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Caring for America’s Hearing

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VOLUME 13, NUMBER 6 AUDIOLOGY TODAY 3

Audiology To d a y

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E D I TORIAL BOA R D

E d i t o rJerry L. Northern

Vice President, Professional Services, HEARx Ltd.Editorial Offi c e

2681 East Cedar Avenue, Denve r, CO 80209(303) 777-4300, FAX (303) 744-2677, [email protected]

Lucille B. BeckV.A. Medical CenterWashington, DC

Carmen C. BrewerWashington Hospital CenterWashington, DC

Marsha McCandlessU n iversity of UtahSalt Lake City, UT

Jane MadellBeth Israel Medical CenterN ew York, NY

Patricia McCarthyR u s h - P r e s b. - S t .L u ke ’s Med. Ctr.Chicago, IL

H. Gustav MuellerAudiology ConsultantCastle Pines, CO

Georgine RayA ffiliated Audiology ConsultantsScottsdale, A Z

Jane B. SeatonSeaton ConsultantsAthens, GA

Steven J. StallerCochlear CorporationE n g l ewood, CO

Deborah HayesThe Children’s HospitalD e nve r, CO

Sydney Hawthorne DavisAAA National Offi c eMcLean, VA

Suzanne HasenstabMedical College of Vi rg i n i aRichmond, VA

Gyl KasewurmProfessional Hearing ServicesSt. Joseph, MI

Diane RussBeltone Electronics Corp.Chicago, IL

ED I TO R I A L ADV I S O RY BOA R DTerm Ending 2003Richard E. GansAmerican Institute of Balance11290 Park BoulevardSeminole, FL [email protected]

Catherine V. PalmerUniversity of Pittsburgh 4033 Forbes TowerPittsburgh, PA [email protected]

Gail M. WhitelawOhio State University141 Pressey Hall1070 Carmack RoadColumbus, OH [email protected]

P re s i d e n t - E l e c tAngela Loavenbruck

Loavenbruck Audiology, P.C.5 Woodglen Drive

New City, NY [email protected]

Past Pre s i d e n tRobert G. Glaser

Audiology & Speech Associates15 Southmoor Circle, NEDayton, OH 45429-2407

[email protected]

BOA R D ME M B E R S- AT- LA RG E

B OARD OF DIRECTO R S

P re s i d e n tDavid Fabry

Mayo Clinic, Audiology Sect. (L5)200 1st Street, S.W.

Rochester, MN [email protected]

Term Ending 2001Alison GrimesProvidence Speech & Hearing1301 Providence AvenueOrange, CA [email protected]

Gyl KasewurmProfessional Hearing Services3134 Niles RoadSt. Joseph, MI [email protected]

Brad StachCentral Institute for the Deaf4560 Clayton AvenueSt. Louis, MO [email protected]

Audiology To d a yN O V E M B E R / D E C E M B E R 2 0 0 1 V O L U M E 1 3 , N U M B E R 6

ED I TO R I A L STA F F

Term Ending 2002Sheila M. DalzellThe Hearing Center, Inc.2561 Lac DeVille Blvd.Rochester, NY [email protected]

Gail I. GudmundsenGudHear, Inc.41 Martin LaneElk Grove, IL [email protected]

Robert W. SweetowUniversity of California MedicalCenter - San Francisco400 Parnassus AvenueSan Francisco, CA [email protected]. edu

AUDIOLOGY TODAY welcomes feature articles, essays of professional opinion, special reports and letters to the editor. Submissions may besubject to editorial review and alteration for clarity and brevity. Closing date for all copy is the 1st day of the month preceding issue date.

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INSIDE THIS ISSUE • VO L U M E 13, NU M B E R 6, 2001

A u d i o logyToday

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NORTHERN LITESASHA Shocks Audiologists by Signing Pact with AAO-HNS — Jerry Northern 7

What Patients Should Know About America’s Hearing Healthcare Team 9

America’s Hearing Healthcare Team Joint Statement 9

INTERNET POSTINGSASHA Trades Autonomy for AAO-HNS Endorsement of CCCS — David Fabry 10

Hearing Healthcare Team — Larry Higdon 10

ELECTION RESULTS 14

FEATURE ARTICLEOn Renaming Auditory Neuropathy as Auditory Dys-Synchrony 15— Charles Berlin, Linda Hood & Kelly Rose

VIEWPOINTThe Value of Independence in an Era of Consolidation — Michael Metz 18

TOPICS IN REIMBURSEMENTICD-9-CM Coding: Code to the Highest Level of Specificity 20

HEARCAREERSA Sound Solution for your Employment Search @www.audiology.org 23

ARTICLEAmerican Academy of Audiology Voices Concerns Over USPSTF Findings 25Related to Newborn Hearing Screening

NEWBORN HEARING SCREENINGBecause Babies Can’t Tell Us If They Can’t Hear 26

CONVENTION 2002 NEWSDestination Philadelphia 28Education Explosion 31

ARTICLEScope of Practice for Audiologists’ Assistants — Teri Hamill, Barry Freeman 34

A MOMENT OF SCIENCENoise Induced Hearing Loss — Prevention in a Pill? — Kelly Tremblay 37& Lisa Cunningham

AMERICAN BOARD OF AUDIOLOGYThe Time is Now! — Robert Keith 38ABA Celebrates Three Years of Excellence in Audiology 39

ARTICLEAre We Really Helping People Hear Better? — Cynthia Beyer 40

AUDIOLOGY INDEXAuthor Index 2001 52

President’s Message 11

Executive Update 13

Letters to the Editor 13

Washington Watch 36

Classified Ads 42

News & Announcements 44

Education Calendar 50

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LOOKING FOR NEW OPPORTUNITIES?Check our fabulous new feature at www.audiology.org:

H e a r C a r e e r s…a sound solution for your employment search .See pages 23-25 in this issue.


J e r ry L. Northern, Editor

ASHA stunned the audiology world by signing on with“ A m e r i c a n ’s Hearing Healthcare Team Initiative,” a concept origi-nated by the Academy of Otolaryngology-Head and Neck Surgery(AAO-HNS). This proposal was discussed and rejected by theAmerican Academy of Audiology (AAA). ASHA’s joining hands withthe ENTs was a surprise action that blindsided many audiologists.The commitment made by ASHA was, in fact, an uncharacteristical-ly sudden move that seemed to occur without much audiologistinput, open discussion or legislative council debate. The JointStatement between ASHA and AAO-HNS was concurrently pub-lished by both professional organizations on their respective web-sites. Although the Joint Statement was benign enough, the AAO-H N S ’s description of the “team” as published on its website not onlyacknowledges the otolaryngologist as the sole “captain” of the hear-ing healthcare team, but the statement presents a confusing pictureto the public by defining the roles of audiologists and hearing aidspecialists in the same terms.

According to American Academy of Audiology President DavidF a b ry, the declaration that the otolaryngologist is the captain of“ A m e r i c a ’s Hearing Healthcare Initiative”, with audiologists and hear-ing aid specialists participating at the same level of subserv i e n c e ,was “unacceptable to audiologists and not in the best interests of ourpatients” (AT, 13:4, pg 6, 2001). ASHA apparently felt otherwise andsigned on with AAO-HNS - leaving many audiologists to believe thatASHA “sold out” the profession of audiology - possibly in return forA A O - H N S ’s support for the ASHA Certificate of Clinical Competence(CCC-A). A key issue in this debate is the fact that AAO-HNS andASHA endorse the CCCs as the “recognized standard” for audiologyrather than the entry-level designator that it is. As audiologistslearned of ASHA’s submission to become a member of the “team”,audiology internet and list serves were filled with expressions ofa n g e r, disappointment and letters of resignation from ASHA.

During the past 6 months, The Academy had face-to-face meet-ings and conference calls searching for a way to collaborate withAAO-HNS. Despite our repeated attempts to negotiate with AAO-HNS, the American Academy of Audiology could not accept the pro-posed statement as consistent with our long-term goals for the pro-fession of audiology. It was not so much for what the proposedstatement said, but more importantly, it was what was left out of theagreement. At first glance, the joint statement recognizes audiolo-gists as “autonomous” and audiologists may even “practice inde-pendently” but the message is clear that audiologists are somethingless than “the captain” of the team. To wit:

1 . AAO-HNS would not negotiate regarding the role of hearinginstrument specialists on the “team”, thereby equating theirs e rvices with those provided by licensed audiologists;

2 . AAO-HNS would not accept our scope of practice that audiolo-gists provide diagnostic information pertaining to hearing and

balance difficulties. It is the position of The Academy that whileE N Ts are responsible for treatment of ear disease, and audiol-ogists are concerned with hearing and balance disorders, bothE N Ts and audiologists provide diagnostic evaluations. This is acritical point of our reimbursement discussions with CMS (pre-viously known as HCFA), and our petition to change our SOCstatus from “therapist” category to “diagnosing” profession;

3 . AAO-HNS would not yield on their assertion that audiologistsshould only perform tests at their direction - a situation whichwould restrict our ability to bill for services “incident to” physi-c i a n ’s orders.The Academy Board of Directors decided that joining

“ A m e r i c a ’s Hearing Healthcare Team Initiative” was not a goodthing for the profession of audiology. Collaborative marketing ofour profession will only be beneficial if there is a symbiotic rela-tionship between the involved parties, and this “team” initiative wasflawed from the start. The Academy officers communicated ourconcerns directly with ASHA and clearly stated our objections andopposition to the statement. However, our desires to continuemoving the profession forward apparently fell on ASHA’s deaf ears.

