The Listening Brain at Work

MarApr2012

The magazine of, by, and for audiologists

Published by the American Academy of Audiology | www.audiology.org

Audiology and Patient Trust

The Business of Influence

Itemized Value Pricing

The Listening Brain at Work

From this moment, everything

changes.

A holistic approach to helping first-time users find a clear path to success with hearing instruments.

Visit www.noweffect.com or call us at 1.800.526.3921 to learn more about Oticon Intiga and The Now Effect.

The N w Effect

Oticon Intiga:Immediate Acceptance.

Immediate Benefits.

Agil takes speech understanding in difficult situations to a new level with Speech Guard signal processing technology.

Clinical tests have shown that Oticon Agil delivers improved speech understanding, providing:

1.4 dB more clarity

16-18% more words understood

This gives your patients more energy to follow, participate and engage in the conversation!

Speech Guard automatically adjusts gain level in changing environments without the speech distortions of traditional compression systems.

For more information about Agil, visit us at www.oticonusa.com or call us at 1.800.526.3921.

Oticon Agil miniRITE

Help Your Patients Participate More

Actively with Agil...

From this moment, everything

changes.

A holistic approach to helping first-time users find a clear path to success with hearing instruments.

Visit www.noweffect.com or call us at 1.800.526.3921 to learn more about Oticon Intiga and The Now Effect.

The N w Effect

Oticon Intiga:Immediate Acceptance.

Immediate Benefits.

Agil takes speech understanding in difficult situations to a new level with Speech Guard signal processing technology.

Clinical tests have shown that Oticon Agil delivers improved speech understanding, providing:

1.4 dB more clarity

16-18% more words understood

This gives your patients more energy to follow, participate and engage in the conversation!

Speech Guard automatically adjusts gain level in changing environments without the speech distortions of traditional compression systems.

For more information about Agil, visit us at www.oticonusa.com or call us at 1.800.526.3921.

Oticon Agil miniRITE

Help Your Patients Participate More

Actively with Agil...

Clinicians are faced with audiometric data management challenges in their practices on a daily basis. GSI understands these clinical demands and has solutions to fi t any type of environment.

Let GSI be your guide in mapping out the best solution for your practice.

Setting The Clinical Standard www.grason-stadler.com

Grason-Stadler, 7625 Golden Triangle Drive, Suite F, Eden Prairie MN 55344

800-700-2282 • 952-278-4402 • fax 952-278-4401 • e-mail [email protected]

Explore Customized E-RecordSolutions for Any Environment

DIRECT INTERFACE

GSI SUITE+ OTOACCESS

AUDBASEAUDIO TYMP MODULE NOAH

QUASAR CONNECT

Visit us at AudiologyNOW! Booth #1331

DIRECT INTERFA

CEQ

UASA

R CO

NNEC

T

FOR NOAH

AUDIO TYM

P MO

DU

LE

+ OTOACCESSGSI SUITE

+ O SS A

RECTIN

Record Solutions

AUDBASE

MarApr2012Volume 24 No 2

Contents

18 the Listening Brain at Work Behavioral tests of dichotic listening have proven effective in the identification of individuals with auditory processing disorders. It has become increasingly apparent in recent years, however, that cognitive variables, play an important role in the response to dichotic stimulation. By James Jerger and Mary Reagor

32 Audiology and Patient trust Trust levels are consistently correlated to a patient’s decision to follow a health-care provider’s recommendations. The more patients trust their health-care providers, the more likely they will follow recommendations for treatment and continue doing business with them.By Kris English and Gyl Kasewurm

40 the Business of Influence Learn more about the AAA Foundation’s inaugural

offering of the Improving Patient Care Through Innovation in Workplace

Management lecture. Dr. Fabry speaks with this year’s speaker, Candace Bertotti,

who will present “Influencer: How to Create Change in Your Audiology Workplace.” By David Fabry and Kathleen Devlin Culver

48 Itemized Value Pricing: Responding to Changes in the Health-Care system

Regardless of whether you bundle or itemize product prices, it is critical to understand your value and to communicate this value to your patients.By Barry A. Freeman

56 Harboyan syndrome: A Case Report The authors report on two sisters, with a history of congenital hereditary endothelial dystrophy, who were born with diffuse, bilateral corneal clouding that extended to the periphery. After they began to lose their hearing between 10 and 11 years of age, they were diagnosed with Harboyan syndrome, also known as corneal dystrophy-perceptive deafness. By Robert M. DiSogra and Kammi B. Gunton

edItoRIAL MIssIonThe American Academy of Audiology publishes Audiology Today (AT) as a means of communicating information among its members about all aspects of audiology and related topics.

AT provides comprehensive reporting on topics relevant to audiology, including clinical activities and hearing research, current events, news items, professional issues, individual-institutional-organizational announcements, and other areas within the scope of practice of audiology.

Send article ideas, submissions, questions, and concerns to [email protected].

Information and statements published in Audiology Today are not official policy of the American Academy of Audiology unless so indicated.

CoPyRIgHt And PeRMIssIonsMaterials may not be reproduced or translated without written permission. To order reprints or e-prints, or for permission to copy or republish Audiology Today material, go to www.audiology.org/resources/permissions/pages/default.aspx.

© Copyright 2012 by the American Academy of Audiology. All rights reserved.

dePARtMents

8 PResIdent’s MessAge Discipline Your Mind By Therese Walden

10 exeCutIVe uPdAte AudiologyNOW! 2012, 2013, and Beyond By Cheryl Kreider Carey

12 KnoW-HoW Selling Yourself By Tracey Irene

14 CALendAR Academy and Other Audiology-Related Deadlines

16 AudIoLogy.oRg What's New on the Academy's Web Site

66 CAse study CSI: Audiology By Paul Pessis

72 CodIng And ReIMBuRseMent Otoacoustic Emissions FAQs

75 ABA Dreith Earns All Three ABA Certifications By Torryn P. Brazell

78 ACAe CoRneR Program Accreditation and Quality Improvement By Martha R. Mundy

Academy News

83 2012 ACAdeMy HonoRs Celebrate This Year’s Academy Honors Recipients

88 2012 JAAA edItoR’s AWARd Commemorate This Year’s Two Recipients

89 WAsHIngton WAtCH Tools for Effective Advocacy at AudiologyNOW! By Melissa Sinden

91 Just JoIned Welcome New Members of the Academy and Student Academy

92 neWs And AnnounCeMents Salary Survey | Task Force Report on Presbycusis

93 FoundAtIon uPdAte Marion Downs Lecture Presenter Linda Luxon | An Ear to the Ground Environmental Scan Now Available | Auction 4 Audiology | Scholarship Opportunities

1-800-221-0188 l www.widexpro.com

Small, compact housing

Convenient 675 battery for long battery life

Choice of Power and Super Power receivers provide flexible solutions and outstanding sound quality

SUPERpower and performance

Widex Super Introduces RIte technology to the Super power Segment

The American Academy of Audiology promotes quality hearing and balance care by advancing the profession of audiology through leadership, advocacy, education, public awareness, and support of research.

Content editor

David Fabry, PhD | [email protected]

editorial Advisors

Mindy Brudereck, AuD

Paul Pessis, AuD

Christopher Spankovich, PhD

editor emeritus

Jerry Northern, PhD

executive editor

Amy Miedema, CAE | [email protected]

Managing editor

Joyanna Mills, CAE

Art direction

Suzi van der Sterre

Marketing Manager

Angela Ugoji

editorial Assistant

Kevin Willmann

Web Manager

Marco Bovo

Advertising sales

Heather Troast | [email protected] | 800-501-9571 ext. 124

AMeRICAn ACAdeMy oF AudIoLogy oFFICes

Main office11730 Plaza America Drive, Suite 300

Reston, VA 20190Phone: 800-AAA-2336 | Fax: 703-790-8631

Capitol Hill office312 Massachusetts Avenue, NE

Washington, DC 20002Phone: 202-544-9334

AMeRICAn ACAdeMy oF AudIoLogy MAnAgeMent

executive director Cheryl Kreider Carey, CAE | [email protected]

deputy executive director Edward A. M. Sullivan | [email protected]

senior director of Finance and Administration Amy Benham, CPA | [email protected]

senior director of government Relations Melissa Sinden | [email protected]

senior director of Meeting services Lisa Yonkers, CMP | [email protected]

senior director of Communications Amy Miedema, CAE | [email protected]

director of Industry services Shannon Kelley, CMP, CEM | [email protected]

director of education Meggan Olek | [email protected]

director of Regulatory Affairs Sharmila Sandhu, Esq. | [email protected]

American Academy of Audiology Foundation director of operations and development Kathleen Devlin Culver, MPA, CFRE | [email protected]

American Board of Audiology Managing director Torryn P. Brazell, CMP, CAE | [email protected]

BoARd oF dIReCtoRs

PResIdentTherese Walden, AuD Walter Reed National Military Medical Center, Audiology and Speech [email protected]

PResIdent-eLeCtDeborah L. Carlson, PhDUniv. of TX - Medical BranchCtr. for Audiology & Sp. [email protected]

PAst PResIdentPatricia (Patti) Kricos, PhDUniversity of [email protected]

MeMBeRs-At-LARgeE. Kimberly Barry, AuDDept. Veterans [email protected]

Bettie Borton, AuDDoctors Hearing [email protected]

Rebekah F. Cunningham, PhDA.T. Still [email protected]

Brian Fligor, ScDChildren’s Hospital Boston and Harvard Medical [email protected]

Thomas Littman, PhDFactoria Hearing Center [email protected]

Devin McCaslin, PhDVanderbilt Bill Wilkerson [email protected] Erin L. Miller, AuDUniversity of [email protected] Eilene Rall, AuDChildren’s Hospital of [email protected]

David Zapala, PhDAudiology Section-Mayo [email protected]

ex oFFICIosCheryl Kreider Carey, CAEExecutive Director, American Academy of [email protected]

Kari MorgensteinPresident, Student Academy of [email protected]

Audiology Today (ISSN 1535-2609) is published bimonthly by the American Academy of Audiology, 11730 Plaza America Drive, Suite 300, Reston, VA 20190; Phone: 703-790-8466. Periodicals postage paid at Herndon, VA, and additional mailing offices.

Postmaster: Please send postal address changes to Audiology Today, c/o Membership Department, American Academy of Audiology, 11730 Plaza America Drive, Suite 300, Reston, VA 20190.

Members and subscribers: Please send address changes to [email protected].

The annual print subscription price is $115 for US institutions ($138 outside the US) and $56 for US individuals ($105 outside the US). Single copies are $15 for US individuals ($20 outside the US) and $20 for US institutions ($25 outside the US). For subscription inquiries, telephone 703-790-8466 or 800-AAA-2336. Claims for un delivered copies must be made within four (4) months of publication.

Full text of Audiology Today is available on the following access platforms: EBSCO, Gale, Ovid, and Proquest.

Publication of an advertisement or article in Audiology Today does not constitute a guarantee or endorsement of the qual-ity, safety, value, or effectiveness of the products or services described therein or of any of the representations or claims made by the advertisers or authors with respect to such prod-ucts and services.

To the extent permissible under applicable laws, no responsibil-ity is assumed by the American Academy of Audiology and its officers, directors, employees, or agents for any injury and/or damage to persons or property arising from any use or opera-tion of any products, services, ideas, instructions, procedures, or methods contained within this publication.

PATI

EN

T COMMUNICATIO

N

PATIE

NT FINANCING

Sycle.net automates repetitive tasks and integrates with your existing technology to save you time—so you can spend it where it counts: with your patients.

SALE

S GENERATION

Save time with Sycle.net

Visit us this year booth 1181 at AudiologyNOW!

Call to sign up!

(888) 881-7925or visitwww.sycle.net/atmThe Number One Hearing Care

Practice Management System

eDocs

8 Audiology Today | MarApr2012

PResIdent’s MessAge

discipline your Mind

In deference to my guilty pleasure, I had to use a Harry Potter reference this year. The title of this article, spoken by Professor Severus Snape while teaching Harry the skill of occulmency (magical defense of the mind against external pen-etration), came to me as I began to think about topics for this March/April issue of AT. Of course! Coming soon is the ultimate opportunity to

“discipline one’s mind”—attendance at AudiologyNOW!® 2012, the 24th annual conference of the American Academy of Audiology.

At the end of March, we have a huge opportunity to expand the breadth and depth of our profes-sional knowledge. As Mark Twain said, “Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do…sail away from the safe harbor...catch the trade winds in your sails. Explore. Dream. Discover.” By “sailing” into Boston, MA, to attend AudiologyNOW! 2012 you will have abundant oppor-tunities to explore and discover. AudiologyNOW! is truly one of our professional life experiences that never disappoints.

The theme this year is “Audiology Means Business,” and, as always, there will be a stellar line-up of subject matter experts, presenting a broad educational program that will cover treatment, practice manage-ment, electrophysiology, hearing loss prevention, pediatrics, research,

adults, education, implantable devices, and much more.

There will be ample opportuni-ties to attend ABA Tier 1 courses for credential maintenance and enough continuing education hours (35, to be exact) to ensure your annual licen-sure requirements are met.

The fourth annual Academy Research Conference (ARC) will focus on noise-induced hearing loss and will attract clinicians, researchers, and students alike. New for 2012, there will be a mini-conference associated with AudiologyNOW! called Global Perspectives on Central Auditory Processing Disorder, which will bring together international experts, clinicians, and researchers to discuss recent advances in clini-cal practice and current and future research directions.

We will engage with our A4 part-ners for festivities such as the AAA Foundation’s Auction 4 Audiology and Happy Hour with a Boston View, the ABA’s annual Meet and Greet, and numerous events for the Student Academy such as the Mix and Mingle, the SAA membership meeting, and the inaugural SAA/AAA Foundation Benefit: Cheers for Ears. Additionally, the old stand-bys, Celebrate Audiology, General Assembly, Trivia Bowl, the PAC event, Honors and Awards Banquet, clinical and research posters, State Leaders Workshop, and more will bring your colleagues and friends together for networking, discussions, frivolity, and fellowship.

Boston, MA, is a town steeped in history from its beginnings as the commercial, financial, and educa-tional (think Harvard, MIT) center of New England to its legacy for the literary elite (Nate Hawthorne, Hank Longfellow, etc.). Boston has some-thing to offer for everyone. While we are there, we will add to our profes-sion’s esteemed history. Like Boston, we build on the past and create the future based on the collective efforts of the people—our single greatest resource. Our annual conference is about real professionals: clinicians, researchers, private practitioners, educators, and students.

Attendance at AudiologyNOW! 2012 will transform you—as should all the continuing education you pur-sue throughout the year. Attendance at the conference (for CEUs) is just the beginning of the educational year for me. Like you, I am continu-ally immersed in CE opportunities throughout the year such as the

I knew it would happen at some point.

MarApr2012 | Audiology Today 9

PResIdent’s MessAge

JAAA continuing education program, where we get to read all the latest research and obtain credit for doing so. We have an extensive on-demand library of Web seminars on a broad range of contemporary and usable topics in eAudiology, and there are amazing local and regional state audiology organization meetings year-round.

I’ve had the privilege of attending and presenting at many state audiol-ogy organization meetings for years now, and I have to tell you, the pro-gram committee members for these events are laboring most of the year

to bring CEs close to home. By using the local subject matter experts and sprinkling in a few national/international names to fill out the educational program, the state plan-ners rock. What effort on behalf of our colleagues to continually raise the bar for professional continuing education—to discipline the mind.

Life is not a dress rehearsal. With that in mind, we should be exhausted at the end of each day, taking full advantage of all the (CE) opportuni-ties provided to us in addition to our day jobs! This lifelong educational pursuit is what keeps us relevant—

to ourselves, our patients, our research, and our profession. It’s not that hard to do—all you need is passion and commitment (and a few, occasional distractions into the Wizarding World of Hogwarts!).

Therese Walden, AuD President American Academy of Audiology

We make microphones kemar.us

Visit us at AudiologyNOW! and help us celebrate KEMAR’s birthday and learn about the history behind this personality

1972-201240 years and still the same– but different

Booth 1173

Audiology Today | MarApr201210

exeCutIVe uPdAte

The fact that AudiologyNOW! (AN!) 2012

AudiologynoW!® 2012, 2013, and Beyond

is imminent is well known among audiologists. Perhaps lesser known is when the operational process began for the largest gathering of audiologists to launch on March 28. Here’s a clue: the cities for AN!17 and AN!19 are currently being finalized!

In brief, the process to develop each AN! begins years in advance of the actual event and includes the following:

� 5–6 years—select city

� 3–4 years—negotiate contracts with approximately 10 hotels in host city

� 1–2 years—execute license with convention center

� 18 months—appoint audiologist to chair AN! Program Committee

� 11 months—develop educational program, program committee members/staff meet

� 11 months—select booth space

This timeline shows as many as five separate AN!s being handled simul-taneously, each at a different stage in the development process, necessitating differing expertise. To direct and manage this process, the Academy has four meeting professionals who work year-round ensuring that each AN! is a seam-less, meaningful experience for audiologists.

So, while AN!12 and Boston are in the spotlight and being executed, Academy staff is also gearing up for AN!13 in Anaheim and the site visit next month (April)…negotiating hotel contracts with Nashville for AN!18…begin-ning work with Los Angeles for AN!19…and researching cities beyond!

Cheryl Kreider Carey, CAE Executive Director American Academy of Audiology

AN! Fun Facts200+ hours to develop the online registration/housing programming

One million pounds of freight on exhibit floor

12,000 man hours at the convention center

14,000 hotel room nights in 10 hotels

Three 18-wheelers to haul audio-visual equipment for educational sessions to convention center

21,775 individual ribbons

68,000 pieces of badgestock for attendees and exhibitors

A record-setting 7,607 attended AN!11

During AN!11, 16,664 educational sessions were attended representing 2316 CEUs granted for AN!11

118,000+ individuals have attended this event the past 23 years


exeCutIVe uPdAte

20

06

20

07

20

08

20

08

20

08

20

09

20

10

20

11

20

12

JANUARYWashington, DC, selected for AN!11(Contingent on new headquarter hotel being built)

JANUARYNegotiated license with Anaheim’s convention center for AN!13

JUNEReplaced DC with Chicago for AN!11 and moved DC to AN!12(DC still contingent on new headquarter hotel being built)

OCTOBER Replaced DC with Boston for AN!12

OCTOBER Karen Jacobs appointed Chair of AN!12 Program Committee

OCTOBER Tish Gaffney appointed Chair of AN!13 Program Committee

DECEMBERNegotiated Boston hotel contracts and license with Boston’s convention center for AN!12

DECEMBERNegotiated San Antonio hotel contracts for AN!15

DECEMBERNegotiated Phoenix and Nashville hotel contracts for AN!16 and AN!18

MAYAN!12 Program Committee meeting in Boston


KnoW-HoW

selling yourself: the Personal side to AudiologyBy Tracey Irene

H ow do you market your prac-tice? The profitability of a practice depends on the abil-

ity to sell. However, there is a human component that is often forgotten in our marketing practices. Have we created an environment that is too focused on the products we deliver? Have we sacrificed ourselves and the value of our services by focusing so heavily on hearing aids? Do our patients recognize that we are more than just salespeople?

The downfall of price marketing is the emphasis it places on cost. It sends the message that the cost of the product is the predominant factor in purchasing. If purchasing hear-ing aids is no different than buying a TV, we have inadvertently led our

patients to seek out the lowest price and undervalue our services.

How can we create an environ-ment of change? We can begin by changing our approach to marketing. A unique marketing plan focused on patient care, professional expertise, and outcomes can promote your business and set you apart from the competition.

Patient-Centered CareServices are delivered based on respect for patients’ preferences, values, and needs. Focus on the patient experience by asking your-self, “what are my patients looking for?” The answer to this question may be different depending on the practice type, patient demographics,

and geographical location. The key is to ensure that your marketing practices are meeting the needs of your patients. A practice could use outcome surveys as a means to accumulate data on satisfaction, needs, and areas for improvement. The information acquired in this process can then be added to market-ing literature to highlight the value of the services that you provide through patient testimonials.

Professional expertiseWhat expertise do you provide that enhances the outcome? We all have a unique approach to providing patient care. Your strengths may be in your counseling skill, use of estab-lished verification methods, or years


KnoW-HoW

of experience. Draw attention to these strengths by developing your biographical information on your professional Web site. By effectively marketing and using your strengths, you can build trust and create patient loyalty.

outcome MeasuresBest practice methods can enhance your service delivery and increase patient satisfaction. Using objective and subjective measures to verify the fitting will improve outcome and build trust with your patients. Additional services such as an auditory training program or group orientation may distinguish your practice from your competition.

Another way to draw focus to your services is to use partial or complete

unbundling practices in billing. The advantage of unbundling is that the patient can identify the portion of the cost related to product and services. The counseling process will give you the opportunity to market the value of the services you provide. The structure or method that you choose to separate your fees will depend on the model that best meets your practice’s and patients’ needs. Additional information on unbun-dling can be found in the article,

“Myth Busters: Can You Unbundle and Stay in Business?” (Sjoblad and Warren, 2011).

Transformation is difficult and takes time. Start by making small changes to your brochures, Web site, and advertising in your prac-tice. Create value in the services you

offer, and convert your transactional patients to life-long customers.

Tracey Irene, AuD, is a senior audiologist with Professional Hearing Services, a division of Moreland Ear, Nose, and Throat Group, LTD, in Milwaukee, WI. She is also a member of the Academy’s BEST Committee.

Reference

Sjoblad S, Warren BW. (2011) Myth busters: can you unbundle and stay in business? Audiol Today 23(5):36–45.

Illustration by Johanna van der Sterre.

www.comfortaudio.us | [email protected] | Phone (847) 656 5450

Comfort Digisystem – a complete range of digital Assistive Listening Devices. The Comfort Digisystem range of microphones and receivers is wireless and fully digital. It uses the advantages of digital technology perfectly in school, at work and at home – wherever crystal clear sound perception is needed.

