain’s processing of sound enabling novel tools to target diagnosis and remediation

• next generation hearing aids and cochlear implants with enhanced capabilities

• evidence-based guidelines for candidature, fitting and rehabilitation that match technologies and services to individual patient needs

• self-fitting and web-based hearing healthcare delivery models that enable improved access for regional and remote communities

Cochlear Ltd have released the latest version of their cochlear implant the Nucleus 6 System, which is powered by a new sound management system. The SmartSound iQ has been designed to enable the device to automatically process sounds and adapt to a recipient’s different hearing situations to deliver a more natural hearing experience.

Their SCAN program analyses microphone input signals and classifies the sound environment into one of six scenes - speech in noise, speech, noise, music, quiet and wind - the most distinct hearing situations that some cochlear implant recipients have identified as a challenge. For each scene, SCAN selects the most appropriate microphone directionality pattern (standard, fixed or adaptive) and activates the scene technology based on the environment.

Results from a recent trial with 21 adult cochlear implant users indicated that all trial recipients successfully upgraded to the Nucleus 6 system and preferred SCAN as their default listening program.

Dr Chris Roberts, Cochlear CEO/President says: “With Nucleus 6, we have built on our long history of innovation in sound processing to give our recipients the best technology available so they can hear

their best in real world hearing situations. The Nucleus 6 is also capable of operating as

a hearing aid and a cochlear implant system simultaneously. This

has the benefit of boosting a recipient’s remaining natural hearing and combining it with the electrical hearing

provided by the implant so they can hear clearer

and crisper sound."



Researches at the Johns Hopkins University and the National Institute on Aging (NIA) have reported the loss of brain volume in humans seems to be fast-

tracked in older adults with hearing loss.The discovery adds to a growing list of health consequences associated with

hearing problems including increased risk of dementia, falls, hospitalizations, and diminished overall physical and mental health.

For the study, Frank Lin MD PhD and his colleagues used information from the ongoing Baltimore Longitudinal Study of Aging to compare brain changes over time between adults with

normal hearing and adults with impaired hearing. In the Longitudinal Study 126 people underwent yearly magnetic resonance imaging to track brain changes for up to 10 years. Each also had complete physicals at the time of the first MRI in 1994, including hearing tests. At the start, 75 had

normal hearing, and 51 had impaired hearing with at least a 25-decibel loss.After analysing their MRIs from the following years, Lin and his colleagues determined those whose

hearing was already impaired had accelerated rates of brain atrophy (loss) compared to those with normal hearing. Overall, the scientists report those with impaired hearing lost more than an additional

cubic centimeter of brain tissue each year compared with those with normal hearing.Those with impaired hearing also had significantly more shrinkage in particular regions including the

superior, middle and inferior temporal gyri, brain structures responsible for processing sound and speech. These findings suggests it may be even more important than previously thought to treat

hearing loss rather than ignore it.Source: www.hopkinsmedicine.org

WHY IT IS SO IMPORTANT TO TREAT HEARING LOSS!

High Body Mass LINKED TO HEARING LOSS IN WOMEN

A high body mass and a large waist are both associated with self-reported hearing loss, a new study has found.Researchers used data from a 20-year prospective study of 68,421 women who were 25 to 42 years old at the start. After controlling for age, smoking, diabetes, hypertension and other factors, they found that the higher the body mass index, the greater the risk for hearing loss. Compared with women with a BMI under 25, those with an index of 25 to 29 had an 8% increased risk. The numbers kept going up in tandem: 11% for 30 to 34, 16% for 35 to 39 and 19% for those above 40. The increasing risk associated with larger waist circumference followed a similar pattern.

The study, published in the December 2013 issue of The American Journal of Medicine, found moderate physical activity — as little as four hours of walking a week — also reduced the risk for hearing loss. Researchers found no further advantage in more vigorous exercise.The lead author Dr Sharon Curhan, a clinical researcher at Brigham and Women’s

Hospital in Boston, suggested that obesity might compromise blood flow to the inner ear and therefore exercise might improve it, which could explain the associations.

“Hearing loss may not be an inevitable part of growing older,” she said. “There may be things we can do to prevent it.”Source: http://www.amjmed.com/article/S0002-9343%2813%2900673-6/abstract

As part of the XXXII World Congress of Audiology the public are being invited to a FREE exhibition and lecture on hearing loss and communication.

HEAR FOR THE FUTURE EXPO

Hearing health professionals will be available to let you know if your iPod listening volume is too loud, help you better understand the other risks to hearing health and the best ways to find out if an individual, their partners, family or friends have a hearing loss.

Cochlear implant recipient and Australian water polo athlete, Jamie-Lee Lewis will also be appearing at the Expo thanks to the Hear and Say Centre. She will share her experiences of living with a hearing loss and insights into living with a cochlear implant.

Dr Chris Lind from Flinders University will give the Denis Byrne Memorial Lecture providing his insights into how people with hearing loss communicate and the role their partners and family play in assisting them.

The Expo is open to anyone with an interest in finding out more about hearing and how to manage and prevent hearing loss.

The Expo is being held on Sunday, 4 May from 12 to 4pm in Exhibition Hall 1 at the Brisbane Convention Centre, Southbank, Brisbane.www.hearnet.org.au/hear-for-the-future


Unlike hearing aid banks that recycle and dispense hearing aids for people who cannot afford them, the Hearing Care Industry Association (HCIA) has established a new type of hearing aid bank.

The aim of the HCIA's hearing aid bank is to assist those with hearing loss on low incomes, as defined by the Federal Government, who are not eligible for the Commonwealth Government hearing program, and are either excluded from the paid workforce or are at risk of leaving the paid workforce, due to hearing loss.

Successful applicants receive a voucher, which is redeemable for a hearing aid, comparable to the Office of Hearing Services fully subsidised device schedule. Where two aids are required, two vouchers are supplied. The voucher enables individuals to choose where they wish to have their aid supplied and fitted.

The HCIA's Silent Leadership Challenge funds this initiative with last year's challenge attracting 72 participants across five states and territories raising just under $30,000.

To find out about the hearing aid bank or apply go to www.silentleadershipchallenge.com.au

Translating research into practiceA post-XXXII World Congress of Audiology symposium on hearing and the brain will be held in the Australian Hearing Hub lecture theatre on Friday 9 May from 9am-4pm. International experts will provide clinicians and researchers with current information on the interaction between aging, cognition and hearing loss. To register go to www.wca2014/post-congress.html


In the Aug-Nov13 issue we told you about MED-EL's launch of the RONDO® in the US - the world's first single unit cochlear implant.

Now it is available in Australia. Approved by the Therapeutic Goods Administration in January 2014 the RONDO® combines the coil, control unit and battery into a single device.

MED-EL has announced if you choose their cochlear implant by 30 June 2014 you will receive both the RONDO® single-unit processor that attaches magnetically and the OPUS 2 behind-the-ear processor.

To participate in this program you do have to commit to filling out their

"2 Ways to Hear Survey" that will help MED-EL fine tune future designs of hearing implant

systems.

BEST OF BOTH WORLDS

1st HEARING AID

GN Resound have launched a revolutionary hearing aid capable of streaming high-quality stereo sound from an iPhone, iPad and iPod Touch without the need for an additional remote control, accessory or pendant.

ReSound LiNX enables users to talk on the phone and listen to music in high-quality stereo sound through the hearing aids.The accompanying ReSound Smart App provides control of preferred volume levels as well as treble/bass settings. It also uses geo-tagging to assign and adjust to the acoustics of frequently visited places like home, work, and favourite restaurants. And to top it off the ReSound Smart™ app also features a ‘Find My Hearing Aid’ function to help pinpoint where your hearing aids are when misplaced!


RONDO® single-unit processor

OPUS 2 behind-the-ear processor

newsbites

made for A research team investigating tinnitus has revealed new insights into the link between the exposure to loud sounds and hearing loss. Results of the study lead by Dr Martine Hamann, Lecturer in Neurosciences at University of Leicester were published in Journal of Neuroscience 12 February 2014.

Dr Hamann said: "A previous publication has shown that exposure to loud sound damages the myelin which is the protection sheet around cells. We have now shown the closer links between a deficit in the "myelin" sheath surrounding the auditory nerve and hearing loss. It becomes obvious why hearing loss is correlated with auditory signals failing to get transmitted along the auditory nerve.

"This new study is particularly important because it allows us to understand the pathway from exposure to loud sound leading to the hearing loss. We now have a better idea about the mechanisms behind the auditory signals failing to get transmitted accurately from the cochlea to the brain. Consequently, targeting myelin and promoting its repair after exposure to loud sound could be proven effective in noise-induced hearing loss."

Source: http://medicalxpress.com/news/2014-02-tinnitus-advance-link-exposure-loud.html

NEW UNDERSTANDING: The Pathway From Loud Noise Exposure To Hearing Loss

For more information contact your local MED-EL clinical specialist.

XXXII World Congress of AudiologyRegistrations now open!

Hosted on behalf of International Society of Audiology (ISA) by its affi liated associations, Audiology Australia and HEARing Cooperative Research Centre the

XXXII World Congress of Audiology will feature presentations on: • Hearing health issues associated with occupational and lifestyle noise exposure;

• Neural plasticity and managing hearing loss in older adults; • Strategic and sustainable solutions for addressing global hearing loss;

• World Health Organisation audiology initiatives; and• The future of hearing healthcare.

HOSTED BY

CRC

HOSTED BY

THE

THE

CRCCRCCRCCRCCRCINGINGINGING3–7 May 2014 Brisbane Convention and Exhibition Centre, Brisbane Australia

AudiologyTHE INTERNATIONAL SOCIETY OF


For more information please visit www.wca2014.com or email [email protected]

About BrisbaneBrisbane is Australia’s fastest growing city and is rated the world’s sixth best business destination by the Economist Magazine.

The gateway to Queensland’s most popular tourist region, Brisbane is located just 20 minutes from the the city centre and has regular fl ights from other Australian capital cities each day.

Brisbane Convention and Exhibition CentreBrisbane Convetion and Exhibition Centre located in Southbank, Queensland, Australia was voted World-wide Convention Centre team of the year in 2012.

About the Host OrganisationsAUDIOLOGY AUSTRALIA: Australia’s largest member-based organisation representing professional audiologists and providing clinical certifi cation and continuing professional development.

THE HEARING CRC: An internationally unique consortium of research, clinical and industry organisations that undertakes clinical research and technological innovation to prevent and better manage hearing loss.

ISA: A member-based organisation that facilitates a greater understanding of audiology and the sharing of knowledge to protect and rehabilitate human hearing through its highly regarded publication The International Journal of Audiology.

Conference contact:Consec – Conference ManagementPO Box 3127, BMDC ACT 2617 AustraliaT: +61 2 6251 0675 F: +61 2 6251 0672 E: [email protected]

CRC

THE

THE

CRCCRCCRCCRCCRCINGING




XXXII World Congress of AudiologyRegistrations now open!

Hosted on behalf of International Society of Audiology (ISA) by its affi liated associations, Audiology Australia and HEARing Cooperative Research Centre the

XXXII World Congress of Audiology will feature presentations on: • Hearing health issues associated with occupational and lifestyle noise exposure;

• Neural plasticity and managing hearing loss in older adults; • Strategic and sustainable solutions for addressing global hearing loss;

• World Health Organisation audiology initiatives; and• The future of hearing healthcare.

HOSTED BY

CRC

HOSTED BY

THE

THE

CRCCRCCRCCRCCRCINGINGINGING3–7 May 2014 Brisbane Convention and Exhibition Centre, Brisbane Australia



For more information please visit www.wca2014.com or email [email protected]

About BrisbaneBrisbane is Australia’s fastest growing city and is rated the world’s sixth best business destination by the Economist Magazine.

The gateway to Queensland’s most popular tourist region, Brisbane is located just 20 minutes from the the city centre and has regular fl ights from other Australian capital cities each day.