As it stands now, ASHA has committed our entire profession—not just active ASHA members— to the self-serving initiativecreated by AAO-HNS. Further, the inclusion of the CCC-A in the“definition” of an audiologist in the initiative joint statement is anapparent reach to further entrench audiologists to being defined bycertification — a likely trade off to ensure a steady revenue streamfor ASHA. As our profession evolves to the AuD, our Academybelieves that an audiologist’s ability to practice must be defined byeducational standards, state licensure, a national examination andcontinuing educational requirements - not an annually purc h a s e dcertificate. How can the profession of audiology achieve autono-m y, independence and doctoring level recognition while workingunder the “direction and supervision” of physicians?

This may be the most important challenge to the profession ofaudiology since the beginnings of audiology during World War II.We find ourselves in a situation where ASHA (composed largely ofspeech-language pathologists) has handed over the reigns of ourprofession of audiology to a group of physicians whose majoritymembership is composed of laryngologists, rhinologists and facialplastic surgeons and otologists are a minority. Take the time toread the joint statements on the following pages. Consider thecommentaries and reach your own decisions and judgementsabout your new membership on “America’s Hearing HealthcareTeam Initiative.” It should be obvious to all audiologists that this“team” will not enhance our abilities to serve our patients, will notmove us forward as a profession, and has relegated us firmly intothe role of technicians.

ASHA ShocksAudiologists by SigningPact with AAO-HNS


A m e r i c a ’s Hearing Healthcare Te a mJoint Statement

Joint Statement of the American Speech - L a n g u age-Hearing Association and theAmerican Academy of Otolaryngology-Head and Neck Surgery (Downloadedf rom the website of the American Speech - L a n g u age-Hearing Association atw w w. p ro f e s s i o n a l . a s h a . o rg / re s o u rc e s / a ffi l i a t e s / a a o h n s _ j o i n t ag re e.cfm

More than 28 million Americans suffer from hearing impairments, but only20% seek help for their hearing loss. With the goal of building public awa r e n e s sof hearing loss, its causes, its prevention, and treatment/rehabilitation optionsavailable from hearing professionals, the American Academy ofOtolaryngology—Head and Neck Surgery (AAO-HNS) has launched A m e r i c a ’sHearing Healthcare Team Initiative. The Team consists of the otolaryngologist—head and neck surgeon, audiologist, hearing instrument specialist, primary carep hysician, consulting physician, nurse, speech-language pathologist, educator,and researcher.

As the physician leaders of the Team, the A AO-HNS has invited other profes-sional member organizations to join the Initiative. The American Speech-Language-Hearing Association (ASHA), the professional association of audiolo-gists and speech-language pathologists, is one of the organizations joining theHearing Healthcare Team. The two associations have agreed to the following def-inition of audiologists and their role on the Team:

• Audiologists are autonomous professionals and an integral part of A m e r i c a ’sHearing Healthcare Team. T h ey collaborate with otolaryngologists and othermembers of the hearing healthcare team to provide the most efficient accessand best quality care to children and adults with hearing and balance disorders.

• Audiologists may practice independently to identify, assess, and manage dis-orders of the hearing and balance systems. The nationally accepted certifi c a-tion standard for audiologists is the ASHA Certificate of ClinicalCompetence (CCC-A).

• The Team Initiative has been endorsed by the American Medical A s s o c i a t i o nand the American College of Surgeons. Additional organizations are beingrecruited for endorsement and support. Upon A S H A’s joining this effort, theA AO-HNS and ASHA agreed to the following concepts:

— The patient is best served by a team approach, with multiple potentialpoints of entry to the hearing healthcare team through various team pro-fessionals.

— The team approach is the best, most eff e c t ive method for expanding accessto care and enhancing the treatment of hearing and balance disorders.

— Audiology and otolaryngology mutually recognize each profession asi n t egral and autonomous members of the hearing healthcare team.

— Educational and clinical collegial cooperation creates the most benefi c i a lrelationship among team members.

— An appreciation of the skills and training of each professional group,including the diagnostic and medical/surgical treatment capabilities of theotolaryngologist and the identification/assessment/rehabilitation capabil-ities of the audiologist, enhance such cooperation.

— The team initiative can strengthen relationships between audiologists andotolaryngologists.

— Because both longevity and environmental toxic noise are increasing, thenumber of Americans with hearing and balance disorders will grow dur-ing this decade, creating additional need for A m e r i c a ’s HearingHealthcare Team.

— A m e r i c a ’s Hearing Healthcare Team is committed to increasing publicawareness of the impact of hearing loss and removing barriers to eff e c-t ive services for the large population of hearing impaired persons cur-rently unserve d .

©2001 A AO-HNS, Inc.

What Patients Should Knowabout A m e r i c a ’s Hearing

H e a l t h c a re Te a m(Downloaded from the website of the American Academy of Otolaryngology -Head and Neck Surgery at w w w. e n t n e t . o rg / a h h t i . h t m l.

A m e r i c a ’s Hearing Healthcare Team Initiative (AHHTI)-phy s i c i a n s ,audiologists, and hearing instrument specialists-can provide all the ele-ments necessary to diagnose and treat hearing loss, which affects morethan 28 million Americans. The treatment of the patient with hearing lossis based upon a final medical diagnosis provided by a physician expert indisorders of the ear.

CO M P O S I T I O N O FT H EH E A R I N GH E A LT H CA R ET E A M

The leader of A m e r i c a ’s Hearing Healthcare Team is the otolaryn-gologist, who by education, training, and experience, understands eara n a t o m y, hearing loss, sound transmission, and medical and surgical con-ditions that can cause or worsen hearing loss. The law allows patients towa ive a medical examination. How eve r, such a decision may not be in thep a t i e n t ’s best interest.

The patient’s primary care phy s i c i a n is a fundamental member ofthe Team and often refers the patient for an evaluation of hearing loss.This phy s i c i a n ’s broad perspective of the patient’s health enable moredetailed evaluations and overall management of systemic medical condi-tions that may underlie or contribute to a hearing loss.

In the course of the evaluation of a patient with suspected hearingloss, it may be necessary to seek additional specialty phy s i c i a n c o n s u l-tation. For instance, a patient with symptoms and signs suggestive ofmultiple sclerosis might be referred to a neurologist for additional testingand care.

Au d i o l o g i s t s are autonomous professionals and an integral part ofA m e r i c a ’s Hearing Healthcare Team. T h ey collaborate with otolaryngol-ogists and other members of the hearing healthcare team to provide themost efficient access and best quality care to children and adults withhearing and balance disorders. Audiologists may practice independentlyto identify, assess, and manage disorders of the hearing and balance sys-tems. The nationally accepted certification standard for audiologists isthe ASHA Certificate of Clinical Competence (CCC-A).

Hearing instrument specialists are also members of the A m e r i c a ’sHearing Healthcare Team. T h ey have special training in the testing ofpatients who seek rehabilitation for hearing loss and in selecting and fi t-ting the most appropriate assistive hearing device. The hearing instru-ment specialist offers a public service by fitting and maintaining hearingaids, usually in an independent community setting.

There may be other healthcare personnel invo l ved with the eva l u a t i o nand care of the patient with a hearing loss, including nurses, phy s i c i a nassistants, hearing testing technicians, and makers of artificial ears (forcongenital defects). These individuals perform valuable supportive serv-ices when required.

Working in the background, but vital to any medical and surg i c a lhealthcare, is the re s e a rc h e r who seeks to improve the diagnostic meth-ods and treatment of patients with hearing loss through innovations intesting and medical or surgical therapies. A m e r i c a ’s Hearing HealthcareTeam is dedicated to the highest level of evaluation, diagnosis, and treat-ment of those who seek care for a hearing loss. The patient is the centerof the team and, after being fully informed of the diagnosis and treatmentoptions, has the right to choose how he/she will be treated. The teamleader is the physician, usually an otolaryngologist-head and neck sur-geon, who is best trained to diagnose the medical cause of hearing lossand offer medical and surgical therapy. With full access to the completeteam of dedicated professionals, A m e r i c a n s ’ ability to communicatee ff e c t ively is in good hands with the hearing healthcare team. © 2001 A AO-HNS, Inc.


ASHA Trades Autonomy for A AO - H N SEndorsement of CCCs

(internet posting: ‘aaalert’, n ew s l e t t e rs @ a u d i o l og y l i s t s . o rg Sept. 19, 2001)

Six months ago, the leadership of the American Academy of A u d i o l o g y(AAA) was approached by the American Academy of Otolaryngology - Headand Neck Surgery (AAO-HNS) regarding our participation in “A m e r i c a ’sHearing Healthcare Team Initiative” (AHHTI) introduced in March, 2001. Ina disturbing and unexpected move, the American Speech-Language-HearingAssociation (ASHA) announced last week that they have committed our pro-fession to the American Academy of Otolaryngology-Head and NeckS u rgeons (AAO-HNS) in the “A m e r i c a ’s Hearing Healthcare Team Initiative ”(AHHTI). Although the lofty ideals of the published joint statement(h t t p : / / w w w. e n t n e t . o rg / a h h t i 2 . h t m l) are commendable, the interpretation ofthe statement by both organizations indicates conspicuous inconsistenciesr egarding the role of audiologists on the hearing healthcare team. For this rea-son, the American Academy of Audiology (AAA) had declined seve r a lmonths ago to obligate audiology to AHHTI, and this decision was commu-nicated directly to ASHA and other related professional orga n i z a t i o n s .

