Highlights of the Congress

presented by

Dr. Dr. h.c. Monika Lehnhardt

May 6th, 2012

Day 1 was dedicated to Basic ResearchBiological and Genetic Basis for Hearing Loss

Distinguished speakers from the Laboratory of Molecular Genetics, National Institute of Deafness and Other Communication Disorders, National Institutes of Health, Rockville, Maryland, USA (Thomas B. Friedman, Inna A. Belyantseva, Robert Morell) and from the Department of Physiology of the University in Kentucky, USA (Gregory I. Frolenko) talked about

Overview of the genetics of early onset human deafnessShaping stereocilia from top to bottomUsing massively parallel sequencing to identify the genetic cause

of hearing loss in a new patientTRPA1 – mediated cell signaling pathways in cochlear protection

and damage

What will the physician do with this information and will the patient want to know?Next Gene sequencing and genetic studies are needed.

Day 1 was dedicated to Basic ResearchAuditory Research

Chaired by the world-renowned scientist Jos J. Eggermont from the Department of Psychology at the University of Calgary, Canada, who also had an invited lecture on

“Effects of long-term moderate level noise exposure on the cortical representation of sound: implication for speech perception”.

One key statement in this lecture, which is relevant for parents to remember, was: The audiogram does not tell us about the problem!

Topics covered were:

Investigation of the neural link between the two ears – Contra-lateral modulation of ABR before and after unilateral cochlear ablation in a mouse model

D-methionine administration protects ABR thresholds and hair cells from kanamycin induced ototoxicity in pigmented guinea pigs

Auditory processing disorder and imaging of corpus callosum fibers using diffusion tensor imaging

An application of ERP-fMRI technique for assessment of auditory attention

The speakers were R.V. Harrison from the Department of ORL at the University of Toronto, Kathleen Campbell from the Southern Illinois University School of Medicine, Springfields, USA, D. L. McPherson from the Brigham Young University, Provo, Utah, USA and M. Rusiniak from the Institute of Physiology and Pathology of Hearing, Warszawa.

Day 1 was dedicated to Basic ResearchElectrophysiology and Psychoacoustics

Topics covered were:

An adaptive signal detection paradigm for use with sensory evoked potentials (McPherson)

Analysis of otoacoustic emissions fine temporal structure (O. Belov, Moscow) Auditory nerve neuropathy and brain-stem auditory

neuropathy due to infantile thiamine deficiency: long-term auditory sequelae (J. Attias, Haifa, Israel)

Spectrum resolving power of hearing as measured by rippled-noise probes (A. Supin, Moscow)

Nonlinear effects in the auditory masking of the high-frequency pulsed sounds by noise with a rippled structure of the amplitude spectrum

(L. (Rimskaya-Korsakova, Moscow)

Fo For parents it may be relevant to know that: “Thiamine is crucial for normal auditory development and function,

and its deficiency may be considered an acquired metabolic cause of neuropathy of the auditory system in infants”.

Day 2 started with a SymposiumImplantable Technologies in Rehabilitation of Patients with Hearing Loss

Moderator - Robert Cowan, MelbournePanelists - Roland Laszig, Freiburg, Germany, Th. Nikolopoulos, Athens, P. Skarzynski, Warszawa and George Tavartkiladze, Moscow

Some key facts and statements:R. Laszig states that there is good reason for treatment in case of monaural

hearing:70–93 % of patients have a difference in the hearing level between the two

ears, 54–84 % suffer from Tinnitus53 adults were enrolled in a study to look at the results of CI for SSD in FRBetter hearing as compared to CROS and BAHA was achieved in all patients

(this refers to speech understanding, spatial hearing and quality of speech as well as localization of sound / speech).

Suppression of Tinnitus was achieved in 95% of the group.“Soft surgery” to preserve residual hearing is desirable!P. Skarzynski talks about “Partial Deafness Treatment” and claims 3756 CI

patients in the course of 20 years, out of which 1512 were treated for “partial deafness”.