Brisbane Convention and Exhibition CentreBrisbane Convetion and Exhibition Centre located in Southbank, Queensland, Australia was voted World-wide Convention Centre team of the year in 2012.

About the Host OrganisationsAUDIOLOGY AUSTRALIA: Australia’s largest member-based organisation representing professional audiologists and providing clinical certifi cation and continuing professional development.

THE HEARING CRC: An internationally unique consortium of research, clinical and industry organisations that undertakes clinical research and technological innovation to prevent and better manage hearing loss.

ISA: A member-based organisation that facilitates a greater understanding of audiology and the sharing of knowledge to protect and rehabilitate human hearing through its highly regarded publication The International Journal of Audiology.

Conference contact:Consec – Conference ManagementPO Box 3127, BMDC ACT 2617 AustraliaT: +61 2 6251 0675 F: +61 2 6251 0672 E: [email protected]

CRC

THE

THE

CRCCRCCRCCRCCRCINGING




Audiologist Roberta Marino has collaborated with world hearing aid expert, Professor Harvey Dillon, to compile this special report on the 15 most useful features to look for when choosing a hearing aid, irrespective of the brand.

MOST USEFUL TOP 15

THE

Australia's Professor Harvey Dillon is THE authority on hearing aids and author of the textbook Hearing Aids, referred to by audiologists around the world as “The Bible”.

HEARING AID FEATURES

SPECIAL REPORTC

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Most hearing aid wearers want the latest and most powerful technology. But, comparing product features (even for audiologists) can be very confusing as each manufacturer uses different proprietary descriptions and marketing terms that can be challenging to interpret in a meaningful way.

Hearing aid companies have research departments that literally spend hundreds of millions of dollars on determining which features they can provide and improve upon to give maximum speech clarity and comfort of use. Each has their own unique formula in an attempt to give the most natural hearing possible and their own unique way of describing various technologies and features. Given there are at least 10 major manufacturers who supply hearing aids to the Australian market and that each has at least 30 different models of hearing devices over different technology levels and each offering different features, it can be very difficult to tease through features and what they mean.

Therefore, we’ve condensed the features down and given them a generic term so that when you are looking at which hearing aid to use for you or a loved one’s hearing loss, you have some idea of what capabilities each feature includes.

FEATURES FOR BETTER HEARING

AUTOMATIC DIRECTIONAL MICROPHONESome of today’s hearing aids, based on the

acoustic environment, will automatically switch between omnidirectional and directional modes without input from the wearer.

In omnidirectional mode all surrounding sounds are given equal weighting. The user will be aware of sounds arising from all directions. This mode may be preferable when the wearer is in a quiet listening environment and will provide natural spatial perception.

In directional mode incoming sounds from in front are given greater amplification than sounds from the sides and rear. This feature may be applied in noisy situations to improve the ability to hear speech in noise as

we typically face the person we want to hear. Directional microphones have been clinically proven to help improve speech understanding in noise, provided the person talking is reasonably close to the listener.

The illustration above shows an automatic directional microphone at work. The man’s hearing aid automatically switches to directional mode giving preferential amplification to his conversational partner (indicated by the blue triangular zone) and diminished amplification to the peripheral and background noise sources.

ADAPTIVE DIRECTIONAL MICROPHONEA more sophisticated use of directional

microphone, adaptive directional mode is able to change the pattern of the microphone’s sensitivity to reduce (but certainly not eliminate) multiple dominant noise sources.

MOST USEFUL

1

SPECIAL REPORTGORDON CLINIC

26/767 PACIFIC HIGHWAY

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Hearing aids that suit your lifestyle...

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The image above illustrates the man’s hearing aid selectively diminishing the sound of the overhead airplane (incomplete top pink circle), the radio noise (incomplete middle yellow circle) and the barking dog (incomplete bottom purple circle) for best access to his conversational partner’s voice.

FEATURES FOR SOUND COMFORT

SPEECH AND NOISE MANAGEMENTThis feature reduces the effort of understanding speech in noisy situations.

The noise reduction system analyses the temporal pattern (produced by a succession of stimuli) or modulation of the incoming sound to determine whether noise or speech is the dominating signal in each frequency channel.


It then adjusts the frequency response to enhance speech. This feature often works in conjunction with the directional microphone system.

TRANSIENT NOISE REDUCTIONThis noise reduction system specifically targets transient,

impulsive and abrupt noises like rustling paper or clanging dishes without affecting speech signals.

The waveforms below show how the sound wave varies with time. The second image shows how the transient noise peaks are significantly reduced when this feature is activated.

Speech unclear with background noise.

Noise management technology detects and reduces noise level so speech becomes clearer.

Speech management technology identifies and increases the ratio of speech relative to the noise.

environment, watching TV, having a one-on-one conversation, driving the car or in a social situation.

Information about the user’s adjustments, principally via the volume control and in some cases the tone control, is stored in a memory. The usage pattern is used to change the start-up gain (degree of amplification), and optionally the frequency and compression characteristics, of the hearing aid when it is switched on.

In more advanced hearing aids the user’s adjustments are compared to the acoustic environment present at the time of the adjustment and reapplied when the user re-enters a similar environment.

ACCLIMATISATION MANAGERIn many cases hearing loss is gradually acquired and so often

without realising it the person's brain slowly adapted to a much quieter world. Consequently when they are introduced to the level of amplification required to optimise their hearing (based on their audiogram and other test results) it can be perceived as too loud and overwhelming.

Naturally many users are content with less than the recommended volume because they would rather have a “comfortable” setting, which defeats the purpose of using a hearing aid. This is where an acclimatisation manager feature is valuable as it manages the transition process of getting comfortable with the volume without requiring multiple visits to the audiologist.

Hearing aids equipped with this feature are able to automatically increase the amplification levels gradually over a period of time. The audiologist can set the time period for the acclimatisation and how quickly the next level of adaptation is reached to allow the auditory system to acclimatise to the appropriate amplification.

FEATURES USING WIRELESS CONNECTIVITY

BINAURAL SIGNAL PROCESSINGFor the many people who

wear two hearing aids, binaural signal processing is invaluable. This


WIND NOISE REDUCTIONThe noise of wind blowing across a hearing aid microphone can

be very annoying, especially if you are trying to talk to someone. The wind noise reduction feature specifically detects the presence of wind and suppresses it. This is a particularly useful feature for people who play outdoor sports or are regularly on the water or in windy conditions.

ADAPTIVE FEEDBACK CANCELLATIONFeedback is the whistling sound

that is caused by amplified sound leaking back into the hearing aid microphone and being re-amplified. It is more likely to occur when there is a large air vent in the hearing aid and/or when high levels of amplification are required.

Feedback reduction systems available in hearing aids have helped to reduce the occurrence and severity of feedback, providing more flexibility with hearing aid fittings.

Older, less sophisticated feedback systems reduced the amplification of the aids often resulting in under-amplification in order to limit feedback/whistling.

Current advanced feedback systems have little or no effect on the hearing aid amplification as they use a process that creates an equal and opposite signal that is added to the feedback path to cancel the original feedback signal.

FEATURES FOR INDIVIDUALISATION

VOLUME, FREQUENCY RESPONSE & SITUATION LEARNING

The ability of a hearing aid to “remember” and replicate an individual’s preferred settings for different listening environments gives a more comfortable fitting and greatly enhances the user experience. This means settings can be easily changed when in a quiet

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transient noise

transient noise

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transient noisereduction system activated

image courtesy of Siemens

Unitron's Moxi2


any user adjustments of the volume or program across the two hearing aids, ensuring the user’s listening experience is optimised.

REMOTE CONTROL CONNECTIVITYVery useful for

people with manual dexterity issues who find it difficult to “feel” the control buttons on a hearing aid, a user-operated remote control provides easier wireless adjustment of hearing aid features and controls. Also with the demand for smaller and smaller hearing aids and more and more features, the ability to fit all these onto the hearing aid itself is not possible.

BINAURAL CONTROL COUPLING/SYNCHRONISATION

Wireless technology allows two devices to “talk” to each other. This means that hearing aids with binaural control coupling can simultaneously synchronise

feature allows the two hearing aids to communicate wirelessly so that key features of the devices can work together to optimise the wearer’s listening experience, comfort and speech clarity in quiet and in noise.

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The images below courtesy of Oticon illustrate Binaural Noise Management. When binaural noise management is off (top image) the noise levels from the tap (orange wave), blender pink wave, whistling kettle (green wave) are loud and make identifying lady's voice (blue wave) difficult. When the binaural noise management feature is on (bottom image) the background noises are significantly reduced and the voice sound is enhanced. To listen to the effects of binaural noise management go to www.oticon.com

Binaural signal processing allows the directional microphones, noise reduction and speech in noise features, wind noise reduction and other features to work together and assist the wearer to better localise sounds (detect the direction of the sounds) and reduce the chance of undetected feedback.

Unitron's Moxi2

image courtesy of Siemens


TINNITUS MASKINGTinnitus is a frustrating and sometimes debilitating

condition that often accompanies hearing loss. For those with the condition having an inbuilt masking feature that generates an external sound through the hearing aid to facilitate sound therapy is a blessing.

WIRELESS BLUETOOTH™ AUDIO STREAMING Bluetooth™ has essentially

turned a hearing aid into a headset for digital audio from phones, TVs, MP3 players and laptops that are Bluetooth-enabled.

Hearing aids with Bluetooth wireless capabilities are extremely useful, especially for people who use a mobile phone. Without the benefit of Bluetooth functionality, making mobile phone calls wearing a hearing aid is difficult due to audio feedback and static from radio interference.

The signals from Bluetooth-enabled devices are wirelessly streamed via Bluetooth directly to a small lightweight

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OTHER FEATURES TO CONSIDER

FREQUENCY COMPRESSIONThe frequency compression feature in hearing aids

provides an alternative fitting strategy for individuals with profound high-frequency hearing loss or whose hearing loss inhibits the interpretation of high-frequency information even when amplified. Frequency compression shifts high frequencies otherwise beyond the audibility of the wearer to a lower frequency range where there is better residual hearing.

High-frequency hearing loss not only makes it harder to hear many sounds but they can also be quite distorted (somewhat like pixilation on a TV screen). The majority of people with hearing loss due to ageing and general noise exposure experience loss in the higher frequencies (the 2000 to 8000 Hertz range) affecting their ability to understand speech because many consonants (s, h, f) are high-frequency sounds.

While standard amplification might bring back audibility, with frequency compression the user can experience a fuller spectrum of sound and better word distinction for some sounds.

gateway device (usually worn around the neck or in a pocket). This device then sends a very low-power wireless signal to the hearing aid. The end result is that the sound is transmitted to the hearing aids without background noise or degradation of sound quality from reverberation. If hearing aids are worn in both ears, the signal is received in stereo.

Some hearing aids can receive wireless signals directly from other devices, without the intermediate gateway device.

Bluetooth enabled hearing aids can also receive information from FM systems like induction loops installed in many public places, places of worship, theatres and lecture halls or other assistive listening devices.

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Everyone's hearing loss problems are different And they're not all solved with hearing aidsThere are over 50 different reasons why you could be suffering from hearing loss.

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Whether your hearing condition is new, long-standing or your have persistent ringing in the ears (tinnitus), the first step is to call us.

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Phonak's neck worn Bluetooth “iCom” system streaming sound from the laptop and mobile phone to the hearing aids.

Unitron's uDirect neck-worn device acts as an interface between Unitron wireless hearing instruments and Bluetooth® enabled devices, wired audio input signals, or FM transmitted signals.

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Green line = lower frequencies that can be heard. Red line = high frequencies that are inaudible.

Inaudible sounds (high frequency) are compressed into lower frequency range which can be heard


TINNITUS MASKINGTinnitus is a frustrating and sometimes debilitating

condition that often accompanies hearing loss. For those with the condition having an inbuilt masking feature that generates an external sound through the hearing aid to facilitate sound therapy is a blessing.