The reasons for A A A’s refusal to participate in the AHHTI were simple:although the diagnosis and treatment of hearing and balance disorders repre-sents a continuum of care that is best served by a team of professionals,patient care must not be compromised in the process.

• Including hearing instrument specialists in an expanded and equiva l e n trole to audiologists is, frankly, unacceptable. According to the A AO - H N Swebsite h t t p : / / w w w. e n t n e t . o rg / a h h t i . h t m l, hearing instrument specialistsare recognized as a member of A m e r i c a ’s Hearing Healthcare Team whoh ave “special training in the testing of patients who seek rehabilitation forhearing loss and in selecting and fitting the most appropriate assistivehearing dev i c e .”

• According to A AO-HNS, otolaryngologists are the ga t e keepers of hearingand balance care, and audiologists may test hearing only when ordered byp hysicians. Audiologists may identify abnormal responses; the diagnosisof hearing loss, how eve r, is a physician responsibility.

WH YI ST H I S AG R E E M E N TD E L E T E R I O U S TO O U RP RO F E S S I O N?• Agreement or endorsement of these statements jeopardizes the approach

of obtaining limited license practitioner status with the Centers forMedicare and Medicaid Services (formerly HCFA) and third party payers,and restricts the role of the audiologist in the hearing healthcare system.

• A S H A’s commitment to AHHTI, and their inclusion of an outdated certi-fication process (CCC-A) in the initiative, rather than education standardsand state licensure (similar to other healthcare professions), also compro-mises quality and raises costs. In return for subjugating the profession ofaudiology to physicians, ASHA gained A AO - H N S ’s support of the CCC-A program.

Equally disturbing is the fact that audiologists reading the Press Releaseonly will not understand the true intent of this agreement, which is stated onthe A AO-HNS website. Whether a reluctance to highlight the differences pro-moted in the respective websites as opposed to the wa t e r e d - d own PressRelease is a deliberate attempt to shield the truth from members is unknow n .Therefore, take the time to visit the A AO-HNS website, rev i ew the informa-tion on AHHTI for yourself, and make your own judgments. If you disagree,contact ASHA to tell them that this is a bad move for audiology.

This is not simply “ASHA bashing,” or a matter of “us” and “them,”because it commits audiology to AHHTI at a great cost to the profession.

—David Fa b r y, PhD, President, AAA

Hearing Healthcare Team

(internet posting a s h a - a u d - f o r u m @ p o s t m a n . c o m, Sept. 19, 2001)

I don’t often post to the listserve as I have viewed it as an opportunity foraudiologists to share clinical insights and trade success stories in patienttreatment and rehabilitation. How eve r, since the posting of A S H A’s joiningA m e r i c a ’s Hearing Health Care Team has drawn some questions I’d like too ffer some facts regarding the effort. I wo n ’t reiterate the statements made inmy initial attempt Monday to clarify why we think this is a very positived evelopment for audiology.

ASHA, AAA, and other audiology organizations have long held to theprinciple of autonomy and independence for audiology. The joint statementof ASHA and A AO-HNS, the full text which is included below, reflects a sig-n i ficant change in the position of A AO-HNS toward the profession of audi-o l o g y. ASHA wo r ked collaboratively with A AO-HNS to develop a defi n i t i o nthat reflects the autonomy of the profession of audiology, the independenceof its practitioners, and easier access to hearing health care by consumersthrough multiple points of entry, e.g., audiology or otolaryngology.

One of the Hearing Healthcare Te a m ’s goals over the next five years is tobuild public awareness of hearing loss, its causes, its prevention, treatmentand rehabilitation options available. ASHA believes this is a positiveresponse to repeated requests from our members for increased visibility forthe profession of audiology. Such public awareness will also benefit con-sumers as increasing numbers of individuals with hearing loss seek hearinghealth care.

In spite of what has been suggested by AAA officers on this listserve ,there is absolutely nothing in the Joint Statement of ASHA and A AO - H N Sthat precludes the recognition of limited licensed practitioner status by healthcare payers, including Medicare. To the contrary, the fact that audiology isrecognized as an autonomous and independent profession by A AO-HNS willhelp efforts to obtain this status with leg i s l a t ive and regulatory bodies.

ASHA recognizes that there are materials on the A AO-HNS Web site thatare inconsistent with the intent and spirit of the Joint Statement of ASHA andA AO-HNS. Because of the terrorist attacks on New York and Wa s h i n g t o n ,DC, the staff of A AO-HNS has only just returned from their annual meetingin Denver—by bus. ASHA has asked A AO-HNS to update the informationappearing on their Web site, including the definition of audiologists andother statements so that the language reflects our agreement and collabora-t ive spirit of the hearing healthcare team. Please be patient, this is a diffi c u l ttime for all. In the meanwhile, please keep in mind that A AO-HNS hasagreed to the definition of audiologists in the joint statement.

As we wo r ked with the leadership of A AO-HNS, we found them willing tolisten and be responsive to our concerns. As I said in my earlier email (Monday,September 17), the definition of audiologists and the removal of aural rehabili-tation from the fitter and dispenser definition were primary objectives if wewere to continue discussion. The definition of audiologists has been very satis-factorily achieved. ASHA has long recognized hearing aid dealers play a spe-c i fic role in providing services to those with hearing loss; how eve r, not includ-ed are the provision of aural rehabilitation and testing for purposes other thanfitting and dispensing of hearing aids. We will be watching closely furtherd evelopments related to the redefinition of hearing instrument specialist.

We are proud of the progress we have made on behalf of audiology,which, I might add, was accomplished with the knowledge of and input fromASHA audiology leaders. The joint statement has been on A S H A’s Web sitefor over a week and can be found at h t t p : / / p r o f e s s i o n a l . a s h a . o rg / r e s o u r c e s /a ffi l i a t e s / a a o h n s _ j o i n t a g r e e . c f m. We hope audiologists will read the fullstatement that has been developed and recognize the importance of the defi-nition of audiologists and agreement by A AO-HNS that there should be mul-tiple points of entry to the system if we are to offer the best quality servicesto those with hearing and balance disorders. Thanks for reading this epistle,I hope it helps your understanding of A S H A’s eff o r t .

— Posted by Larry Higdon, PhD, A S H A

I N T E R N E T P O S T I N G S


On September 21, 2001, Congressman Mark Fo l ey (R-FL)introduced HR 2934, the “Medicare Aural Rehabilitation andHearing Aid Coverage Act of 2001,” which would amend Ti t l eXVII of the Social Security Act to provide Medicare coverage forhearing aids and aural rehabilitation services to hard-of-hearingsenior citizens. The tragic events of September 11, 2001 make itimpossible for the 107th Congress to conduct “business as usual,”and therefore, it is unlikely that this bill will pass this year.R egardless, it does raise important issues related to third-partyr e i m bursement for hearing aid services.

Hearing loss is a major health issue affecting nearly 10% of theUS population. Untreated hearing loss in the elderly has beenreported to cause a higher incidence of depression, anxiety andsocial isolation (National Council on Aging, 2000). That said, hear-ing loss tends to be an undervalued disorder in our society, and only20% of the roughly 28 million Americans with measurable hearingloss wear hearing aids reg u l a r l y.

One of the most significant barriers to increased hearing aid useis the fact that in the United States, hearing aids are not covered bymost public or private insurance plans, including Medicare. With theaverage cost of binaural hearing aids well over $2000, this repre-sents a significant economic obstacle. In addition, a new report pub-lished by AARP suggests that for those over 50 years of age, the ga pbetween rich and poor is widening. Fully 14% of those over 50 donot have health insurance, and disposable income for non-cove r e dhealth expenses is extremely limited. The issues with developing ar e i m bursement program for hearing aids are complicated by a num-ber of factors described below :

CH A N G I N G DE M O G R A P H I C S

First, the current Medicare-served population of approximately40 million people will swell as the 77 million baby boomers bornbetween 1946 and 1964 march steadily towards retirement age.Second, the number of “wo r kers per Medicare beneficiary” hasbeen steadily declining since the 1970s; in 2001, the ratio is 3:7,and by 2040 is projected to be 2:1. The Centers for Medicare andMedicaid Services (CMS), formerly known as HCFA, willundoubtedly be increasingly vigilant regarding the bu d g e t a r yimpact of new entitlement programs when fewer wo r kers will besupporting more retirees.

PAT I E N T A N D PROV I D E R CH O I C E

The second issue relating to reimbursement is that the focus mustnot be solely on the product. That is, this program is not simply thed i s t r i bution of “one size fits all” devices — case closed, problems o l ved. In fact, the diagnostic and rehabilitative process with hear-ing aids is often lengthy, particularly with elderly patients who mayh ave diminished cognitive function. To facilitate this process, how-eve r, audiologists must be able to bill and receive payment fromCMS without supervision by other healthcare professionals. Pa t i e n t swith hearing loss benefit from multiple entry points into the hearinghealthcare system, and audiologists should serve as an —not the—independent entry point. This will result in enhanced access and

i m p r oved efficiencies for serviced e l ivery to patients.