The most common objective measurement method is Neural Response Telemetry

50% of patients with SS HL do not want any solution because they do not want to wear anything on their head. Many patients do not even realize they have a problem.

School screening has shown that 10% of children have a hearing problem. Roland Laszig expresses his conviction that we have no other choice than

providing a CI to children as early as possible. We do not know enough about neuroplasticity that would allow us to wait

Day 2 continued with a Round TableCochlear Implantation – Criteria continuously changing

Moderator: T. Nikolopoulos, GreecePanelists: S.Burdo (Varese, Italy), R. Gray (UK), R. Filipo

(Rome, Italy) G. Kyrafinis (Greece), R. Laszig (Germany).

• Is it advisable to provide a CI under the age of 6 months?

All panelists agreed that this is not the case, unless the child had meningitis.

• Which tests are useful for a 6 months old child to base the decision on?

EABR, cortical responses, emissions with and without HA, compare clinical results with behavioral, electro-cochleography (FR)

• At which age are children too old for a CI?Sandro Burdo: at around 5 years, the key is whether a child

has oral communicationRoland Laszig: There is no sharp edge! Important is the

training background, is there any residual hearing? What is the level of expectation from the parents?

Roger Gray: the cochlear nucleus is important. By the age of 13 years the degeneration is complete

Bilateral CI is supported by all panelists, however in the UK funding is only available in case the HL is > 90dB.

Cochlear Implantation – Criteria continuously changing

• Would you implant a child at the age of 2 years, suffering from 70dB HL across the range, diagnosed at 18 months?

R. Laszig would, R. Gray no because of lack of funding, Filipo in Italy would be careful and S. Burdo in Italy would implant one CI and continue with HA on the other side.

• What about HA trials? S. Burdo minimum 3 months, not only HA but also vibrator, R. Laszig advocates HA

for training and adapt the children to wear the outer components of the CI. R. Gray is also for trials for 3 months except for in case of meningitis.

• Which communication mode is best? S. Burdo: My centre is an oral centre, candidates who use sign language go to

another centreR. Laszig: We offer a chanceR. Gray: A signing environment may hinder the development of spoken language

• What about a deaf child from a deaf family?In case another family member, e.g. the grandmother will talk to the child a CI is

indicated.These children do very well and use bimodal communication. • What is an absolute contraindication?R. Laszig: the absence of the auditory nerve, the absence of the cochlear, in case the patient or the parents are not able to mechanically use the device, fatally sick persons who have a life expectancy of only a couple of months

Day 2 parallel sessions onNewborn Hearing Screening and

Speech Perception

The Newborn Hearing Screening comprised four presentations about the situation in the UK, Mexico and Latin America, Belarus and Russia and was chaired by Adrian Davis from the UK.

The Speech Perception comprised five presentations, mainly about various tests (e.g. multi-frequency Animal Sound Test, HEARD, Matrix) and was chaired by Frans Coninx from the Netherlands and Inna Koroleva from St. Petersburg.

Another invited lecture was by Giancarlo Cianfrone on “Strategies for early detection of psychological comorbidity in tinnitus

patients”

Day 2 with 4 sessions on CICochlear Implantation I

Chaired by Roland LaszigRobert Cowan (Melbourne) had three presentations Six years experience with a totally implantable cochlear implantThe microphone is embedded in the titanium case. The “invisible hearing” can also be used with an

external processor. At 55dB all patients get recognition but all lower as compared to using the external device. Some use the 3G during the day and the invisible hearing during the night. The external also charges the internal device.

The battery autonomy is dropping over time, it will have to be replaced after 16 years when using it 10 hours a day.