WIRELESS BLUETOOTH™ AUDIO STREAMING Bluetooth™ has essentially

turned a hearing aid into a headset for digital audio from phones, TVs, MP3 players and laptops that are Bluetooth-enabled.

Hearing aids with Bluetooth wireless capabilities are extremely useful, especially for people who use a mobile phone. Without the benefit of Bluetooth functionality, making mobile phone calls wearing a hearing aid is difficult due to audio feedback and static from radio interference.

The signals from Bluetooth-enabled devices are wirelessly streamed via Bluetooth directly to a small lightweight

12

OTHER FEATURES TO CONSIDER

FREQUENCY COMPRESSIONThe frequency compression feature in hearing aids

provides an alternative fitting strategy for individuals with profound high-frequency hearing loss or whose hearing loss inhibits the interpretation of high-frequency information even when amplified. Frequency compression shifts high frequencies otherwise beyond the audibility of the wearer to a lower frequency range where there is better residual hearing.

High-frequency hearing loss not only makes it harder to hear many sounds but they can also be quite distorted (somewhat like pixilation on a TV screen). The majority of people with hearing loss due to ageing and general noise exposure experience loss in the higher frequencies (the 2000 to 8000 Hertz range) affecting their ability to understand speech because many consonants (s, h, f) are high-frequency sounds.

While standard amplification might bring back audibility, with frequency compression the user can experience a fuller spectrum of sound and better word distinction for some sounds.

gateway device (usually worn around the neck or in a pocket). This device then sends a very low-power wireless signal to the hearing aid. The end result is that the sound is transmitted to the hearing aids without background noise or degradation of sound quality from reverberation. If hearing aids are worn in both ears, the signal is received in stereo.

Some hearing aids can receive wireless signals directly from other devices, without the intermediate gateway device.

Bluetooth enabled hearing aids can also receive information from FM systems like induction loops installed in many public places, places of worship, theatres and lecture halls or other assistive listening devices.

13

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(adults only)




Phonak's neck worn Bluetooth “iCom” system streaming sound from the laptop and mobile phone to the hearing aids.

Unitron's uDirect neck-worn device acts as an interface between Unitron wireless hearing instruments and Bluetooth® enabled devices, wired audio input signals, or FM transmitted signals.

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sy o

f Sie

men

s

Green line = lower frequencies that can be heard. Red line = high frequencies that are inaudible.

Inaudible sounds (high frequency) are compressed into lower frequency range which can be heard














(adults only)



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Tinnitus is the perception of sound within the human ear when no actual sound is present. It can be experienced as a variety of persistent and unpleasant noises from ringing to whirring, buzzing or hissing and can vary from person to person. About 18% of Australians have tinnitus at some time in their lives. It is estimated that 70% to 85% of the hearing-impaired population experience some variety of tinnitus, but the proportion with constant, severe tinnitus is much smaller. The prevalence rates are higher with increased hearing loss, because it is a deficit in properly functioning nerve fibres that enables other nearby nerve fibres to stimulate the brain even without a sound being present. * †

If you experience persistent tinnitus, tinnitus in only one ear or tinnitus accompanied by dizziness and/or balance problems, consult your GP or audiologist to ensure the symptoms are not of an underlying medical condition.

REFERENCES* Nondahl DM, Cruickshanks KJ, Wiley TL, Klein R, Klein BE, Tweed TS. Prevalence and 5-year incidence of tinnitus among older adults: the epidemiology of hearing loss study. J Am Acad Audiol. 2002;13(6):323-31.

† Martines F, Bentivegna D, Di Piazza F, Martines E, Sciacca V Martinciglio G. Investigation of tinnitus patients in Italy: clinical and audiological characteristics. Int J Otolaryngol. 2010;2010:265861.

RECHARGEABILITY Some behind-the-ear hearing aids offer the option of a

rechargeable battery so there is no need to replace the batteries when flat. However, before you consider purchasing a specialised hearing aid battery charger if your preferred hearing aid doesn't come with its own recharge system consider this advice from HABEX the hearing aid battery experts in Australia: "For someone who changes the zinc-air battery in two hearing aids every 2 weeks, battery usage will be around 9 packets (6 batteries per packet) of zinc-air hearing aid batteries per year. This represents a fraction of the total cost of rechargeable equipment. In our estimation, at least 4 to 5 years will pass before the higher cost of rechargeable equipment will be recovered, assuming of course that the rechargeable batteries can survive that long, which is doubtful".

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HQ



There’s an old English proverb ‘success has many fathers, failure is an orphan’ that is certainly true of the cochlear implant. Last year, the vision, persistence and innovative work of three scientists was honoured when they were jointly awarded the most respected science prize in the world.

The 2013 Lasker-DeBakey Clinical Medical Research Award for the development of the modern cochlear implant, a device that restores hearing to individuals with profound deafness, went to Graeme Clark (78, Laureate Professor Emeritus, Electrical Engineering, University of Melbourne, Australia), Ingeborg Hochmair (60, Founder and CEO of MED-EL Medical Electronics, Austria) and Blake Wilson (65, Adjunct Professor, Surgery

and Biomedical Engineering, Duke University, USA).

For many the word ‘‘bionic’’ conjures up images of the Six Million Dollar Man. In reality, the word describes the merging of the world of electronics with the world of biology. For an implant to be successful there needs to be a way to connect the device with living tissue and be able to pass electronic signals back and forth via an electrode. In order for this to occur, the electrode structure must be biologically compatible, not prone to infection and be stable for the lifespan of the implant. As a result, the development of bionic devices has seen the evolution of large multi-disciplinary research teams all bringing their respective expertise together to overcome these challenges and achieve a common goal.

A MODERN MIRACLEAs of 2010, approximately 219,000 people across the globe had received cochlear implants (CI) with more than 80% dispensed since 2000. The numbers are increasing rapidly; by the middle of 2013, over 320,000 people had CIs and almost 40,000 had one in each ear.

As the device's effectiveness has grown, so too has the number of potential candidates. Now, adults who have severe age-related hearing loss are taking advantage of the invention, as are those with single sided-deafness.

CIs have delivered exceptionally dramatic effects to children. If a person can't hear during the first few years of life, the brain can't fully equip itself to understand and acquire speech. Early intervention is therefore crucial. Of every

Still considered a modern miracle, the cochlear implant is the first medical intervention to substantially restore a human sense. Marion Williams and Helen Lowy investigate how today’s cochlear implant has been the result of research in so many disciplines over more than 250 years and the dedicated work of many visionaries (only some of whom are mentioned in this article), as well as the companies and institutions that funded and supported this visionary work across the globe.

Who invented the cochlear implant?

Image courtesy of Advanced Bionics


1,000 babies born, more than one is deaf. Today, on average 60% of implants

worldwide go to children; those who live in an industrialised nation routinely receive them between age 1 and 2 years, because early intervention enables most children to attend regular schools.

Some individuals now receive implants in both ears, which is especially helpful not only to enrich hearing in general, but also for localising speech in noisy settings. People are also combining CIs with hearing aids to get the most out of both instruments where electrical stimulation in the areas of the cochlea that respond to high frequencies can synergise well with hearing aids that enhance low-frequency perception.

PERSEVERANCEA relentless and sometimes audacious pursuit in the face of scepticism is the underlying theme of the history of the CI.

Highly-learned and well-intentioned scientists of the 1960s and 1970s rejected the potential of the CI. It was believed an artificial device was too simplistic to provide useful hearing via electrical stimulation given the complexity of the inner ear.

Based on flawed assumptions it failed to account for the potential of the central nervous system to construct meaning. Today, it is clear that the auditory stations of the brain offer remarkable processing capacity and plasticity, paving the way for the continued development of prosthetic hearing.

THE AGE OF ELECTRICITYThe first recorded attempts at electrical stimulation of the ear appeared as early as 1748. Englishman Benjamin Wilson described his experiment on a deaf woman that resulted in improved hearing after several treatments. He tried it on six other deaf people without any success. In the same year, Italian Giuseppe Veratti reported that a 70-year-old woman with severe hearing loss and tinnitus improved after several treatments with electrical stimulation.

Similar attempts were made in France, Sweden, Italy and England.

Soon after inventing the battery, Italy’s Alesssandro Volta carried out an experiment on himself in the late 1790s. He connected a battery to two metal rods that he inserted into his ears. When the circuit was complete, a sensation like a ‘boom within the head’ then a sound resembling boiling thick soup was heard. Considering the “disagreeable sensation” as dangerous to the brain he stopped the experiment. But this didn’t discourage other attempts to electrically stimulate hearing during the 19th century.

In 1801, German Carl Grapengiesser published a chapter on using direct current on diseases of the ear. French neurologist Duchenne de Boulogne, recognised as having greatly advanced the science of electrophysiology, published a book in 1864 on the use of electricity in the treatment of hearing

loss. His experiment resulted in a sound like a fly’s wings beating between a pane of glass and a curtain. In 1868, German Rudolf Brenner published a book on the electrical stimulation of the ears. His rigorous research showed how the placement of electrodes and variations in the polarity, rate and intensity of the stimulus affected the sound received. In 1905, American La Forest Potter patented an electrical stimulating system using the bone behind the ear to transmit the current.

This initial period of optimism using bioelectrical approaches to cure deafness was followed by a period of scepticism as the applications appeared to be invasive and required ongoing critical evaluation.

RENEWED INTERESTIt wasn’t until the 1930s, when thermionic tubes were miniaturised and used in radios, hi-fi amplifiers and hearing aids,


Grapengiesser's external ear bilateral stimulator

Who invented the cochlear implant?



that interest was renewed in reproducing hearing artificially.

Americans Wever and Bray of Princeton University in 1930 discovered the bioelectric signals generated in the inner ear in response to sound stimuli, demonstrating that electrical responses of a cat’s auditory nerve had properties similar to those of natural sounds.

Russians Gersuni and Volokhov in 1936 examined the effects of alternating electrical stimuli on hearing. They found hearing persisted after surgical removal of the eardrum and ossicles (small bones in the middle ear), and theorised that the cochlea was the site of stimulation.

In 1939, the Americans Stevens and Jones thought electrical impulses were translated into sound vibrations before they reached the inner ear – the electrophonic effect. Their 1940 study indicated that when the cochlea was stimulated electrically 3 mechanisms produced hearing – the middle ear, the basilar membrane and auditory nerve.

A wealth of research in the 1940s and 1950s into the mechanisms involved in electrophonic hearing showed that hearing is produced by converting electrical energy into sound vibrations and that some element of cochlear functionality is necessary. It was known that deafness due to a defect in the inner ear or the auditory nerve couldn’t be fixed by filling the cochlear region with electrical energy, and localised stimulation of the auditory nerve fibres was needed.

MAJOR BREAKTHROUGHSIn the 1950s, despite decades of progress in understanding the basic physiological and psychophysical aspects of hearing, the medical profession could do little for profound deafness.

The earliest recorded attempt at direct electrical stimulation of the auditory nerve exposed during an operation was by Swedish neurosurgeon Lundberg in 1950, but the patient could only hear noise. A more dramatic experiment was performed in February 1957 when a totally deaf man about to undergo nerve graft surgery begged his Paris otologist Charles Eyriès to find a way to give him some hearing, however minimal. In deciding to implant an electrode used in

physiological research on hearing, Eyriès together with electrophysiologist André Djourno took a heroic step.

Djourno and Eyriès provided the first detailed description of the effects of directly stimulating the auditory nerve in deafness by placing a single wire on the exposed auditory nerve. The patient reported hearing a sound like a cricket chirping and in further experiments was able to perceive rough differences in pitch. Sounds of higher pitch were confusing but he recognised simple words like 'mama' and 'papa'. Sadly the device failed after a few weeks. One other patient was implanted that same year with similar results.

somewhere in the internal auditory canal where a few millimetres of the nerve was accessible. Nevertheless, they must be considered the first to have implanted an electrode in a human inside the ear to electrically stimulate the auditory nerve, causing a patient to temporarily experience crude sounds. Moreover, they predicted the imminent development of the CI, concluding in their first report “the electrical stimulation of the cochlea itself, in analogous conditions, would without doubt allow the construction of a possible mechanism for electrical hearing.” Djourno’s legacy is that he anticipated many features now incorporated into modern CI design.