In addition, the development of ar e i m bursement program for hearingaids should not sacrifice technologyfor increased utilization. That is,m a ny of the “basic” hearing aidsthat are provided to the nation’sMedicaid programs provide little, ifa ny, benefit in noisy listening env i-ronments. For most current insur-ance coverage, no “top up” benefi texists allowing patients to incrementthe basic benefit amount prov i d e dby the program to purchase dev i c e s

with more advanced technology. Specifying the option for Medicarepatients to “top up” would enable broad coverage, but also ensure thatpatients may select more advanced devices without placing undueeconomic hardship on the program. The Academy believes this is anessential component of any bill deserving of our support.

“ UN B U N D L E D” PR I C I N G ST R U CT U R E

This has been a topic of hot debate for many years; historically,costs of the hearing test, hearing aid selection and fitting, aural reha-bilitation and follow-up services have all been “bundled” into the ini-tial purchase price, first by commercial hearing aid dealers, and later,by audiologists. Although this practice of providing “free for service”diagnostic and rehabilitative service may assist practitioners with localcompetition, it has placed audiologists in a tenuous position withhealthcare reimbursement agencies, including CMS. Currently, partof the poor Medicare reimbursement for diagnostic audiologic eva l u-ations is due to the mixture of “simple fee” and “free for service”practices that trade free hearing tests for access to hearing aid patients.As long as this practice continues, the value provided by a compre-h e n s ive audiologic evaluation will be discredited, and thus Medicarer e i m bursement will be abysmal. Furthermore, unless (and until) audi-ologists —not physicians— receive fair reimbursement for auralrehabilitation services, practitioners will not be able to afford to wo r kwith Medicare patients and stay in business, and quality of outcomewill suff e r. No bill for Medicare reimbursement of hearing aidsshould be sent to Congress without clear guidelines for 1) reimbu r s e-ment of diagnostic and rehabilitative services, 2) who provides theseservices, and 3) outlawing the practice of giving away diagnostic hear-ing tests in exchange for access to hearing aid patients.

Compared to other Western countries, the U.S. is the ex c e p t i o n ,rather than the rule, in not having a program for third-party reim-bursement of hearing aids. The changing demographics will like l yincrease pressure to develop a program, but care must be taken toensure quality of outcome, improved access and reasonable cost. T h eAmerican Academy of Audiology Board of Directors will be eva l u a t-ing HR 2934 to determine whether to support, modify or oppose thisbill on that basis. Please feel free to contact the National Office or anyBoard Member with your input.

David Fabry

D AVID FA B RY

Medicare Coverage For Hearing Aids: Prescription For Cure Or Disaster?


I can’t start my article without first acknowledging the tragic eve n t sof September 11. We were all greatly affected that day and will bef o r evermore influenced by the outcome of those events. May each ofyou, whether you were directly or indirectly affected, find peace andcomfort in your family and friends. And may God bless America as wework to eradicate terrorism from US soil and from the wo r l d .

As we move forward in our work at The A c a d e m y, we are faced withan interesting issue. The American Academy of Audiology was recent-ly denied membership on the AMA Health Care Professional A d v i s o r yCommittee (HCPAC). This committee fosters participation by orga n i-zations representing non-MD/DO professionals in CPT coding changesthat affect HCPAC members.

On September 27, The Academy was advised that the AMA previ-ously selected the American Speech-Language Hearing Association(ASHA) as the most appropriate organization to represent audiologistson the HCPAC, according to the following rationale:

• “ASHA represents more than 103,000 audiologists, speech-languagepathologists and speech and hearing scientists;

• 90% of all certified audiologists are members of ASHA. In addition,90% of all members of The Academy are members of A S H A ;

• C e r t i ficate of Clinical Competence in Audiology (CCC-A) adminis-tered from ASHA, serves as the industry standard for credentialingand determining the professional qualifications of audiologists;

• ASHA established a standing committee of audiologists and speech-language pathologists to ensure appropriate CPT procedures are inplace for audiology and speech-language pathology. A u d i o l o g ycodes are proposed and discussed by only audiology members.”The HCPAC rules allow for only one representative from any spe-

cialty to sit on the committee. As a result, audiologists’ voice on theH C PAC Committee that establishes CPT coding and, ultimately, deter-mines procedures for which you can receive reimbursement has been,and will continue to be, from ASHA and only ASHA.

As long as audiologists are comfortable with the status quo, andb e l i eve the rationale outlined in the HCPAC letter to The A c a d e m y, then

ASHA will continue to claim to represent the audiology professionbecause they have the “numbers.” How eve r, judging from the numer-ous comments we received regarding A S H A’s recent agreement withA AO-HNS to join A m e r i c a ’s Hearing Health Team Initiative, manyaudiologists do not want ASHA to speak for them. We hear from moreand more of our members that although they belong to various mulit-disciplinary organizations, that the “voice” speaking on behalf of audi-ologists should come from the largest organization composed only ofaudiologists and comprised of, by and for audiologists. Our A c a d e m yhas a strong and successful record of working on behalf of all audiolo-gists, whether they are members of our organization or not. It is impor-tant that we continue to let other organizations and government agen-cies know that we truly represent audiologists — not speech-languagepathologists, not hearing aid specialists — but only audiologists.

E x e c u t i v e U Pd a t eLaura Fleming Doyle, CAE

ACADEMY MEMBERSHIP IS GROWING Almost 8% in less than 2 Years!

Several sources estimate there are 12,900 US Audiologists. Wehave room to grow. Encourage your Colleagues to join.

American Academy of Audiology membership(potential membership: 12,900*)

1997 6557

1998 6554

1999 6898

2000 7178

2001 YTD 7457

*estimate from the Bureau of Labor and Statistics

LE T T E R FR O M T H E AM E R I C A N AC A D E M Y O FOT O L A RY N G O L O G Y - HE A D & NE C K SU R G E RY

I was interested to find Dr. David Fa b r y ’s column inAu d i o l ogy To d a y (July-August, 13:4, pg. 6) addressing A m e r i c a ’sHearing Healthcare Team Initiative, a program recently launchedby the American Academy of Otolaryngology - Head and NeckS u rg e r y, the American Otological Society, and the A m e r i c a nNeurotology Society, and endorsed by the American College ofS u rgeons. His column could be the start of a dialogue on howotolaryngologists and audiologists can cooperate in an effort toinform patients and the public that the optimal diagnosis andtreatment of hearing and balance disorders is often a collectivee ffort by professionals from different disciplines, each withexpertise and a proud tradition of public service.

The A AO-HNS has always been fully committed to a teame ffort in order to improve patients’ access to quality and coordi-nated healthcare for hearing disorders. We believe that primarycare physicians, physician specialists, audiologists, and hearinginstruments specialists each has a unique a role in patient care byvirtue of their documented training and clinical ex p e r i e n c e .

D r. Fabry closes his column stating that “the collaborationbetween physicians and audiologists is a logical means to...pro-viding the best care to every patient, every day, though integ r a t-ed clinical practice, education and research.” I wholeheartedlyagree with Dr. Fa b r y. Presently only 20 percent of the popula-tion who needs hearing healthcare is accessing resources fortreatment. A m e r i c a n ’s Hearing Healthcare Team could be thevehicle that brings us all together to care for the 80 percent thatremain untreated.

S i n c e r e l y,Ja ck L. Gluckman, MD, President, A AO-HNS 9/7/01

Hear Ye Hear Ye…L E T T E R T O T H E E D I T O R


AAA Pre s i d e n t - E l e c tBRAD STA C H was elected to theposition of President-Elect of theAmerican Academy of Audiology and willassume that office on April 1, 2002.Stach, a Founding Member and the firstS e c r e t a ry - Treasurer of the Academy hass e rved our organization in many capaci-ties. He is currently a member of TheAcademy Board of Directors and serv e sas Chair of the Finance Committee. Stachis the author of several textbooks inaudiology and a well-known lecturer andt e a c h e r. Stach is Director of Audiology

and Clinical Services at the Central Institute for the Deaf and Professor in theDepartment of Speech and Hearing at Washington University in St. Louis.Following his term as President-Elect, Stach will serve as the President ofthe American Academy of Audiology beginning July 1, 2003 through June30, 2004 following Angela Loavenbruck’s term .

K ATHLEEN CAMPBELL is Professor andDirector of Audiology at Southern IllinoisUniversity School of Medicine in Springfield, IL.She was awarded The Academy’s PresidentialCitation for her work on the professional PracticeGuidelines. Campbell holds two patents fordrugs that prevent ototoxic and noise-inducedhearing loss and she is the recipient of numerousNIH research grants. Her areas of special interestare reimbursement issues, professional stan-dards and audiology autonomy.

H O L LY HOSFORD-DUNN is President of theTucson Audiology Institute in Tucson, AZ.Dunn has more than 20 years experience inprivate practice and has authored and editedtextbooks on practice management. Her spe-cial interest areas are continuing education,a u d i o l o g y ’s role in healthcare delivery systemsand outcome measures for program evaluationand hearing aid researc h .

BRENDA RYA L S is Professor of Audiology andDirector of the Auditory Research Laboratory inthe Department of Communication Sciences andDisorders at the James Madison University inHarrisonburg, VA. Ryals is currently President ofthe American Auditory Society and Chair of theAcademy Research Committee. Her areas ofinterest include research in auditory develop-ment and plasticity, and graduate education andtraining in audiology.

ELECTION

AAA Board of Dire c t o r sThe following three nominees were elected to The Academy Board ofDirectors for a three-year term beginning April 1, 2002 and runningthrough June 30, 2005.