The microphone is the key issue, because we need to avoid body noise.The other question is whether we will have a long-term-rechargeable battery.Surface modifications to improve performance of cochlear implant electrode arraysA drug eluting electrode is a feasible vehicle for delivery of therapeutic agents into the cochlea. The

goal is to modulate the tissue response. Clinical experience with the Nucleus slim straight electrode arrayThis is a new electrode, specifically designed to preserve the residual hearing. First results are very

promising. Predictions of success with cochlear implants using neural networks (S.Haumann, MHH)

• There were parallel sessions on Rehabilitation and Genetics, both comprised four lecture.• The session on rehabilitation was chaired by R. Harris from Canada, • the session on genetics by T. Friedman

Day 2 LunchThe Cochlear Satellite Symposium Performance. And more

Moderator - Roland LaszigAn International Faculty shared their latest insights and covered the following topics:Asymmetric hearing lossPartial deafnessConductive and mixed hearing lossSingle sided deafness (SSD)

Most of these topics were covered in previous lectures. We can provide written information upon request.

The afternoon was dedicated to parallel sessions on Cochlear ImplantationScreening ProgramsSpeech AudiometryHumanitarian Audiology

Day 2Cochlear Implantation II

Chaired by Monika Lehnhardt and Sandro Burdo

Scalability of post-operative care for CI-recipients (Monika Lehnhardt)The full text and slides will be uploaded in the weblog

New frontiers in the remote cochlear implant fitting (Vigen Bakhshinyan)The full text and slides will be uploaded in the weblog

Perception of temporal cues of environmental and speech sounds by cochlear implanted patients (I. Koroleva)

Videos of her work with children in St. Petersburg were shown

The role of the initial period in the rehabilitation of deaf children after cochlear implantation (Albina Sataeva)

Videos of her work with children in the Institute in Moscow were shown

Speech-hearing system formation of hearing impaired children (Emilija Leongard)Emilija changed the title and spoke about a natural and auditory verbal approach in

working with children with CI. We will receive her manuscript in Russian and English and will upload it in the

weblog

Day 2Cochlear Implantation II

Chaired by Monika Lehnhardt and Sandro Burdo

The development of musical pitch perception and production in children with hearing aids and children with cochlear implants (P. Boyle)

Impressive videos where shown and the only question was: “ Why not use music in the rehabilitation for children with CI? “

FOX Fitting to Outcomes eXpert: preliminary results of a multi-centric study in

Advanced Bionics’ users (D. Gazibegovic)This software seems to improve the fitting process, especially in the early time (first two

weeks). It is recommendable for all CI manufacturers to agree on a common platform for fitting CI

Development of a Mandarin expressive and receptive vocabulary test for

children using cochlear implants (Lena Wong)There are 27,8 Mio hearing impaired people in China (2,1% of the total population)2006–2013 the total number of CI will be 17.750 and 2012-2015 another 16.000!!!There are only 100 audiologists in the country, no speech therapists! What a challenge!!Electrode array impedances fluctuation in normally functioning cochlear M. (M. Litvak)

L.S. Vygotsky: “Deafness does not change only the child’s attitude to the world but primarily has an influence on his/her relationship with people”.

Day 3Evidence Based Practice in Audiology

Moderator : L. HicksonPanelists: L. Wong, G. Keidser, A. Laplante-Levesque

This was an excellent symposium with highly competent ladies who discussed whether

Evidence based practice is the way the profession has to go?

A very vivid discussion with pros and consconcluded this session

Day 3 Key-note lecture of this conferenceAuditory biophysics and instrumentation – important pillars of audiology

The outstanding presenter was David Kemp from the UK – the discoverer of otoacoustic emissions

He highlighted how long it can take from detecting / inventing something to application in practice.

What makes a discovery to invention? How long does it take to clinical application?What turns a laboratory phenomenon into a useful clinical test?Application is often handicapped by lack of common standard for normal thresholds.He illustrated the phenomenon how long it takes :We waited 1700 years for steam to cause the industrial revolution!