NEXT STEPSDissemination of the French duo’s pioneering work was slow to arrive in America. Their report appeared only in the French medical literature and of the pair the more likely to have interactions with American clinicians was Eyriès, but his interest in the project was short-lived. Their work may have remained in obscurity if a patient of Californian otologist William House had not shown him a news cutting in English around 1959 that was optimistic about electrical stimulation to replace hearing.

Los AngelesInspired by the French developments, in December 1960 William House collaborated and financed research to replicate their experiment with neurosurgeon John Doyle and his electrical engineer brother James Doyle. They first attempted electrical stimulation to elicit hearing during stapes surgery by placing a needle electrode into the open oval window. Patients reported hearing the stimulus without discomfort, dizziness or facial nerve stimulation. These responses were sufficient encouragement to implant a patient with a hard-wire device. The first willing subject was a profoundly deaf 40-year-old man. In January 1961, a gold wire electrode was inserted under local anaesthetic. The patient reported hearing the electrical stimuli, but had poor loudness tolerance. Several weeks later the wire was removed.

A second patient, a deaf female, was

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Djourno’s cochlear implant courtesy of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (published in Phillip R Seitz's French origins of the cochlear implant.)

Eyriès resisted Djourno’s efforts to find an industry partner to help them design something more reliable. In 1958 Djourno’s work with Roger Maspétiol resulted in improved lip-reading by providing the rhythm of the speech, but didn’t produce understanding of speech and in 1959 he abandoned the work.

The cochlea was never mentioned in Djourno and Eyriès writings and the electrode was certainly placed


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implanted the same month. She was already undergoing ear surgery for another procedure. A single gold wire electrode was placed into the scala tympani (one of the fluid-filled cavities in the cochlear labyrinth) at the base of the cochlea. Over the ensuing days, the current intensity required to illicit a response increased and the wire was removed due to fear of infection.

With the first patient’s encouraging response, House and Doyle decided to reimplant him with a 5-wire electrode array to stimulate the cochlea at five different positions along its length, each sensitive to a different range of frequencies. The results obtained were promising: the patient had some basic frequency discrimination and could identify words in small closed set (ie, three words). However after several weeks of testing the device was removed to avoid infection.

Word of the two implanted patients reached the newspapers with an overly optimistic description of an “artificial ear” resulting in House and Doyle being overrun by patients seeking a cure for their deafness and investors seeking to cash in on an emerging medical technology. House recognised the danger in such publicity and disagreement over how aggressively to proceed with the implant given the initial biocompatibility issues brought an end to his collaboration with the Doyles.

The Doyles continued to experiment, implanting a patient in November 1962 with otolaryngologists Leland House (not related) and Frederick Turnbull. Research by Doyle and his team in 1964 involved inserting an array of 4 electrodes into the cochlea of a profoundly deaf person. Although the results were only satisfactory, it was regarded as significant that the patient was able to repeat phrases. Due to a lack of funding, in 1968 the Doyles ceased their investigations.

Stanford UniversityOne of the most important CI researchers was another American, otolaryngologist Blair Simmons of Stanford University, who was also stirred by the work of Eyriès and Djourno. In July 1962 he was presented with the unexpected opportunity to electrically stimulate the

exposed auditory nerve of an 18-year-old patient with mild hearing loss who was undergoing an exploratory craniotomy under local anaesthetic. The patient agreed to be tested during the operation and undertake auditory training beforehand. During the procedure the patient described auditory sensations and was able to discriminate stimulation frequencies.

In May 1964, Simmons performed the first multi-channel CI implantation with a 6-electrode device with each electrode individually stimulated. He took a different surgical approach to House placing the electrode through the tympanic cavity directly into the modiolus (the central axis of the cochlea). The patient was a 60-year-old deaf man with severe tunnel vision who agreed to undergo implantation under local anaesthetic despite the fact the implantation would likely fail and yield no useful hearing. Psychoacoustic testing was challenging given his combination of disabilities. He could perceive a limited range of frequencies and recognise simple tunes such as Three Blind Mice, but the sound was distorted. Although he couldn’t understand speech, Simmons demonstrated that by stimulating different areas of the cochlea, different pitch perceptions could be produced. Reported in Science in 1965, it was the first detailed study on a patient and so an important contribution to the early development of CIs. It seems it was also the first time the term 'cochlear implant' was used in a scientific publication to describe the artificial inner ear.

Simmons’ conclusions were pessimistic. He estimated the likelihood that a CI could ever provide a clinically useful means of communication to be

“considerably less than 5%” and human implantation at Stanford was postponed in favour of animal testing. While others focused on experimenting on volunteers, in 1971 Simmons teamed up with Robert White and two graduate students in electrical engineering to develop a CI system. They worked on numerous hardware variations to determine long-term biocompatibility and made several important contributions in the area of speech processing.

House resumes workCIs still needed to improve the insulation material used for the implant wire and their biocompatibility. On this and other problems House resumed his work in 1967 with Jack Urban, an electrical engineer experienced in surgical procedures.

Abandoning the multi-electrode system, House and Urban aggressively pursued implanting their single-channel device in human patients, but always with durability and safety top of mind. Patient Charles Graser became a long-term experimental subject. His stimulation levels and results remained stable over years, which gave credence to the safety of the electrical stimulation.

Many of the observations and modifications that House and Urban reported were based solely on Graser, who as a ham radio operator had an excellent knowledge of the electrical side of the experiments. His observations enable the engineers to devise new complex electronic equipment and update existing machines. He agreed to a number of different operations and kept a diary with detailed accounts of the sounds be could or could not hear and the conditions under which the various devices functioned or malfunctioned, in addition to feedback he gave at the lab. One of the priorities of the engineers was to build a portable stimulator so that Graser could make use of the implant at home and work to record his impressions of sounds many take for granted: birdsongs, traffic noises, kitchen equipment, the voices of his wife and colleagues.

The House/Urban partnership produced the first CI system that could be used outside of the laboratory by


Dr. William House at an operating microscope.

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patients. This result was a landmark in the history of CIs and House is widely regarded as the “father” and foremost pioneer of the CI.

Encouraged by their experiments, they pressed on with more implants so they could study the effects in a large group of people. An audiologist and speech pathologist joined the team to design a rehabilitation program with consultation and evaluation before implantation and intensive training, observation and follow-up afterwards. From 1972 into the mid-1980s they implanted more than 1,000 patients.

In April 1973 House and Urban published their first article about the long-term results of their CI based solely on Graser. They stated, “We feel that the electronic cochlea is now ready for more widespread testing and development… We present this evidence in the hope that teams… will commence as soon as possible to investigate this new possibility and continue to refine these techniques.”

In 1977 House devised a strategy to bring CIs to market by creating a “good news story” and by 1978 he had set up the first multi-centre clinical trial of CIs in Los Angeles, Indiana and a number of other locations to provide definitive proof that the technology was “life-changing” for patients.

In 1981, 3M after a number of abortive

involvements with other groups entered into a licence agreement with House. In October 1983, 3M sought premarket approval from the US FDA. The device was deemed safe and in October 1984 became the first CI to be approved for use in deaf adults aged 18 or over.

Internationally the market for CIs grew slowly. Deaf people were not coming forward in the numbers anticipated by professionals and manufacturers. Concerned by this 3M launched a campaign to persuade doctors to promote the technology among patients, but still results were disappointing. From 1986, 3M slowly began to reduce their commitment to the field, halting marketing activities as well as research on an advanced model.

San FranciscoDuring the 1960s, while in private practice, otolaryngologist Robin Michelson began experimenting with implants. His first implant was a single-channel devise in a profoundly deaf woman. The gold wire hardened and broke after several days and was explanted. Several other patients were implanted and his preliminary work was presented in October 1970. The patients had pitch perception based on stimulus frequency and could recognise speech but not words. They had also lost whatever residual hearing they had prior to implantation.

Aware of his work, Francis Sooy at the University of California, San Francisco (UCSF) persuaded Michelson to bring his implant investigations to the university. With otolaryngologist Robert Schindler and neurophysiologist Michael Merzenich, the team experimented on animals and tested four patients before two finally received a totally implanted CI in 1970. Their report in 1971 was the first published article dealing with multiple patients implanted with a single-channel CI.

The responses from their experiments on cats were compared with psychoacoustic measures in the human implanted subjects using the same electrical stimuli for both groups. The conclusion from this work was that to convey complex sounds such as speech, a multiple electrode arrays would be

necessary. Their findings were presented in 1973 marking the beginning of the race towards the development of a multi-channel CI.

In 1981 the first UCSF multi-channel CI was implanted and clinical evaluations began in 1985 with the sponsorship of the Storz Instrument Company. This also involved the Research Triangle Institute (RTI) in North Carolina where investigators were developing processing strategies sponsored by the National Institutes of Health with UCSF as one of the clinical partners. Studies showed promising results but more support to fully develop and market the UCSF multi-channel CI was required.

In 1986, Schindler approached the Alfred Mann Foundation, set up by industrialist Al Mann to support the development of revolutionary medical devices. He asked if they would be willing to take on the development of a CI. Al Mann made the project a priority and in 1993 founded Advanced Bionics Corporation (AB) to develop neuro-stimulation devices including CIs.

AB took part in developing a new multi-channel device combining the electrode array developed by UCSF and a processing strategy developed at RTI called the Clarion. The first development team included seven engineers and scientists. Clinical trials began in 1991 and in 1996 the US FDA approved the AB Clarion. It had a multi-program processor with a unique single headpiece design, independent volume and sensitivity controls.

In 2004, Boston Scientific acquired AB and in 2008 Mann and others acquired back the portion of AB that develops, manufactures and distributes CIs. AB was acquired in 2009 by Sonova Holding AG, the parent company of hearing aid brands Unitron and Phonak.

CONTROVERSIES AND DOUBTSThe initial reaction to CIs by auditory scientists and otologists other than the developers was highly critical. Many experts offered categorical statements that CIs could not possibly restore any useful hearing or speech perception. However the pioneers persisted in the face of this intense criticism.

The year 1973 was a crossroad for William House MD (rear), Charles Graser and Jack Urban.

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Michelson and Schindler. Chouard needed an industrial partner

willing and able to produce an implant along the lines he had conceived. After failing to generate interest among large electronics firms such as Philips and Thomson, a small French firm Bertin & Cie would take on the task aided by a government subsidy. The result was the first extra-cochlear single-channel device named Monomac.

In 1976 they introduced the Chorimac-8 with 8 channels and in 1982 the Chorimac-12. A considerable variability in outcomes was reported compared to other CIs in development. The major problems were difficulty of implantation and the large size of the external unit. However, vowels were well recognised and consonant voicing was well differentiated.

French group Neurelec, owned by MXM, acquired Bertin’s patent in 1986 and was first to launch a fully-digital CI system in 1992 under the name Digisonic. Neurelec was spun off as a separate entity and in April 2013 was sold to Danish group William Demant, the parent company of Oticon Medical.

AustriaAnother active group was headed by Erwin Hochmair and Kurt Burian at the Technical University of Vienna. At the time they used a hermetically-sealed glass package developed by electrical engineering PhD student Ingeborg Desoyer (who later married Hochmair).

They proceeded to design a multi-


CI development. Until then CI was considered at best ‘an idea with potential’ and at worst ‘a dangerous experimental procedure’. Only Michelson and House were performing implants on human subjects and both were surgeons far from the mainstream and whose funding was from private sources. In order for CI development to proceed, they would need to be granted legitimacy as a valid research pursuit with government funding and broad-based clinical application.

In June 1973, the 1st International Conference on Electrical Stimulation of the Acoustic Nerve was organised at UCSF. Blair Simmons, Robert White, William House, Jack Urban, the UCSF team and Claude-Henri Chouard from France participated. By this point, the term 'cochlear implant' had been definitively entered into medical literature.