Comfort Digisystem – for crystal clear sound perception


CALendAR

APRIL

MARCH 7eAudiology Web seminar—ethical and Best Practices in Humanitarian efforts (.2 Ceus)

www.eaudiology.org

13eAudiology Web seminar—Coding and Reimbursement series: Insurance 101 (.1 Ceus)

www.eaudiology.org

28Academy Research Conference

Boston, MA

www.academyresearchconference.org

28–31AudiologynoW!

Boston, MA

www.audiologynow.org

30eAudiology Web seminar—Clinical decision Making, Report Writing, the electronic Medical Record, and Audiology Competencies (.3 Ceus)

www.eaudiology.org

25eAudiology Web seminar—speech Mapping Results (.1 Ceus)

www.eaudiology.org


AudIoLogy.oRg

A Guide to Itemizing Your Professional Services In response to member interest, the Academy has created a guide to item-izing professional services, including detailed information regarding how to develop a business plan, dealing with insurance companies, and hearing ser-vices claim examples for your review.

Visit www.audiology.org and search keywords “guide to itemizing” or use the QR code to view the guide on your mobile device.

speech Audiometry, Word Recognition, and Binomial Variables: Interview with gary Lawson, Phd

Ceus, eAudiology, and ethics Courses: Interview with Cornelia gallow, Professional development Manager, American Academy of Audiology

Hearing Protection, Auditory Rehab, and Musical expertise: Interview with Marshall Chasin, Aud

To learn more, visit www.audiology.org and search by the interviewee’s name or use the QR codes to view the interviews on your mobile device.

ReSound Alera®.Taking rich, vibrant sound

a few steps further

…with the ReSound Unite®

Mini Microphone

www.gnresound.com/Alera Hear the difference.

Announcing the ReSound Unite Mini Microphone – a game-changing, truly wireless accessory that can be

discretely clipped to a companion’s clothing and will transmit the speaker’s voice directly to any Alera wireless

hearing instrument. Patients can now hear speech from 5 to up to 20 feet away. The Mini Microphone also

works as a wireless transmitter for MP3 players or other electronic devices.

Resound Alera – leading edge technology, unparalleled sound quality with lots of options.

Find out why so many dispensers fit it.

“The best way to present to patients is, without a doubt, through demo’ing the device. I have been doing this in the office and everyone loves it. We will be including the mini mic with ALL Alera purchases because it makes such a difference.”

“...it makes such a difference.”

- Jennifer LaBorde The Hearing Center at Medical Center Clinic

Scan this code to view

a quick presentation on the

ReSound Unite Mini Microphone.

Visit us at Booth 1063!



The Listening Brain at

WorkBy James Jerger and mary reagor

It has become increasingly apparent in recent years that cognitive variables, especially attention, play an important role in the response to dichotic

stimulation. In this study the authors asked to what extent such factors might be revealed and quantified by studying auditory event-related

potentials (AERPs) evoked in the process of responding to a dichotically presented semantic

category decision task.



I n 1961 a curious asymmetry in auditory per-ception called the “right-ear advantage” was described by Doreen Kimura, then working in the neuropsychology laboratory of Brenda Milner at the Montreal Neurological Institute. Milner and Kimura were attempting to apply a technique first developed by Donald Broadbent (1958), a British psychologist, who was studying the

apparently remarkable ability of air traffic controllers to process multiple channels of information simultane-ously. Broadbent presented three pairs of dissimilar digits to the two ears simultaneously (i.e., “dichotically”) and instructed the listener to report all digits heard in any order. The technique, now called the “dichotic digits test” is still in clinical use. As Kimura administered the dich-otic digits test to a young adult normal control group she observed that, on average, digits heard on the right ear were reported slightly but consistently more accurately than those heard on the left ear. In the half century since the discovery of this “right-ear advantage” (REA), liter-ally thousands of papers and scores of books have been devoted to the phenomenon.

Much of the research on dichotic listening and its clinical application has been based on relatively simple behavioral responses in equally simple dichotic para-digms (e.g., “You will hear a word in your right ear and a different word, at the same time, in your left ear. Repeat back everything you hear in any order.”). But research over the past two decades (e.g., Pichora-Fuller et al, 1995; Gatehouse et al, 2003; Humes, 2007; Foo et al, 2007; Lunner and Sundewall-Thoren, 2007; Wingfield and Tun, 2007; Rudner et al, 2011) has shown that more complex listen-ing tasks, requiring more sophisticated processing than simply repeating back what was heard, and more complex techniques of analysis such as electrophysiologically recorded auditory event-related potentials (AERPs) better reflect the cognitive processing associated with real-life listening. In particular, AERPs permit fine-grained temporal analysis of the cognitive components associated with listening tasks (Michalewski et al, 1986; Kok, 1997; Nager et al, 2001; Mehta et al, 2009). In this article we ask to what extent AERPs, recorded in response to a complex listening task, can further illuminate the curious interau-ral asymmetries associated with the right-ear advantage.

Word to Right Ear

No Match

No Match

Category Match Right

Category Match Left

Reference Word

Word to Left Ear

Time Time

A. Conventional Dichotic Paradigm B. Semantic Category-Judgment Paradigm

FIGURE 1. Two dichotic listening paradigms: (A) Conventional dichotic paradigm—two different words are presented to the two ears simultaneously; (B) Semantic category-judgment paradigm—a reference word, presented diotically, is followed by two words presented dichotically. The second word to either ear may or may not match the semantic category of the reference word. On each trial the probability that one of the two dichotic words will be a category match is 0.50. The probability that the match word will be presented to the right ear is 0.50.

First Word

Diotic

Second Word

Dichotic

www.otodynamics.com • USA 1 800 659 7776 • International +44 1707 267540 • email [email protected]

Satisfies all OAE CPT codes with Gold Standard OAEs

Now in high resolution color

Booth 1719

OtoportOtodynamics

Audiology Systems

Read more at otodynamics.com/otoport



In the conventional dichotic paradigm, two different linguistic stimuli are presented simultaneously to the two ears: the presentation has usually been via earphones, but loudspeaker presentation is a viable alternative (Jerger and Martin, 2004). The two stimuli may be syllables, words, or sentences. FIGuRE 1A illustrates this paradigm for word pairs presented via loudspeakers arranged at azimuths of 90 degrees (opposite the right ear) and 270 degrees (opposite the left ear). FIGuRE 1B shows the paradigm employed in the present study. It is a variant on the classic semantic category judgment task (Kutas and Iragui, 1998). Participants hear a single-syllable, conso-nant-vowel-consonant (CVC) reference word, presented diotically, followed by a pair of CVC words, presented dichotically. The task is to decide whether either of the dichotically presented words belonged to the same semantic category as the reference word. In the present study there were three conditions of presentation: (1) cat-egory match between reference word and word presented to right ear dichotically (Match Right, or MR), (2) category match between reference word and word presented to left ear dichotically (Match Left, or ML), and (3) no category match between reference word and word presented either to right or left ears dichotically (No Match, or NM). TABLE 1

shows examples of each condition.The task was purposely designed such that listen-

ers had little difficulty in responding correctly to each trial. Our interest lay in examining the degree of percep-tual and cognitive effort necessary to achieve this high

performance level. Auditory event-related potentials evoked by the dichotically presented words were recorded from 30 active scalp electrodes affixed according to the international 10–20 system (Jasper, 1958).

We studied 20 adults with normal hearing aged 18–59 years. All were right-handed by questionnaire. Initial examination of the AERPs evoked by the dichotically presented words revealed that the N1-P2 complex evoked by the onset of the word was followed by a broad negativ-ity extending spatially over the left parietal, central, and frontal regions and temporally over the latency range from approximately 300 to 1000 msec. The following sections describe three dimensions of this evoked activ-ity, waveform morphology, amplitude topography, and latency topography. Interest is focused on comparisons among the three conditions, MR, ML, and NM.

Waveform MorphologyIn general, the waveform of the AERP to an isolated word is characterized by three prominent components, (1) a negative peak, usually denoted N1, in the latency range from 80 to 120 msec, (2) a positive peak, usually denoted P2, in the latency range from 50 to 300 msec, and (3) a relatively slow, negative-going wave, peak-ing in the 400–500 msec range but extending over the latency range from about 300–700 msec. The N1 peak is largely, although not entirely, preattentive (Näätänen and Picton, 1987). It signals the recognition that the onset of an auditory event has been recognized. The P2 peak is

Table 1. Examples of the Three Conditions

Condition Reference Word Dichotic Words

Diotic R L

Match Right (MR) dog cat ball

Match Left (ML) dog car fox

No Match (NM) dog fork hat

www.earserv.com 1-800-992-3726

Staying in touch with your patients is the best way for your practice to grow deeper community roots. It’s good practice management to communicate often and keep your patient list up to date. But sometimes the work of connecting with patients gets pushed too far down the TO DO list.

ESCO’s ConnectCare helps you stay in touch with your patients

ESCO provides you with the tools to reinforce your quality patient care. There is no charge to your practice for these personalized mailings;

• Custom patient satisfaction survey

• Annual recall letter

• Birthday letter with your special message

• Reminder that warranty coverage is about to expire including an offer for ESCO insurance coverage

Check out all the benefits of ConnectCare online at earserv.com.

Call us at 1-800-992-3726 or email us at [email protected]

Connect

with ESCO –

Booth 1513 at

Audiology NO

W



less well understood. It may represent initial evaluation of the general category of the auditory event about to be processed (Shahin et al, 2005). The third component, a relatively slow, negative-going wave, peaking in the 400–500 msec range but extending over the latency range from about 300 to 700 msec, was first described in con-nection with semantic incongruity of words embedded at the ends of sentences (Kutas and Hillyard, 1980) and was originally labeled N400. For this reason negativity over this latency range has often been denoted N400, or N4. More recent evidence indicates, however, that a number of linguistic and cognitive processes may be identified within this latency range. The processing negativity por-tion of the AERP waveform to isolated words apparently reflects the serial and parallel analysis of a number of partially overlapping perceptual and cognitive processes: they include, but are not necessarily limited to, attention (Näätänen et al, 2001), phonological processing (Connolly et al, 2001), semantic processing (Kutas and Iragui, 1998), and semantic memory (Kutas and Federmeier, 2000). In recognition of this complexity, we refer to this component, in the present article, as “processing negativity,” or simply PN (Gomes et al, 2007).

FIGuRE 2 shows illustrative waveforms at electrode CP3 (centro-parietal region over left hemisphere) for the three conditions (MR, ML, and NM). The N1 and P2 components showed little variation across the three conditions. In the case of the processing negativity (PN) component, however, differences among the three conditions were substantial. Depth of processing negativity over this latency range was least for match words presented to the right side, significantly greater for match words pre-sented from the left side, and substantially greater still for nonmatch words. We interpret the differences in PN amplitude shown in FIGuRE 2 to indicate that the depth of processing, that is, perceptual and cognitive demand, was least in the MR condition, greater in the ML condition, and greatest in the NM condition. In other words there was less perceptual and cognitive demand on listeners when a match word was presented to the right side than when it was presented to the left side. We interpret that finding as consistent with a slight REA. In addition it is interest-ing to observe the even greater difference between the

FIGURE 2. Grand-averaged AERP waveforms recorded from scalp electrode CP3 (left hemisphere—centro-parietal region) for the semantic category judgment paradigm under three conditions: (1) Match Right (MR), (2) Match Left (ML), and (3) No Match (NM).

Mean Amplitudes

FIGURE 3. Scalp topographic maps of processing negativity recorded from 30 active electrodes over the latency range from 300–700 msec under three conditions (MR, ML, and NM). Negative activity is maximal over the frontal region of the left hemisphere but evident over both hemispheres. It is least for the MR condition, greater for the ML condition, and greatest for the NM condition.

Topographic Brain Maps



match and no-match conditions. This finding suggests, nonunexpectedly, that there was a greater demand on cognitive processing resources when both words must be analyzed and resolved as “different-from-the-reference-word” than when only one of the two dichotic words must be so analyzed.

Amplitude topographyFIGuRE 3 maps the distribution of evoked voltages across the surface of the scalp for the processing negativity component, for each of the three conditions, MR, ML, and NM: The maps show the scalp topography in the latency range of the PN component (300–700 msec). Differences among the three conditions were substantial. Activity was maximal in the fronto-central region but asymmetric to the left hemisphere. Overall negative activity of the PN component was least in the MR condition, greater in the ML condition, and, again, greatest in the NM condition.

To compare the distribution of mean amplitudes for the two components across coronal electrode arrays we computed mean amplitudes of all 30 electrodes separately for the N1/P2 component and the PN component. Mean

FIGURE 4. Mean negative amplitudes calculated from grand-averaged waveforms across the temporo-parietal coronal array of electrodes for the N1/P2 region (50–300 msec) and the PN region (300–700 msec). Greatest differences between MR and ML conditions occured at left-hemisphere electrode CP3 and midline electrode CPZ.

Dichotic Waveforms

• Better handling of myogenic artifact• Less susceptible to interference• Consistent performance and results• Reduces rescreens and rescheduling• Automated, easy to use• Portable, wireless convenience• Supports HiTrack and OZ SystemsSM

• Dedicated 24/7 customer support

See it. Try it. Believe it.

www.vivosonic.com

Book a free demonstration today!First 10 customers receive a gift.

Tel: 1.416.231.9997E-mail: [email protected]

Newborn Hearing Screening System

Non-Sedated ABR, OAEsNon-Invasive ECochG

Fully Automated ASSR

Advanced Technologiesfor quality hearing diagnostics testing

• Reliable ABR recordings without sedation• Superior digital signal processing methods• Patented bio-amplifer reduces interference• Easy-to-use wireless recording• Choice of OAE probe for pediatric use

Practical Advantagesover popular systems on the market

Now available with insert earphones!

Better quality, reliability, usability, performance and more.

iieess

New from

Simply better!



amplitude is a measure proportional to the area under the waveform across the 50–300 msec range for the N1/P2 component and across the 300–700 msec latency inter-val for the PN component. The maximal intercondition differences appeared at the electrodes across the temporo-parietal coronal array. These mean amplitudes are shown in FIGuRE 4. Again we see equivalent results across condi-tions for the N1/P2 complex but substantial intercondition effects for the PN component. The greatest differences between MR and ML conditions occurred at the centro-parietal 3 (CP3) and centro-parietal midline (CPZ) electrode sites. The REA (difference between MR and ML mean amplitudes) was slightly larger over the left hemisphere.

Latency topographyIt is often the case that latency of an AERP component is taken as the latency at the peak of the component. FIGuRE

5 shows these latencies for the N1 and PN peaks at the MR, ML, and NM conditions. In the case of both compo-nents there was little or no systematic variation across the three conditions. But, as shown in FIGuRE 2, the actual

differences across the three waveforms over the entire extent of the PN component, rather than solely at the peak, were substantial. Such waveform differences are better evaluated by means of cross-correlation analysis (Stanley, 1975; Stearns, 1975). This is a mathematical technique that can be employed to quantify the similarity between two ERP waveforms. Since each is comprised of voltage levels at discrete time intervals, one can compute the Pearson product-moment coefficient of correlation (r) between the two waveforms. The resultant r expresses the degree of similarity between the two waveforms. Suppose that one waveform is displaced in time by a specified interval (e.g., 1 msec) relative to the other wave-form and the correlation coefficient is recomputed. Let

“tau” represent the degree of time displacement in either direction. If the Pearson r is recomputed as a function of tau, the result is a function relating tau to r. The tau value at which this “cross-correlation function” is maximized (i.e., the tau value at which the r is greatest) indicates how much temporal delay of one waveform is needed relative to the other waveform in order to maximize the similarity

FIGURE 5. Mean peak latencies calculated from grand-averaged waveforms across the temporo-parietal coronal array of electrodes for the N1 negative peak and the PN negative peak. Differences among conditions were small for both peaks.

Peak Latencies

FIGURE 6. Tau values derived from maxima of cross-correlation functions comparing MR and ML conditions across five coronal electrode arrays. All show a right-ear latency advantage ranging from 20 to 45 msec over the extreme left electrode site, then declining systematically to zero as the electrode site moves from the extreme left to the extreme right hemisphere.

Dichotic—MR vs. ML (Tau in msec)



between them. The tau value is, in effect, a measure of the overall latency difference between the two wave-forms. If, for example, the waveform evoked by stimulus presentation from the right side of space must be delayed by 46 msec in order to maximize the r value between right-sided and left-sided waveforms, then it could be argued that right-sided presentation enjoys a 46 msec

“advantage” over left-sided presentation with respect to the relative latencies of the two waveforms.

In FIGuRE 6, tau, comparing MR and ML conditions, is plotted against electrode position for five different coro-nal electrode arrays, frontal, fronto-temporal, temporal, temporo-parietal, and parietal. In all arrays tau values (latency differences) are greatest over the left hemisphere, indicating a right-sided latency advantage, or REA: this REA declines to zero as the electrode site moves from the far left to the far right hemisphere. FIGuRE 7 shows tau values for four cross-correlation analyses across the temporo-central electrode array. The function denoted by the grey squares is repeated from FIGuRE 7. It compares the MR and ML conditions over the PN latency interval

www.weitbrecht.com1-800-233-9130 (V/TTY)

1500 Olympic BlvdSanta Monica, CA 90404 email: [email protected]

Available through:

See for YourselfCapTel® captioned telephone shows

word-for-word captions of everything a

caller says, helping people to understand

every word — even if they have difficulty

hearing it.

> Powerful amplification up to 40dB

> Large easy-to-read display

> Works with free service to

show captions

> Enables patient to hear what they

can and read what they need to

FIGURE 7. Tau values across temporo-central electrodes, comparing MR vs. ML, MR vs. NM, ML vs. NM, and as control, N1/P2 Match vs. NM.

Dichotic Cross—Correlation Comparisons Temporo—Central Electrodes (Tau in msec)



from 300–700 msec: The REA is maximal over the left hemisphere, declining to 0 at the far right hemisphere (T8) electrode. The function denoted by the red diamonds plots tau values for the comparison between the MR and NM conditions over the PN latency range. Not unexpect-edly the REA is greater for this comparison. It should be noted, however, that the slope of the function is similar to the MR versus ML function, showing maximal right-sided advantage over the left hemisphere. The function denoted by the blue diamonds shows tau values for comparisons over the N1/P2 latency range from 50–300 msec. Not unexpectedly these tau values are close to zero advantage across the entire electrode array. Finally, the function denoted by the maroon circles shows tau values when the comparison is between the ML and NM conditions. Here, predictably, there is a left-ear advantage (LEA) over the entire electrode array. The figure shows, moreover, that this LEA is slightly greater over the right hemisphere.

discussionResults can be summarized as follows:

1. The right-ear advantage (REA) appears in the pro-cessing negativity (PN) component of the AERP as a reduction in the depth of negativity in the MR condi-tion relative to the ML condition. In addition, depth of processing in both the MR and ML conditions is less than the apparent processing demand in the NM condition.

2. This observation is consistent with the concept that “Same” judgments involve less processing demands than “Different” judgments. In both the MR and ML conditions, the semantic category of one dichotic word is judged “Same” as the category of the reference word: the other dichotic word is judged “Different.” However, in the NM condition both dichotic words are judged

“Different” from the reference word.

3. Cross-correlational comparisons of waveforms across the three conditions reveal that the latency difference between MR and ML conditions is greatest over the extreme left hemisphere, declining to zero over the extreme right hemisphere. Latency differences are greatest between the MR and NM conditions. One may also observe a left-ear advantage (LEA) by comparing the ML with the NM condition. Here the effect is great-est over the extreme right hemisphere and declines gradually over the midline and left hemisphere.

4. In a dichotic listening paradigm, the combination of a more cognitively complex listening task with measures of auditory event-related potentials (AERPs) yields a greater array of relevant data than the percent correct scores provided by a conventional behavioral approach. From the present data one may extract the following measures: (a) MR versus ML differences in PN amplitude and cross-correlational latency, (b) MR ver-sus NM differences in PN amplitude and latency, (c) ML versus NM differences in PN amplitude and latency, (d) MR versus ML differences in hemispheric asymmetry, (e) MR versus NM differences in hemispheric asym-metry, (f) ML versus NM differences in hemispheric asymmetry. In addition one may employ the N1/P2 responses as a check on the validity of asymmetries observed later in the waveform.

For an example of how such information might improve auditory processing disorder (APD) evaluations, consider the problem of differentiating genuine APD from a purely attentional problem. We have shown not only that depth of perceptual and cognitive demand is greater for left-sided than for right-sided matches but also that there is an even greater processing demand for the NM condition. This provides a framework for evaluating the extent of interaural asymmetry in the Match conditions against the degree of processing reflected by the NM data. Within such a framework it should be possible to separate a genuinely abnormal interaural asymmetry (e.g., abnormal left-ear deficit) from an inability to marshal the attention necessary to address the dichotic stimuli adequately. In the case, for example, of genuine left-ear deficit, a large difference in PN depth for MR versus ML waveforms should be accompanied by a normal relation between processing depths of MR and NM waveforms. In the case of an inability to marshal adequate attention, however, one might anticipate an equal lessening in the depth of all three PN components.

ALSO OF INTERESTAcademy Clinical Practice Guideline

“Diagnosis, Treatment and Management of Children and Adults with Central Auditory Processing Disorder.” Log in to www.audiology.org and search keyword “CAPD” or scan the QR code to view the guideline on your mobile device.



Another opportunity to assess the nature of abnormal left-ear deficits is provided by the ability to contrast the hemispheric distribution of the right-ear latency advan-tage relative to the NM condition with the left-ear latency advantage relative to that same NM condition. Will the normal relationships hold, or will they be grossly dis-torted by a left-sided abnormality?

In summary, we can mine the dichotic listening paradigm for more information by two changes in our approach: (1) changing from a simple “repeat back” response to a more complex listening task requiring a cognitive decision; (2) taking advantage of the temporal precision provided by auditory event-related potentials.