2001 RESULTS


ON RE N A M I N GAU D I T O RY NE U R O PAT H Y A S AU D I T O RY DY S-S Y NC H R O N Y

BAC KG RO U N D A N D DE F I N I T I O N SNeither ABR nor otoacoustic emissions are objective tests of hear-

ing. ABR reflects synchrony of the VIIIth nerve and related sensorystructures, usually in response to a brief acoustic pulse, while normalemissions signify a normal endocochlear potential, middle ear spaceand (probably) outer hair cells. The diagnosis of Auditory Neuropathy /Auditory Dys-synchrony is made when OAEs and/or large cochlearmicrophonics are present and both middle ear muscle reflexes andABRs are absent. Sometimes the ABR appears to be present but it isreally a cochlear microphonic or unmaskable hair cell response ratherthan a maskable neural response. Comparing an average consisting ofp o s i t ive polarity clicks to an average made up of nega t ive polarityclicks separates neural from hair cell responses, because the hair cellresponses reverse polarity while the neural responses do not (Berlin etal.,1998; See Figure 1). Middle ear reflexes are virtually always absentas are the efferent olivocochlear reflex (or suppression of otoacousticemissions) and masking level differences (MLD) (Berlin et al., 1993;Berlin et al., 1994).

We believe substituting or adding the term Auditory Dys-s y n c h r o ny (Adys) to Auditory Neuropathy (AN) in the initial diagno-sis is semantically quite important for the following reasons:1. The auditory nerve itself is not always affected. In fact, it may

often be quite normal.

a. Most writers agree with Starr et al. (1991) that this is a timingdisorder and may be either axonic, dendritic, or even primari-ly sensory in nature. (See 1.d. below). While there areundoubtedly AN patients who have true neural disorders, neu-ral disease need not be the sole culprit.

b. This is NOT always an axonic disorder. Transtympanic elec-t r o c o c h l e o g r a p hy, when performed, reveals the same reve r s i n gcochlear microphonic at the cochlear level that one sees withs u r face recorded ABRs. In a purely axonic (but probably notspiral ganglion) disorder, a Wave I will be recordable eve nthough the rest of the ABR might be desynchronized by, forexample, Multiple Sclerosis or other leukodystrophies. On theother hand, there are unquestionably AN patients whose auraln e r ve biopsies and/or postmortem temporal bone studies show

a paucity of healthy axons (Starr et al., 2001-PersonalCommunication).

c. Only twelve of 100 of our patients show signs of neuropathyin other systems so fa r, (Starr et al., 2000; Berlin et al., 2001)although we have not followed the pediatric patients well into adulthood.

d. Examination of temporal bones of 3 premature infants whohad absent ABRs, no Wave I, and presumably normal OAE atbirth (not actually tested, but presumed normal because of theundisturbed outer hair cells) reveal mostly normal and healthyouter hair cells, healthy sensory nerve fibers past the habenula perforata, but mostly absent inner hair cells(Amatuzzi et al., 2001).

e. The Bronx Waltzer Mouse (Steel and Bock, 1983) and theB e e t h oven Mouse (Steel et al., 2001), which may be animalgenetic models for this disorder, show a similar pattern ofabsent inner hair cells, while outer hair cells are mostly normal.

f. Fan Gang Zeng et al. (1999) have shown that gap detectionand temporal modulation transfer functions in these patientsare abnormal. Based on these data, he has also produced anextremely valuable synthesis of what speech might soundlike to patients with a wide range of timing problems. He hasalso shown that masking interferes quite abnormally withsuch patients, ostensibly by “filling in” whatever gaps mightbe audible.

g. Cochlear implants have been successful for many auditoryd y s - s y n c h r o ny/auditory neuropathy patients (Shallop et al.,2001; Berlin et al., 2001), a procedure that might not eve nh ave been semantically considered if the term“ N e u r o p a t hy” were taken literally to mean proven damageto the Auditory Nerve .

2 . Calling this group of observations “auditory neuropathy” maylead to inappropriately discounting cochlear implants as a u s e f u l t r e a t m e n t .

a. Semantic theory (Korzybski, 1958) warns us that the words weuse to describe a situation or object often dictate how we thinkabout it or treat it. This awareness heightens our current sensi-t ivity to politically incorrect language. For example we area s ked to avoid using demeaning terms like “girl” or “babe” toadult females, or “boy” or “son” to adult males to whom weare not related. This practice, how eve r, can be stretchedb eyond reason, for example, by calling looters “alternativeshoppers” and prisoners “guests of the penal system” so as notto hurt their feelings (Beard and Cerf, 1994).

b. Using the term “Auditory Neuropathy” implies to some thatthe VIIIth nerve itself must be compromised and, erg o ,Cochlear Implantation might not be useful. At one time wegave such advice because the first few patients we saw hadperipheral neuropathies that we extrapolated to include theVIIIth nerve. In fact, just the reverse seems to be true in manypatients.

c. Implantation has subsequently proven to be useful in at least18 of 20 patients in our sample in this country in either restor-

Charles Berlin, Linda Hood, Kelly Rose, Louisiana State University Health Sciences Center, New Orleans, LA

Implications for a clearer

understanding of the

underlying mechanisms

and management options

f e a t u r e a r t i c l e


ing or establishing synchrony, establishing a robust electricalABR, and restoring the middle ear muscle reflex (Berlin etal., 2001; Shallop et al., 2001). One of the two unsuccessfulpatients about whom we are aware is a child with FriedreichAtaxia reported by Miyamoto (1999).

d. We owe this breakthrough use of implants to one set of coura-geous parents of two of our children who opted for implantsa gainst our early advice, and to the surgeon (George Fa c e r )and audiologist (Jon Shallop) who supported their effort. T h eparents were emboldened by two other surgeons who hadsuccessfully implanted two AN/Adys patients with flat A B R swithout knowing their patients had normal otoacoustic emis-sions. Shallop et al. (2001) have shown nicely that, on theoperating table, EABR becomes synchronous and shows anormal latency-intensity function, and electrically evo ke dmiddle ear muscle reflexes are robust. These excellent resultsstrongly suggest that many nerve fibers have been activa t e d ,and the middle ear muscle reflex hasbeen energized with electrical stimula-tion, probably by enhancing neural syn-c h r o ny. Knowledgeable practitionerswould not withhold implantation even ifthere were axonic depletion (Starr,2001-Personal Communication), so thatthis becomes a moot point so long as theconcept of Auditory Neuropathy issemantically indexed to mean some-thing other than absent nerve fibers.

e. Before implantation, hearing aids (andAuditory Verbal T h e r a py) have not beens h own to help these patients learn lan-guage auditorily (Berlin et al., 2001)r egardless of their audiograms, but sup-port of language through visual means(Cued Speech, signs, and to a lesserextent, lip reading) is very useful.

VA R I A B L E TI M E CO U R S E SFurther reasons to avoid the term A u d i t o r y

N e u r o p a t hy unless there is clear proof of otherneurological disease can be gleaned fromr ev i ewing the various post-diagnosis pathswhich some of these patients have follow e d .

The patients on whom we have ve r i fi a b l erecords, especially those 34/100 with surpris-ingly mild hyperbilirubinemia (under 14 ml/dl),fall into six categories (Berlin et al., 2001).1 . Some patients develop normally, and start

to hear and speak within a year to 18months (7/100 in this sample). Their A B R sh ave remained abnormal so far with oneexception. Their hearing in noise as theymature, and whether they are diagnosed ash aving CAPD, remains to be eva l u a t e d .

2 . Some patients lose their otoacoustic emis-sions and cochlear microphonics, andb e h ave either severely deaf or occasionallys h ow unexpected but ephemeral episodes of hearing.

3 . Some patients lose their otoacoustic emissions but NOT theircochlear microphonics while behaving anywhere from seve r e l ydeaf to occasionally showing unexpected hearing abilities( Withnell, 2001).

4 . Some patients stay the same, behaving very deaf all the while. T h e s eare usually genetic in origin and we have 8/100 subjects who havefamilial disorders with NO accompanying peripheral neuropathy.

5. Some of these patients (12/100) develop peripheral neuropathiessuch as Charcot-Marie-Tooth disease later in life. This latter cat-egory more commonly describes later onset A N . These patientsare quite likely to have true Auditory Neuropathies as part oftheir systemic neuropathies. T h ey develop speech and languagenormally but slowly lose speech comprehension, especially innoise or in less-than-ideal listening conditions.

6. Some patients go through life without complaining of any prob-lem; they develop speech and language normally and would only

ON RENAMING AUDITORY NEUROPATHY AS AUDITORY DYS-SYNCHRONY:Implications for a clearer understanding of underlying mechanisms and management options

FIGURE 1.

Example of a true ABR to a condensation and rarefaction pulse immediately belowand a pseudo ABR which is really a Cochlear Microphonic, or hair cell response, justb e l ow that. A true neural response does NOT reverse in polarity when the stimuluspolarity is reversed, and the wa ve forms get smaller and later. In a cochlear micro-phonic, the wa ve forms simply get smaller but not later and generally disappear below60 dB. Also, CMs do NOT reduce in amplitude when masked. Note third set of trac-ings which reveal the polarity reversal of the wa ves in the middle figure. (See Berlin,et al., 1998 for more interpretation.)