The next turning point for the CI came in March 1975 when the US National Institutes of Health sponsored a thorough evaluation of patients who had received CIs at that time. Thirteen subjects implanted with single-channel devices by Michelson and House were brought to the University of Pittsburgh for extensive psychoacoustic, audiological and vestibular testing by audiologist and neurophysiologist Robert Bilger.

Published in 1977, The Bilger Report concluded that single-channel devices could not support speech understanding but that patients’ speech production,

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lip reading and quality of life were all enhanced with the device. It marked the first objective evaluation by the mainstream scientific community.

As the benefits were evident, the original question of whether electrical stimulation of the auditory nerve could yield useful hearing was finally answered.

MULTI-CHANNEL DEVELOPMENTSThe Bilger Report concluded the next step in CI development lay in the exploration of a multi-channel prosthesis. Work in this area was already underway in the US, Europe, Britain and Australia.

FranceIn 1973, French otologist Claude-Henri Chouard, a former student of Eyriès, teamed up with physiologist Patrick MacLeod to devise a procedure to implant electrodes through 12 separate openings into the cochlea to exploit the pitch peculiarities of each section of the cochlea in a hope to achieve better speech perception.

The first implant was in 1976 followed by seven more. Although not supported by audiological data, they reported that about 50% of ordinary words were understood without lip reading. This would spawn an interest in multi-channel devices that would eclipse the pioneering single-channel implants.

In 1977 he patented his device in France and in 1978, organised the first international course on the multi-electrode CI in Paris attended by House,

1980

1970

1960

1950

1790

CLARION(San Franscisco)

Advanced Bionics(Stanford)

3M-SC ALL-HEAR(Los Angeles)

CHORIMAC(Paris)

MXM/Neurelec

MED-EL(Vienna)

NUCLEUS(Melbourne)Cochlear Ltd

MichelsonMerzenich

Simmons

SimmonsWhite

House

DoyleHouse

DjournoEyries

Chouard

Volta

Burian, Hochmair, Desoyer

Clark

Developers and place of origin of devices that have evolved into cochlear implant systems and are in extensive use. Early stage development indicated by thin red line, clinical applications in heavier blue line

Adapted from The History of Cochlear Implants by Marc D Eisen MD PhD






program


✓✓✓✓


✓


channel implant that stimulated the auditory nerve at several locations and used a voice encoder-type speech processor. They settled for an 8-channel CI using materials known for their biocompatibility. Interestingly the design concept anticipated modern CIs and would have been well suited to Blake Wilson’s CIS strategy, if it had been known then.

After two years of development, Burian implanted the world’s first multi-channel microelectronic CI in a patient in December 1977 and then another in March 1978. The second patient could reliably discriminate and identify stimulation channels.

They focused on creating a fully implanted device. Their 4-channel CI became the workhorse for years to come - the channels could be stimulated simultaneously and electrode configurations switched. But, after patient tests, they opted for less power-hungry monopolar stimulation, a concept that is now used by almost all CI manufacturers.

In 1979, the Hochmairs spent six months at Stanford University meeting Blair Simmons and other early CI researchers. That year, with a modified version of the device used in implants in Vienna, they demonstrated in a quiet environment via a small, body-worn sound processor and broadband analogue stimulation, some understanding of words and sentences without lip reading.

A minor modification in 1980 to the small take-home processor of two of the Hochmairs' patients allowed them to understand speech without lip reading to a certain degree in everyday life using

just one channel. With these patients, and many others, they learned how to individually adjust the frequency shaping and the amplitude compression to optimise speech understanding.

The results achieved in the 1980s with their stimulations method (known as single-channel broadband analogue strategy) were much better than those obtained with the House CI and on par with other CIs at the time, despite the fact they didn’t use place pitch. This was most likely due to the high flexibility and length of their electrode, allowing fairly deep insertion to reach the innermost fibres at the apex of the cochlea.

In 1981, with 17 university-built

with poorer speech performance the product wasn't approved. The 3M/Vienna relationship,which ended in 1988, significantly delayed the Hochmairs’ timeline compared to other groups.

Taking advantage of everything they had learned, they decided to grow their small company MED-EL. In March 1990 they employed the first three people and Ingeborg Hochmair left her academic career to become CEO. Erwin Hochmair had been appointed as director of the Institute of Applied Physics at the University of Innsbruck, Austria where basic cochlear implant research was expanded by an agreement between the University and MED-EL, with support from the Austrian Research Fund.

In 1991 MED-EL broke new ground with the very first behind-the-ear processor called COMFORT made possible by their CI’s very low power consumption and external processing.

Also breaking new ground was electrical engineer Blake Wilson of Duke University who did research with both UCSF and RTI. Results of his new continuous interleaved sampling (CIS) processing strategy study was published in 1991 to widespread acclaim. As MED-EL’s approved 8-channel CI did not show a big improvement in results, they started to develop an 8-channel CI (later called the COMBI 40) with a wearable processor specifically designed for a fast CIS strategy. They communicated this plan at the 3rd International Cochlear Implant Conference, which they organised in Innsbruck in April 1993. It was first implanted in January 1994 marking the end of the era of broadband analogue CIs and received European approval in 1994 and US FDA approval in 2001.


research CIs implanted, they were contacted by 3M who wanted to enter the hearing-device market using the CI as a flagship. 3M were already marketing the single-channel House device and had high expectation for the new Vienna CI and the Hochmairs signed. Due to safety concerns about intra-cochlear electrodes, 3M decided to pursue only an extra-cochlear version. However

Dr Ingeborg and Dr Erwin Hochmair






program


✓✓✓✓


✓


channel implant that stimulated the auditory nerve at several locations and used a voice encoder-type speech processor. They settled for an 8-channel CI using materials known for their biocompatibility. Interestingly the design concept anticipated modern CIs and would have been well suited to Blake Wilson’s CIS strategy, if it had been known then.

After two years of development, Burian implanted the world’s first multi-channel microelectronic CI in a patient in December 1977 and then another in March 1978. The second patient could reliably discriminate and identify stimulation channels.

They focused on creating a fully implanted device. Their 4-channel CI became the workhorse for years to come - the channels could be stimulated simultaneously and electrode configurations switched. But, after patient tests, they opted for less power-hungry monopolar stimulation, a concept that is now used by almost all CI manufacturers.

In 1979, the Hochmairs spent six months at Stanford University meeting Blair Simmons and other early CI researchers. That year, with a modified version of the device used in implants in Vienna, they demonstrated in a quiet environment via a small, body-worn sound processor and broadband analogue stimulation, some understanding of words and sentences without lip reading.

A minor modification in 1980 to the small take-home processor of two of the Hochmairs' patients allowed them to understand speech without lip reading to a certain degree in everyday life using

just one channel. With these patients, and many others, they learned how to individually adjust the frequency shaping and the amplitude compression to optimise speech understanding.

The results achieved in the 1980s with their stimulations method (known as single-channel broadband analogue strategy) were much better than those obtained with the House CI and on par with other CIs at the time, despite the fact they didn’t use place pitch. This was most likely due to the high flexibility and length of their electrode, allowing fairly deep insertion to reach the innermost fibres at the apex of the cochlea.

In 1981, with 17 university-built

with poorer speech performance the product wasn't approved. The 3M/Vienna relationship,which ended in 1988, significantly delayed the Hochmairs’ timeline compared to other groups.

Taking advantage of everything they had learned, they decided to grow their small company MED-EL. In March 1990 they employed the first three people and Ingeborg Hochmair left her academic career to become CEO. Erwin Hochmair had been appointed as director of the Institute of Applied Physics at the University of Innsbruck, Austria where basic cochlear implant research was expanded by an agreement between the University and MED-EL, with support from the Austrian Research Fund.

In 1991 MED-EL broke new ground with the very first behind-the-ear processor called COMFORT made possible by their CI’s very low power consumption and external processing.

Also breaking new ground was electrical engineer Blake Wilson of Duke University who did research with both UCSF and RTI. Results of his new continuous interleaved sampling (CIS) processing strategy study was published in 1991 to widespread acclaim. As MED-EL’s approved 8-channel CI did not show a big improvement in results, they started to develop an 8-channel CI (later called the COMBI 40) with a wearable processor specifically designed for a fast CIS strategy. They communicated this plan at the 3rd International Cochlear Implant Conference, which they organised in Innsbruck in April 1993. It was first implanted in January 1994 marking the end of the era of broadband analogue CIs and received European approval in 1994 and US FDA approval in 2001.


research CIs implanted, they were contacted by 3M who wanted to enter the hearing-device market using the CI as a flagship. 3M were already marketing the single-channel House device and had high expectation for the new Vienna CI and the Hochmairs signed. Due to safety concerns about intra-cochlear electrodes, 3M decided to pursue only an extra-cochlear version. However

Dr Ingeborg and Dr Erwin Hochmair


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Today MED-EL is still privately owned by the Hochmairs and is the largest hearing-implant provider in Europe and the second largest in the world.

AustraliaInfluenced by the work of Simmons and Chouard, otolaryngologist Graeme Clark was convinced that for people to be able to hear running speech, a multi-channel device was needed. The development of such a device, he believed, would depend upon considerable basic research with animals.

At Sydney University in 1967 he started his research using electrical stimulation on animals to determine how best to design a CI for people. In 1970 he was appointed as a foundation professor at the University of Melbourne providing a platform to press forward with his bold plans that many colleagues believed were a waste of time.

His single-minded determination to go against the grain of contemporary thinking made it hard to secure funding through the scientific fraternity. In a stroke of luck, a donation to his research by Rotary was reported on ABC TV news and by chance business tycoon Sir Reg Ansett happened to be watching. He owned what is now Channel 10 and thought having a charity telethon would be good. For four years, from 1973, all money raised from the Nerve Deafness Appeal went to Clark’s project and also gave him great exposure to more potential donors. Without this his project may never have continued.

Clark, like the Hochmairs, believed that to avoid infection the implant should be totally embedded in the skull and activated by radio signals rather than coupled to an external source. He also believed the electrodes should be placed inside the cochlea itself.

By 1973 he required engineering expertise. He managed to find funds to get Ian Forster and Jim Patrick involved in developing the miniaturised components, turning his attention to the surgical procedure that would be fundamental to the implant’s success. To master the technique, he and assisting surgeon Brian Pyman practised the operation on about 50 cadavers.

He was still challenged with how to get

the electrode placed safely and securely inside the tiny and delicate spiral cochlea. In 1977, while playing with a blade of grass and a small spiral shell, he noticed when he inserted the blade into the shell that the graded stiffness and flexible tip of the grass meant it easily wrapped around the spiral almost reaching the apex. He immediately knew the electrode design must mimic this.

After a decade of work, Clark felt ready to try out his prototype with an array of 10 electrodes on a volunteer. The CI was about the height of a single square of chocolate (not much bigger than the size today) and the speech processor was the size of a binocular case compared to the French model that required a trolley to wheel it around. In August 1978, he did his first implant operation on a 48-year-old man who had a year earlier become deaf after a head injury. Four weeks later when the wound had healed, he was tested to see if he would recognise voicing and the rhythm of speech. Clark's team played the national anthem ‘God Save the Queen’ and he bolted upright. The news received widespread coverage.

Several obstacles still remained before Clark’s successful 1978 initial implant evolved into today’s bionic ear. Much effort was placed into making the speech processor smaller and more portable, and research funding was running low. Clark was approached by 3M but they opted to go with the simpler single-channel House implant. He then went to the government who provided some funding in 1979 at a time when they were encouraging high-tech development.

Similar to the UCSF story, in 1981 Clark approached Paul Trainor, the owner of the Nucleus Group of companies that specialised in medical devices for

help with commercialisation. Nucleus embarked on a three year evaluation and once US FDA approval was granted in October 1985 on the enhanced 20-channel device, Cochlear was established.