James Jerger, PhD, is distinguished scholar-in-residence in the School of Behavioral and Brain Sciences, University of Texas at Dallas (UTD), Richardson, TX. Mary Reagor, MS, is a graduate student in the Cognition and Neuroscience Program at UTD. This study was completed in partial fulfillment of her doctoral research program.

References

Broadbent D. (1958) Perception and Communication. Oxford: Pergamon Press.

Connolly J, Service E, D’Arcy R, et al. (2001) Phonological aspects of word recognition as revealed by high-resolution spatio-temporal brain mapping. Cogn Neurosci Neuropsychol 12:1–7.

Foo C, Rudner M, Ronnberg J, et al. (2007) Recognition of speech in noise with new hearing aid compression release settings requires explicit cognitive storage and processing capacity. J Am Acad Audiol 18:553–566.

Gatehouse S, Naylor G, Elberling C. (2003) Benefits from hearing aids in relation to the interaction between the user and the environment. Int J Audiol 42(Suppl. 1):S77–S85.

Gomes H, Duff M, Barnhardt J, et al. (2007) Development of auditory selective attention: event-related potential measures of channel selection and target detection. Psychophysiology 44:711–727.

Humes L. (2007) The contributions of audibility and cognitive factors to the benefit provided by amplified speech to older adults. J Am Acad Audiol 18:590–603.

SavesYou Time

SavesYou

Money

GrowsYour Brand

Identity

©2011 Elite Hearing Network 5822NATA

Exclusive Discounts from 8 Major Hearing Aid Manufacturers

Boston • March 28-31

Your Success Is Our Business!

Learn more, Visit booth #1673

Imagine having a support team of industry leaders focused on the

success of your business.

The Elite Hearing Network is just that. We are 100% focused on helping you succeed on your terms... you choose how much support you want and where. You retain complete

control of your business.Membership is FREE

with no minimumcommitment.

Business Intelligence • Full Service Marketing • HearPOReferrals • Financing Solutions • Best Practices

Retirement Plan • FREE Membership

Make your practice more successful.

Call Today 877-703-3508or visit www.elitehearingnetwork.com

5822_NATA AAA_PreShow_AudiologyToday_Layout 1 11/16/11 1:21 PM Page 1



Jasper H. (1958) The ten-twenty electrode system of the International Federation. Electroencephalogr Clin Neurophysiol 10:370–375.

Jerger J, Martin J. (2004) Hemispheric asymmetry of the right ear advantage in dichotic listening. Hear Res 198:125–136.

Kimura D. (1961) Cerebral dominance and the perception of verbal stimuli. Can J Psychol 15:166–171.

Kok A. (1997) Event-related potential (ERP) reflections of mental resources: a review and synthesis. Biol Psychol 45:19–56.

Kutas M, Federmeier K. (2000) Electrophysiology reveals semantic memory use in language comprehension. Trends Cogn Sci 4:463–470.

Kutas M, Hillyard S. (1980) Reading senseless sentences: brain potentials reflect semantic incongruity. Science 207:203–205.

Kutas M, Iragui V. (1998) The N400 in a semantic categorization task across 6 decades. Electroencephalogr Clin Neurophysiol 108:456–471.

Lunner T, Sundewall-Thoren E. (2007) Interactions between cognition, compression, and listening conditions: effects on speech-in-noise performance in a two-channel hearing aid. J Am Acad Audiol 18:539–552.

Mehta J, Jerger S, Jerger J, et al. (2009) Electrophysiological correlates of word comprehension: event-related potential (ERP) and independent component analysis (ICA). Int J Audiol 48:1–11.

Michalewski H, Prasher D, Starr A. (1986) Latency variability and temporal interrelationships of the auditory event-related potentials (N1, P2, N2, and P3) in normal subjects. Electroencephalogr Clin Neurophysiol 65:59–71.

Näätänen R, Alho K, Schroger E. (2001) Electrophysiology of attention. In: Pashler H, ed. Steven’s Handbook of Experimental Psychology. Vol. 4. New York: Wiley, 601–653.

Näätänen R, Picton T. (1987) The N1 wave of the human electric and magnetic response to sound: a review and an analysis of the component structure. Psychophysiology 24:375–425.

Nager W, Rosenthal O, Bohrer I, et al. (2001) Human event-related potentials and distraction during selective listening. Neurosci Lett 297:1–4.

Pichora-Fuller M, Schneider B, Daneman M. (1995) How young and old adults listen to and remember speech in noise. J Acoust Soc Am 97:593–608.

Rudner M, Ronnberg J, Lunner T. (2011) Working memory supports listening in noise for persons with hearing impairment. J Am Acad Audiol 22:156–167.

Shahin A, Roberts L, Pantev C, et al. (2005) Modulation of P2 auditory evoked responses by the spectral complexity of musical sounds. Neuroreport 16:1781–1785.

Stanley S. (1975) Digital Signal Processing. Reston, VA: Reston.

Stearns S. (1975) Digital Signal Analysis. Rochelle Park, NJ: Hayden.

Wingfield A, Tun P. (2007) Cognitive supports and cognitive constraints on comprehension of spoken language. J Am Acad Audiol 18:548–558.

Assist your clients with:

* Tinnitus* Hyperacusis* Auditory Processing* Ear related dizziness* Aural rehabilitation

Using the latest neuroscience technology, Sound Therapy offers a portable tinnitus treatment that goes beyond the standard tinnitus management plan.

What is Sound Therapy?Sound Therapy is a portable listening program which enhances ear and brain function. It uses spectrally altered classical music to enhance neural plasticity and brain integration. It is based on the proven science that music can be used to stimulate new brain pathways. The program has evolved over 70 years of development by pioneering scientists in the fields of medicine, psychology, audiology and music therapy.

Who is Sound Therapy for?Sound Therapy is of particular benefit to both adults and children with auditory problems. Primarily used to alleviate tinnitus, it also helps associated symptoms such as anxiety, sleep disorders, hyperacusis, background noise discrimination, dizziness, ear pressure, auditory processing problems, sensory processing disorder,speech problems and more.

AUDIOLOGISTSDo a short course to add Sound Therapy to your practice.

* Take our 6 hour self Study course

* Register as a Sound Therapy consultant

* Help your clients to achieve better ear and brain health Visit www.SoundTherapySYNERGY.com/Audiology for further information or contact US Audiological Support Director Dr Donna Segal on (317) 691-2369

Portable - Affordable - EasyPortable - Affordable - Easy

Sound Therapy

SYNERGY

Sound Therapy SYNERGY New Tinnitus Treatment

Sound Therapy SYNERGY New Tinnitus Treatment

Sound Therapy SYNERGY is a scientifically based, portable treatment that can now be easily incorporated into an audiology practice. Spectrally activated classical music is combined with multi-sensory exercises and support tools. The ease and accessibility of this treatment makes it an attractive choice for the tinnitus patient.

For Audiologists, Sound Therapy is a tool to help those hard to treat conditions such as tinnitus, hyperacusis, dizziness, Central Auditory Processing Disorder and figure ground discrimination. By stimulating the ear mechanism and re-mapping the auditory pathways, Sound Therapy brings varying levels of relief to these conditions. It may also improve hearing aid compliance by reducing central auditory processing disorder.

Recent research into brain plasticity has revealed how auditory remapping can help to reduce tinnitus symptoms. Research has shown that "by providing the right input, in a frequent, intense manner for a long enough period of time, firing patterns in the brain become more organised and efficient. This added stimulation helps the auditory pathways to process sound in a more normal fashion. Sound signal reception is changed in the auditory cortex so that the brain can finally make sense of the signals it receives. "

Because Sound Therapy is portable, affordable and easy, it can easily be incorporated into any clinical practice or any person's daily routine.

The Sound Therapy is used to achieve auditory remapping, which goes beyond the normal goals of music therapy. In this program the music is specially filtered so as to stimulate and improve auditory function. In this structured program the sound progresses through several stages to reduce the impact of tinnitus over the initial six month time frame.

The frequencies in the music are altered and the high frequencies are progressively enhanced. Simultaneously, other tones are used to partially mask the tinnitus noise to create a different response in the nervous system.

After an enthusiastic reception at the ADA conference in Florida last year, Sound Therapy SYNERGY will be attending AudiologyNOW! in Boston, March 2012.For current updates and the latest information on Sound Therapy SYNERGY visit www.Sound.TherapySYNERGY.com/Audiology

Sound Therapy SYNERGY resonates with audiologists

ADVERTISEMENT


TrusT levels are consistently correlated to a patient’s decision to follow a health-care provider’s recommendations. The more patients trust their health-care providers, the more likely they will follow recommendations for treatment and continue doing business with them in the future.


By KrIs engLIsh and gyL KaseWurm

AudiologyandPAtient trust

B uilding and establishing relationships of trust with patients and referral sources can be extremely challenging. Audiologists could be pardoned for sometimes wondering if, within the field of health

care, we have more than our share of challenges in this area. When we sit down with a new patient for the first time, it is not uncommon to notice one or more resistance indicators—years of waiting, minimal enthusiasm for improving the status quo, and second-hand reports from friends and family about hearing aids that did not help. It is a tough position to be in—we’ve only just met this person, yet already we are playing catch-up in the trust department.

It seems that people are becoming more and more cynical of pro-fessional service providers, which is not surprising considering that a reputation can be ruined in a matter of seconds by a disgruntled patient on Twitter. Unfortunately, many inexperienced or impatient audiologists would rather “close a sale” than take the requisite time to build a rela-tionship that will result in patient trust. Even when patients are eager for help and open to suggestions, there still is the matter of us. Why does a patient trust us? What can we say and do to be worthy of that trust, and is it important to try?

These are important questions to consider, especially the last one—is it important to try? The evidence in the “trust literature” strongly indicates


audiology and Patient Trust

yes. Trust levels are consistently correlated to a patient’s decision to follow a health-care provider’s recommenda-tions (for example, see FIGuRE 1). Simply put, the more patients trust their health-care providers, the more likely they will follow recommendations for treatment and con-tinue doing business with them in the future. Hall et al (2002) contend that of all the variables that affect patient success, trust “may prove to be the most fundamental relationship attribute, one that pervasively affects behav-iors, outcomes, and other attitudes.”

In many respects, our ability to engender patient trust may be the most important asset of an effective audiolo-gist (Taylor, 2009). And yet, although “we know it when we see it,” we may be hard pressed to describe trust. Our working definition is drawn from Thom et al (2004), who describes trust as “the acceptance of a vulnerable situa-tion in which the truster believes that the trustee will act in the truster’s best interests.” The truster—that is, our patient—will not immediately assume we are trustworthy. This “state of grace” has to be earned. As the “trustee,” we bear the professional burden of demonstrating our trust-worthiness. How is this done?

to trust or not to trust?Patients decide to trust us when they perceive that we are technically competent, we put the patient’s welfare first, and we possess interpersonal competence (Thom et al, 2004). In addition to providing complete and honest information, interpersonal competence includes the abil-ity to build relationships, listen, understand, and express care. These interpersonal skills are demonstrated by both

“word and deed”—what we say, how we say it, what we do, and how we do it. Since audiology especially struggles with patient adherence, we must give particular consid-eration to words and deeds that engender trust. Following are four field-tested suggestions for consideration; how-ever, we conclude with a call to action for a more scholarly approach to this topic.

one: effective Communication Builds trust

Listening One of the hallmarks of a successful audiologist is the ability to be a skilled listener. The basis of a successful patient consultation is being able to ask probing questions and then patiently wait for the answers. Asking effective questions and taking the time to really listen and evaluate the answers is a skill that develops with time and experi-ence. Gathering information about a patient will enable an audiologist to effectively assess patient needs and develop the most appropriate solutions that address those needs. Being a good listener is not an easy skill to acquire, especially when sitting face to face with a patient explain-ing his or her hearing loss for what seems to be the 100th time. It is easy to anticipate what you think a patient is going to say and jump to a solution before a patient is ready to accept it. It is important to give patients time to relate their hearing problems in a friendly and relaxed

FIGURE 1. Thom et al (2002) categorized 732 patients as having high, moderate, or low trust per scores on the Patient Trust in Physician Scale. The higher the trust level, the more often patients said “yes” to the question, “Do you intend to follow your doctor’s advice?”

Intend to Adhere to Rx?

HIG

H T

RU

ST

MO

D T

RU

ST

LOW

TR

US

T

91%84%

53%



environment and not to rush to a conclusion before the patient is ready to accept one.

Fully attentive listening means undistracted listening. For instance, while it is a common and effective practice today to use computers to record patient notes, we must keep our eyes on patients as much as possible. Otherwise, no matter what we say, we will not appear to be really listening to everything they have to say.

our turn in the ConversationFor our part, we respond to indicate our understanding of a patient’s situation, and advance the conversation with our recommendations. The more effectively we respond to our patients’ concerns, the more opportunities we create to earn a patient’s trust (Taylor, 2009). However, effective communication skills cannot be taken for granted; even the most technically proficient audiologist is doomed to fail if he or she is unable to discuss solutions or the price of those solutions with a patient.

The importance of effective communication skills was supported by a recent meta-analysis (Zolnierek and DiMatteo, 2009), which reported a strongly positive and significant relationship (p < .001) between patients’ deci-sions to adhere to health recommendations and their health-care providers’ ability to communicate effectively. Specifically, the authors found that the odds of adherence to recommendations are 2.16 higher if we communicate effectively with our patients.

But what exactly is effective communication? According to patients, effective communication occurs when the health-care provider (Fiscella et al, 2004)

� elicits and validates patients’ concerns,

� inquires about patients’ ideas and expectations,

� assesses the impact of symptoms on functioning, and

� responds to patients’ emotional distress with empathic language.

Readers will recognize that effective communication as described here is consistent with counseling skills described in audiology literature (Clark and English, 2004).

two: satisfaction Builds trustPatients who achieve new and sometimes difficult goals for their hearing health do so in large part because they are actively involved in the process of learning to hear bet-ter, and realize that satisfaction is directly related to their effort and involvement in that process. Audiologists who

Interpersonal skills are demonstrated by both “word and deed”—what we say, how we say it,

what we do, and how we do it.

How do you measure success?

Audiologists who use our patient newsletter report patient satisfaction ratings greater than 92%

✓ Improved patient satisfaction✓ Increased patient loyalty✓ More patient referrals

For a free trial issue, call 800-342-1643

Hearing HealthCare News®

www.hearinghealthnews.com



Even the most technically proficient audiologist is doomed to fail if he or she is

unable to discuss solutions or the price of those solutions with a patient.



work in true partnership with their patients are not satis-fied until their patients are satisfied, and never assume that “all is well” but are continually checking in with their patients and having honest dialogues about whether their expectations are being met. However, it is critical to remember that patient satisfaction is often transient.

A patient may be satisfied today but become dissatis-fied tomorrow if an expectation isn’t met or if they feel that we are rushing through an appointment or exhibiting an uncaring attitude. We can’t expect a patient to reveal every fear, bias, or concern they have regarding better hearing the first time we meet with them. This intimacy should evolve over time as the level of patient trust increases.

three: good Business Builds trustWe cannot expect to earn our patients’ trust if we provide faulty products or low-quality services. People want value for their hard-earned dollars. We should strive to add value to the relationship by only offering the best. When we give our word that we will deliver a product or service, make sure it can be done as promised and in

a timely manner. Nothing destroys a relationship faster than broken promises. It’s rare for many customers to get service that goes above and beyond what’s expected. If we exceed client expectations, we will gain a competitive advantage while building patient trust. Once in a while, however, a product or service just doesn’t work out for a patient, and when this happens, the best and sometimes only way to remedy dissatisfaction is to give the patient their money back.

Four: truth in Advertising Builds trustThrough the decades, audiologists have typically mar-keted directly to consumers, using traditional advertising media as the primary method for acquiring new patients. Consider the number of messages that an average patient receives each day. It is not surprising that a patient would doubt an audiologist’s motivation when our typical mar-keting messages are filled with ads that promote “two for one” or read, “Wanted: 30 hearing-impaired persons for a special study.” Many of the messages communicated by audiologists to consumers throughout the years have

Live from AudioLogynow!® in Boston!

2012 mArion downs Lecture in PediAtric AudioLogythe diLemmA of dizziness in chiLdren (.15 CEUs)

fridAy, mArch 30, 10:00 Am et

Presented By LindA Luxon, cBe Bsc frcPuniversity college London

free web seminar available through eAudiology. visit www.eAudiology.org to register.

funded by the AAA foundation with a grant from the oticon foundation.



been related to products and technology, and really don’t promote the benefits of better hearing or the advantages of working with a qualified audiologist. Many patients don’t seek the help of an audiologist until they have seen multiple ads promoting low-cost and easy solutions to their complicated hearing problems. Unfortunately, it may take a great deal of time and multiple patient visits to dispel the notion that successful outcomes are inevitable and can be accomplished easily with little effort from the hearing impaired consumer.

To help patients focus on us and our desire to earn their trust, marketing efforts of an audiologist should pro-mote the benefits of better hearing and the need to work with a qualified and patient-centered professional rather than promoting specific products and/or price specials. Too often, audiologists take the easy way out and rely on ads developed by manufacturers that focus on products instead of developing their own marketing campaigns that promote the personal brand of their business.

Product-focused marketing can mislead patients into believing the more that they spend, the better the solution will be, and this can create unrealistic expectations. Our goal should be to educate consumers on the benefits of better hearing while also reminding them of the integral role that the audiologist will play in that process. Patients who are misled into believing that a product alone will solve their problem are almost always dissatisfied, and that dissatisfaction will not lead to a trusting relationship with the person who sold them that product, namely us.

A Call for ActionSince trust levels are correlated to patient adherence, we’ve offered four suggestions to help engender patient trust in audiology practice. However, the profession must move beyond suggestions and address the topic of patient trust with our own evidence. Unlike medicine, audiology currently has no way to measure patient trust, except informally through patient retention and word-of-mouth referrals. We would be naïve to assume that a system-atic understanding and evaluation of patient trust is not necessary. Should we adapt one or more of the existing trust scales designed for medicine? Or should we develop a scale that specifically addresses audiology concerns? Trust is a key consideration, as patients decide whether to pursue hearing help. As an issue so closely related to patient success, our attention to patient trust is overdue.

Kris English, PhD, is a professor with the University of Akron/NOAC, and Gyl Kasewurm, AuD, is owner of Professional Hearing Services Ltd in St. Joseph, MI.

References

Clark JG, English K. (2004) Counseling in Audiological Practice: Helping Patients and Families Adjust to Hearing Loss. Boston, MA: Allyn & Bacon.

Fiscella K, Meldrum S, Franks P, Shields C, Duberstein P, McDaniel SH, Epstein RM. (2004) Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care 42(11):1049–1055.

Hall MA, Dugan E, Camacho F, Kidd K, Mishra A, Balkrishnan R. (2002) Measuring patients’ trust in the primary care providers. Med Care Res Rev 59(3):293–318.

Taylor B. (2009) Discovery/fulfillment: a consultative selling system for audiologists. Audiology Online. http://www.audiologyonline.com/articles/article_detail.asp?article_id=2182.

Thom D, Hall MA, Pawlson LG. (2004) Measuring patients’ trust in physicians when assessing quality of care. Health Affairs 23(4):24–132.

Thom D, Kravitz R, Bell R, Krupat E, Azari R. (2002) Patient trust in the physician: relationship to patient requests. Fam Pract 19(5):476–483.

Zolnierek KBH, DiMatteo MR. (2009) Physician communication and patient adherence to treatment: a meta-analysis. Med Care 47:826–834.

ALSO OF INTEREST“What Type of Impression Is Your Office Making?” by Tracey Irene (AT March/April 2010). Log on to www.audiology.org and search keywords “type of impression” or scan the QR code to view this article on your mobile device.



By davId FaBry and KaThLeen devLIn CuLver

business the

influenceof

Audiology MeAns Business. That’s the theme of AudiologynoW!® 2012. How appropriate, then, that this will be the setting for the American Academy of Audiology Foundation’s inaugural offering of the improving Patient Care Through innovation in Workplace Management lecture.

Candace Bertotti, a member of the facilitator faculty of VitalsmartsTM, will present “influencer: How to Create Change in your Audiology Workplace.” Vitalsmarts influencer Training was selected as a 2009 Top Training Product of the year by Human Resource executive® magazine, and Bertotti’s presentation will provide tools for audiologists who strive to positively impact future behavior of patients, staff, and colleagues. ABA Tier one continuing education will be available for this lecture; it will also be Webcast live from Boston on March 31 and on-demand through June 30 on eAudiology.org. This presentation is underwritten with a generous grant from Phonak Hearing systems.

Recently, david Fabry, Phd (Audiology Today Content editor and member of the Foundation Board) and Kathleen devlin Culver (Foundation director of operations and development) had a moment to engage in a crucial conversation with Candace Bertotti and laura Potter, media relations specialist, for Vitalsmarts.


The Business of Inf luence

hank you so much for joining us today. Candace, what attracted you to a career in leadership development? Candace Bertotti (CB): Well, my first interest is in making a meaningful and positive difference for people. I think I am motivated by a sense of gratitude and purpose, but it also fits my skill set well. I am a strong extrovert, and feel comfortable in large groups, so it is also what I’m good at.

I see. Laura, can you describe a brief history of the course development at VitalSmarts (Crucial Conversations, Influencer, etc.)? Laura Potter (LP): Sure. The VitalSmarts cofounders are also the coauthors of our four best-selling books and training programs, including Influencer. They first came together in 1990 with the mission to increase humanity’s capacity to change for good. With their organizational behavior background, they decided that this mission is best accomplished through the path of corporate training through VitalSmarts. We believe that classical application of good social science can enable organizations to be substantially more effective, adding value to the world. Basically, to make workplaces more humane and empower individuals to achieve much more of what they want from life.