He spoke about Roentgen, Thomas Gold, Bekesy, Alexander Graham Bell, David Edward Hughes – the inventor of the radio and audiometer in 1879

David believes that middle ear power diagnostics is the future!We see 15 dB variations /deviations in the commonly used OAE machines, which is

unacceptableThe vast majority of sensory hearing loss involves the outer hair cell dysfunction, but this is

not true for all hearing dysfunctionsOAE are a leakage of energy of the functioning cochlea – they are only a by-product!The cochlear functional homeostasis is a bounce effect – a reaction to loud sound, i.e.

challenge. This is not fatigue, this is excitation.David Kemp proved again to be a visionary.

Day 3Experimental data on protection against inner ear damages Advanced Bionics Satellite Symposium

Gaetano Paludetti had another invited lecture on Experimental data on protection against inner ear damages”

At lunch time Advanced Bionics held their Satellite SymposiumA New Era of Innovation

Mike Sundler presented data on hearing aids and cochlear implants

• 10 Mio hearing aids p.a. and a turnover of 15 billion CHF; • 30.000 cochlear implants p.a. with a turnover of 800 million CHF;• The performance for speech perception increased dramatically from 10% with the early coding strategies

to 100% with the latest (in quiet)!• He stated that the original goal of designers of CI was to develop an aid to lip reading. All their

expectations were surpassed.• Clearvoice was approved in 2012.• Neptune – the latest speech processor of ABC – is appealing to consumers (cosmetically, “designed to be

used in the swimming pool”)

• There is a technology match between Sonova and Advanced Bionics, there is potential for synergy.

• The FOX fitting system addresses the increasing number of recipients and lack of audiologists . There are better results after two weeks, there is continuous progress, less deviation.

Day 3 afternoon Early Hearing Detection and Intervention for Adults

This was a special sessionmoderated by F. Grandori from Milano, Italy

Hearing loss in adults /elderly is happening very slowly. Habituation is evident!“Integration through immediate intervention” was funded by the EC in the years 2008 to 2011.

SUN – Speech Understanding in Noise TestHearing “Acuity”, supra-threshold performance. This is a multi-choice test with a touch screen interfaceIt is available in Italian, German, English, French, Spanish and Mandarin, not in Russian yetIt is easy, fast, comfortable, low cost, tested in non-clinical setting

Adrian Davis spoke about the fact that there are 4,9 Mio people with a Hearing Loss in the UK and 3,8 Mio do not have a Hearing Aid!

We are faced with a “demographic time bomb”.We need to address the current need, prevalent need and future need.Screening helps us to address all of these.Should there be a universal screening for the population over 60 years of age?Probably all we need is a target / sub-population screening.It should be opportunistic, e.g. in hospitals or at the General Practitioner.

There were several sessions on Hearing Aids andone on the vestibular function

Day 3Evidence Based Practice

Chaired by A. Laplante-Lévesque Presenters: Louise Hickson, Adrian Davis Cost effectiveness was proven by Davis et al in 2007 but what about 2012?

“To think that the needs of hearing impaired people can be met by hearing aids is insane. The majority of people do not want a hearing aid”.

Research was done to find out, whether older people hear better nowadays, and the answer is Yes.

30% of the population that is older than 70 years wears a hearing aid.People with a hearing loss are more likely to have depressions, cataract

and diabetes at the same time.How do we respond to unmet needs? Universal Hearing Screening is not

the answer. A targeted Hearing Screening might be.

Beyond hearing aids: We need to increase awareness, increase capacityand ensure quality of service. Hearing aids are not the only option. Aural Rehabilitation programs are promising. Participative decision making is increasingly important. New clients want

an option. We need to take into account key predictors – the self-reported difficulty in hearing and the readiness for change!

Day 4 Closing

This high level scientific congress was closed on May 3rd.

With Robert Cowan as the new President and George Tavartkiladze as the new General Secretarythe International Society of Audiology will enter into A New Era!