Manufacturing began in Sydney and specialist subsidiary companies were established in the US, Europe and Asia and the global success story was underway. In 1988, Nucleus was sold to Pacific Dunlop who sold all its divisions to foreign companies except for Cochlear that remained Australian. In 1995 it was floated on the stock exchange. Today, Cochlear is the global leader in implantable hearing solutions.

THE FUTUREWhile there have been great advances in CI technology, it is the plasticity of the brain that largely contributes to these positive outcomes. The CI has not only benefited those with impaired hearing but also hearing research into neuronal repair and whether it is possible to stimulate growth and re-growth of cochlear neurons. On a larger scale it has stimulated research into brain plasticity and to what extent the brain adapts to new forms of stimulation and in what time frame. CI development seems to be slowing down, not because of reduced effort but because of the difficult problems that remain to be solved, the greatest challenges being speech understanding in noisy environments and music perception.

Special thanks for their assistance in preparing this report go to John Tonkin who performed the first single-channel CI in Australia in 1977, Graeme Clark and SCIC’s Bill Gibson. References and videos visit www.HearingHQ.com.au.


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Professor Graeme Clark


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all about...columnDeafining MomentsDaniela Andrews, a Melbourne writer, lost her hearing to an autoimmune condition at 27. She now has two cochlear implants and two children.

Marge Simpson has it easy. Yes, I know she’s married to Homer. Yes, I understand she is Bart Simpson’s mother. I get that, really I do. What I’m talking about here is her hairstyle. You know it? Of course you do. You must. That iconic big blue beehive.

Now I don’t envy the headaches she must endure. The bizarre looks she probably gets. The money she spends on hair spray. No. What I envy is the smooth, trouble-free hairdressing appointments she must have. ‘Just the usual beehive. Same shade of blue.’ She never has to explain what she wants.

To be honest, I don’t miss the hairdressing chit-chat. Even before I lost my hearing, it always felt forced. But I do miss being able to explain what I want done with my hair during the actual hair cut. And more than anything, being able to hear during the cut. Because it seems my lip-reading is pretty appalling. At my last appointment, I was sure the hairdresser told me to ‘take a seat over here so I can wash your hair’ but it turns out she said ‘we’re out of hot water today so enjoy the icy blast you’re about to receive to your head.’ Yeah. Must have been that.

And it’s always awkward. Oh so awkward. Especially when my usual hairdresser is unavailable and I have to give the spiel to the new person. ‘Now before you start, I have to tell you that I’m actually …’ CLUNK. The over eager hairdresser who started combing her fingers through my hair has just sent one of my sound processors flying across the floor. She reddens, laughs nervously without looking into my eyes and mumbles an apology, tentatively handing the alien gadget back to me before going back to finger combing. ‘… deaf.’ I continue. I smile, trying to make her feel comfortable again. ‘It’s OK,’ I say, ‘I actually have one on the other side …’ CLUNK. Silence. And a broken ear hook. My smile starts to wane. And I’m losing confidence. So I stick to the tried and true. The same hairstyle I’ve worn since I became deaf, really. Because it’s one that needs no explanation.

I walk out sporting ‘The Rachael’, aka ‘Jennifer Aniston’. (What can I say, I’m a 90s child. If I was older, I might be sporting ‘The Farrah’.) It’s easier this way. Guaranteed to be consistently cut. Should there come a day when a hairdresser gets it wrong, I still have future options. I can always ask for ‘The Marge Simpson’, you see. And, failing that, I’ll ask for ‘The Sinead O’Connor’ instead!

Most people think that we hear with our ears. While this is not wrong, it’s only half the story. We only “hear” sounds correctly if our brain is able to analyse and interpret the nerve impulses that the ears transmit to the brain. The amount of analysis that is performed by the brainstem, the midbrain and the cortex as these nerve impulses make their way into our perceptions is staggeringly large and not at all well understood by scientists. It’s not surprising that a mechanism this complicated can sometimes not work properly. Such problems are known as Central Auditory Processing Disorders (CAPD). They can occur even when the ears themselves work normally, or can occur in addition to a hearing loss, and in

Professor Harvey Dillon and Dr Sharon Cameron from the National Acoustic Laboratories (NAL) explain.

Central Auditory Processing Disorders in Children

Sinead O’Connor (Rolling Stone magazine '92)



during their early childhood. At the time their brain should have been learning to combine sounds at the two ears, one or both ears was sending an attenuated and sometimes fluctuating signal to the brain. Long after the middle ear problems cleared up, their effects on the brain’s processing of sounds remained. Typically the problem becomes apparent during primary school when the child misunderstands speech, just as if he or she had a hearing loss. Not surprisingly, spatial processing disorder is very prevalent among Aboriginal children because they unfortunately have such a high prevalence of middle ear infections in childhood.

The good news for children with spatial processing disorder is that it can be fully remediated. NAL has invented a take-home computer program called LiSN & Learn that enables children to practice focussing on sounds arriving from the front and suppressing sounds arriving from each side. The difficulty of the task is constantly adapted to be challenging for each child. The most common result is that over three months of practice for 15 minutes per day, five days per week, the level of the target sounds can be made 10 dB lower than before training, with the children still understanding them equally well.

The ability to diagnose and remediate spatial processing disorder is a valuable advance in the field of CAPD. However, much more remains to be done.

In one strand of research, NAL and Macquarie University are developing a version of LiSN-S that uses tones instead of sentences as the test material. If successful, this test will be suitable for use in any country no matter what language the child speaks and so will be able to be used all around the world.

Professor Harvey Dillon and Dr Sharon Cameron from the National Acoustic Laboratories (NAL) explain.

some circumstances because of a hearing loss.

Diagnosing CAPD is difficult – more difficult than many clinicians realise. The symptoms of CAPD in children (misunderstanding, apparent inattention, misbehaviour) overlap heavily with those of attention deficit disorder, memory disorders, language disorders and even low IQ. Further, even the results on tests commonly used to diagnose CAPD can be affected by these other disorders. Research at the National Acoustic Laboratories (NAL) over the last 10 years has identified one specific form of CAPD that we can diagnose unambiguously.

We have termed this condition “spatial processing disorder”. In a noisy place, most of us can focus our attention on sounds coming from one direction (usually the front) and suppress distracting sounds coming from other directions. Our brain achieves this by taking advantage of the tiny differences in time and intensity with which the various sounds arrive at each ear. Some children, however, never learn to do this spatial processing as well as other children.

The test to diagnose this condition is called the Listening in Spatialised Noise Sentences test (LiSN-S). It compares each child’s ability to understand speech when the target sound and distracting sounds come from different directions and then from the same direction. Because the diagnosis is based on the difference in performance between conditions there is little chance of the other disorders being misdiagnosed as CAPD. All the sounds are presented through headphones, but they are created and delivered in a way that makes them seem to come from the different directions.

Research at NAL, at Melbourne University and at Flinders University is showing that spatial processing disorder is very common among children who had protracted middle ear disturbance (caused by an infection in the middle ear)

Central Auditory Processing Disorders in Children In another strand of research, NAL

is investigating what frequently causes children who experience difficulties in their academic progress to perform poorly on hearing tests where different sounds are presented simultaneously to each ear. Such tests, called dichotic tests, are commonly used to diagnose CAPD. We suspect, however, that the reasons for poor performance on this test are more diverse and complex than is generally thought. Until we better understand why each individual child who fails the test does so, it will not be possible to fully help these children.

Further research in other aspects of CAPD in children is planned. The eventual aim is to efficiently diagnose several specific forms of CAPD and provide remediation specific to each and so remove these “hearing” barriers to children reaching their potential.

For more information about CAPD, spatial processing disorder, locations in Australia where children can be tested

using the LiSN-S test and where remediation through the LiSN &

Learn program is available visit http://capd.nal.gov.au.

To watch the ABC TV's Catalyst program on

Spatial Processing Disorder go to http://capd.nal.gov.

au/media.shtml

CAPD is also relevant to elderly adults and diagnosis is even more complicated than it is for children. This is because it is common, if not normal, for elderly adults to have some hearing loss. This complicates the CAPD diagnosis as it is often unclear whether low scores on any auditory test is a consequence of the distortions happening in the ear or in the brain. Much more research is necessary on this topic before there will be sufficient understanding to routinely test for and hopefully remediate CAPD in elderly people.


I am 60 years old and about a year ago I started to experience tinnitus in my left ear.

Some months ago my doctor put me on Stemetil as my head was feeling squeezed in and tight bringing on dizziness. I had an MRI scan which was negative and am on Tinnitus Retraining Therapy (TRT) with Sound Therapy and a masker. So far I’ve not had much improvement. Is it common for people with tinnitus to have a problem with their head? If so, what can be done about it? Is there medication available?

Q

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ask the experts

Professor Bill Gibson: According to a population study performed in the Blue

Mountains, 30% of people over the age of 55 years have some tinnitus1. The problem is that there are structures within the brainstem that can perpetuate and amplify the tinnitus sound. These structures increase the tinnitus when you think about it or become anxious and stressed. Hopefully your tinnitus will subside gradually with the TRT treatment.

There are many causes of dizziness and your normal MRI result excluded the more horrifying causes. The most common cause is associated with a sudden drop in blood pressure, especially in people taking medications to lower their blood pressure, and is usually worse on suddenly standing up after lying down.

Tinnitus can be associated with Meniere’s disease, a condition associated with too much fluid in the endolymph compartment of the inner ear. The dizziness or vertigo comes as attacks that last from 10 minutes to several hours and cause a sensation that the world is spinning around associated with nausea and usually vomiting. The attacks may be heralded by increased tinnitus in the affected ear and a feeling of fullness in the ear. If your dizziness has these characteristics, you should ask an ENT surgeon to investigate further.

Another common cause of similar attacks of vertigo is migraine. Usually there is a past history of classic migraine or a strong family history. Often, some years after the last ‘headache’ migraine attack, the person begins to suffer attacks of vertigo due to changes in the blood flow through the vestibular nuclei (brainstem structures associated with balance). The attacks can be associated with tinnitus and a mild headache over the entire scalp. The hearing remains unaffected although some high frequency loss can occur in older age. An ENT surgeon or a neurologist can help establish the diagnosis and treat the problem.1 Sindhusake D, Golding M, Wigney D, Newall P, Jakobsen K, Mitchell P (2004) Factors predicting severity of tinnitus: a population-based assessment.J Am Acad Audiol , 15:269-280

A

Emma Scanlan: There are lots of factors to take into consideration when choosing

a style of hearing aid. The range of devices available is very broad from tiny devices that are completely in the ear canal to implantable devices with external and internal components like the cochlear implant.

The style of devices depends on the type of hearing loss, the degree of loss, the shape of the ear, personal preference and ear health factors among others. In general, the smaller the hearing aid, the lower the power, so people who use these tend to have low to moderate hearing loss and so may appear to be doing better because they don’t need so much help!

There are exceptions to the bigger = powerful rule as the completely in-the-canal devices can be pushed a long way down the ear canal, thereby increasing the sound pressure level at the eardrum. This means that it takes less power for these devices to get more volume. They are still not suitable for profound hearing losses. Also, some people’s ear canals are simply not large enough to accommodate this style of hearing aid or are an unusual shape which makes it hard for the device to fit in the ear - you could have a sharp bend or a very narrow canal which could make wearing an in-the-ear device difficult.

Depending on the loss, aids that sit behind-the-ear can be fitted with very narrow tubing and a simple dome that sits in the ear avoiding issues with ear canal shape and size. These also allow fresh air and natural sound into the ear canal. For some people, the sensation of wearing the hearing aid in-the-ear and the subsequent effect of hollowness or loudness of their own voice is unpleasant and so prefer an open style of device.