Fantastic. From that description, it seems to me like the breadth of this approach can reach a wide variety of clinical, business, and medical/health-care environments.LP: Definitely. VitalSmarts is based on more than 30 years of ongoing research, and we have consulted and trained with more than 300 of the Fortune 500 to help them realize significant results. The companies have been in industries all across the board. Some of our main verticals, however, have been health care and safety. Specifically, we’ve completed high-leverage research to help those industries achieve the results that matter most in communication and behavior change, but we have a variety of skills that can be applied within any job setting.

I just finished Influencer: The Power to Change Anything, which describes the “six sources of influence” model. Chapter 3 talks about how the ability to relay real experiences through storytell-ing provides everyone with an influence tool that is both accessible and powerful. Is there a spe-cific catalyst or story that led to the development of VitalSmarts, or was it the collective experience of the four founders?LP: My understanding in speaking to the founders is that there wasn’t a specific incident, but there was a clear evolution. The first book, Crucial Conversations, was writ-ten to see how they could make changes in people’s lives through focusing on interpersonal communication. We did a study that shows that employees who avoid crucial conversations in the workplace waste $1,500 year and an eight-hour workday. So, getting employees and people with the skills to speak with complete candor and respect, regardless of the issues or persons involved, makes a huge difference. What the founders realized, however, was that Crucial Conversations didn’t provide clear direc-tion for how to handle conflict, broken promises, and violated expectations. So, they wrote Crucial Confrontations, which is focused on developing a model to help people actually influence change to correct those behaviors that were causing them to not follow through on commit-ments. Influencer is focused on corporate change and the need for individual, self-directed change. That’s a brief summary of the evolution of this curriculum.

Thank you for that overview. What sets this model apart from others used in corporate environments?LP: The Influencer Model shows that those who use, in combination, six sources of influence in personal, social, and structural categories are 10 times more likely to suc-ceed in their team’s efforts. Our research was published in MIT Sloan Management Review (www.vitalsmarts.com/userfiles/10xinfluence/influencerresearchreport.pdf).



Excellent. Candace, have you worked with other management models, and what is it that attracted you to VitalSmarts as an approach for leadership development?CB: One thing that sets this model apart is that there’s a lot of thought given to how participants learn and how research is presented in a way that really connects to people’s lives and results. For example, I won’t just stand up and give a lecture at AudiologyNOW!, I’m going to make sure the group is interacting with one another, that they are looking at videos, working with partners, really engaged and thinking about the connection to “real life.” Something VitalSmarts does in all of their training is to think about how participants will leave with a direct connection between the model and how it will help them get results.

It sounds to me like this might apply to clinical environments as well, because we are often faced with patients who are not personally engaged—or motivated—to wear amplification because they fail to make a connection with how a device can improve their overall communica-tion skills. CB: Absolutely, and I would even expand on that. What I hear you saying is that there’s an implied personal ability and personal motivation. I would extend that to examine the other reasons that they are not wearing their hearing aids—the Influencer Model makes you think about the other reasons. That is:

1. Is there peer pressure in their social circle?

2. Are there people that are enabling or inhibiting them from being able to wear a hearing aid?



3. Structurally, are there health-care resources that are going to cover this and increase the person’s ability to purchase it?

4. What are the current incentives?

When we diagnose the issues using these tools, we realize there are many reasons why people are not wear-ing their hearing aids. It’s not just their own personal ability and motivation; there are other people involved and outside motivators involved, and the more precisely we can diagnose why the individual is not wearing or getting hearing aids, the more precisely we can pre-scribe a solution and a strategy.

Well, you certainly understand the issues. As the book Influencer points out, there are often many issues and many barriers. If we can iden-tify and isolate the critical ones, we move from being overwhelmed or paralyzed by the array of choices to being able to identify a specific solu-tion that enables us to act.CB: True, as long as we avoid the pitfall that complex problems always require simple solutions. An overwhelm-ing problem makes change inevitable, but what is critical is how we boil it down to a few vital behaviors that need to change and then overwhelm those vital behaviors with sources of influence.

Is there a single element of the “six sources of influence” that is typically the most difficult one for people to achieve competence?CB: No, there is not any one source that is more influen-tial than another or that is more challenging than another, but I find what is challenging is what Laura said: people often think that complex problems require simple solu-tions. For example, Grandpa won’t wear his hearing aids, so therefore we need to motivate him. We try to give him a pep talk, light a fire under him, and in fact, a big pep rally might not be the reason at all. We think we’re doing something, but in reality there are many other reasons

we’re not addressing that we need to address in order to get him to wear his hearing aids.

Obviously, this extends to the business environ-ment as well. CB: Yes, you can use the same approach with a company or a medical practice. For example, if you want to increase the bottom line in your business, you might think you

need to upgrade your computer system to provide better results. Of course, in real-ity there are many reasons why we’re not hitting our numbers and getting the results we want. It’s a pitfall because we think we’re doing some-thing, and we think we are moving forward when in reality, we’re

just choosing one simple solution for this very complex problem. It goes back to what Laura was saying about simultaneously using as many of the sources as possible to achieve results.

We live in a society now where we’re looking for a “silver bullet,” a simple solution to complex problems, and what you’re saying is that com-plex problems often require complex solutions. What you are both saying is that the balance of power shifts when multiple sources of influence are used to provide exponential capacity for achieving complex solutions that are not pos-sible individually—right? The scalability of this includes environments as diverse as Grandpa’s decision to purchase hearing aids and the strate-gies used by a practice or clinic to grow their business. Do you have another specific example in other medical settings that you can share?CB: One exciting example was related to a customer sat-isfaction study. A particular hospital wanted to figure out the vital behaviors necessary to provide a positive deviant for customer satisfaction. They looked at hospitals that had really high scores in customer satisfaction and asked

“what are they doing differently?” What they found in their

...we [must] avoid the pitfall that complex

problems always require simple solutions.

Let’s make it easier – together! To hear more about how Oticon can support you, call us today on the exclusive Pediatric line at 888-684-7331 and speak with one of our pediatric audiologists or customer specialists. And to see how we can help you solve other pediatric challenges, visit www.making-it-easierusa.com.

Real Life Challenges

So where will you find the answers you need?

When fitting children – particularly if you’re not doing it every day – it’s not just about being able to offer good products at favorable prices. It’s about being able to get support whenever you need it from people who understand the challenges you face. Work with Oticon, and experienced pediatric account managers will be ready to help you achieve your professional goals. Work with Oticon, and a team of Pediatric and FM specialists will be at your disposal whenever you have ques-tions that need answering – with a dedicated phone line just for you.

Oticon Pediatrics – for dedicated solutions AND qualified support

People are ready to help“The fact that there’s a dedicated pediatric team at Oticon makes me do my job better. When I have a question and I call up, some-

one can always navigate me through it. Parents have also called up to ask questions and they’ve always been met with a really wonderful reception from everybody on the telephone.”

Anita-Stein Meyers, AuD, CCC-A Shelley & Steven Einhorn Audiology Ctr Center for Hearing and Communication New York, NY



research is that they did five things to get results in every interaction with patients.

1. Smile,

2. Make eye contact,

3. Identify yourself,

4. Let people know what you’re doing and why, and

5. Ask the patient if there is anything else that he or she needs.

They created a robust influencer strategy around these behaviors and increased their customer satisfaction scores dramatically.

One thing that stands out about this example is that it required analysis of the current system and a commitment to change behavior. In audiology, like many other professions, we are often resis-tant to change because it is easier to keep doing things the way we have always done them. The most common excuse is that we don’t have time to make a change. How do you address that?CB: Coming up with an influence strategy that’s effec-tive and comprehensive takes time. It takes time for me to think thoughtfully about how I can improve results in my practice, but not doing that is going to cost me more time. It does take time, but the alternative takes longer.

One of the first examples in Influencer detailed the complications with the eradication of the guinea worm disease in West Asia and Sub-Saharan Africa, effectively attempting to eliminate a global disease without finding a cure. It reminded me of our efforts to educate the public regarding noise-induced hearing loss. Through regulation of allowable noise levels in the workplace, OSHA minimized the impact of occupational noise exposure, and yet the inci-dence of nonoccupational noise exposure has consistently risen, particularly in younger indi-viduals. How do we put the sources of influence to work on this societal problem?CB: Reducing hearing loss is the measurable goal. The next step is to identify the vital behaviors to get people to reach that goal. Is it encouraging them to carry earplugs so they can use them when there is loud noise? What are the other behaviors? Next, you need to come up with sources of influence for those behaviors. For instance, the CDC has the challenge of trying to communicate to people how to reduce the behaviors that spread the flu. There are many things people can do, but they have narrowed it down to a few vital behaviors so that the message is absorbed. If people are given too many things to do, they’re not going to do them. In the past few years, I’ve



seen more people cough into their elbows. When I was a kid, everybody just coughed into their hand.

I would argue that this is a vital behavior—that doing this one thing will make more of a difference than lots of other things. And because they focused on that, the behavior is seen more often. There’s probably some study out there that indicates that this behavior has reduced the spread of the flu by x percent. How can you translate that to audiology? What is the behavior that is going to be the most likely to get me to avoid noise-induced hearing loss? Is there something I can do in my day-to-day life? That is going to be the key—identifying what those vital behaviors are and then discovering how we influence those behaviors.

How do we stress the urgency, or need for pre-vention, when the consequences of loss are not felt until much later?CB: I like to think of the example of getting people to stop smoking when they don’t see the effects of it. People aren’t changing, because they are not motivated because the consequences of the behavior are down the road. One of the things we talk about in the Influencer course and during my talk is strategies for motivating people who aren’t motivated. There are several ways to motivate them, including the use of vivid stories. You have to con-nect to people’s existing values.

This is very insightful information, and I think that you have definitely connected with many issues facing audiologists today. I look forward to hear-ing your talk at AudiologyNOW! Thank you both for taking the time to meet with us today!

David Fabry, PhD, is the content editor for audiology Today. Kathleen Devlin Culver is the director of development and operations for the American Academy of Audiology Foundation.

Help PUSH the PAC.

Academy members, stop

by the Advocacy Booth at

AudiologyNOW!® 2012 or

contribute online.

Visit www.audiology.org, search

keywords “PUSH the PAC.”


Itemized Value PricingResponding to Changes in the Health-Care SystemBy Barry a. Freeman

t he recent discussion about unbundling product prices (Amlani et al, 2011; Sjoblad and Warren, 2011) is timely but not necessarily new. Prior to

the 1978 Supreme Court decision that led audiologists to dispense hearing aids, patients were required to pay the audiologist for professional services and pay a dispenser for the product. As audiologists began dispensing, they tended to adopt the bundled pricing model for product sales rather than itemizing and charging separately for professional services. With anticipated changes in the health-care system, the advent of more patients purchas-ing hearing aids online, and an increase in third-party reimbursement for amplification devices, it is time for audiologists to understand the value of their services and consider whether unbundling and itemizing their product prices is an appropriate strategy for their practice.

Pricing ModelsIn the past decade, many models for unbundling prices have been reported in the literature, at meetings, and anecdotally. Patricia Gans explained that she had patients make two separate payments—one check for 45 days worth of professional services and a second check for the hearing aid (Nemes, 2004). If the aid was returned for credit, the patient would have the hearing aid check returned while the practice would keep the payment for

Regardless of whether you bundle or itemize product prices, it is critical to understand your value and to communicate this value to your patients.

professional services. Future visits would be charged as an office visit.

At Nova Southeastern University in Florida, variations of the Gans model were initially adopted in the

university clinic. There were two primary reasons for adopting an unbundled model at the university. First, faculty wanted to teach doctoral students that there was value in their professional services and expertise. By unbundling, students would learn that they could and should charge for their knowledge, skills, and profes-sional expertise. Second, Florida is a state with many snowbirds. These primarily are retired seniors that spend a portion of the year enjoying the Florida sunshine and a portion of their year at home in another state. An ethi-cal question was raised about charging for services that may not be rendered, a clear violation of ethical practice guidelines. By charging these patients a bundled price, would the clinic be required to provide a refund for the portion of the year when the patient was out of state or, perhaps, deceased?

In discussing an unbundled model, Amlani et al sug-gest unbundling the product price by features that can be associated with patient benefits and outcomes. This differs from the models presented in other publications where the product is priced and professional services



Itemized value Pr icing: responding to Changes in the health-Care system

are itemized. In both of these models, the challenge is determining the price to charge patients for the device compared to professional services. Charging a price for the hearing aid inclusive of the quantity discount, for example, is insufficient considering the marketing and other overhead costs involved in patient recruitment and management. The discounted price or even a single unit price is probably not the true cost of the product for the practice. Also, the practice needs to assess the appro-priate fee to charge for professional services that are in addition to the product cost. This requires a valuation of an audiologist’s time and expertise. All of these factors might suggest that bundling is an easier option. However, many hearing care providers in Florida had to change their thinking and policies when the Department of Vocational Rehabilitation in Florida changed their hearing aid reimbursement policies.

the Florida dVR Case studyIn 2004, the Florida Department of Vocational Rehabilitation (DVR) informed all of their counselors to start purchasing recom-mended hearing aids from HearingPlanet.com. Historically, a DVR client would be referred to an audiologist for hearing aids. The audiologist would recommend the hearing aids and submit an invoice to DVR for the bundled price of the hearing aids which DVR would then pay. In 2004, DVR learned that they could purchase the hearing aids less expensively from HearingPlanet.com. The hearing aids were ordered, purchased, and shipped by DVR to the client’s audiologist for the fitting. When questioned by audiologists about reimbursement for the fitting and follow-up fees, the director of DVR explained that audiologists typically only charged a single bundled price and never separately itemized the hearing aid charges and the costs for professional services. The director explained that DVR wanted a way to man-age their budgets and found that the traditional bundled model

was too expensive. After discussions, DVR agreed to pay unit costs for the hearing aids plus negotiated professional fitting and follow-up fees to the audiologist. The audiologists were forced by DVR to go from a bundled to an itemized model where there was value placed on the time and expertise of the audiologist.

To properly itemize or unbundle product and service costs, the audiology practice must determine the value of their professional services. Even if the practice decides to continue to bundle their hearing aid and professional ser-vices into a single price to the patient, these prices must reflect the true costs and value of the professional time and expertise to provide these services.

Too often, when audiologists are asked how they set their fees for hearing aids, they report that prices are based on the competition or a recommended formula provided by the manufacturer. Yet, is this adequate to cover costs and make a reasonable profit? The behavioral economists note that if no one complains about your prices you might be too low and if everyone complains about your prices, you might be too high (Ariely, 2010). Also, if your prices tend to fall in the middle of your com-petitors, you end up competing with everyone on price, a trap that audiologists should avoid.

Audiologists need to adhere to performance pricing where they compete based on their professionalism and expertise and not on prices. As Amlani et al notes, “price is not the primary barrier to hearing aid adoption.” Once an audiologist negotiates a price or accepts a discount coupon from the patient, then they are telling the patient that price is more important than the professional ser-vices. In these days of coupons, price advertising, big box stores, and online sales, the audiologist must differentiate their practice and policies from the competition. Patients value our professional expertise, and that is what we need to promote. Do not compete on price but, rather, on

TABLE 1. Compensation Per Minute for a Hypothetical Audiology Practice

Item Annual Cost Per-Minute Cost (2,000 hours of work per year)

Overhead cost $72,000 $0.625

Personal salary/benefits $130,000 $1.08

Profit goal $50,000 $0.41

total required revenue per minute $2.11



the value of your services (Freeman, 2011). Below is an example of performance pricing based on an actual audi-ology practice in the United States.

Hypothetical Practice Example: Susan Smith, AuD, owns Concierge Audiology Services. Rather than selling hearing aids for a bundled price, she charges patients the single unit cost of the hearing aid plus a professional fee to cover the first 90 days of profes-sional services. Patients then pay a monthly fee for full concierge hearing care, including batteries, cleaning, and follow-up services.

What Are your services Worth?It is an invaluable exercise to know your costs and financial goals and set your fees accordingly. Every office should calculate the per-minute cost to keep their doors open. The initial step is to calculate the practice costs. These are the sum of the overhead and direct costs. The practice costs represent the practice expenses minus owner compensation and the costs for products. These costs represent the rent, staff salaries, phone, lights, and other recurring expenses. If, for example, the average cost to keep a practice operating is $6,000 per month and it is estimated that the practice will see patients 20 days per month at eight hours per day, then the costs per minute for the hypothetical practice in this example would be $0.625 to keep the doors open.

Hypothetical Practice Example: $6,000 per month/160 hours (20 work days per month at eight hours per day) = $37.5 per day/60 minutes = $0.625 per minute

These projections exclude the salary of the owner and profitability. As presented in TABLE 1, assume that an audiologist wants to generate a personal salary of $100,000 plus 30 percent benefits or $130,000 of personal

ALSO OF INTERESTIn response to member interest on this topic, the Academy developed a guide to itemizing professional services. Log on to www.audiology.org and search keywords “itemized guide” or scan the QR code and view the guide on your mobile device.

Coding and Reimbursement SeriesUpcoming Live CEUs

MAR 13 Insurance 101Presented by Frieda Toback, AuD, and Debra Abel, AuD

.1

MAY 8 Preparing for the ICD-10 Code Set TransitionPresented by Kyle Dennis, PhD, and Debra Abel, AuD

.1

JUL 10 Documentation How To’s: If It’s Not in the Chart, It Didn’t HappenPresented by Debra Abel, AuD

.1

New to the On-Demand Library CEUs

Coding Changes for 2012Presented by Debra Abel, AuD

.1

Medicare Enrollment and Regulations Presented by Debra Abel, AuD

.1

Unbundling and Itemizing Hearing Aid ServicesPresented by Debra Abel, AuD, and Stephanie Sjoblad, AuD

.1

A M E R i C A n A C A D E M Y o F A U D i o L o g Y

Visit www.eAudiology.org for dates and to register.



compensation per year. The audiologist plans to work 40 hours per week for 50 weeks per year at a compensa-tion rate of $65 per hour (40 hours/week x 50 weeks per year = 2,000 hours per year at compensation rate of $65 per hour = $130,000). This equates to $1.08 per minute ($65/60 minutes = $1.08). In addition, if the audiologist would like to generate a profit of $50,000 per year, which

is an additional $0.41 per minute ($50,000/2,000 hours/60 minutes = $0.41 per minute).

So, in our hypothetical examples, professional fees should be based on generating $2.11 per minute to cover overhead costs ($0.625), owner compensation ($1.08), and profit goals ($0.41). In other words, for every hour (60 min-utes) spent with a patient, the minimum charge should be $126.60 ($2.11 x 60 minutes) for this example. Needless

TABLE 2. Agreed-to Services by Hypothetical Audiology Practice

Monaural (hours) Add for Binaural (hours)

Hearing aid evaluation and consultation 1.0

Ear impression 0.5 0.5

Hearing aid fitting and counseling (initial) 1.0 0.5

One-week follow-up 0.5 0.25

Four-week follow-up 0.5 0.25

Three-month clean and check 0.25 0.25

Six-month clean and check 0.25 0.25

One-year clean and check 0.5 0.5

15-month clean and check 0.25 0.25



Walk-in visits during two years 2.0

Staff time to book appointments 1.0

Time to record visits in chart 0.5

Time to write letters to referrals 1.0

total estimated time in hours 10 hours 13.25 hours

total estimated time in minutes 600 minutes 795 minutes

Fee for services at $2.11 per minute $1,266 $1,680

You wouldn’t give him hearing aids with surprises.

Why do itwith his financing?

Information above is for providers and not for patient distribution.©2012 JPMorgan Chase & Co. All rights reserved.AT0312

Visit us at booth # 1080 during AudiologyNOW!

ChaseHealthAdvance.com/AT 1-888-388-7633

Visit us at boooth # 1080 during AudiollogyNOW!

ChaseHealthhAdvance.com/AT

Their Surprise Financing: Our No Surprise FinancingSM:Initially seems like a good deal. The true cost to patients is hidden in the fine print. A single, one-size-fits-all approach to service. Patients may have unexpected surprise payments.

12, 18 or 24 month no-interest payment plans.Patient terms and responsibilities are clearly explained. Individualized, attentive service. Your patients know exactly what to expect.



to say, many third parties will not reimburse at this level. Therefore, fees for uninsured services provided in this practice example must be increased to offset the loss from discounted fees, or more efficient lower cost services must be provided to cover costs and meet financial goals.

While these projections provide estimates for costs and fees for professional services, they are not specific to setting product prices. As noted, it is common to mark up products over the wholesale cost. However, what is the rationale, and will this markup cover costs? The sim-plest approach to estimate fees, whether you bundle or unbundle your product prices, is to make a list of all the services you provide as a part of the product delivery. For example, the bundled cost of the hearing aid may include a hearing evaluation, hearing aid fitting, and an average number of follow-up appointments, plus other expenses and commitments of time that should be included in the price. These should be determined and priced accordingly.

Hypothetical Practice Example: The audiologists at the practice met to discuss a best-practice hearing aid fitting and management plan. The audiologists agree that the following services will be provided during the two-year warranty period for the hearing aids that are dispensed by the clinic (TABLE 2).

Based on these projections and a per-minute cost of $2.11 for the hypothetical office in our example, it is estimated that the practice will need to charge $1,266 for a monaural fitting and $1,680 for binaural amplification to meet the overhead costs and profit projections for the practice. Of course, these costs are in addition to the costs for the products such as the cost of the hearing aids, ear-molds, batteries, and other products that may be provided. In addition, if the practice in our example participates in third-party programs where products are discounted, then the cost in other areas will need to be increased to offset the discounted costs.

Regardless of whether this hypothetical practice bundles or unbundles their prices, the per-minute costs can be applied to establish usual and customary fees for products and services. If audiologists continue to bundle

their product prices, they still should mark their super-bill/encounter form with all of the provided services. The price still can be bundled but the message to patients is that there is value in the professional services provided as a part of the hearing aid fitting.

ConclusionRegardless of whether you bundle or itemize product prices, it is critical to understand your value and to com-municate this value to your patients. Prices should be set based on your expenses and goal to make a reason-able profit. Each practice is unique, and to suggest that a practice can set its prices based on the competition or the recommendations of a manufacturer is a clear formula for financial failure. Do not compete on price but, rather, compete on the value of your services.