Normal ABR to+ and - clicks

Pseudo ABR(CM)

to a single polarity

c l i c k

Inverting CMrevealed by theuse of + and

then - clicks inseparate averages


be discovered if someone had done an ABR as part of either adiagnostic screening for CAPD or research project. These maybe the adult results of infant patients in category 1 above, whoh ave lost only a few inner hair cells, or have had rapidly autolyz-ing kernicterus, or had particularly plastic nervous systems.

At present, we have no idea how many people like this exist orh ow many develop neuropathies much later in life, since we saw ourfirst patient with this symptomatology in 1982. An audiologist attend-ing one of our ABR courses was trying to develop local norms. Shestudied her obstetrician’s 12-year-old son who had no auditory com-plaints. She was surprised to find that he had an absent ABR andabsent middle ear muscle reflexes, and she sent him to us for study.At the time, lacking an otoacoustic emissions system, we did notk n ow how to interpret this anomaly but Worthington and Peters(1980) and later Kraus et al. (1984) had published papers on suchpatients so we simply assumed he must be one of them. Recent fol-l ow up in 2001 shows that the patient still expresses no complaints,has finished law school, having gone through college and law schoolostensibly with no special auditory complaints or neurological prob-lems. How eve r, his parents note that he is having increasing diffi c u l-ty in the courtroom in understanding speech in noise and recognizingwhen he is being addressed from the side or from behind.

SU G G E ST I O N S F O R MA NAG E M E N TPatients who fall in categories 2 through 5 above usually have

speech perception that is quite poor. In our experience, auditory ve r-bal therapy with hearing aids but no visual clues usually does NOTfacilitate language development, except under ideal signal-to-noiseconditions. If there is any usable hearing, it fails rapidly with theslightest bit of simultaneous noise. Thus these patients sometimesappear to hear and sometimes don’t, depending upon the signal-to-noise (S/N) ratio. Please note that when parents of such children saythat their child sometimes hears without hearing aids, or even whentheir implants are turned off, this may very well may be true andshould not be ascribed to the parents’ poor observational skills or to“ failure to accept their child’s deafness.”

Pouring visual language into these children as early as possiblepostures the parents to handle this state of affairs well. We preferCued Speech (CS) because it is related to the sounds of spoken lan-guage and will ultimately complement a cochlear implant if chosen.Others prefer Sign Language, which is not phonologic and may notmeld as well with implants. If the child’s hearing ability improve s ,no harm is done and, if CS is used, it facilitates phonologic awa r e n e s sand English grammar.

There are pluses and minuses to using both CS and Signs. Simplesigns of nouns and verbs are usually easy to learn for both parent andchild, and the child can usually use them to make his/her needs betterk n own. How eve r, more complex utterances and more advanced signvo c a bulary require that the parents stay one step ahead of the child,and that they ultimately be able to sign much if not all of their con-versation within “eyeshot” of their eavesdropping child. Such a childis then exposed to a spatial language whose grammar, if the signs areAmerican Sign Language (ASL), is different from English. If SignedExact English (SEE) is used, there is good reason to believe it is notreally a language in the purest sense (Fleetwood and Metzger, 1998)and can in the long run stultify language usage and comprehension.

For normal hearing, English-speaking parents, true fluency andp r o fi c i e n cy with CS is generally faster and easier to acquire than withAmerican Sign Language or Signed Exact English. A new sign is notneeded for any word already in the parents’ vo c a bu l a r y. Using CSaround the house, especially as family members communicate to one

a n o t h e r, allows the child to visually eavesdrop on the family interac-tions and learn language, grammar and phonology naturally. CuedSpeech supports, and in turn is supported by, Cochlear Implantation;what is seen is also heard and phonological awareness, an essentialingredient for literacy, is facilitated. In addition, Cued speech allow sthe child to eavesdrop on other languages in addition to English,which, in our multi-cultural society, is often highly desired by multi-lingual families. For more information see the National Cued SpeechAssociation website at h t t p : / / w w w. n c s a . c o m.

RE F E R E N C E SAmatuzzi, M.G., Northrop, C., Liberman, M.C., Thornton, A., Halpin, C., Herrman,

B., Pinto, L.E., Saenz, A., Carranza, A., & Eavey, R.D. (2001). Selective inner haircell loss in premature infants and cochlea pathological patterns from neonatali n t e n s ive care unit autopsies. A rchives of Otolaryngology Head and Neck Surge r y,127(6), 629-36.

Beard, H., & Cerf, C. (1994). The Official Politically Correct Dictionary andH a n d b o o k . N ew Yo r k : Villard Books.

Berlin, C.I., Hood, L., Cecola, R.P., Jackson, D.F., & Szabo, P. (1993). Does Type Ia fferent neuron dysfunction reveal itself through lack of efferent suppression?Hearing Research, 65, 40-50.

Berlin, C.I., Hood, L., Hurley, A., & Wen, H. (1994). The first Jerger lecture:Contralateral suppression of otoacoustic emissions: An index of the function of themedial olivocochlear system. O t o l a r y n g o l ogy Head Neck Surge r y, 110 (1), 3-21.

Berlin, C.I., Bordelon, J., St.John, P. , Wi l e n s ky, D., Hurley, A., Kluka, E., Hood, LJ.(1998) Reversing Click Polarity May Uncover Auditory Neuropathy in Infa n t s .Ear and Hearing. 19(1), 37-47.

Berlin, C.I. (2001). Managing and renaming Auditory Neuropathy (AN) as part of acontinuum of Auditory Dys-synchrony (AD). A b s t racts of the 24th MidwinterR e s e a rch Meeting, Association for Research in Otolaryngolog y, 486,137.

F l e e t wood, E.D., & Metzger, M.A. (1998). Cued Language Structure: An Analysis ofCued American English Based on Linguistic Principles. S i l ver Spring: LanguageMatters, Inc.

Korzybski, A. (1958). Science and Sanity: An introduction to Non-AristotelianSystems and General Semantics. Connecticut: The International Non-AristotelianLibrary Publishing Company.

Kraus, N., Bradlow, A.R., Cheatham, M.A., Cunningham, J., King, C.D., Koch, D.B.,Nicol, T.G., McGee, T.J., Stein, K.L., & Wright, B.A. (2000). Consequences ofneural asynchrony: A case of auditory neuropathy. Journal of the Association forR e s e a rch in Otolaryngolog y, 1, 33-45.

Kraus, N., Ozdamar, O., Stein, L., & Reed, N. (1984). Absent auditory brain stemresponse: Peripheral hearing loss or brain stem dysfunction? L a r y n g o s c o p e, 94,4 9 9 - 4 0 6 .

Miyamoto, R.T., Kirk, K.I., Renshaw, J., & Hussain, D. (1999). Cochlear implantationin auditory neuropathy. L a r y n g o s c o p e, 109(2Pt1), 181-5.

Shallop, J.K., Peterson, A., Fa c e r, G.W., Fa b r y, L.B., & Driscoll, C.L. (2001).Cochlear implants in five cases of auditory neuropathy: Postoperative fi n d i n g sand progress. L a r y n g o s c o p e, 111(4 Pt 1), 555-62.

S t a r r, A., McPherson, D., Patterson, J., Don, M., Luxford, W., Shannon, R., Sininger,Y., To n o k awa, L., & Waring, M. (1991). Absence of both auditory evo ked poten-tials and auditory percepts dependent on time cues. B ra i n, 114, 1157-1180.

S t a r r, A., Sininger, Y.S., & Pratt, H. (2000). The varieties of auditory neuropathy.Journal of Basic Clinical Physiology and Pharmacolog y, 11(3), 215-30.

Steel, K.P., & Bock G.R. (1983). Hereditary inner ear abnormalities in animals.Relationships with human abnormalities. A rchives of Otolaryngolog y, 109, 22-29.

Steel, K.P., Kiernan, A.E., Erven A., Rhodes, C., Tsai, H., Hardisty, R.E., Nolan, P. ,Peters, J., Brown, S.D., Hunter, J., A h i t u v, N., Zalzman, M., Hertzano, R., Ben-d avid, O., Vreugde, S., Avraham, K.B.Balling, R., Hrabe, De Angelis, M.,GuEnet, J. (2001). New mouse models for hearing and balance defects from theEuropean mutagenesis programmes. A b s t racts of the 24th Midwinter ResearchM e e t i n g, Association for Research in Otolaryngolog y, 514, 145.

Withnell, R.H. (2001). Brief report: the cochlear microphonic as an indication of outerhair cell function. Ear and Hearing, 22(1), 75-7.

Worthington, D., & Peters, J.F. (1980). Quantifiable hearing and no ABR: Paradox orerror? Ear and Hearing, 1, 281-285.

Zeng, F.G., Oba, S, Garde, S., Sininger, Y., & Starr, A. (1999). Temporal and speechprocessing deficits in auditory neuropathy. N e u ro re p o r t, 10(16), 3429-35.

We thank the Oberko t t e r, Marriott, A H R F, DRF Foundations andNIDCD for their support.

ON RENAMING AUDITORY NEUROPATHY AS AUDITORY DYS-SYNCHRONY:Implications for a clearer understanding of underlying mechanisms and management options


RE M E M B E R T H E M OT H E R W H O O B S E RV E D,

“All of the children in the marching band are

out of step except my Johnny?” Talk about

a p p reciating independence... The current situ-

ation of hearing aid consolidation may bene-

fit from some discussion since to d ay’s hearing

aid environment may remind some of us

about independence and the loss of same.

