Highlights of the XXXI World Congress of Audiology Moscow, April 29 – May 3, 2012

Summary of the World Congress of Audiology in Moscow by Monika Lehnhardt.

Day 1 was devoted to basic research

Biological 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 deafness

Shaping stereocilia from top to bottom

Using massively parallel sequencing to identify the genetic cause of hearing loss in a new patient

TRPA1 – mediated cell signaling pathways in cochlear protection and damage

The question was raised: What will the physician do with this information and will the patient want to know?

Next gene sequencing and genetic studies are needed.

 

Auditory Research

This session was 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 in this session 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.

 

Electrophysiology and Psychoacoustic

Another session on a highly scientific and technical level on

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)

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”.

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).

ABSTRACTS CAN BE PROVIDED UPON REQUEST!

 

Day 2 started with a symposium on

The Implantable Technologies in Rehabilitation of Patients with Hearing Loss

Moderator was Robert Cowan, Melbourne

Panelists were Roland Laszig, Freiburg, Germany, Th. Nikolopoulos, Athens, P. Skarzynski, Warszawa and George Tavartkiladze, Moscow

Here are some key facts and statements from this symposium

Roland Laszig states that there is good reason to do something in case of monaural hearing:

70 – 93 % of patients have a difference in the hearing level between the two ears, 54 – 84 % suffer from Tinnitus.

53 adults were enrolled in a study to look at the results of CI for single sided deafness in Freiburg.

(There is also experience with 3 children). The duration of deafness was less than 10 years.

Better 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.

Th. Nikolopoulos emphasizes that temporal bone imaging is important to avoid surprises for the surgeon!

“Soft surgery” to preserve residual hearing is desirable. The term was “coined” by Ernst Lehnhardt.

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”.

George Tavartkiladze emphasizes the need for objective measures in CI, professional candidate selection and speech processor adjustment.

Stapedius reflex measurements should be made intra-op and post-op during SP fitting.

The most common objective measurement method in use is Neural Response Telemetry.

Electrically evoked brainstem responses (EEBR): for SP adjustment it is possible for use contra-lateral EESR. Sometimes it is necessary to exclude some electrodes from the map, and the decrease in speech discrimination is very small.

There is a significant reduction in spread of excitation in perimodiolar electrodes.

We find a good correlation between NRT and behavioral thresholds.

50% of patients with Single Sided Hearing Loss 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.

An open question is still how predictive the results are from adults for children.

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 to be able to wait.

Roland Laszig also believes that robotic surgery is in an early stage, it is still expensive, but in a few years we will have the support from robots in CI surgery.

 

Cochlear Implantation – Criteria continuously changing

This was a Round Table moderated by Th. Nikolopoulos

Panelists were Sandro Burdo (Varese, Italy), R. Gray (UK), R. Filipo (Rome, Italy) G. Kyrafinis (Greece) and R. Laszig (Germany).

Here some answers to interesting questions:

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

In Freiburg also electrocochleography is used and they do not recommend the use of HA for 6 months any longer, less is fine, cortical responses are not measured on a routine basis, behavioral responses sometimes delay the decision, ASSR is useful.

At which age are children too old for a CI?

Sandro Burdo: at around 5 years, the key is whether a child has oral communication

Roland 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.

Sandro Burdo: “All children – whether deaf because of Connexin 26, i.e. deaf born, or acquired – are hungry for sound”

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 (this is an emergency case).

Which communication mode is best?

S. Burdo: My centre is an oral centre, candidates who use sing language go to another centre

R. Laszig: We offer a chance

R. 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 cochlea, 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

 

There were parallel sessions on

Neonatal Hearing Screening and Speech Perception

which I obviously could not attend.

The Neonatal 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 then by Giancarlo Cianfrone on “Strategies for early detection of psychological comorbidity in tinnitus patients”.

Another three parallel sessions were held before lunch.

 

Cochlear Implantation

chaired by Roland Laszig

Robert Cowan had three presentations as the author of two. R. Briggs attended the conference in Baltimore at the same time.

The topics were:

Six years experience with a totally implantable cochlear implant

The microphone of this device is embedded in the titanium case. The “invisible hearing” can also be used with an external processor. Research looks at the results and compares speech perception with the “invisible hearing” and the “conventional hearing” (with the external SP).

At 55dB patients are still getting recognition, but all lower when using the “invisible hearing” (no external SP).

All patients are affected by body noise; there is little or no adaption to body noise.

Some use the 3G during the day and the invisible hearing during the night.

The external also charges the internal device.

It is clearly beneficial to hear also while sleeping, swimming etc.

The battery autonomy is dropping over time (6 years and 16 hours without charging).

The battery will have to be replaced after 16 years when using it 10 hours a day.

The microphone is a key issue, because we need to avoid the body noise.

The other question is, whether we will have a long-term rechargeable battery.

Surface modifications to improve performance of cochlear implant electrode arrays

A 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 array

This is a new electrode, specifically designed to preserve residual hearing. First results are very promising.

S. Haumann from the MHH, Hannover presented on

Predictions of success with cochlear implants using neural networks

 

There were again parallel sessions on

Rehabilitation and Genetics

which I could obviously not attend.

Both sessions comprised four lectures.

The session on rehabilitation was chaired by R. Harris from Canada, the session on genetics by T. Friedman.