Barry Freeman, PhD, works at Audiology Consultants, Inc., in Ft. Lauderdale, FL.

References

American Academy of Audiology. (2011) Code of Ethics.

Amlani A, Taylor B, Weinberg T. (2011) Increasing hearing aid adoption rates through value-based advertising and price unbundling. Hear Rev 18(13):10–17.

Ariely D. (2009) Predictably Irrational. New York: Harper Collins.

Freeman BA. (2011) Patient-centered care: strategies for practice success. Audiol Pract 3(4):19–25.

Nemes J. (2004) To bundle or not to bundle? That is the question. Hear J 57(4):19–24.

Sjoblad S, Warren BW. (2011) Can you unbundle and stay in business? Audiol Today 25(5):36–45.

Pure Carat™ is Siemens most versatile RIC BTE. As you can see, Pure Carat is perfect for just about everyone. It’s packed with power for longer-lasting performance yet doesn’t sacrifice discretion thanks to the smaller, size 13 battery. It’s loaded with features including AutoPhone® and Telecoil, and even has a new Tinnitus program. With four receiver options, including a 75dB

receiver, Pure Carat fits up to severe hearing loss making it the most versatile hearing aid for 90% of patients.

Pure Carat joins our full line of hearing instruments which offers up to twenty wireless and rechargeable BTE options.

And, with clinically-proven* BestSound™ Technology, you can give your patients the best hearing possible.

Call (800) 766-4500 to speak to a Siemens Sales Representative or visit www.usa.siemens.com/hearing to learn more.

www.usa.siemens.com/hearing

The all-in-one Pure Carat™ RIC BTE.Powerful, rechargeable, discreet, wireless – all-in-one for everyone.

User controlon/off, programmable miniReceiver unit

Click dome

Integrated telecoil

Changeable housing

Battery compartment

Chargingcontact

Durable size 13 battery

Tinnitus program

miniTek®

Pure CaratActual Size

eCharger

45 dB 65 dB

55 dB 75 dB

*Visit www.usa.siemens.com/hearing/clinicalproof Copyright © 2012 Siemens Hearing Instruments, Inc. All rights reserved. 1/12 SHI/13039-12



The authors report on two sisters, now aged 18 and 21 years, with a history of congenital hereditary endothelial dystrophy (CHED), who were born with diffuse, bilateral corneal clouding that extended to the periphery. They each began to lose hearing between 10 and 11 years of age. They were evaluated and diagnosed with bilateral, progressive, sensorineural hearing loss. The diagnosis of Harboyan syndrome, also known as corneal dystrophy-perceptive deafness (CDPD), was made shortly thereafter.

Little has been published about prognosis and management strategies for this rare syndrome. We offer some suggestions based on current clinical practice.

Harboyan SynDromECongenital Hereditary Endothelial

Dystrophy (CHED) and Progressive Sensorineural Hearing Loss:

a Case reportBy roBerT m. dIsogra

and KammI B. gunTon

C HED is a group of disorders characterized by a devel-opmental defect in the

corneal endothelium that results in a thickened and opacified cornea. Genetically, CHED is associated with either autosomal dominant (CHED1) or autosomal recessive (CHED2) genetic mutation of the SLC4A11 gene located on chromosome 20p13-p12. According to Desir and Abramowicz (2008), an additional subset of those with CHED2 presents with mutation at the CHED locus on the same chro-mosome, resulting in progressive sensorineural hearing loss and diag-nosis of Harboyan syndrome. “More than 50 percent of the reported cases have been associated with parental consanguinity,” consistent with an allelic disorder derivative of CHED2


harboyan syndrome—Ched and Progressive sensor ineural hear ing Loss

(Desir and Abramowicz, 2008). “A total of 62 different SLC4A11 mutations have been reported in 98 families (92 CHED2 and six Harboyan). All reported cases have been consistent with autosomal recessive transmission” (Desir and Abramowicz, 2008).

“The ocular manifestations in Harboyan syndrome include diffuse bilateral corneal edema occurring with severe corneal clouding, blurred vision, visual loss, and nystagmus. They are apparent at birth or within the neonatal period and are indistinguishable from those characteristic of the autosomal recessive CHED (CHED2)” (Desir and Abramowicz, 2008). As indicated in Desir and Abramowicz (2008), hearing deficit in Harboyan syn-drome is slowly progressive and is most often identified in patients between the ages of 10 and 25 years old. Presently, there are no reported cases in the literature of patients with prelingual deafness, but significant hearing loss has been detected in patients as young as four years of age (Desir and Abramowicz, 2008). These findings suggest that hearing loss may impact speech and language development.

Diagnosis of Harboyan syndrome is dependent on clinical criteria, including detailed ophthalmological and audiological assessment. Molecular verification of the clinical diagnosis is possible (based on autosomal domi-nance/recessiveness) to distinguish between CHED1 and the more rare CHED2, but the audiometric findings are essential to differentiate Harboyan syndrome from CHED2 (Desir and Abramowicz, 2008). Differential diagnostic

measures should be used to rule out the numerous other genetic, metabolic, developmental, and acquired diseases that present with corneal clouding (e.g., Peters anomaly, sclerocornea, limbal dermoids, and congenital glaucoma) (Desir and Abramowicz, 2008).

The ocular manifestations of Harboyan syndrome may be treated with topical hyperosmolar solutions, but corneal transplantation is often required in the majority of cases for maximum visual benefit and prognosis (Desir and Abramowicz, 2008). Patients with CHED should be given the option of audiometric evaluation, and contin-ued monitoring is especially important for patients with Harboyan syndrome, due to the progressive nature of the sensorineural hearing loss in most cases. Monitoring should continue every six–12 months until hearing loss is identified. If hearing loss is identified, then the diagnosis of Harboyan syndrome is made. The use of hearing aids will be part of the long-term management.

epidemiology“Population-based epidemiological data for Harboyan syn-drome are not available as there are only seven reports of this syndrome in the literature. To date, 24 cases from 11 families of various origin ... have been reported” (Desir and Abramowicz, 2008), and none previously have been reported in the United States (Nemoto, 1986; Magli et al, 1997; Meire et al, 1998; Puga et al, 1998; Abramowicz et al, 2002; Desir et al, 2007).

FIGURE 1. Eye phenotype, untreated adult with Harboyan syndrome. A, The cornea presents congenitally with a ground glass, bluish-white opaque cornea from diffuse edema of the stroma. B, Slit lamp examination showing milkiness and increased thickness of the cornea.



syndromes Associated with Progressive Vision and Hearing LossThe National Consortium of Deaf-Blindness (2010) reports over 50 syndromes in which vision and hearing are affected. Harboyan syndrome is not listed. Incidence figures range from one case (Crigler-Najjar syndrome, Hand-Schuller-Christian [Histiocytosis X], and Morquio syndrome [MPS IV-B]) to 746 cases (CHARGE Association). There are two other categories listed: “No Determination of Etiology” (1,646 cases) and “OTHER: Hereditary Syndromes/Disorders” (1,233 cases). Although not speci-fied, it is possible that a Harboyan syndrome case (or more) might be present in these categories but not specifi-cally identified due to its global rarity.

ocular ManifestationsFIGuRE 1 illustrates the eye of an untreated adult with Harboyan syndrome. According to Desir and Abramowicz (2008), “CHED is believed to result from the hypoplasia or degeneration and dysfunction of the endothelial cells. The endothelium regulates corneal hydration by actively pumping out water from the stroma into the aqueous humor. The Na/K ATPase-driven ion pump plays a crucial role in this mechanism [1]. Excessive water entry into the stroma causes disruption of the collagen fibrils resulting in scattering of light and opacification.” The clinical and histological features of CHED include diffuse epithelial and stromal edema, defects in Bowman’s membrane, loss of endothelial cells, multinucleated endothelial cells, and a thickened Descemet’s membrane (Desir and Abramowicz, 2008).

As described previously, there are two variants of CHED. Autosomal dominant transmission occurs in CHED1. It is characterized by onset later in childhood, with milder edema and opacification. No hearing loss has been reported with CHED1. In contrast, CHED2 is an autosomal recessive disorder with onset at birth or dur-ing the neonatal period. The clinical findings are more severe in CHED2 with diffuse stromal edema extend-ing to the periphery of the cornea. Epithelial edema has been reported as well. There is often associated nystag-mus from severe visual loss. The corneal appearance in Harboyan syndrome is indistinguishable from CHED2, and the transmission is also autosomal recessive (Desir and Abramowicz, 2008).

Since cases of CHED2 are indistinguishable both clinically and genetically from Harboyan syndrome, it is imperative that an audiometric evaluation be completed (Desir and Abramowicz, 2008). The authors of this article

also recommend that distortion product otoacoustic emis-sion studies be performed with these patients.

early IdentificationThe Joint Committee on Infant Hearing (JCIH) endorses early detection of and intervention for infants with hearing loss. The goal of early hearing detection and intervention (EHDI) is to maximize linguistic competence and literacy development for children who are deaf or hard of hearing (JCIH, 2007).

A complete head and neck examination for craniofa-cial anomalies is recommended to document defects of the auricles, patency of the external ear canals, and sta-tus of the eardrum and middle ear structures. “Atypical findings on eye examination … may signal a syndrome that includes hearing loss” (JCIH, 2007, page 15). Therefore, it is imperative that ophthalmology, optometry, otolaryn-gology, and audiology have a close relationship when an infant is diagnosed with CHED.

A s one of the top places to be in scenic Northeast Kingdom, experience Northeastern Vermont Regional Hospital. We know you’ll love it here.

AUDIOLOGISTFULL-TIME W/BENEFITS FOR BUSY ENT PRACTICE – Perform basic and advanced diagnostic hearing evaluations for patients aged 4 months through geriatric adults. Perform ENG testing. Perform in-person hearing aid fitting, including making ear impressions. Educate and counsel patients regarding their hearing impairment and strategies and devices to assist them. Coordinate services to school aged children with the Consultants for the Hearing Impaired and Speech Pathologists in the school system. This position requires a Master’s degree with certification by the American Academy of Audiology (AAA). Certification also required by the American Speech Language Hearing Association (ASHA). Must be licensed by the state of Vermont as an audiologist.

Please visit our website at www.nvrh.org to apply or send résumé to: Carol Chmura, Employment Manager – HR; [email protected]; Fax: 802-748-7398

We are located in the Northeast Kingdom of Vermont, in scenic St. Johnsbury.



The earliest reported case of Harboyan syndrome is four years of age (Desir and Abramowicz, 2008). Therefore, a CHED diagnosis may be made, but a CHED2 diagnosis (incuding Harboyan syndrome) may only be made after hearing loss is first identified then monitored for pro-gression. It is not well documented whether otoacoustic emission testing was available in those countries where Harboyan syndrome has been reported.

Despite the obvious benefits of EHDI programs, an infant diagnosed with CHED could more than likely pass the hearing screening. Until all CHED babies are followed by periodic audiometric evaluations (specifically, distor-tion product otoacoustic emissions testing), the age of onset will remain a mystery. When delays in speech-language development and/or inconsistent responses to speech and environmental stimuli occur, suspicions should be raised that a hearing loss might be present.

Referral to an audiologist would be in order. In the United States, otoacoustic emissions testing is the standard for newborn hearing screenings as well as infants and toddlers.

ophthalmology evaluation and ManagementWhen the sisters were initially seen by the pediatric ophthalmologist, the corneal diameters were each less than 10 mm horizontally. The intraocular pressure was normal in each eye. The pupils, iris, anterior chamber, and fundoscopic exam were normal. The optic nerves had no cupping or pallor. The parents are nonconsanguine-ous, and there is no family history of corneal dystrophies, blindness, or congenital glaucoma.

Right Ear

— 2003 Baseline [school data], age 10

— 2006 Initial evaluation, age 15

Δ—Δ 2011 Current, age 18

FIGURE 2. Baseline, initial audiometric evaluation, and most recent right ear pure tone data on the younger sibling (Katie).

Left Ear

X—X 2003 Baseline [school data], age 10

— 2006 Initial evaluation, age 15


FIGURE 3. Baseline, initial audiometric evaluation, and most recent left ear pure tone data on the younger sibling.

−10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

Hea

ring

leve

l (dB

)

0.125 0.25 0.5 1 2 4 8Frequency (kHz)

−10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

Hea

ring

leve

l (dB

)

0.125 0.25 0.5 1 2 4 8Frequency (kHz)



The older sibling’s course was complicated by amblyopia, which was treated with patching. Her vision deteriorated to a best-corrected visual acuity of 20/80 in the right eye and 20/125 in the left eye. She was referred for a corneal transplant but, after thoughtful discussion, chose not to proceed. The younger sibling has maintained vision of 20/50 in each eye with refractive correction. As teenagers, they currently utilize five percent sodium chlo-ride drops in each eye to minimize their edema.

Audiological evaluation and ManagementHearing deficit in Harboyan syndrome is slowly progres-sive and typically found in patients 10–25 years old. There are no reported cases with prelingual deafness; however,

a significant hearing loss in children as young as four years old has been detected by audiometry, suggesting that hearing may be affected earlier, even at birth (Desir and Abramowicz, 2008).

Two teenaged sisters of nonconsanguineous parents were initially seen in 2008 for audiological evalua-tions because of progressive changes in hearing and an increase in communication complaints. Jennie was 18 at the time, and Katie was 16. Their mother reported that they each had been diagnosed with CHED. Aside from the visual impairment, only Jennie had a positive otologic his-tory (middle ear pathology treated by her pediatrician and later by an otolaryngologist who subsequently inserted a pressure equalization tube in the left ear after fluid was aspirated from the middle ear space).

Right Ear

— 1999 Baseline [school data], age 10

— 2006 Initial contact, age 18


FIGURE 4. Baseline, initial audiometric evaluation, and most recent right ear pure tone data on the older sibling (Jennie).

Left Ear

X—X 1999 Baseline [school data], age 10

— 2006 Initial contact, age 18


FIGURE 5. Baseline, initial audiometric evaluation, and most recent left ear pure tone data on the older sibling.

−10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

Hea

ring

leve

l (dB

)

0.125 0.25 0.5 1 2 4 8Frequency (kHz)

−10

0

10

20

30

40

50

60

70

80

90

100

110

120

130

Hea

ring

leve

l (dB

)

0.125 0.25 0.5 1 2 4 8Frequency (kHz)



These subjective responses were confirmed using distortion product otoacoustic emissions (DPOAE) testing, an objective test of outer hair cell function in the cochlea. Figures 6 and 7 show the DPOAE baseline and current data for each ear on the younger sister.

Figures 8 and 9 show the DPOAE baseline and current data for each ear on the older sister.

−30

−25

−20

−15

−10

−5

0

5

1.5

Baseline2011

2 3 4 6 8 (kHz)

−35

−30

−25

−20

−15

−10

−5

01.5 2 3 4 6

Baseline2011

8 (kHz)

−30

−25

−20

−15

−10

−5

01.5 2 3 4 6

Baseline2011

8 (kHz)

−35

−30

−25

−20

−15

−10

−5

01.5 2 3 4 6

Baseline2011

8 (kHz)

FIGURE 6. Baseline and most recent right ear DPOAE data on the younger sibling.

FIGURE 8. Baseline and most recent right ear DPOAE data on the older sibling.

FIGURE 7. Baseline and most recent left ear DPOAE data on the younger sibling.

FIGURE 9. Baseline and most recent left ear DPOAE data on the older sibling.

A review of their hearing screening results from ele-mentary and middle school identified the first changes in hearing with each sister between 10 and 11 years of age. They continued to fail the school screenings. Katie’s hearing loss progressed more rapidly by the time she and her sister were seen for the initial audiologic evaluation in 2008. However, throughout middle school and high school, they were A/B students despite the hearing loss and not wearing hearing aids. The older sibling is now a senior in college. Tinnitus and vestibular problems

were denied by each girl. Word intelligibility scores have been excellent from the beginning and remain excel-lent. FIGuRES 2 AND 3 show the baseline school pure tone audiogram (Jennie in 1999 and Katie in 2003), the initial audiometric evaluation (2008), and the most recent pure tone test (2011) of each sister.

The audiogram configurations are “flat” rather than sloping. A flat configuration suggests that the thresholds are essentially the same at all test frequencies result-ing from a loss in outer hair cells, changes in the stria



vascularis, or loss of cochlear neurons. The SLC4A11 gene is expressed in the cochlea where it is critical for main-taining homeostasis of cochlear fluid and endolymph (Desir at al, 2007).

These subjective responses were confirmed using distortion product otoacoustic emissions (DPOAE) testing, an objective test of outer hair cell function in the cochlea. FIGuRES 6 AND 7 show the DPOAE baseline and current data for each ear on the younger sister. FIGuRES 8 AND 9 show the DPOAE baseline and current data for each ear on the older sister.

Each sister was later evaluated by an otologist and sub-sequently medically cleared for a trial period with digital hearing aids. Both sisters were fitted binaurally with multiprogram systems that allow the girls to manually change programs to reduce background noise and use the telephone. Communication strategies supplemented the hearing aid fitting. Each sister was monitored quarterly, and audiograms were obtained monthly at first to moni-tor any further progression of this loss.

Both sisters had immediate success with their hearing aids, and they wear them daily. Aided, they have better speech understanding and environmental awareness including an improved ability to localize where a sound is originating. The younger sibling now drives, but the older sister does not. Thus, the use of the aids while driving is now a safety issue.

Because their hearing levels appear to have stabilized, the sisters still have their hearing thresholds (includ-ing DPOAEs) monitored every six months to identify any further changes. The hearing aids will be reprogrammed accordingly. The older sister’s middle ear pathology has resolved. The progression of the younger sibling’s hearing loss was more rapid but has now been stable. The older sibling’s loss is also stable. The literature reports progres-sive hearing loss with Harboyan syndrome (Harboyan et al, 1971) but does not specify time lines or stability periods (if any) due to its rarity as a syndrome and limited longitudinal research. It appears that all reported cases are bilateral, symmetrical losses. Middle ear pathology is not common although the older sister needed a pressure

Live from AudioLogynow!® in Boston!

2012 improving pAtient CAre through innovAtion in workpLACe mAnAgement LeCture infLuenCer: how to CreAte ChAnge in your AudioLogy workpLACe (.3 CEUs; ABA CErtifiCAnts: tiEr 1)

sAturdAy, mArCh 31 pArt i 10:00 Am et, pArt ii 2:00 pm et

presented By CAndACe Bertotti, mpA, pmp vitalsmartstm

free web seminar available through June 30, 2012, on eAudiology. visit www.eaudiology.org to register.

funded by the AAA foundation with a grant from phonak hearing systems, inc.



equalization tube inserted to resolve the unilateral middle ear pathology. Their speech does reflect the degree and type of hearing loss reported. The diagnosis of Harboyan syndrome was made based on the progression and type of hearing loss associated with CHED.

Audiology summary

1. Harboyan syndrome presents with a late onset (after age four years; however, earlier diagnoses have not been reported) of bilateral sensorineural hearing loss starting in the 25–30 dB range from 250–8000 Hz.

2. The audiometric configuration can be sloping or flat.

3. Unilateral hearing loss has not been reported.

4. Middle ear pathology has been reported but appears isolated/coincidental and not part of the syndrome.

5. Infants diagnosed with CHED1 should have their hear-ing monitored semiannually with a baseline series of tests as soon as the CHED diagnosis is made.

6. Testing can be objective and subjective with otoacous-tic emissions as the preferred test.

7. Tinnitus and vestibular problems do not appear to be part of this syndrome.

8. Patients respond well with digital hearing aids; binau-ral aids are strongly recommended.

9. Federal law specifies the educational accommodations needed in schools when a child with vision and/or hearing loss is enrolled.

Audiology Recommendations

1. Children diagnosed with CHED should have a com-prehensive baseline audiogram (including distortion product otoacoustic emissions) as soon as a diagnosis is made.

2. In younger children, when there is a delay in speech-language development and/or inconsistent responses to speech and environmental stimuli suspicions are raised, a hearing loss might be present. Referral to an audiologist would be in order. If hearing loss is identi-fied to be sensorineural then periodic monitoring

(every six months or sooner) should be scheduled. If progression of the loss is noted, then the CHED2/Harboyan syndrome diagnosis can be made.

3. Because children have their hearing screened at birth then periodically by the pediatrician as well as in school, the first report of not passing the screen-ing should be referred to an audiologist immediately. Middle ear pathology must be ruled out; however, middle ear pathology does not appear to be part of this syndrome. Sensorineural hearing losses can be helped with digital hearing aids fitted binaurally.

4. Unilateral losses, tinnitus, and vestibular problems do not appear to be part of the syndrome; therefore, special tests are not needed.

5. Because the literature lacks specific guidelines for monitoring the progression of the loss, the authors recommend semiannual evaluations (including distor-tion product otoacoustic emissions).

6. For school-aged children, classroom accommodations can be made. Hearing aids have built-in integrated FM receiver systems that allow a direct audio input from the teacher’s microphone/transmitter. Hearing aid services are managed as needed.

7. Monitoring should be semiannual or sooner if changes in hearing are suspected or reported.

ophthalmology Management

1. The ocular abnormalities in patients with CDPD may be treated with topical hyperosmolar solutions (five percent sodium chloride drops in each eye to mini-mize edema).

ALSO OF INTEREST“Detection of Ophthalmic Impairments Indirectly with Electronystagmography” (JAAA 15(3):258–263). Visit www.audiology.org and search for keywords “detection of ophthalmic” or scan the QR code and download the article on your mobile device.



2. Corneal transplantation (penetrating keratoplasty) represents the definitive treatment.

3. Corneal transplantation results in substantial visual gains and has a relatively good surgical prognosis.

Robert M. DiSogra, AuD, Board Certified in Audiology, is the director of Audiology Associates of Freehold, PC, in Freehold, NJ. Kammi B. Gunton, MD, is a board certified ophthalmologist and practices in the Department of Pediatrics and Ocular Genetics at the Wills Eye Institute in Philadelphia, PA.