Smaller aids can also mean less functionality such as less hearing programs or no telecoil. However in these hi-tech days of remote controls, streamers and remote microphone technology, even very small devices have more and more options. The most important thing is to ensure that you discuss your individual wishes and concerns with your own audiologist to make sure that you choose something that is right for you. The audiologist can guide you and provide expert advice on clinical aspects of the fitting. Some people are happy to sacrifice a little on the functionality or sound quality to obtain the style of the hearing aid they want and that is a choice that only the hearing user themselves can make.

Why do I need to wear a hearing aid that sits behind my ear? My audiologist says

it is better but I see people wearing tiny aids that sit in their ear and they seem to hear very well.

Q

A


Roberta MarinoSenior Audiologist

Specialist Hearing Services

Emma ScanlanPrincipal Audiologist

Australian Hearing

ask the experts

Why does my 2-year-old son cry and hold his ears every time we fly,

especially when we are landing?Q

Send your questions to:Hearing HQ ExpertsPO Box 649Edgecliff NSW 2027 or [email protected]


Emma Scanlan: There are lots of factors to take into consideration when choosing

a style of hearing aid. The range of devices available is very broad from tiny devices that are completely in the ear canal to implantable devices with external and internal components like the cochlear implant.

The style of devices depends on the type of hearing loss, the degree of loss, the shape of the ear, personal preference and ear health factors among others. In general, the smaller the hearing aid, the lower the power, so people who use these tend to have low to moderate hearing loss and so may appear to be doing better because they don’t need so much help!

There are exceptions to the bigger = powerful rule as the completely in-the-canal devices can be pushed a long way down the ear canal, thereby increasing the sound pressure level at the eardrum. This means that it takes less power for these devices to get more volume. They are still not suitable for profound hearing losses. Also, some people’s ear canals are simply not large enough to accommodate this style of hearing aid or are an unusual shape which makes it hard for the device to fit in the ear - you could have a sharp bend or a very narrow canal which could make wearing an in-the-ear device difficult.

Depending on the loss, aids that sit behind-the-ear can be fitted with very narrow tubing and a simple dome that sits in the ear avoiding issues with ear canal shape and size. These also allow fresh air and natural sound into the ear canal. For some people, the sensation of wearing the hearing aid in-the-ear and the subsequent effect of hollowness or loudness of their own voice is unpleasant and so prefer an open style of device.

Smaller aids can also mean less functionality such as less hearing programs or no telecoil. However in these hi-tech days of remote controls, streamers and remote microphone technology, even very small devices have more and more options. The most important thing is to ensure that you discuss your individual wishes and concerns with your own audiologist to make sure that you choose something that is right for you. The audiologist can guide you and provide expert advice on clinical aspects of the fitting. Some people are happy to sacrifice a little on the functionality or sound quality to obtain the style of the hearing aid they want and that is a choice that only the hearing user themselves can make.

Why do I need to wear a hearing aid that sits behind my ear? My audiologist says

it is better but I see people wearing tiny aids that sit in their ear and they seem to hear very well. Professor Bill Gibson AM

Head of ENT UnitUniversity of Sydney

Roberta Marino: You often hear the little ones on flights crying,

especially on descent because of ear pain associated with an inability to equalise air pressure. Problems with regulating ear pressure is common and can be as high as 25% in children and 5% in adults.People with upper respiratory infection, allergies causing congestion or middle ear problems are more likely to have trouble equalising their ears when flying because their pressure equalisation tubes (Eustachian tubes) are typically not functioning at their optimum.The Eustachian tube runs from behind the ear drum to the back of the nose and throat. Every few minutes when we swallow, talk, chew or yawn, this closed tube opens and allows air in and out of the middle ear space (circled below)*.In a normal functioning ear, the pressure of the air behind the ear drum is equal to atmospheric pressure. For most people these tubes do a good job of keeping the pressure in the middle ear spaces equal to the atmospheric pressure inside the plane and they have little if any discomfort or prolonged hearing issues.

A

Chewing, yawning or performing the Valsalva manoeuvre (blocking the nose and blowing into a closed mouth) can help to equalise the pressure and often a “popping” sensation is described when the Eustachian tube opens and the pressure is equalised.For others flying can be a painful experience. Their Eustachian tubes can be blocked and when the plane takes off the atmospheric pressure becomes lower than the pressure of the air behind the eardrum causing the eardrum to bulge outwards. On landing, the eardrum bulges inwards and often the Eustachian tube is “locked” up to the extent that even the Valsalva manoeuvre is ineffective. In extreme cases this pressure build up can result in a burst eardrum.In children, the Eustachian tubes often cannot regulate themselves as well as adults resulting in ear pain.

* EarPlanes are a type of earplug developed specifically for flying by the prestigious research centre the House Ear Institute. They are available for adults and children to help slow down the rate of pressure change. I was pleasantly surprised how effective they are when I used them recently. Typically I need to constantly chew, swallow and perform the Valsalva manoeuvre to reduce my ear discomfort and blocked hearing on flights but with the EarPlanes I experienced little pressure change. They are inserted into the ear canals when the seat belt sign goes on at take-off and removed at maximum altitude. The Ear Planes manufacturer recommends re-inserting their plugs an hour before landing rather than waiting for the seat belt sign to turn on and they can be removed again when the seat belt sign goes off. You can purchase EarPlanes online via the link on www.hearinghq.com.aueustachian tube

ear drum

Here are some suggestions that may assist in providing ear relief for travellers:

On ascent, atmospheric pressure decreases relative to pressure in the middle ear, causing the eardrum to bulge outwards. The Eustachian tube should open, releasing air to the atmosphere via the nasopharynx.

On descent, atmospheric pressure increases, causing the eardrum to bulge inwards. If the pressure is not too great, swallowing or yawning may equalise the middle ear to atmosphere.

1. Where possible never fly with an upper respiratory infection.

2. Perform the Valsalva manoeuvre at ground level before take-off to check if your ears “pop”.

3. If you consistently have ear issues when flying, consult your GP or audiologist to check if your eardrum appears normal and that your canals are clear of wax and debris. A tympanometer is used to assess the

functioning of the middle ear system including the Eustachian tube.

4. Your GP may recommend or prescribe nasal sprays for use prior, during or after a flight.

5. During descent when the pressure change is greatest the Modern Medicine of Australia Journal recommends:

- staying awake (Eustachian tubes do not open well during sleep)

- yawn or make chewing movements (with or without food) - swallow fluids or suck a lolly (menthol or eucalyptus) and allow babies to suck on a breast/bottle - do the Valsalva manoeuvre

6. Use special EarPlanes* earplugs during flight.

7. In severe cases of middle ear problems or pain, grommets (tympanostomy tubes inserted in the ear drum) may be required.

* middle ear space


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REAL PEOPLE

real stories...

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It’s been three years and five months since I received my cochlear implant. I was 30 years old and my first child was just seven months. I remember being a bundle of nerves. Will the surgery be successful? Will it live up to my expectations and dreams? What will my beautiful baby sound like? Today I know without a doubt that my decision to have the implant so I could communicate completely with my children was the right one.

I was eight months old when during a routine Mothercraft test my unsuspecting parents were told I was profoundly deaf and would never speak or go to a

mainstream school. Our family has no history of deafness and I was a happy babbling baby so it came as a huge shock to Mum and Dad. They resolved, however, to do everything possible to help me communicate through speech. I was immediately fitted with hearing aids, which enabled me to discern loud noises though not spoken words. I had to be taught how to decipher the limited range of distorted sounds, as well as try to register sounds I couldn’t hear by identifying them through miniscule differences in lip movement. I then had to convert these interpretations into intelligible speech by making pronunciations often beyond my own range of hearing. It was not easy and involved countless hours of extra tuition after school, made all the more difficult as I would feel burned out after coping in a hearing world during the day.

When I became pregnant with our first child, I had a major rethink. By then I

had grown to live comfortably with my deafness. I had integrated happily in a mainstream school and graduated from university. I had married a lovely man and had a great group of friends. I felt in many ways that my hearing loss had made me self-reliant and given me the ‘steel’ to live a happy life. I had started Hear For You, a mentoring program for deaf adolescents. I felt I had turned my deafness into a virtue and I knew my husband Thomas loved me for the person I was. However when our first child Camilla was born I thought hard and decided I would enjoy being a mum all the more if I could communicate better with my children – and them with me.

The implant took some adjusting to. The avalanche of new sounds felt intensely confusing. My brain had to translate the sensations and then tell me that that’s the sound of Milla crying; that’s the sound of Thomas talking to me; that’s the sound of rain. It took time to

Olivia Andersen is the founder of Hear For You, an award winning mentoring program for deaf adolescents, a Hearing HQ editorial advisory board member and very proud mum of three beautiful hearing children. She shares why she decided to have a cochlear implant at 30.


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happen automatically. At that stage I had no way of knowing if what I was hearing was what everyone else heard. It was like learning not just a new language, but landing on a new planet where sound itself is utterly different and you have to find your way around. I was, and still am, on a sound safari.

It has been a gradual process. As part of the rehabilitation Thomas and I spent ten minutes every day doing listening practice. I would have to discern which of two similar sounding words he was saying without looking at his lips. The hard work has paid off with my listening, but I notice my lip-reading skills have diminished slightly as I become more dependent on my cochlear implant. I have always felt lip-reading is my own “secret weapon” – it’s amazing what people whisper to each other in a crowded bar 20 metres away! Needless to say, this is a small price to pay. I’m still waiting on the call up from ASIO!

We now have three beautiful children – Camilla 3, Noah 2 and Evie who is just 8 months old. Life is full on and I often wonder how I would be coping if I didn’t have my cochlear implant. I can differentiate Milla and Noah’s voices as they play in another room. I can hear Evie crying upstairs when she wakes and I am downstairs at the opposite end of the house - even with the television on. Before my surgery, I used to carry the baby monitor everywhere with me - I was so afraid of not hearing Milla cry.

Noisy environments are still difficult though. One day at the playground I was pushing Milla and Noah on swings from behind, blissfully unaware of their calls of "Enough Mumma! Enough Mumma! I want to get off!". A concerned bystander eventually told me my children want to get off the swings - one of my most embarrassing moments to say the least.

I love playing children’s songs in the car and singing along with the kids. It used to be impossible for me to sing in tune now my cochlear implant seems to “enjoy” Jay Laga’aia’s ‘Ten in the Bed’ CD. It appreciates his deep, rich voice. There must be something about his Maori accent. I am also enjoying clapping songs

including Miss Mary Mack with my children at home and at playgroup. It is so different from when I felt isolated from this activity as a little girl in the school playground. In some ways, I am going through childhood stages again and it is a wonderful thing to be sharing with my children.

We recently welcomed ‘Cochlear Koala’ into our home - a cuddly stuffed koala wearing a toy speech processor attached to a tiny magnet tucked inside his head - a gift from my cousin. The kids love his uniqueness, embrace his difference and include him in their imaginative play with their other stuffed animals.

Twelve months after switch on, I had a 20-minute telephone conversation with my mum – with only two “repeat” requests. My hearing improves each day, but one of my biggest challenges is finding time to devote myself as much as I’d like to ongoing rehab. When my little ones are a bit older and I surface again, I plan to 'bury my head' in learning.

My implant has helped me appreciate the nuances of how a person is feeling through their voice whether upset, happy, angry or speaking with sarcasm or irony. Previously I relied solely on body language so it is good to be able to hear as well as intuit things.

Before my cochlear implant, Thomas and I needed to have eye contact to communicate. He had to find me in the house if he wanted to say something to me. I, on the other hand, would be able to shout loudly at him from wherever I was to 'instruct/request' him to do something. An unfair advantage he thought! Thomas is now able to talk to me from another room and no longer needs to get my attention with a high-pitched “cooee” call. Now he has stopped using this call I must say I miss it! This reminds me of a humorous card he gave me on the way home from switch on. With my head filled with strange and alarming noises, Thomas handed me a card he claimed

had been written to me by Milla: “From now on, you have to do everything that Dad says, as you have no excuse!”