 

The Cochlear Satellite Lunch Symposium was on “Performance. And more”.

Moderator was Roland Laszig and topics covered were

– Asymmetric hearing loss

– Partial deafness

– conductive and mixed hearing loss

– single sided deafness (SSD)

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

 

The afternoon was dedicated to

Cochlear Implantation (three sessions)

Screening Programs

Speech Audiometry

Humanitarian Audiology

 

The Cochlear Implantation II session

Was chaired by Monika Lehnhardt and Sandro Burdo

Topics were the following:

Scalability of post-operative care for CI-recipients presented by Monika Lehnhardt

The full text and slides are available and will be uploaded on the weblog

New frontiers in the remote cochlear implant fitting presented by Vigen Bakhshinyan

The full text and slides are available and will be uploaded on the weblog

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

The role of the initial period in the rehabilitation of deaf children after cochlear implantation

presented by Albina Sataeva

Speech-hearing system formation of hearing impaired children – this title was changed by

Emilija Leongard and she spoke about a natural and auditory verbal approach when working with children

We will receive her manuscript in Russian and English and will upload it in the weblog

The development of musical pitch perception and production in children with hearing aids and children with cochlear implants

This presentation should be given by Christine Rocca , who did not make it to the meeting.

P. Boyle from ABC presented in her place.

A couple of very impressive videos were 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 presented by D. Gazibegovic

This software seems to improve the fitting process, especially in the early time (first two weeks) and it seems recommendable for all CI manufacturers to agree on a common platform

Development of a Mandarin expressive and receptive vocabulary test for children using cochlear implants by Lena Wong from the University of Hongkong

There are 27,8 Mio hearing impaired people in China (2,1% of the total population).

In the years 2006 to 2013 the total number of CI will be 17.750 (donation from Taiwan).

In the years 2012 to 2015 another 16.000 CI will be funded by the Chinese government.

At the same time there are less than 100 audiologists in the country and basically no speech therapists. What a challenge!

Electrode array impedances fluctuation in normally functioning cochlear implants presented by M. Litvak from Tomsk, Russia

Quote from 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”.

 

A poster session (25 posters) concluded the day.

 

Day 2 started with a symposium on

Evidence Based Practice in Audiology

Moderator was L. Hickson

Panelists 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.

 

The key-note lecture of this conference was on

Auditory biophysics and instrumentation – important pillars of audiology

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

He covered various aspects during his one hour presentation.

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?

Application is often handicapped by a lack of common standard for normal thresholds.

He illustrated this phenomenon on steam power, which finally enabled the industrial revolution.

What turns a laboratory phenomenon into a useful clinical test?

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 worked on transient evoked emissions of the earth to storms as a detector of lightening

He believes that middle ear power diagnostics is the future!

We see 15 dB variations /deviations in the commonly used OAE machines, which is unacceptable

No OAE machine manufacturer claims compliance with the standard, because the standard does not make sense.

He mentioned a very interesting book “What fire is in mine ears” (Progress in auditory mechanics) published by Springer Verlag.

The vast majority of sensory hearing loss involves an outer hair cell dysfunction, but this is not for all hearing dysfunctions.

OAE are a leakage of energy out of the functioning cochlea – they are only a by-product!

We still do not fully understand – look at Stagner, Martin & Martin 2012.

The cochlear functional homeostasis is a bounce effect – a reaction to loud sound challenge.

This is not fatigue, this is excitation.

David Kemp proved again to be a visionary.

 

Another invited lecture was on

Experimental data on protection against inner ear damages

Presented by Gaetano Paludetti

 

This was followed by the Lunch Symposium by Advanced Bionics

A 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.

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.

He believes that the perimodiolar concept has not proven a real advantage.

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.

Other questions like potential risks during surgery were addressed by a surgeon from Casablanca and

P. Boyle spoke about T-Mic Wireless Connection, Automatic Gain Control and Programmable IDR.

 

In the afternoon we had another special session on

Early Hearing Detection and Intervention for Adults

Moderated 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 test

Hearing “Acuity”, supra-threshold performance is a multi-choice test with a touch screen interface.

It is available in Italian, German, English, French, Spanish and Mandarin, not in Russian yet.

It is easy, fast, comfortable low cost, tested in non-clinical setting.

The sensitivity is 83% and the specificity 74% (in a controlled environment).

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 three sessions on Hearing Aids and one on the Vestibular Function

 

Interesting was finally the session on

Evidence Based Practice

Chaired by A. Laplante-Lévesque

Presenter Louise Hickson

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 insanity.

The majority of people do not want a hearing aid”.

Research was done to fine 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 capacity and ensure quality of service.

Hearing aids are not the only option, aural rehabilitation programs are promising. They work in improving speech understanding, reducing hearing disability and improving quality of life.

Participative decision making is increasingly important. There is a continuum of decision power between the clinician and the client.

New clients want options, decision aids are well received. We need to take into account key predictors and they are the disability and the stage of change (the self-reported difficulty in hearing and the readiness for change).

 

A poster session (25 again) concluded the day

 

This high level scientific congress was closed on Wednesday, May 3rd. With Robert Cowan as the new President and George Tavartkiladze as the new General Secretary the International Society of Audiology will enter a new era.

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