Acknowledgments

The authors wish to acknowledge Jennie and Katie, the two sisters who made this study possible. Periodically (while in between classes and on summer and winter school breaks) they ventured to Philadelphia from New Jersey for their eye evaluations then back to New Jersey for their hearing evaluations as part of this study. The authors wish to extend their profound thanks and gratitude to Jennie and Katie’s parents for giving us permission to pursue our concern that their daughters might have Harboyan syndrome.

We wish to thank the professional and administrative staff at our respective places of employment for their assistance in the preparation of this article.

Special thanks to Audiology Associates of Freehold, PC, the Pediatric Ophthalmology Department of the Wills Eye Institute, Philadelphia, and Salus University ( formerly the Pennsylvania College of Optometry, Elkins Park, PA) for their research assistance; Dr. Sapna Brahmbhatt, Freehold, NJ, for all otologic services; and the authors’ families for their ongoing support while we researched this rare syndrome.

References

Abramowicz MJ, Albuquerque-Silva J, Zanen A. (2002) Corneal dystrophy and perceptive deafness (Harboyan syndrome): CDPD1 maps to 20p13. J Med Genet 39:110–112.

Desir J, Abramowicz MJ. (2008) Congenital hereditary endothelial dystrophy with progressive sensorineural deafness (Harboyan syndrome). Orphanet J Rare Dis 3:28.

Desir J, Moya G, Reish O, Van Regemorter N, Deconinck H, David KL, Meire FM, Abramowicz MJ. (2007) Borate transporter SLC4A11 mutations cause both Harboyan syndrome and non-syndromic corneal endothelial dystrophy. J Med Genet 44:322–326.

Harboyan G, Mamo J, Kaloustian V, der Karam F. (1971) Congenital corneal dystrophy, progressive sensorineural deafness in a family. Arch Ophthalmol 85:27–32.

Joint Committee on Infant Hearing (JCIH). (2007) Year 2007 Position statement: principles and guidelines for early hearing detection and intervention programs. Pediatrics 120(4):898–921.

Magli A, Capasso L, Foa T, Maurino V, Ventruto V. (1997) A further observation of corneal dystrophy and perceptive deafness in two siblings. Ophthalmic Genet 18:87–91.

Meire FM, Pantelis V, Schuil J. (1998) Comment on ‘A further observation of corneal dystrophy and perceptive deafness in two siblings.’ Ophthalmic Genet 19:105–106.

National Consortium of Deaf-Blindness. (2010) www.nationaldb.org.

Nemoto S. (1986) Family cases of Harboyan syndrome. Jibiinkoka 58:161–165.

Puga AC, Nogueira AH, Félix TM, Kwitko S. (1998) Congenital corneal dystrophy and a progressive sensorineural hearing loss (Harboyan syndrome). Am J Med Genet 80:177–179.


CsI: Audiology—you Be the detective!By Paul Pessis

W elcome back to an ongoing article series that chal-lenges the audiologist to

identify a diagnosis for a case study based on a listing and explanation of the non audiology and audiology test battery. It is important to recognize that a hearing loss or a vestibular issue may be a manifestation of a systemic illness. Being part of the diagnostic and treatment “team” is a crucial role of the audiologist. Securing the definitive diagnosis is not only rewarding for the audiolo-gist, but it enhances patient hearing and balance health care.

Case HistoryA 50-year-old female patient was riding her bicycle, hit a stone in the roadway, and was thrown over the handlebars. She was wearing a helmet, but it was smashed from the impact of the fall. The paramedics brought the patient to the emer-gency room, where she complained of muffled hearing in the left ear, a “wet” feeling in the left ear, and vertigo (especially when bending backward or lying down). There was no tinnitus, otorrhea, or otalgia. The right ear was fine.

Past Medical HistoryShe had no prior history of head trauma, loss of consciousness, vertigo, or hearing loss. She wasn’t taking any medications. Her health was excellent. After her fall, she was evaluated by a neurologist who felt she had a normal neurological exam but was concerned she had suffered a concussion second-ary to the bicycle accident.

Physical examinationThe patient had bruises over the left temporal region and left mas-toid (Battle’s sign). There were no lacerations. It was noted that there

CAse study

FIGURE 1. Physical exam of tympanic membrane.

FIGURE 2. Findings of audiometrical exam.


CAse study

were small amounts of fresh blood in the posterior bony ear canal on the left. The tympanic membrane was intact, but there was dark fluid in the left middle ear. A very care-ful “read” of the tympanic membrane showed a visible abnormality along the posterior superior canal wall at the annulus. FIGuRE 1 is a “picture” of the patient’s tympanic membrane and view into the middle ear. Look carefully and see if you are able to recognize the abnormality along the posterior superior canal wall; it will help in making the correct diagnosis for this patient.

FindingsThere was no nystagmus. Her facial movement appeared symmetrical.

Results of her audiometrical exami-nation revealed a left ear mixed hearing loss (SEE FIGuRE 2). She had a normal tympanogram for the right ear and a flat tympanogram for the left. Ipsilateral acoustic reflexes were absent in the left ear but present for the right.

sRts � Right 10 dB � Left 30 dB

Word Recognition scores � 100 percent bilaterally

Reflexes (IPsI) � Right normal � Left absent

oAes � Right pass � Left absent

Otoacoustic emissions were present for the right ear and absent for the left. A VNG was performed, which identified rotary nystag-mus from the head-hanging right Dix-Hallpike maneuver. Horizontal pursuit and optokinetic nystagmus were normal and symmetric. Calorics were balanced. No other abnormali-ties were observed.

Consider the FactsThe patient presents with:

� Head trauma � Blood in the ear canal

Come See Us at AudiologyNOW! 2012 Booth 1743.

Protect your patients’ hearing aids

Generate more revenue

Strengthen long termaudiologist-patient relationships

Call for our new brochureat 1-800-525-7936

www.discoverywarranties.com

4

4

4

4


CAse study

� Blood in the middle ear � Vertigo � No nystagmus � Mixed hearing loss of the left ear

differential diagnosisYou be the detective. Possible diagno-ses could be:

� Concussion with vertigo � Ossicular dislocation � Idiopathic SNHL, left ear � Temporal bone fracture

Radiological studiesThe CT scan report states:

� Nondisplaced longitudinal frac-ture of the left temporal bone

� The fracture extended from the mastoid through the posterior superior external auditory canal to the TMJ (also reference back to the picture of the TM!).

FIGuRE 3 is the CT scan for this patient.

The MRI report states that there are frontal lobe contusions bilaterally, which can support the presence of a concussion.

And the diagnoses are...Nondisplaced longitudinal

fracture of the temporal bone and labyrinthine concussion with vertigo

discussionThis patient is fortunate that the fracture spared the cochlea and vestibular system and did not disrupt the ossicular chain. The fracture caused a laceration of the middle-ear mucosa that caused bleeding into the middle-ear space. This is the “dark fluid” seen in Figure X of the middle ear. It will resorb with time. Despite the fact that the vestibular system was not fractured, it does not pre-clude trauma from the labyrinthine concussion. Since the bones along the fracture line were not displaced, sur-gery was not indicated. The fracture

will heal with time. Of note: although the patient’s riding helmet was shat-tered, it provided enough protection to prevent a more serious injury.

temporal Bone FracturesThere are two basic types:

� Longitudinal: Follows the long axis of the petrous bone. It gener-ally results from a blow to the temporoparietal region (side of the head).

� Transverse: Crosses the long axis of the petrous bone. It is usually secondary to a blow to the frontal or occipital regions.

Longitudinal FracturesThey constitute approximately 80–90 percent of temporal bone fractures. They often pass through the superior canal wall to the anterior canal wall and the TMJ. They are usually associ-ated with:

FIGURE 4. CT scan for different patient showing longitudinal fracture.

FIGURE 3. CT scan for patient.

Longitudinal Temporal Bone Fracture

Visit us in Boston at AudiologyNOW! Booth #1152 to see the new HearUSA and discover the many ways in

which HearUSA can boost your business or career.

Our network can turbocharge your practice.

We help thousands of independent hearing clinics grow stronger every day:

HearUSA’s new relationship with AARP® extends our reach to millions of their members.

With millions of covered lives, the HearUSA Hearing Care Network offers significant growth potential for any independent hearing care provider.

Draw from major managed care programs, health plans, employer groups & subscriber organizations.

We contract with the groups. You get the patients.

This Is An Opportunity You Don’t Want to Miss. Call 1-800-333-3389 option 2 now for details or www.hearusa.com

Join our extraordinary team as an employee.

Through the AARP Hearing Care Program provided by HearUSA, AARP members have access to quality products, outstanding service, discounted pricing, and security in their hearing care decisions. This program provides access to state-of-the-art hearing aid technology, education and follow up care.

AARP contracts with providers to make products and services available to AARP members. HearUSA pays a fee to AARP and its affiliate for use of the AARP trademark and other services. Amounts paid are for general purposes of AARP and its members.

Or align yourself with a referral powerhouse.

Help us achieve our mission: to make top quality hearing care accessible through our company-owned clinics in CA, FL, MA, MI, MO, NC, NJ, NY, PA and OH.

Flexible hours, high salaries and upward mobility make HearUSA a very rewarding company to work for. In fact, our employees rate us highest in job satisfaction and benefits.

Considering an even bigger change? Learn how you can benefit from selling your practice. Call 1-800-333-3389 option 2 for additional information. HearUSA provides fair valuation.


CAse study

� Hemotympanum (blood in the middle ear)

� Perforation/tear of the tympanic membrane

� Ossicular dislocation

� Both a conductive and a high fre-quency SNHL (due to labyrinthine concussion)

FIGuRE 4 is a CT scan from a dif-ferent patient showing a similar longitudinal fracture

transverse FracturesThey may transect the bony labyrinth, the cochlea, and/or the internal auditory canal. A transverse fracture may result in permanent hearing loss and/or vertigo. It can be associated with facial nerve paralysis in up to 50 percent of cases. FIGuRE 5 is a CT scan of a transverse fracture.

It is not uncommon with this diagnosis to have associated post-traumatic vertigo. It is most often

described as dysequilibrium, to be more precise. In rare circumstances, there can be a delayed onset of endolymphatic hydrops. Dislodging of the otoconia has been postulated as the cause for positional vertigo of the post-traumatic type if there is no fracture of the labyrinth.

early treatmentBased on the findings of the exam, test results, and CT scan findings, the ENT prescribed high-dose ste-roids to reduce the inflammation and swelling of the membranes within the cochlea, as well as the cochlear, vestibular, facial nerves, and so on. If facial nerve paralysis had been present, it would have resulted in exploration of the nerve pathway to remove bone fragments and reattach the “cut” ends of the nerve.

subsequent treatmentIt is necessary to perform serial audiograms to measure changes in hearing. If a conductive hearing loss remains, surgery of the middle ear

for ossicular reconstruction and/or tympanic membrane repair may be indicated. If a sensorineural hear-ing loss remains, then the use of amplification needs to be pursued. Finally, if the patient continues to have vestibular symptoms, canalith repositioning would be helpful.

The lesson to be learned is that the patient will benefit from a team of diagnosticians who understand the global implications of the test findings. Procuring the correct diagnosis is essential, but the imple-mentation of a treatment plan allows the patient to get better. In this case, the patient greatly benefited from canalith repositioning and reported benefit from wearing a receiver-in-the-canal aid hearing aid that she reported “balances her hearing” and improves her ability to hear in noisy environments.

In short, it is rewarding to be a diagnostic detective. “Case” closed until the next issue of AT!

Paul Pessis, AuD, is president of North Shore Audio-Vestibular Lab in Highland Park, IL.

FIGURE 5. CT scan of traverse fracture.

Booth 1719

EchoportThe choice of OAE instruments in the Echoport series meets the most demanding of needs. The ILO288 models offer TEOAE and DPOAE screening with programmable test protocols and a powerful patient database, while the ILO292 models with V6 software provide a full range of advanced clinical tests - TEOAE, DPOAE, SOAE, DP Growth, Bilateral TE and DP plus Contralateral Suppression.

When you need reliability and OAE results you can trust from a desktop instrument, choose Echoport.

www.otodynamics.com • USA 1 800 659 7776 • International +44 1707 267540 • email [email protected]

Read more at otodynamics.com/echoport

Satisfies ALL OAE CPT codes

OtodynamicsAudiology Systems


otoacoustic emissions—Frequently Asked Questions

CodIng And ReIMBuRseMent

For CPT code 92588, the new code descriptor says “a mini-mum of 12 frequencies.” Does that mean I need to perform 12 frequencies in total or 12 frequencies per ear?A “minimum of 12 frequencies” would need to be completed for each ear.

Who can perform CPT code 92558, the OAE screening code?Support personnel, an audiologist, or a physician can perform this test.

When should I use 92558?If the provider of the service relies only on the equipment determin-ing the pass/fail response, without further clinical assessment and/or interpretation, report 92558.

What is required with “interpre-tation and report?”You are to include the interpretation of the test results in the patient’s medical record. A printout from the equipment by itself is not considered a report.

The American Academy of Audiology, the Academy of Doctors of Audiology, and the American Speech-Language-Hearing Association offer the following frequently asked questions resource to assist members with practice and billing questions for the new otoacoustic emissions screening code, CPT code 92558, as well as the new code descriptors for CPT codes 92587 and 92588.

It is recommended that members consult with facility billing departments as well as with third-party payers for guidance. Payers may dictate the use of specific diagnosis codes, modifiers, and coverage determinations. Members should also consider consulting with equipment distributors if questions arise regarding specific equipment protocols and capabilities.

The definitions for the otoacoustic emissions (OAE) codes are as follows:

92558: Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis

92587: Distortion product evoked otoacoustic emissions, limited evaluation (to confirm the presence or absence of hearing disorder, three to six frequencies) or transient evoked otoacoustic emissions, with interpretation and report

92588: Comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation of the test, with a report



Do I need a modifier with any of these codes?CPT code 92558 may require the -33 modifier, preventive service. It is important that audiologists consult the specific guidance that will be provided by some third-party payers, which may dictate the use of this modifier. For more information, see www.ama-assn.org/resources/doc/cpt/new-cpt-modifier-for-preventive-services.pdf.

For CPT codes 92587 and 92588, can a technician perform the test and the audiologist do the interpretation and report?Yes, as with all the codes that have the technical component (TC)/ professional component (PC) split (92540-92546, 92548, and 92585), if the test is performed by a techni-cian under the direct supervision of a physician or by a physician, the test can be filed with the TC modi-fier. If an audiologist is performing the interpretation and report, he or she would file the claim with the

-26 modifier. Services provided by a technician cannot be filed by an audiologist or with the audiologist’s national provider identifier (NPI).

My equipment will allow me to do only eight frequencies. What code should I report?For anything less than 12 discrete frequencies, report 92587.

What if I do both distortion product and transient-evoked OAEs?You may report 92587 with the -22 modifier, increased procedural ser-vice, to indicate the additional test.

Preview Auction Items OnlineBidding Is Open March 19–31

If interested in donating an item to the auction, contact Auction HQ: [email protected].

Proceeds from Auction 4 Audiology support research, education, and public awareness in the hearing sciences through the American Academy of Audiology Foundation.

auction4audiology

Visit www.biddingforgood.com/auction4audiology to v iew and bid on auct ion items.



Do the frequencies have to be octave and midoctave?No, they can be any combination indicated by case history or test results, but the requirement of at least 12 distinct frequencies for both ears must be met to file 92588.

What is the difference between 92587 and the new screening code?The new screening code is an auto-mated pass/fail test, which may be performed by support personnel. CPT code 92587 requires three to six distinct frequencies, interpreta-tion, and a statement of the presence or absence of hearing loss and the frequencies affected.

What if my equipment does not have the capability to perform 12 distinct frequencies?Anything less than 12 frequencies will require reporting 92587, with interpretation.

I repeat six frequencies two times/ear for reliability. Can this be considered as the mini-mum of 12 frequencies for CPT code 92588?While it is important to prove reliability, this scenario does not constitute the minimum of 12 frequencies for the use of CPT code 92588 since it is six frequencies that have been repeated. CPT code 92588 requires 12 discrete frequencies. You

may, of course, run 12 frequencies twice for reliability, which would constitute appropriate use of 92588.

CPT codes are the property of the American Medical Association. This guidance is for informational purposes only and was created by the American Academy of Audiology, the Academy of Doctors of Audiology, and the American Speech-Language-Hearing Association.

Did you know that as an Academy member, you can…Save money on � Auto insurance � Business owners insurance � Professional liability insurance � Health/life/long-term care insurance—

individuals and employees

� Calling card � Credit card payment processing—special

rates on transaction fees charged for your business’ credit payments

� Car rental

Promote yourself with � Compensation and Benefits Survey—

make sure you are competitively compensated

� Fellow logo—use on your Web site and stationery

� Direct Connect—link from our Web site to yours

� Framing—for personal recognition

� Messages On Hold—promote yourself, audiology, and hearing health care to patients on hold

� HEARCareers—post resumes and search job listings for free

� Resume Review Service

Learn more about these benefits at www.audiology.org, search keyword “benefits.”


Board of Governors

Gail M. Whitelaw, PhD, Chair

Angela S. Pond, AuD, First Chair

Mindy Brudereck, AuD

John A. Coverstone, AuD

Barbara L. Kurman, AuD

Kerry Ormson, EdD, AuD

Yvonne S. Sininger, PhD

Past Chair ex officio Member

Antony R. Joseph, AuD, PhD

Public representativePatty A. Keffer, MBA

american academy of audiology Board of

directors LiaisonDavid Zapala, PhD

Managing director ex officio Member

Torryn P. Brazell, CMP, CAE

for aBa information, contact:American Board of Audiology

11730 Plaza America Drive

Suite 300

Reston, VA 20190

800-881-5410

[email protected]

AMeRICAn BoARd oF AudIoLogy (ABA)

susan dreith, Aud, Becomes First ABA

Certificant to earn All three designations

By Torryn P. Brazell

Susan, you are the first audiologist to hold all three of ABA’s designations: Pediatric Audiology Specialty Certification, Cochlear Implant Specialty Certification, and Board Certification. This is quite a feat. What moti-vated you to earn all three designations? I initially obtained my Board Certification from ABA when I applied to take the Cochlear Implant Specialty Certification exam in 2007. I wanted to obtain this specialty designation as one way of promot-ing the excellence of the cochlear implant program at our facility. When I became aware of the spe-cialty certification in pediatrics, I was immediately motivated to earn the certification. Having worked as an audiologist in a pediatric hospital for 20 years, and with the pediat-ric population in several previous employment settings, I have seen children whose hearing losses have been misdiagnosed, improperly man-aged, and inadequately supported.

Unfortunately, I have seen some professionals who, albeit well meaning, may not have had the necessary knowledge or experience to accurately identify and provide effective management and support for a hearing-impaired child and his

or her family. I strongly believe that these children and families deserve to receive audiological services by professionals with special expertise in pediatrics.

Do you plan to advertise your uniqueness in having all three designations? To your patient population? To your referral sources? Throughout my career, I have been dedicated to developing my exper-tise in pediatric audiology, (re)

Susan Dreith, AuDChildren’s Hospital Colorado



habilitation, and cochlear implants. Obtaining the specialty certifications in those areas was a natural choice. I strive to provide exceptional audio-logical services in a hospital that is a nationally ranked pediatric hospital serving a multistate region. The hospital’s marketing and physician relations department may choose to advertise my designations.

Do you identify all three designations in clinic correspondence? In some correspondence I will iden-tify all three designations.

I see that you graduated with an AuD, Central Michigan university (CMu), 2008. Why did you choose this academic program? How do you think this academic program may have provided motivation to earn three designations? I earned my master’s degree in audiology in 1978 from the University of Wyoming. I have worked as an audiologist in a variety of settings, primarily serving the pediatric population. I became the manager of audiology services at Children’s Hospital Colorado in 1998 after seven years of employment as an audiolo-gist at the hospital.

When the entry-level degree in audiology was transitioning from the master’s to the AuD, I was motivated to obtain my AuD because I felt it was the appropriate professional next step for my role as a manager and supervisor of new graduates with the AuD. I also wanted to expand my education while continuing to work full time.

I chose the CMU distance learn-ing program because I felt it was a challenging program with academic requirements and expectations that were most commensurate with a doctoral-level degree. I thoroughly enjoyed the coursework and gained a great deal, professionally, from earn-ing the degree.

How can I make myself more marketable and profitable?The ABA Certification program identifies and recognizes audiologists and audiology students whose knowledge base and ethical practices are consistent with professionally established standards and who continue to enhance their professional knowledge through continuing education.

� ABA Certification enhances your career.

� Specialty Certification in Cochlear Implants is available.

� Specialty Certification in Pediatric Audiology is available.

� Provisional Certification for students is FREE.

To learn more about ABA certifications, visit www.americanboardofaudiology.org.



My motivation to earn the ABA designations stems from my personal and professional goals of providing high-quality, pediatric family-centered care, and repre-senting one of the top 10 children’s hospitals in the nation.

What made you decide to become an audiologist? How many years have you worked as an audiologist? When I first started college, I was a fairly typical college student, declaring a couple of different majors in the first two years. I wanted to work in a career where I could teach or serve children. Realizing that my first career choices simply were not for me, I became interested in deaf and blind education (not knowing the field of audiology existed). I discovered the audiology program at the university I was attending and, after taking several undergraduate courses in audiology and communication disorders, I was excited to declare audiology as my major.

I graduated with a bachelor’s of sci-ence degree in audiology and received a graduate assistantship for course-work and training in audiology and aural (re)habilitation at the University of Wyoming. My graduate training provided me with the focus I desired, providing comprehensive, family-cen-tered services for deaf/hard-of-hearing children. I have worked in audiology for over 30 years and have enjoyed my career immensely.