Music is an adventure. Sometimes, before my implant, Thomas and I would go to a concert together. Just because you are deaf doesn't mean you can’t enjoy the atmospheric excitement at a concert. The music was loud enough so I could feel it and I liked to observe other people’s reactions. At a Billy Ocean concert when he was singing some of the slow tunes, Thomas could see I was getting bored, so he tapped out the beat on my hand. But when Billy belted out ‘Lover Boy’ (what a hit) and the crowd started dancing and singing it had a great effect on me. I now enjoy concerts all the more because I can follow the tune, as well as feel the pounding beat of the music. Now I’ve got to decide whether I love pop or classical. I think I’ll enjoy both.

Even after three and a bit years I still face the future with great excitement. Before the implant I could only hear 4% of sentences. Six months after I was switched on it dramatically increased to 36% and at 24 months to 48%. When I resume my rehab in earnest goodness knows what this can become. My earlier fear that being able to hear would affect my identity was groundless. I’m still the same person I’ve always been, but now because I’m able to communicate, life is even better.

I am grateful to my cochlear implant for giving me the confidence and control I now have as a mum. I am also grateful that it has opened up whole new horizons of fascination, subtlety and adventure for me.

In some ways, I am going through childhood stages again and it is a wonderful thing to be sharing with my children.

Read about the tools Olivia used to help her adjust to the hearing world at www.hearinghq.com.au

HQ


here to help

INFORMATION & SERVICES

ACT Deafness Resource Centre - CanberraInformation, referral and advocacy servicesT 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395

Audiological Society of Australia Inc Information on national audiological services T 03 9416 4606 F 03 9416 4607

Australian Government Hearing Services ProgramGovernment assistance eligibility informationT 1800 500 726 TTY 1800 500 496

Australian HearingAustralian Government audiology clinicsT 131 797 TTY 02 9412 6802 F 02 9413 3362

Better Health Channel VIC Govt funded health & medical information www.betterhealth.vic.gov.au

Deaf Can:Do (formerly Royal SA Deaf Society)Services to SA deaf and hearing impairedT 08 8223 3335 TTY 08 8223 6530 F 08 8232 2217

Deafness Foundation Research, education & technology support T & TTY 03 9738 2909 F 03 9729 6583

Ear Science Institute Australia Implant CentreHelp with ear, balance & associated disordersT 08 6380 4944 F 08 6380 4950

Guide Dogs SA.NT Adelaide based aural rehabilitation serviceT 1800 484 333 TTY 08 8203 8391 F 08 8203 8332

HEARnet - a better understanding of hearing loss & interactive ear diagram.www.hearnet.org.au T 03 9035 5347

Lions Hearing ClinicFree or low cost services in PerthT 08 6380 4900 F 08 6380 4901

Lions Hearing Dogs Australia Provide hearing dogs and training to recipientsT 08 8388 7836 TTY 08 8388 1297

National Relay Service Helpdesk Telephone access service for hearing impairedM-F 9am-5pm, Sydney time SMS 0416 001 350 T 1800 555 660 TTY 1800 555 630 F 1800 555 690

Parents of Deaf Children - NSWUnbiased information, support and advocacyT 02 9871 3049 TTY 02 9871 3193 F 02 9871 3193

SCIC - Sydney Cochlear Implant Centre Gladesville, Newcastle, Canberra, Gosford, Port Macquarie, Lismore, PenrithT 1300 658 981

Telecommunications Disability Equipment Contact information for special phones: Telstra 1800 068 424 TTY 1800 808 981 F 1800 814 777Optus 133 301 937 TTY 1800 500 002

The Deaf Society of NSW Information & services to NSW Deaf peopleT 1800 893 855 TTY 1800 893 885 F 1800 898 333 SMS 0427 741 420

The Royal Victorian Eye & Ear HospitalCochlear Implant ClinicT 03 9929 8624 F 03 9929 8625E [email protected]

Tinnitus SA Impartial tinnitus information and optionsT 1300 789 988

VicdeafAdvice and support for hard of hearing T 03 9473 1111 TTY 03 9473 1199 F 03 9473 1122

ADVICE & SUPPORT

Acoustic Neuroma Association of AustraliaSupport and information on treatmentE [email protected] T 03 9718 1131/02 4421 6963

Aussie Deaf KidsOnline parent support and forumwww.aussiedeafkids.org.au

Australian Tinnitus Association (NSW) - SydneySupport, information & counselling servicesT 02 8382 3331 F 02 8382 3333

Better Hearing Australia (BHA)Hearing advice by letter, email or in personT 1300 242 842 TTY 03 9510 3499 F 03 9510 6076

Better Hearing Australia CanberraHearing Loss Management & Hospital KitT 02 6251 4713

BHA Tinnitus Self Help/Support Group - TASSupport group for those with tinnitusT 03 6244 5570

BHA Tinnitus Management ServicesT 1300 242 842

Broken Hill & District Hearing Resource Centre IncT 08 8088 2228 F 08 8087 9388www. bhhearingresourcecentre.com.au

CICADA Australia IncFor people with or considering cochlear implantswww.cicada.org.au

CICADA QueenslandFor people with or considering cochlear implantsE [email protected]

CICADA WAFor people with or considering cochlear implantsCoordinator: Lynette 08 9349 7712

Deaf Children Australia Services for hearing impaired childrenT 1800 645 916 TTY 03 9510 7143 F 03 9525 2595

Hear For YouMentoring hearing impaired teensE [email protected]

Meniere’s AustraliaDizziness & balance disorders supportT 1300 368 818 F 03 9783 9208

Self Help for Hard of Hearing People (Aus) IncEducational associationT 02 9144 7586 F 02 9144 3936

EDUCATION

Can:Do 4Kids - Adelaide Programs for deaf, blind & sensory impaired kidsT 08 8298 0900 TTY 08 8298 0960 F 08 8377 1933

Catherine Sullivan Centre - SydneyEarly intervention for hearing impaired childrenT 02 9746 6942 F 02 9764 4170

Cora Barclay Centre - AdelaideAuditory-Verbal Therapy for 0-19 year oldsT 08 8267 9200 F 08 8267 9222

Hear and Say Centres - QLDEarly intervention and cochlear implantsT 07 3870 2221 F 07 3870 3998

RIDBC (Royal Institute for Deaf and Blind Children) Hearing and vision impaired education & servicesT & TTY 1300 581 391 F 02 9871 2196

RIDBC Hear The Children Centre - SydneyEarly childhood intervention for hearing impairedT 1300 581 391 F 02 9871 2196

RIDBC Matilda Rose Centre - SydneyEarly childhood intervention for hearing impairedT 02 9369 1423 F 02 9386 5935

Taralye Oral Language Centre - MelbourneEarly childhood intervention & advocacy T 03 9877 1300 F 03 9877 1922

Telethon Speech & Hearing - PerthEarly intervention program and specialist paediatric audiology servicesT 08 9387 9888 F 08 9387 9889

The Shepherd Centre - NSW & ACTEarly intervention and cochlear implantsT 1800 020 030 F 02 9351 7880

ADVOCACY & ACCESS SERVICES

ACT Deafness Resource CentreT 02 6287 4393 TTY 02 6287 4394 F 02 6287 4395

Arts Access Victoria/Deaf Arts NetworkT 03 9699 8299 TTY 03 9699 7636 F 03 9699 8868

Australian Communication Exchange (ACE) T 07 3815 7600 TTY 07 3815 7602 F 07 3815 7601

Cap that! Captioned for Learningwww.capthat.com.au

Deafness Council Western Australia IncT & SMS 0488 588 863

Deafness Forum of AustraliaT 02 6262 7808 TTY 02 6262 7809

Deaf Sports AustraliaT 03 9473 1191 TTY 03 9473 1154 F 03 9473 1122

Media Access AustraliaT 02 9212 6242 F 02 9212 6289

NMIT Centre of Excellence Vocational EducationT 03 9269 1200 F 03 9269 1484 OTHER

BHA Hearing Aid Bank - donate old hearing aids T 1300 242 842 T 03 9510 1577

Planet Ark - Find a battery recycler near youwww.recyclingnearyou.com.au/batteries

JobAccess Disabilities workplace solutionsT 1800 464 800 TTY 1800 464 800 F 08 9388 7799

Many not-for-profit organisations around Australia and government agencies provide valuable support, advice and information on hearing issues. Please visit www.hearingHQ.com.au to find out more about any of these organisations and to link directly to their websites. For an organisation to be considered for listing they must be a not-for-profit, charity or completely free service.



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Doctors and audiologists can tell you about the procedures and what results may be achieved. Only someone with a cochlear implant can add the dimension of personal experience. Join us for BBQs and presentations.

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books etc...

For more book reviews go to www.HearingHQ.com.au


Deaf Like MeThomas Spradley, James SpradleyDeaf Like Me is the moving account of parents coming to terms with their baby daughter's profound deafness. The love, hope and anxieties of all hearing parents of deaf children are expressed here with power and simplicity. In the epilogue, Lynn Spradley as a teenager reflects upon being deaf, her education, her struggle to communicate, and the discovery that she was the focus of her father's and uncle's book. At once moving and inspiring, Deaf Like Me is an insightful and inspiring read for parents, relatives and friends of deaf children anywhere.

Raising Kids with Cochlear Implants: Personal Narratives from a Family's JourneyAmy Milani PhDThis book is a collection of personal narratives about the author's experience raising a son and daughter with cochlear implants. Excerpts from a journal she wrote following her son’s surgery describe exactly how he began listening and learning language with a cochlear implant. When her daughter is also born with hearing loss, the family moves back to the US to find an appropriate preschool and support system for cochlear implants and to fully embrace oral deaf education. Amy explored the broader issues affecting family life such as the challenges a young child faces wearing equipment and the social implications of hearing in a way that’s unfamiliar to most people. Her narratives provide authentic evidence of the joys and struggles parents experience when helping children with cochlear implants transition into the hearing world.

Teaching Deaf Learners: Psychological and Developmental Foundations Harry Knoors and Marc MarscharkExplore how deaf students (children and adolescents) learn and the conditions that support them reaching their full cognitive potential Ð or not. Beginning with an introduction to teaching and learning of both deaf and hearing students, the authors take an ecological approach to deaf education, emphasising the need to take into account characteristics of learners and of the educational context. They describe characteristics of deaf learners which indicate that teaching deaf kids is not, or should not, be the same as teaching hearing kids. They explore factors that influence the teaching of deaf learners, including language proficiencies, literacy and numeracy skills, cognitive abilities and social-emotional factors. The promise of multimedia-enhanced education is addressed and the possible influences of contextual aspects of the classroom and the school on learning by deaf students. This book bridges the gap between research and practice in teaching and outlines ways to improve teacher education.

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I Can Hear You Whisper: An Intimate Journey through the Science of Sound and Languageby Lydia DenworthAn acclaimed science journalist and mother, Denworth investigates the science of hearing, child language acquisition, neuroplasticity, brain development and Deaf culture.

Lydia Denworth’s third son, Alex, was nearly two when he was identified with significant hearing loss that was likely to get worse. Denworth knew the importance of enrichment to the developing brain but had never contemplated the opposite: deprivation.

In her drive to understand the choices - starting with the angry debate between supporters of sign language and the controversial but revolutionary cochlear implant - Denworth soon found that

every decision carried weighty scientific, social and even political implications. As she grappled with the complex collisions between the emerging field of brain plasticity, the possibilities of modern technology and the changing culture of the Deaf community, she gained a new appreciation of the exquisite relationship between sound, language and learning. Denworth interviewed the world’s experts on language development, inventors of ground-breaking technology, Deaf leaders and neuroscientists at the frontiers of research. She presents insights from studies of everything from at-risk kids to noisy cocktail party conversation, from songbirds to signal processing and from the invention of the telephone to sign language. I Can Hear You Whisper shows how sound sculpts our children’s brains and the life-changing consequences of that delicate process.


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CAPTIONED RELAYcall anyone, anywhere, anytime.

A phone solution for people who are deaf or have a hearing or speech impairment

find out more: www.relayservice.gov.au

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