From the very beginning of the hearing aid industry, manufa c-turers must have recognized the importance of marketing unity.Most of the retail offices of the 1950s and 1960s were “fa c t o r ys t o r e s ,” united in product, marketing, services, and identity. As theindustry grew (those were the days when the industry penetrationi m p r oved annually, sometimes increasing as much as 10% or moreper year), multiple line offices became more prevalent. T h e s eo ffices functioned more or less independently in the sense that theydid not rely upon any one manufacturer for their products, but ratherbought freely from many companies in an effort to “keep up witht h i n g s .” Typically these hearing aid dispensers marketed their inde-pendence and used their buying patterns to substantial advantage.

So, the hearing aid industry matures and part of this maturationi nvo l ves inve s t i gation into potential market and methods to increasem a r ket penetration. Despite the good and bad points of the deliv-ery system of the 1980s and 1990s, even the smallest manufa c t u r e rmust have realized that the present delivery systems were not suffi-cient to generate the business necessary to maintain the desired, sig-n i ficant growth rates and to bring hearing instruments to all thosewho could benefit from them. Audiology enters the fray andattempts to add value to the hearing aid delivery system - value interms of better understanding of normal and abnormal hearing,hearing aid characteristics, clinical measurement of benefit, etc.Still the industry and the delivery system show little growth. In fa c t ,in recent years and throughout the 1990s in general, there has beenno growth. What or who is at fault for this stagnation? How do we“ g r ow the market?” What is wrong with the industry? What do wedo nex t ?

Well, when a market ceases to have the number of sales that am a n u facturer or those otherwise invo l ved desire, there are only ar e l a t ively small number of things that can be altered to create thedesired increase in sales. Changes can be made in such areas ast e c h n o l o g y, manufacturing, distribution, marketing and price. T h emost common change made in most industries is pricing - if pricesare low e r, more sales result.

The hearing aid industry has undergone a staggering change int e c h n o l o g y. Most audiology journals and meetings are directlyconcerned with explaining this technology. An world-class compa-

nies, employing world-class techniques, manufacture many hearinginstruments. So much for changing manufacturing and technology.

Sometimes an industry will mount an advertising campaign thatlets consumers know the value of their product. The more peoplek n ow about the product, or the more they are reminded of the prod-uct, the more likely they will bu y. The television ads for milk, pork,on public radio and TV come to mind as examples. Sometimesthese campaigns are quite successful, but they require the coopera-tion of all parties to be truly successful. No one milkman or TV sta-tion benefits any more than anyone else. (This industry-wideapproach is typically the avenue that most retailers want the indus-try to take.) The trouble with this approach is that it is quite ex p e n-s ive and can take a long time to “bear fruit.” A recent example ofincreasing advertising invo l ves taking a look at the hearing aidsales for 2000. Inspection of the annual sales would indicate thatthe industry increased sales by about 11,000 units between 1999and 2000. This amounts to about 1 hearing aid for every dispens-ing office in the U.S. How much advertising money was spent dur-ing this year? By the manufacturers and by the dispensers? Yo udecide if this is a good return on inve s t m e n t .

Another way of increasing profits is to modify the distribu t i o nsystem. One obvious modification is to eliminate, modify orreplace the “middleman.” Wal-Mart and Costco are good ex a m p l e sof attempts to eliminate a link in the distribution chain by consoli-dating many stores into one big store and allowing the customerinto what is essentially a distribution center. This approach is goodfor some folks and bad for others.

The hearing aid industry is undergoing similar consolidation.And this consolidation appears to pose a threat to the “middleper-sons” (that would be “us”- audiologists). Look at this from thestandpoint that if instrument sales can be maintained or increasedthrough changing the efficiencies of the distribution system, profi t sshould be sustained or increase. One way to make the distribu t i o nsystem more efficient is if retail offices become “company stores.”Also, with an increase in the “unity” of retailers, the returns ongroup advertising, buying from a single manufa c t u r e r, and the insti-tution of centralized management systems, the profits to the systemshould be maintained or increased. If the distribution system ismade more efficient, the model would predict lower costs to con-sumers, increased market penetration, and maintenance or increases o m e o n e ’s profi t s .

OK, if we buy into consolidation, what do we give up to get thisb e n e fit of helping more hearing impaired people? Well, we mayneed to get busier to make the same amount of money since weh ave to see more people. (The profit per sale goes down, but weincrease volume - this could be a “wa s h .”) In seeing more peoplein the clinic, we may not be able to provide a high (time consum-ing) level of services to our patients. This potential compromise inquality must be balanced against the gain in productiv i t y. A dangermay exist in that, at this point, our “patients” may become our“clients” or, worse yet, our “prospects.”

We also may have to give up some clinical independence. T h a t

V I E W P O I N T

The Value of Independence in an Era of ConsolidationMichael Metz, D i rector of Audiology, EPIC, City of Industry, CA


is, in order to maximize profits, we perhaps limit our buying of hear-ing aids. We “make a deal” with one or two manufacturers to bu yhigher volumes of hearing aids at lesser prices. If our prices god own and the units purchased go up, assuming that we stay in bu s i-ness, we begin to see business advantages in dealing with perhapsonly one manufa c t u r e r. And thus we may, at least in some respects,return to the retail hearing aid office model of the 1960s.

So, it seems like the hearing aid industry has changed the tech-n o l o g y, streamlined manufacturing, is attempting to consolidated i s t r i bution and is also making attempts to decrease pricing to thec o n s u m e r. In other words, the hearing aid industry is maturing.Will market penetration increase? A b s o l u t e l y, and eve n t u a l l y. So,w h a t ’s the problem?

Picture yourself as a patient in the office of any professionalo ffering services - dentist, internist, cardiologist, pharmacist or audi-ologist. See if you can construct an expectation that does noti nvo l ve receiving independent, up-to-date, scientifically based infor-mation and recommendations for treatment. Would you be alarmedif the cardiologist could only recommend medications from onem a n u facturer? Or the pacemaker from one company? Or the den-tist only use filling material from one supplier? What about an audi-ologist who is limited to recommending hearing aids from only oneor two companies? Or an Audiologist who does not have time toevaluate you beyond the very rudimentary tests that can also be hadfor “free” from any hearing aid sales offi c e ?

As a patient, would you expect to be evaluated in accordancewith the state of the “science” in audiology and medicine? If youhad a hearing loss, how much information would you like to have?

One big potential problem with a maturing industry in generaland consolidation in particular is that we may have to limit ourchoices. Choices concerning best possible methods and treatmentsmay limit our independence. Consolidation is not a bad model - itworks fine in many business situations. But, while it may be OKwhen it comes to automobile dealers, or discount centers, I wo u l dthink that most professional people, audiologists included, wo u l drather not give up their independence. It would seem that the main-tenance of this independent functioning may be crucial to clinicaljudgement. Could it be that if you compromise this independence,you could also compromise your professional standing?

Business choices many times conflict with professional choices.When these conflicts arise, it is imperative that the patient and theprofession are served, even if that means basic principles of bu s i-ness are put in a secondary position. Even if it means that maxi-mum profit is not reached. To abandon clinical independence, eve ns l i g h t l y, may place our patients at risk of receiving less than whatwe have tried so hard to get them to ex p e c t .

The opinions expressed in this Viewpoint are those of the author{s}and in no way should be construed as representative of the Editor,officers or staff of the American Academy of Audiology.

V I E W P O I N T

The Value of Independence in an Era of Consolidation

NationalSymposium on Hearing in Infants

NationalSymposium on Hearing in InfantsAugust 1-3, 2002Beaver Run ResortBreckenridge, Colorado

sponsored by

Marion Downs Children’sHearing Endowment

Marion Downs NationalCenter for Infant HearingColorado HearingFoundationUniversity of Colorado Health Sciences Center

Call for Contributed PapersDeadline April 1, 2002For Information call 303.372.3190

Call for Contributed PapersDeadline April 1, 2002For Information call 303.372.3190

XXVI INTERNATIONALCONGRESS OF AUDIOLOGY

17-22 March, 2002Melbourne, Victoria, Australia

A diverse scientific program of symposia and round tables and freepapers on topical issues in audiology, plus a consumer forum and

extensive trade exhibition.

Round table and keynote discussions on:Implantable Technology

Speech Perception and PsychophysicsPrevention and Rehabilitation of Hearing Problems in the Elderly

Free papers and posters are welcomed on topical issues in hearingresearch, clinical practice and service delivery.

Deadline for submission of Abstracts is 25 November 2001.

To receive the Main Announcement and Registration Brochure for the XXVI International Congress of Audiology

please contact the congress secretariat:

A limited number of Sponsorships and Exhibition packages are still avail-able. Please contact the congress secretariat for details.

Congress Strategy Pty Ltd.P.O. Box 1127

Sandringham, Victoria, 3191, AustraliaTel: +61 3 9521 8881; Fax: +61 3 9521 8889Email: [email protected]

Website: http://www.conferencestrategy.com.au


R e i m bursement claims require the use of two coding systems:one that identifies the patient’s disease or physical state (theInternational Classification of Diseases, Ninth Rev i s i o n - C l i n i c a lM o d i fication or ICD-9-CM, codes) and another that describes theprocedures, services or supplies provided to your patients (theCurrent Procedural Te r m i n o l o g y, or CPT, codes).