Have you received any recog-nition from your employer for receiving your designations? I have received congratulations from my colleagues within the department as well as the department chair and

director. Honestly, I was just recently notified that I am the only person to hold all three designations! I am honored and proud to be recognized for this distinction.

What have these certifications done for you personally and professionally? How have you benefited, and how do they benefit your patient population? I am proud of the level of expertise I have developed in the areas of pedi-atrics and cochlear implants over the course of my career. It has been a privilege to have Deborah Hayes, PhD, as my mentor and colleague for the past 20 years. I hold very high standards for patient and family care; families who seek services at one of the top 10 pediatric hospitals expect to receive expert pediatric medical care from all professionals. It is my hope and desire that families will recognize that their child’s audiol-ogy care is provided by audiologists who hold specialty certification in pediatrics (or cochlear implants). I am encouraging and supporting the audiologists at our hospital to obtain the ABA pediatric specialty certifica-tion over the next year. My goal is to eventually require the pediatric specialty certification as a condition for employment at our facility.

Last question, Susan. How do you envision the profession of audiology unfolding over the next decade? The field of audiology has broadened so much over the decades. Research

and technological advances have increased our knowledge of hear-ing and hearing disorders and our ability to more accurately diagnose auditory disorders. Audiologists have gained a greater understand-ing of the implications of hearing disorders and have developed more effective treatments. I truly believe that the significant scope of practice within our field necessitates newly trained audiologists to discover their passion(s) within the field and develop expertise in specialty areas. While specialty certifications in pediatrics and cochlear implants are fairly new to the field of audiology, I anticipate professional opportuni-ties may become available in the future to obtain specialty certifica-tions in other subspecialty areas of our field.

Torryn P. Brazell, CMP, CAE, is the managing director of the ABA.

My goal is to eventually require the pediatric specialty certification as a condition for

employment at our facility.


ACAe CoRneR

Program Accreditation and Quality Improvement in Aud educationBy martha r. mundy

Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives. —William A. Foster

d oesn’t everyone involved in the education of audiology students have an interest in

assuring that we do our very best to prepare competent professionals who will be a credit to our programs and the patients we serve?

Exactly how do we do that? Against what standard do pro-grams measure their growth and improvement?

Accrediting agencies can be helpful partners when embark-ing on this frank assessment. As mentioned previously in the ACAE Corner (Church, 2011), although the accreditation process is often viewed with dread, it doesn’t need to be. When programs can partner with an accreditation agency whose site visit team includes audiologists involved

in AuD academic and clinical educa-tion, the outcome can be satisfying and rewarding. This brief article will describe one example of a change we have implemented at the University of North Carolina (UNC) at Chapel Hill in the area of program evalua-tion and improvement as a result of the ACAE accreditation process.

From Master’s to AudFollowing 30 years of audiology education culminating in a master’s degree, in the fall of 2002, the first cohort of AuD students began their four-year course of study at UNC. The approval process for offering a new doctoral degree is not speedy or assured in our state. Requesting approval to plan generated the first round of discussions regarding cur-ricular content, what modifications would be made to existing courses, and what content should be carved out and expanded into separate courses. There were UNC-specific considerations such as whether this degree program would be managed

from within the graduate school as the master’s degree had been, or whether the AuD was more appro-priately offered within the school of medicine.

The termination of the master’s degree and subsequent expansion in semester credit hours for the AuD required a hard look at the number of faculty available to teach. The expectation and responsibility of the university to assure clinical com-petence within the degree program required a similar close look at the availability of clinical resources for students throughout their program of study. Some of these issues have been resolved, for example, the AuD at UNC is managed within the school of medicine. Other issues require ongoing evaluation, e.g., balance and quality in academic and clinical experiences. When the first cohort of students began, the faculty recognized that there would need to be something more than our familiar course evaluations and end-of-semester clinical practicum evaluations.

Valuing student FeedbackCourse evaluations on university campuses are nothing new and at best can be informative for instruc-tors who act on specific trends to improve course content or delivery. At worst, they can be a meaningless exercise if students are not assured


ACAe CoRneR

of their value to the program. In our 10 years of AuD education, various types of course evaluations have been employed—pencil/paper bubble sheets with options for comments, anonymous survey questions, and online numeric ratings to questions with optional comments. Regardless of the format, students are assured of the anonymity of their responses and most faculty find specific comments to be the most helpful aspect of student course evaluation. Although course-specific feedback is impor-tant, it doesn’t tap into students’ perceptions about the program as a whole. At the completion of spring semester annually, AuD students at UNC are asked to respond anony-mously to these questions:

� What are your thoughts (positive or negative) about the academic portion of your program?

� What are your thoughts (positive or negative) about clinical experi-ences during your program?

� Are there courses or clinics you felt were unnecessary?

� Was there content or clinical experience you felt you needed that was unavailable?

� What are your thoughts about the cohesiveness of the program—did the academic and clinical compo-nents seem to work together?

� Are there ways the faculty could be more helpful?

� Are there any areas you see as especially problematic? If so, what are they?

� What do you perceive as the pro-gram’s greatest strength?

� Do you have any other comments/observations that you want to share?

There is a generous time win-dow within which students respond to these questions, and they are encouraged to be specific in areas of criticism and praise. As a result of student feedback in conjunction with faculty discussion, new courses

The Accreditation Commission for Audiology Education Salutes the Programs that have attained ACAE Accreditation

� The Audiology Program, Central Michigan University, Mount Pleasant, MI � The Program in Audiology, Washington University School of Medicine, St. Louis, MO � The Program in Audiology, University of North Carolina, Chapel Hill, NC � The Department of Audiology, Nova Southeastern University, Fort Lauderdale, FL

To learn more about how your program can benefit from ACAE, contact [email protected] or visit www.acaeaccred.org.

A Standard Above the Rest


ACAe CoRneR

have been created, the sequence has been altered bringing more balance without negatively impacting clinic placements. The value of clinical activities in certain placements has been affirmed. Some ongoing challenges have been identified, for example, student reluctance to be candid in clinic and preceptor evaluations in spite of assurance of anonymity. Perhaps, however, the most important aspect of this feed-back is that students know they will be asked and that changes have been made based upon this feedback. They recognize that the information they have to share is important and they can be agents of change within their own program.

other Feedback: Program evaluationObtaining program feedback is not a new concept. Surveys of gradu-ates and employers are commonly suggested by accrediting agencies. Fellow educators are aware, however, of the difficulty in obtaining that information. Querying the employer and having employer contact infor-mation is dependent upon having up-to-date contact information for the graduate. In some instances, employer feedback may be inappro-priate if that individual is unfamiliar with the work or with audiology competencies.

Affirmation and RecommendationsThe information we obtain by systematically requesting program feedback from students was viewed positively by the ACAE site visit team. We knew this feedback to be valuable, we knew it was fairly easy to obtain, and we knew we had it in abundance. What we lacked in breadth, we knew we had in depth with the student

group of stakeholders. A suggestion that emerged from the ACAE review was that, in addition to former students and employers, we cast a broader net—soliciting feedback from colleagues associated with our pro-gram, including adjunct instructors, clinical preceptors, and audiologists not affiliated with our program who could be viewed as representatives of the profession at large. The reviewers acknowledged the challenges associ-ated with obtaining this information but encouraged us to take a long view that extended beyond the dates of the site visit. Since implement-ing that recommendation we have been more successful in obtaining feedback from graduates (100 percent most recently, perhaps related to our history of soliciting feedback from this group throughout their course of study). The response rate from employers remains a challenge, both in the relatively low response rate and few specific suggestions for program improvement. Most impor-tantly, we are now receiving valuable feedback from a broader spectrum of stakeholders and view this as a posi-tive outcome of ACAE accreditation.

Accreditation and stakeholdersEvaluating the quality of an audiol-ogy program is both an internal process that involves students, adjunct faculty, and preceptors, and an external process involving accreditors, educators, preceptors, employers, and graduates. Responses from these inquiries are validating current practices and generating recommendations for improve-ment. According to the Database of Accredited Postsecondary Institutions and Programs (Department of Education, 2012),

“The goal of accreditation is to ensure

that education provided by institu-tions of higher education meets acceptable levels of quality.”

In the ACAE process, identify-ing a broader range of stakeholders and creating lines of communica-tion to capture their perspectives was considered part of an essential process that should not be limited to a single point in time separated by many years.

As stated in the introductory quote, “Quality is never an acci-dent…; it represents the wise choice of many alternatives.” The ACAE review was demanding and time-consuming, but it resulted in several specific recommendations including the one highlighted here. Moreover, the process created the feeling of a continuing partnership based on mutual interest in ongoing quality improvement.

Martha R. Mundy, AuD, is coordinator of audiology studies and associate professor at the University of North Carolina at Chapel Hill.

References

Church GT. (2011) On accreditation. Audiol Today 23(6):82–83.

Department of Education. (2012) The Database of Accredited Postsecondary Institutions and Programs. U.S. Department of Education Office of Postsecondary Education. http://ope.ed.gov/accreditation/Index.aspx (accessed January 3, 2012).

Shop the Academy Storeat AudiologyNOW!® 2012 and online.

Visit www.audiology.org and search keyword “store.”

Audiogram of Familiar Sounds

Land’s End Customizable Academy and SAA Clothing

Hearing Aids, How’s Your Hearing: Ask an Audiologist, and Noise and Hearing Loss Brochures

anaheim, californiaapril 3–6, 2013anaheim, californiaapril 3–6, 2013

celebrate the academy’s 25th anniversary!

american academy of audiology


Academy News2012 Academy Honors

JOIN uS AS WE HONOR THESE INDIvIDuALS at the Academy Honors and Awards Banquet on Thursday, March 29, 6:00–8:00 pm (at the Westin Boston Waterfront) during AudiologyNOW!® 2012 in Boston, MA. This event will recognize the best and brightest of the profession. Tickets for the banquet are $25 per person ($15 for students) and are available through the AudiologyNOW! online registration system.

For more information, contact [email protected].

Jerger Career Award for Research in Audiology This award is given to a senior level audiologist with a distinguished career in audiology. Candidates must be members of the Academy, have at least 25 years of research productivity in audiology (not a related field), and have made significant contributions to the practice and/or teaching of audiology.

Brenda M. Ryals, PhDBrenda M. Ryals, PhD, is the recipi-ent of the 2012 Jerger Career Award for Research in Audiology. Dr. Ryals is a professor of communication sci-ences and disorders and director of the auditory research laboratory at

James Madison University, as well as an adjunct professor of psychology and of speech and hearing at the University of Maryland.

She is a past president of the American Auditory Society, a former member of the executive board of the American Academy of Audiology, and is currently the editor-in-chief of the journal of the American Auditory Society, Ear and Hearing, to name only a few of her contri-butions to the profession.

Her research involving the neural and functional consequences of hair cell regeneration during develop-ment and after injury has informed both the science and practice of audiology and has resulted in fundamental advancements in auditory neuroscience. During her note-worthy career to date, Dr. Ryals has managed to mentor a multitude of young scientists, demonstrating (as one supporter notes) “the curiosity, grace under fire, and eth-ics to which we all might aspire.” Her innovative research, her dedicated support of the science of audiology, and her generous and expert mentoring of the research careers of her students and colleagues all epitomize the essence of the Jerger Career Award for Research in Audiology.



samuel F. Lybarger Award for Achievements in IndustryThis award is given for significant pioneering activity (research, engineering, or teaching) within the field of hearing. This award is restricted to individuals whose achievements occurred while employed by a company or corporation in the hearing health-care fields but whose contributions extended beyond their contributions to their company’s services or product and served to have a significant impact on the understanding of normal or disordered auditory systems.

Earl Harford, PhDA true pioneer in audiology, Dr. Earl Harford’s efforts have helped shape the profession for the past 60 years. He is well known for his academic career, which began at McGill University and then continued at

Northwestern University, where he originally served as a graduate assistant of Dr. James Jerger. Dr. Harford returned there in 1959 as a colleague. During his 17 years on the faculty, he educated many future leaders. His ingenuity prompted the evolution of the CROS and BICROS hear-ing aids, and he was among the earliest researchers to

introduce tympanometry, acoustic reflex measurements, and real ear measurement in the United States.

A prolific publisher and skillful teacher, he was one of the early advocates of the AuD and promoter of the private practice of audiology. Following six years operat-ing his own private practice, Dr. Harford joined Starkey Laboratories as director of university services, where he developed and directed the Audiology Internship Program.

Dr. Harford remains active today teaching classes on hearing loss in his retirement community; he contin-ues to serve as a resource for Starkey Laboratories and Starkey Hearing Foundation; and he serves as a mem-ber of the Board of Directors of the National Council for Better Hearing.

Humanitarian AwardThis award is given to an individual who has made a direct humanitarian contribution to society in the realm of hearing. This award could fit a broad category of significant service-oriented activities. Candidates should have demonstrated direct and outstanding service to humanity in some way related to hearing, hearing disability, or deafness. Candidates should have demonstrated significant and consistent humanitarian contributions, preferably in matters related to hearing.

Devangi DalalDevangi Dalal, an Indian-trained audiologist and speech therapist, has dedicated her career to improving the quality of life of hearing-impaired children in India. Her mission is to make Indian people realize that

“a hearing handicap is no longer a handicap.” She has provided free hearing services (and new digital hearing aids) to children in special schools for the deaf, mobi-lized the press and media to highlight the capabilities of hearing-impaired children, and lobbied bureaucrats, politicians, and nongovernment organizations (NGOs) to provide hearing-impaired children in India with the same privileges as hearing-impaired children in Europe and the United States.

Dalal established the Juvenile Organization of Speech and Hearing (JOSH), an NGO whose purpose is to create awareness and educate and empower hearing-impaired children. Over the last decade, she has provided 550 new digitals hearing aids to low-income children in the Mumbai regions of India, raised awareness of hearing loss, and emphasized the importance of early identifica-tion and proper amplification through books she has written in Gujarati and Hindi. Dalal’s humanitarian work has been life changing for many hearing-impaired children in India and exemplifies the Academy’s Humanitarian Award.



International Award in HearingThe American Academy of Audiology has established an annual international award to honor and rec-ognize achievements of international significance in audiology by an audiologist, hearing scientist, or audiological physician. Nominees should be nonresidents of the united States who have provided out-standing service to the profession of audiology in a clinical, academic, research, or professional capacity, and be in good standing in their country.

Birger Kollmeier, PhDBirger Kollmeier, PhD, is being hon-ored with the American Academy of Audiology International Award in Hearing for his strong influence and outstanding contributions to hear-ing science, psychophysics, auditory

electrophysiology, hearing aid development, and evi-dence-based hearing aid evaluation.

It is clear that he is well known and held in high esteem by his peers in Germany and internationally, and he is also well regarded as chair of the German Audiological Society. Since 2000, Professor Kollmeier has been the chair of the

International Graduate School, Neurosensory Science and Systems, and is also chair of the National Center of Excellence in Biomedical Engineering.

His practical approach to hearing sciences has led to advances in audiology, digital signal processing for hear-ing aids, speech intelligibility testing in German language, and diagnostics. The Medical Physics Research Section that he has led at the University of Oldenburg for 22 years focuses on multidisciplinary knowledge of the auditory system to improve hearing aids. His extensive publica-tions span three decades and cover a wide range of topics that have expanded the scientific body of knowledge not only in Germany but also worldwide.

distinguished Achievement AwardRecipients of this award may include audiolo-gists who have been exceptional educators in the classroom or clinic, innovative in program development, or pioneering in clinical service delivery, teaching, or research. The contribu-tions made by the recipients of the Distinguished Achievement Award must have an impact on the profession of audiology as a whole and not just at a state or local level. More than one Distinguished Achievement Award may be awarded per year. Recipients must be members of the Academy.

Carol Flexer, PhDCarol Flexer’s passion for the listening needs of children in the classroom has been prolific. She is well known for her expertise in pediatrics and educational audiology, and in the early 1990s collabo-

rated with Drs. Carl Crandell and Joseph Smaldino to further research in classroom acoustics and soundfield technologies.

With over 155 publications and as the co-editor/author of 11 textbooks, Dr. Flexer has had a phenomenal impact on those she has served and our profession. She has been

Continued on page 86.



involved in the education of audiologists, teachers, and the public for more than 35 years. For 25 of those years, she worked at the University of Akron where she was named a distinguished professor of audiology.

Today, Dr. Flexer continues to lecture to national and international audiences about pediatric audiology issues. Her ability to captivate those she teaches remains a signature of her presentation style. As so perfectly noted by a colleague, “she has an incredible gift to deliver her message simply and convincingly.” Dr. Flexer has also demonstrated pronounced leadership in her capacities as president for the American Academy of Audiology and the Educational Audiology Association. Undoubtedly, her efforts throughout her career have made her a clear choice for the Distinguished Achievement Award.

James (Jay) W. Hall III, PhDDr. James (Jay) W. Hall III holds a PhD from the Baylor College of Medicine and is currently clinical professor of audiology at the University of Florida. In a career that has lasted decades and is still moving at full

speed, Dr. Hall has been a teacher, a clinician, a leader, a mentor, and a visionary. He has held positions of clinical and academic leadership at some of the most prestigious institutions of higher learning, has published scientific articles, book chapters, and textbooks in great volume, and has mentored many clinicians and researchers of the next generation. Outside his workplace, Dr. Hall has been an incessant and dedicated servant for audiology, serving in various roles of leadership in the American Academy of Audiology and most recently the American Board of Audiology.

Dr. Hall’s contributions and achievements are not limited to one institution, one locality, or even one nation. He has successfully collaborated with scientists and professionals from all corners of the world including South Africa and India. Today, he is pioneering the use of telehealth to spread audiology to the remotest parts of the world. The Distinguished Achievement Award is a fitting honor to a career dedicated to excellence in all aspects of audiology.

Deborah Hayes, PhD Deborah Hayes, PhD, chair, audiology, speech pathology and learning ser-vices at Denver Children’s Hospital, has been a leader in audiology for over 30 years. Her publications are standards for the profession, includ-

ing her textbook with Jerry Northern, PhD, titled Infant Hearing. Recently she organized an international meeting on the child with an auditory neuropathy spectrum disor-der, resulting in a booklet circulated worldwide.

Dr. Hayes has also played a major role in the develop-ment of our professional organizations. She is a Fellow of the American Speech-Language-Hearing Association and served as chair of the Joint Committee on Infant Hearing when it issued some of its most important statements on identification and screening of newborns. She served on the AAA Foundation and Academy boards and as presi-dent of the Academy (1997–1998). She helped implement changes in the government structure and legal status of the Academy and appointed the first Professional Practices Task Force leading to the current Academy credentialing program (ABA). She was annual convention (AudiologyNOW!) chair in Denver (1991).

Jerry Northern, PhD, wrote about her, “Dr. Hayes is the consummate professional; she continues to bring enlightened attention to clinical hearing issues, while gaining increased visibility and respect for the profession of audiology from allied health professionals, legislative representatives, lay groups, parents, and patients. Dr. Hayes represents the highest standards of integrity and is respected by all who come in contact with her.” What else is there to say?

Want to start an SAA chapter at your school? Download the SAA Chapter Application form at www.studentacademyofaudiology.org.

An organization for YOU!StUDent-tO-StUDent netWOrking » Facebook and Twitter » SAA listserv » Student-specific events at AudiologyNOW!®

COMMUnitY inVOLVeMent » University chapters » Volunteer opportunities » Special Olympics Healthy Hearing

reSOUrCeS » The Academy and SAA Web sites » HEARCareers Employment Resource » Resume review service » Professional liability insurance discounts

infOrMAtiOn » SAAy Anything quarterly e-newsletter » Audiology Today » Journal of the American Academy of Audiology online

eDUCAtiOn AnD reSeArCh » Student Travel Award Reimbursement (STAR) Program—funded by the AAA Foundation

» Externship Registry » Research and scholarship opportunities—funded by the AAA Foundation


Academy News2012 JAAA editor’s Award

THE 2012 JAAA EDITOR’S AWARD will be presented to William G. Beck, PhD, and Craig Newman, PhD, on Thursday, March 29, 2012, at the Honors and Awards Banquet during AudiologyNOW! 2012 in Boston. The award is given on an annual basis to one or two members of the editorial board of the Journal of the American Academy of Audiology (JAAA) for outstanding contributions to the peer review of the journal. Awardees Beck and Newman were chosen in late 2011 by then editor-in-chief James Jerger, PhD, and will be honored at the banquet by current editor-in-chief Gary Jacobson, PhD.

William (Bill) G. Beck For the past eight years, William (Bill) G. Beck has been a member of the clinical audiology staff of the South Texas Veterans Health System, pro-viding patient services in both Corpus Christi and Kerrville, TX. Throughout

his career in audiology, he has held a number of service positions with state and local professional associations, many in the area of continuing education. Beck was a founding member of the Colorado Academy of Audiology and the Texas Academy of Audiology (TAA), serving as TAA’s first director of education and vice president for professional affairs. Beck is a board certified audiologist and was elected to the American Board of Audiology® Board of Governors, serving as chair in 2003. In 2001, he was invited to join JAAA’s editorial staff as assistant editor for continuing education. He has served the journal in that capacity since that time, in addition to serving as a reviewer of article manuscripts.

Craig Newman Craig Newman is currently the sec-tion head of audiology in the Head and Neck Institute at Cleveland Clinic and professor in the Department of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western

Reserve University. His research interests have focused on hearing, dizziness, tinnitus outcome measurement, amplification, balance function assessment, auditory evoked potentials, and precepting. Newman was awarded the Jerger Career Award for Research in Audiology in 2004 by the Academy. He has served on a number of profes-sional organization task forces and committees and was a member of the Academy Board of Directors. He has served as a reviewer and editorial consultant for a num-ber of scholarly journals and has been an associate editor (Rehabilitation) for the JAAA for many years.


Academy News

tools for effective Advocacy at AudiologynoW!® 2012

By melissa sinden

Washington Watch

Fourth Annual Advocacy summitThe fourth annual Advocacy Summit will take place immediately follow-ing the State Leaders Workshop on Wednesday, March 28, 1:30–3:00 pm, and is open to all Academy members interested in learning more about how to advocate for issues impor-tant to audiologists. At the summit, you will learn about the Academy’s Key Contacts initiative, which seeks

audiologists interested in becoming the “go-to” person in their state or congressional district for advocacy-related issues. For more information on the Key Contacts initiative, visit www.audiology.org and search keywords “key contacts.” If you are interested in attending the event, or if you have any questions, contact Melissa Sinden at msinden@ audiology.org.

The Government Relations Committee, in conjunction with the Academy’s advo-cacy team, hopes you will take advan-tage of some of the many exciting and informative events at AudiologyNOW! 2012 in Boston. These ses-sions are designed to educate Academy members (with some student-specific opportunities!) on how to become active advocates, and to pro-vide valuable tips on influencing elected officials and working to advance public pol-icy. Here are just a few ways to get involved.


Academy NewsWashington Watch

second Annual student Academy of Audiology (sAA) Advocacy summitLast year’s inaugural SAA Advocacy Summit was a rousing success and this year is shaping up to surpass the achievements in Chicago. Students will hear first-hand accounts of acts of advocacy made by their peers, receive information about how to become an advocate, and learn the results of the student advocacy challenge! Professionals from the Academy’s Government Relations Committee and the Academy’s office in Washington, DC, will also be in attendance to inform participants about current legislative issues. This event takes place Friday, March 30, 9:30–11:00 am.

Advocacy-Centered Learning ModuleDo you need a refresher course from your high school civics class? Want to influence public policy at the state or federal level but don’t know the issues and/or don’t know where to start? If so, you could benefit from attending our learning module titled “The Importance of Advocacy.” This interactive module, hosted by subject matter experts includ-ing John Williams, the Academy’s federal lobbyist, and Melissa Sinden, the Academy’s senior director of government relations, will prepare you in your role as an advocate for the profession. Attendees will be given background information on the legislative process and will leave

with a good understanding of what to expect when meeting with represen-tatives. This learning module will teach you how to become a lobbyist for the profession and ensure the voice of audiology is heard. The ses-sion takes place on Friday, March 30, 2:00–3:00 pm.

the Advocacy Booth: your Home for All things AdvocacyBe sure to visit the Advocacy Booth in Academy Central for all the latest advocacy and PAC information. There you can learn more about the legisla-tive issues important to audiology, check out our exciting giveaways, and find out how YOU can PUSH the PAC!

This year’s Boston Beer and Chowda PAC event will take place at Union Oyster House, 41 Union Street, on Thursday, March 29, 7:00–9:00 pm. Plan to throw on your jeans and join the PAC Advisory Board for an evening of Boston beers, chowder, and other appetizers and libations at America’s oldest restaurant. Tickets are $100 for Academy members and $50 for stu-dent members and may be purchased through registration or at the booth (note that guests are welcome to attend the PAC event, but tickets must be purchased by Academy members). For more information about the PAC, or to make a donation, visit www.audiology.org and search keyword “PAC.” To inquire about purchasing advance tickets to the PAC event, contact Kate Thomas at 202-544-9336 or [email protected].

We look forward to seeing you at one of our many advocacy events in Boston!

Melissa Sinden is the senior director of government relations for the American Academy of Audiology.


Academy NewsJust Joined

new Members of the American Academy of AudiologyMichael Bateman, AuD

Damon Boyce, AuD

Ruth Boyd-Okogun, AuD

Lauren Briggs, AuD

Christie Burch, MS

Liza Button, MA

Connie Campa, AuD

Tina Coderre, MA

Lisa Cowdrey, MA

Carol Critchley, MSc

Joni Del Sordo, MS

Gertjan Dingemanse, PhD

Jennifer Dismuke, MA

Ann Dix, AuD

Mazen El-Banna

Angela Esterline, AuD

Cynthia Fetherston, AuD

Rosario Gould, MA

Heather Gradisek, AuD

Mary Shannon Hamill, AuD

Jill Hammer, MA

Kari Harsh, AuD

Alyson Hoffman, ScD

Christina Kenney, AuD

Yinda Liu, AuD

Raymon McNiven, MA

Susan Merenda, AuD

Jennifer Micacci, MS

Tara Millman, MSc

Faith Mogila, ScD

Mindy Neustadt, MS

Rich Panelli, AuD

Amy Paoletti, AuD

Selena Rogers, AuD

Carol Sayre, AuD

Kelly Shadwick, AuD

Naine Sol, AuD

Paige Wahl, AuD

Xiaoya Wang, MD

Cassandra Wilson, AuD

Rachael Zugel, MS

new Members of the student Academy of AudiologySydney Adams

Katherine Algier

Paige Aufseeser

Ryan Bahl

Juliana Bass

Ashton Bates

Shana Bauer

Rupal Bhakta

Jun Bian

Jacqueline Bibee

Jacqueline Blake

Ashlee Blohm

Anastasia Boyle

Nina Brennan

Marisa Bushman

Cortney Butler

Alyson Butler

Diana Callesano

Anita Calwas

Paul Carter

Sara Chai

Tina Chan

Melissa Clark

Erica Claxton

Renee Cloutier

Keri Cole

Lindsay Collins

Lauren Combs

Chelsea Comeaux

Dori Cormier

Margaret Croskery

Star Dack

Erin Downs

Rose Dumont

Kyle Easter

Molly England

Rachel Ersoff

Alina Fabrizzi

Emily Farbman

Diana Fitzgerald

Allison Godlewicz

Elizabeth Gollhofer

Jennifer Gonzalez

Caroline Gore

Alyson Gruhlke

Hugo Guerrero

Margaret Halinski

Jael Hall

Curtis Hartling

Emily Hehn

Margaret Hill

David Hirchak

Ashley Hirst

Thomas Hladnik

Erin Hunt

Monica Hurt

Julia Jantas

Shirin Jivani

Marc Johnson

Audra Jones

Matthew Kaplan

Jessica King

Jennifer Klimczak

Sabrina Lawley

Erin Lazar

Shekinah Lecator

Naomi Lever

Sarah Levy

Lauren Lewis

Ann Lin

Stephanie Loccisano

Gaurri Mangaonkar

Candice Manning

Michelle McLain

Caleb McNiece

Margaret Miller

Sadaf Momin

Charlotte Morse-Fortier

Elizabeth Musgrave

Kayla Newkirk

Lydia Northern

Stephanie O’Flaherty

Maura O’Rourke

Dina Panopoulos

Jessica Partin

Nicole Payne

Lindsey Quenville

Natalie Raney

Brianna Robertson

Amanda Rodriguez

Alesandra Rosenbalm

Amy Safran

Thomas Sanchez

Daniel Shearer

Alexandra Shevelyok

Rebecca Sims

Eileen Smith

Kristine Sonstrom

Reyna Tenorio

Rebecca Thiesse

Christina Vecchio

Shelley West

Mindy Westfried

Paige Whiteley

Nichelle Wilson

Brooke Worthington

Megan Wozniak

Michelle Ziegler


Academy Newsnews and Announcements

JFLAC 2012 Coming in SeptemberJerger Future Leaders of Audiology Conference (JFLAC) 2012 has been scheduled for September 13–15, 2012, at the Academy Headquarters in Reston, VA. Following AudiologyNOW!, announcements will be made regarding submission of applications.

Academy Task Force Publishes Report on Central Presbycusis The task force’s charge was to review the body of evi-dence surrounding the existence of age-related declines in central auditory processes and the consequences of any such declines for everyday communication and function. Visit www.audiology.org and search keywords “central presbycusis.”

Compensation and Benefits Survey Results AvailableThe Academy conducted its Compensation and Benefits Survey in 2011, and the survey results are now avail-able. The 2011 survey provides total compensation data for audiologists by full-time and part-time status while another section of the survey looks at how an audiologist is paid. Visit www.audiology.org and search keywords “compensation survey.”

update Your E-mail Address with the AcademyDo you receive e-mails from the Academy? Don’t miss out on important information; be sure to keep your informa-tion up-to-date (don’t worry, the Academy does not share e-mail addresses). E-mail any changes to your information to [email protected]

Attending AudiologyNOW®?

Searching for a Job?

Need to Hire an Audiologist?

The HEARCareers Employment Center at AudiologyNOW! 2012 provides employers and job seekers a place to connect.

AmericAN AcAdemy of Audiology

to post a job today.

Visit


Academy NewsFoundation update

2012 Marion downs Lecture to Feature World-Renown expert

in Pediatric Vestibular disorders

t he American Academy of Audiology Foundation is pleased to announce that Linda Luxon, CBE, BSc, FRCP,

will present the 2012 Marion Downs Lecture in Pediatric Audiology. Professor Luxon’s presentation, “The Dilemma of Dizziness in Children,” will be offered on Friday, March 30, at AudiologyNOW! in Boston; the lecture will also be available at no charge on eAudiology in both live and on-demand Web formats.

Professor Luxon has served as the chair of Audiovestibular Medicine at the University of London, based at University College of London (UCL), since 1991. Her presenta-tion will discuss the causes of dizziness in childhood as well as a diagnostic strategy for and management of dizziness in children. Additionally, she will address why balance disorders in children are frequently misdi-agnosed or overlooked, by both parents and professionals, and the high index of clinical suspicion required if an accurate diagnosis and appropriate management are to be put in place. The lecture will include a discussion of risk factors for vestibular pathology and common pathologies giving rise to imbalance in children, and a simple clinical schema for detailed investigation of pediatric vestibular dysfunction will be outlined and appropriate management briefly reviewed.

Richard Danielson, PhD, chair of the Foundation Board, expressed his enthusiasm about Professor Luxon’s featured session at the Boston conference. “Dr. Luxon is uniquely qualified to provide a comprehensive coales-cence of research and clinical approaches to pediatric audiology and vestibular disorders,” stated Dr. Danielson. “It is an honor to make available to audiologists such an esteemed

lecturer and researcher. We thank The Oticon Foundation for funding this program that supports Professor Luxon’s travel to the United States, as well as the availability of technology that enables others to have access to her lecture through the World Wide Web.”

Professor Luxon’s clinical research and teaching experiences encompass a broad range of areas, including vestibular disorders; noise-induced, genetic, and auto-immune hearing loss; and central auditory processing disorders. She was trained in general internal medicine and neurology at St. Thomas’ Hospital and the National Hospital for Neurology and Neurosurgery, Queen Square, London. She was also trained in neuro-otology both at Queen Square (with Dr. Derrick Hood and Dr. Margaret Dix) and at University of California at Los Angeles (with Dr. R.W. Baloh and Dr. V. Honrubia). In 1980, she was appointed as a consultant in neuro-otology at the National Hospital for Neurology and Neurosurgery, the United Kingdom’s largest dedicated neurological and neurosurgical hospital.

Additionally, Luxon has served as the president of numerous professional orga-nizations, including the British Society of Audiology, the Clinical Neuroscience Section of the Royal Society of Medicine, the International Association of Physicians in Audiology, and the European Federation of Audiological Societies. She also currently serves as the Department of Health’s national clinical advisor in audiology and vestibular disorders and officer at the Royal College of Physicians London.

Professor Luxon has authored more than 120 peer-reviewed research papers and 70


Foundation updateAcademy News

chapters in textbooks and is an editor of the Textbook of Audiological Medicine and a coedi-tor of Scott Brown’s Otolaryngology, Handbook of Vestibular Rehabilitation, and Noise and Its Effects—both of which won the George Davey Howells Prize of the University of London for “the most distinguished published contribu-tion to the advancement of otolaryngology during the preceding five years.” As a result of her distinguished career and achieve-ments, she was awarded the Commander of the Most Excellent Order of the British Empire (CBE) in 2010 for her services to medicine. As an international expert in audiology, neuro-otology, and vestibular disorders, Professor Luxon has given invited lectures throughout Europe, the United States, China, Thailand, Korea, New Zealand, and India.

The AAA Foundation is honored to feature her presentation at AudiologyNOW! and is pleased that she will join a growing list of dis-tinguished Marion Downs speakers. To date, seven presentations have been given on sub-jects in pediatric audiology, including genetics, implantation, speech optimization, and treat-ment of children in developing nations.

“At a time when pediatric audiology is becoming increasingly specialized, we are pleased that The Oticon Foundation-sponsored Marion Downs Lecture Series continues to give hearing care professionals timely access to the latest developments in pediatric audiology,” stated Donald Schum, PhD, vice president of audiology and profes-sional relations at Oticon, Inc., upon hearing of Professor Luxon’s selection as the eighth Marion Downs lecturer. “This important lecture series has provided cutting-edge edu-cation opportunities that empower pediatric practitioners to deliver optimal hearing care and solutions to the youngest patients.” For more information on the 2012 Marion Downs Lecture in Pediatric Audiology, visit www.audiologyfoundation.org.

Philanthropy in Action at AudiologyNOW!The AAA Foundation supports research, education, and public awareness at convention. Make plans to participate in our fund-raisers or Foundation-sponsored educational programs while in Boston!

WEDNESDAY, MARCH 28

Cheers for Ears ALPACA AuDIOLOGY AND SOuND ADVICE

Happy Hour with a View HEARuSA HEARING CARE NETWORK

THuRSDAY, MARCH 29

Honors & Awards Banquet

Rock NOW: Oticon’s Benefit Gala & Talent Showcase OTICON, INC.

FRIDAY, MARCH 30

Marion Downs Lecture in Pediatric Audiology THE OTICON FOuNDATION

James Jerger Award for Excellence in Student Research Poster Awards ANONYMOuS DONOR

PhD Networking Lunch

Student Research Forum PLuRAL PuBLISHING

MARCH 31

Audiology unplugged

DiscovEARy Zone

Improving Patient Care through Innovation in Workplace Management Lecture PHONAK HEARING SYSTEMS, INC.

Trivia Bowl SIEMENS HEARING INSTRuMENTS

IN THE FOuNDATION BOOTH AND ONLINE

Auction 4 Audiology: Closing March 31 at Noon ET

OTHER FOuNDATION AuDIOLOGYNOW! PARTNERSHIPS

AudiologyNOW! Member Assistance Program AuBAN, INC. AND

OAKTREE PRODuCTS, INC.

Focus on Foundation eNewsletter LANTOS TECHNOLOGIES

For more information on events or corporate underwriting opportunities, visit www.audiologyfoundation.org or call the Foundation office at 703-226-1049.


Academy NewsFoundation update

March 28: one night, two Benefits

two hundred plus years ago, the Boston waterfront was the site of the Boston Tea Party. The Foundation plans to

continue the Boston “party” tradition by hold-ing two fun benefit events at AudiologyNOW! on March 28!

Tickets are going fast for the annual Happy Hour with a View at the Seaport’s Lighthouse Ballroom from 5:30 to 7:30 pm. No tea will be served, but you’ll find good wine, tasty hors d’oeurves, and friends both old and new at this benefit reception. Tickets are $75 for members and $25 for students. Corporate underwriting for the Happy Hour is provided by HearUSA Hearing Care Network.

The festivities continue at the Foundation/SAA benefit, Cheers for Ears, at Harpoon

Brewery from 7:30 to 9:00 pm. A variety of distinctive and limited-edition beers will be available for tasting at this fun event that supports student initiatives. The suggested donation is $25 for both members and stu-dents. You must be 21 or older to attend; valid ID required at the door. The Cheers for Ears event is underwritten by Alpaca Audiology, Sound Advice Hearing Doctors, and by our friends in the Boston business commu-nity—Harpoon Brewery, Boloco, Upper Crust Pizzeria and Veggie Planet…THANK YOU!

Purchase your tickets for both events with your registration at www.audiologynow.org. A limited number of tickets may also be available on-site in Boston.

Bid eARly and often in Auction 4 Audiology opening March 19

y ou’ll go home from AudiologyNOW! with new skills and new experi-ences. Why not add an autographed

Emmylou Harris guitar or antique replica ear trumpet to your conference “souvenirs?”

These items and many more, including getaways, electronics, handcrafted art, gift cards, celebrity memorabilia, and audiol-ogy tools, will be available in the AAA Foundation’s annual Auction 4 Audiology, held online March 19–31, 2012.

Items are available for preview at www.biddingforgood.com/auction4audiology before online bidding starts March 19. Mark your favorites as convention approaches and then get an up-close look at all of our items at the AAA Foundation booth in Academy Central. Bid anywhere you have

Internet access and, new in 2012, bid on your iPhone! Just download the Bidding 4 Good app from the App Store and search for “American Academy of Audiology Foundation.”

So what are you waiting for? Log on now and get ready to bid EARly and often! Proceeds benefit the AAA Foundation’s mission to support research, education, and public awareness in the hearing sciences.

now Accepting scholarship Applications!

t he Foundation offers several scholarships for audiology students (AuD, PhD, AuD/PhD), and encourages qualified individuals to apply. Visit the Foundation’s Web site for more information. Application deadline: April 30 for the 2012–2013 academic year.

An Ear to the Ground: Environmental Scan on the Future of Audiology, the 2011 report published by the American Academy of Audiology, includes a com-prehensive and forward-looking scan of conditions and trends in audiology, science, technology, and policy. These trends have the potential to impact private practitioners, patients, students, and researchers, in universities and other educational practice settings, medical institutions, and stakeholders in the hearing health community.

This relevant report is now available as a thank-you gift for those who make an Annual Fund gift of $250 or more before April 1. Visit www.audiologyfounda-tion.org to make your contribution today or visit the Foundation Booth at AudiologyNOW! to get your copy.

PRODuCTION OF An EAr To ThE Ground WAS uNDERWRITTEN WITH SuPPORT FROM PLuRAL PuBLISHING.


Classified and Employment Line Listing Rates for Audiology TodayUp to 50 words $125

Each additional word $2

Agency discount not valid for line listings.

Classified and Employment Display Advertising for Audiology TodayAd Rates 1x 6x 12x

Full-Page Black and White

$1,630 $1,425 $1,295

Full-Page 2nd Color Matched

$2,430 $2,225 $2,095

Full-Page Full Color $3,005 $2,800 $2,670

Half-Page Black and White

$1,230 $1,015 $900

Half-Page 2nd Color Matched

$2,030 $1,815 $2,095

Half-Page Full Color $2,505 $2,290 $2,175

Quarter-Page Black and White

$880 $760 $730

Quarter-Page 2nd Color Matched

$1,580 $1,460 $1,430

Quarter-Page Full Color

$2,055 $1,935 $1,905

Agency discount of 10% is valid to recognized agencies only; not valid on line listings.

Contact Heather Troast at The YGS Group at [email protected] for more information or to place an ad.

Web Employment PostingsPosting Rates Members nonmembers

Single 30-Day Posting $245 $290

Single 60-Day Posting $450 $550

3 Job Postings for 1 Month $625 $750

5 Job Postings for 1 Month $980 $1,120

Resume search included with job posting.

Contact Sarah Sebastian at [email protected] for more information.

Advertiser IndexAudigy group Front gatewww.audigygroup.comChase Health Advance 53www.chasehealthadvance.comComfort Audio 13www.comfortaudio.usComputers unlimited 43www.timssoftware.comdiscovery Hearing Aid Warranties 67www.discoverywarrenties.comeckel Industries 85www.eckel.caelite Hearing network 29www.elitehearingnetwork.comesCo ear service Corporation 23www.earserv.comg.R.A.s. sound & Vibrations 9www.kemar.usgrason-stadler 2www.grason-stadler.comHansaton 15www.hansaton-usa.comHear usA 69www.hearusa.comHearing Healthcare news 35www.hearinghealthnews.comIntelligent Hearing systems 39www.ihsys.comnortheastern Vermont Regional Hospital 59www.nvrh.orgoticon C2, 1www.oticonusa.comoticon Pediatrics 45www.making-it-easierusa.comotodynamics 21, 71www.otodynamics.com Resound 17www.gnresound.comsiemens Hearing Instruments 55www.usa.siemens.comsound therapy synergy 31www.sound.therapysynergy.comsoundCure C4www.soundcure.comsycle.net 7www.sycle.netVivosonic 25www.vivosonic.comWeitbrecht Communications, Inc 27www.weitbrecht.comWidex 5www.widexpro.com

Academy Products and Services IndexAAAF Auction 4 Audiology 73www.audiologyfoundation.orgAAAF Marion downs Lecture 37www.audiologyfoundation.orgAAAF Workplace Management Lecture 63www.audiologyfoundation.orgABA Certification Program 76www.americanboardofaudiology.orgACAe 79www.acaeaccred.orgAcademy store 81www.audiology.orgAudiologynoW! 2012 C3www.audiologynow.orgAudiologynoW! 2013 82www.audiologynow.orgeAudiology 51www.eaudiology.orgHearCareers 92www.hearcareers.orgMembership Benefits 74www.audiology.orgPush the PAC 47www.audiology.orgstudent Academy of Audiology 87www.studentacademyofaudiology.org

AUDIOLOGYNOW!® MEANS BUSINESSRegisteR by MaRch 26 and save! SucceSS iS our buSineSS. Whether you are an employer

or an employee in any setting, there are commonalities that

are crucial for staying in business—patient management, best

practices, reimbursement, budgets, support staff, patient

outcomes, and accountability. Learn what your colleagues are

doing to succeed in their practice setting to meet the needs of

our growing patient population.

aMeRican acadeMy OF aUdiOLOgy

Serenade®

What life should sound like

New sound therapy solutionfor the treatment of tinnitus

www.soundcure.comCome see us at the AudiologyNOW! 2012, booth 1796.

Put tinnitus relief in your patients’ hands with Serenade®, a complete, FDA cleared sound therapy solution based on acoustic research conducted by leading university researchers. This simple approach offers complete sound therapy on a handheld device anchored by S-Tones® — novel treatment sounds customized specifi cally to each individual’s tinnitus.

Caution: Federal (USA) law restricts this device to sale by or on the order of a physician, audiologist or other hearing healthcare professional.

Documents

The Listening Brain at Work