The ICD-9-CM coding system was implemented in 1989. ICD-9-CM is used by virtually all third-party payers in the United States asthe coding system for describing patient conditions. The purpose ofICD-9-CM coding is threefold:

• To establish the medical necessity for the visit or service;

• To provide statistics for morbidity and mortality rates;

• To take the written description of a disease or state and translatethat information into numbers, producing a common language.

To show medical necessity, it is important to select the diagnosiscode (ICD-9 code) most specific to the patient’s problem and thenlink the diagnosis to the procedure (CPT code) you perform. Eachprocedure (CPT code) becomes a line item on an insurance claimform. Reimbursement depends upon recording a symptom, diagno-sis or complaint (ICD-9 code) to establish “medical necessity” foreach service. Showing medical necessity means that you justify yourprocedural choice (CPT code) by linking it to an appropriate diag-nosis, symptom or complaint (ICD-9 code).

Each CPT procedure code must be accompanied by at least onediagnosis code (ICD-9). Each CPT code can have up to four ICD-9diagnosis codes on a HCFA-1500 form; how eve r, Medicare onlywants o n e ICD-9 code for each CPT code. The primary diagnosis iscoded first, and then all co-existing conditions that may complicatethe treatment for each visit. This will help to justify service(s) pro-vided. A diagnosis that doesn’t affect your care of the patient shouldnot be coded.

ICD-9 codes are organized in several parts. The first part is analphabetic index of terms and corresponding codes. The second partcontains a tabular (numeric) list that more clearly defines the ICD-9codes and lists the divisions within the codes. Cross-referencing boththe alphabetic and tabular (numeric) lists to ensure accurate and spe-c i fic coding is important.

ICD-9 codes are comprised of three, four, or five digits. T h efourth and fifth digits typically provide additional information forthe categ o r y. For ex a m p l e :

389 Hearing loss [additional digits required]389.0 Conductive hearing loss [additional digit required]389.00 Conductive hearing loss, unspecifi e d389.01 Conductive hearing loss, external ear389.02 Conductive hearing loss, tympanic membrane389.03 Conductive hearing loss, middle ear

Often, a three- or four-digit code is insufficient for proper cod-ing. The tabular list in the ICD-9 manual indicates the number ofdigits required. The fifth-digit assignment is not optional andthe greatest level of specificity must be coded. W h e n ever possi-ble, avoid using a code labeled as “unspecified” as in the ex a m p l eof 389.00 above .

ICD-9 coding is also very important when choosing the best diag-

nosis for a given procedure. For example, when billing for compre-h e n s ive audiometry (CPT code 92557), rather than the ICD-9 code389.00 conductive hearing loss, unspecified, the code that mostaccurately describes the findings should be selected, such as:

389.02 Co n d u c t ive hearing loss, tympanic membrane 389.03 Co n d u c t ive hearing loss, middle ear

For tympanometry (CPT code 92567) on the above patient, forexample, separate diagnoses are available and should be used,such as:

381.10 Chronic serous otitis media384.21 Central perforation of the tympanic membrane

The diagnosis code should either reflect the type of hearing lossor the anatomic fi n d i n g s .

The ICD-9-CM coding manual is updated annually and becomese ff e c t ive on October 1st. For example, new ICD-9 codes for 2002 gointo effect on October 1, 2001. Healthcare providers should alwa y suse the most current ICD-9 coding books to ensure correct codeassignment. Updated coding publications (i.e., ICD-9-CM, CPT,HCPCS, and RBRVS) should be obtained annually. You may contactthe AMA Press at (800) 621-8335.

T O P I C S I N R E I M B U R S E M E N T

ICD-9-CM CO D I N G: CO D E T O T H E HI G H E S T LE V E L O F SPECIFICITY

General Guidelines for ICD-9 Coding

• Code to the highest degree of specifi c i t y. Carry thecode to the fifth digit.

• Link the diagnosis code (ICD-9) to the procedurecode (CPT) on the insurance claim form to identifyw hy the service was rendered, thereby establishingmedical necessity.

• “Ruled out,” “suspected,” and “probable” diagnosescannot be coded. Assign the applicable code for thesign or symptom that describes the reason for thep a t i e n t ’s visit.

• Code the primary diagnosis first. The primary diag-nosis is the main reason for the patient’s visit.

• Code coexisting conditions when they apply to thep a t i e n t ’s treatment for that visit, indicated as second-a r y, tertiary, etc. diagnoses.

• Code chronic conditions only when they apply to thep a t i e n t ’s current treatment. Do not code diagnosesthat are no longer being treated or that do not aff e c tyour care of the patient.


When it comes to careers, members of the audiology profession have veryspecific needs. Sure it’s easy to search for jobs and candidates online, but pop-ular web sites like Monster and Hotjobs usually lump audiologists in with gen-eral health care careers. So what’s an audiology job seeker - or employer - todo? Log on to H e a r C a r e e r s - the American Academy of Audiology’s newestbenefit program - and kick your search into high gear!

Leading-edge technology is used in the new employment area of TheA c a d e m y ’s web site (w w w. a u d i o l o g y. o r g) to bring audiologists searching forjobs and the employers who are seeking them together. When it comes to thecareer connection, finding a job you love and locating employees that you wantto keep go hand and hand. So if you’re searching for a new position, orrecruiting new talent, we think you’ll find this online career recruiting tool easyand effective.

FOR JOB SEEKERS: A ONE-STEP AUDIOLOGY CAREER RESOURCE (and it’s free!)

If you’ve ever tried searching for an audiology position with any of the bigonline career sites, you probably found limited opportunities, to say the least.Your best bet is an employment site geared specifically to you and the audiol-ogy profession...And that’s exactlywhat we’ve done. With H e a r C a r e e r s,you can:• S e a rch and apply for audiology jobs

o n l i n e• Create a confidential, online resume

(So employers can find you!)• S e a rch categories specific to the

audiology profession• Sign up for “Search Agents” that will

notify you via e-mail when newopportunities are posted that meetyour criteria.

Click On HearCareers and Get To Wo r kMaybe you’re getting ready to graduate or move to another town, wouldn’t

it be wonderful if you had everything you needed for your job search right atyour fingertips? Now you do. Start by going to w w w. a u d i o l o g y. o r g and click-ing on H e a r C a r e e r s. This is where you’ll find information for job seekers andemployers, plus career-related goodies like salary survey info, interviewing tipsand techniques, and other up-to-the-minute employment information.

HearCareersA Sound Solution for Your Employment Search @ www. a u d i o l og y. o rg

If you’re looking for a career in audiol-o g y, this is the place to start. Not sure whatyou want? View All Jobs to get an idea ofw h a t ’s out there. You can do a simpleS e a r c h by keyword (“audiologist” will hit forsure), or use the Advanced Search for moretargeted results. Simply enter detailed infor-mation such as the type of work environ-ment you seek (research, education, AuDexternship), experience level (entry level,experienced) and the location in the U.S. orabroad where you would like to work.

When you find a job you like, simplyclick on Apply for this Job. The first time

you visit this screen, skip the login and start completing the informationrequested. You will be asked to enter a cover letter, a text version of yourresume, and will have the option to attach a formatted version of your resume,as well. Once you apply for a job, you automatically create a password-pro-tected confidential account that stores your contact information and resumes.On future visits you can simply enter your H e a r C a r e e r s login and password toretrieve your information and quickly apply to additional positions.

Now make your search interactive by signing up for the Notify Me “ s e a rc hagent” feature. You’ll receive an e-mail letting you know when a position thatmatches your ideal job is added to the site. Just enter your e-mail address,what type of position you’re searching for, when you want the notifications tostop coming and a description of your dream job. Then sit back and let thejobs come to you.

Ready to take your search one step further? Post Your Resume so employ-

You’ve justgotten your AuDand you’re readyto make yourname in thea u d i o l o g yp r o f e s s i o n .Where do youstart?

You’re comfortablewith your job butcan’t help wonderingif you’re lettingbetter opportunitiespass you by. How doyou discreetly findout what’s available?

VIEW ALL JOBSVIEW ALL JOBS

POST YOUR RESUMEPOST YOUR RESUME


ers can find y o u. If you’ve already applied for a job, then enter yourH e a r C a r e e r s login and password to retrieve your information. Otherwise, skipthe login and start filling out your contact information. You’ll be asked toinclude the type of position you want and your current salary, as well as yourcareer objective and desired salary. You’ll also be asked to “cut and paste” thetext of your resume into the form. A big bonus of this feature is the ability tokeep your identity confidential. That way, you can quietly look for a positionwithout worrying about your current employer discovering that you’re “keep-ing your options open.”

So how do you keep track of all this information? Once you have eitherapplied for a job or posted your resumé, just go to Access My PersonalA c c o u n t, enter your H e a r C a r e e r s login and password and easily manage yourjob search. Now you’re ready to edit your resumé, change your personal pro-file, sign up, or edit your search agent through Notify Me and more. You caneasily see how many times your resumé has been viewed, keep track of howmany positions you’ve applied for, and view information about companies thatcurrently have listed openings on the site. You can even see when a positionyou’ve applied for has been filled. When a job becomes deactivated, it willappear with a red line through it. H e a r C a r e e r s is absolutely the best way tomanage your future.

FOR EMPLOYERS: THE ULT I M ATE AUDIOLOGY STAFFING SOLUTION

H e a r C a r e e r s offers employers a focused recruitment solution. This is yourdirect line to more than 7,000 Academy members plus thousands of students,international audiologists, related hearing care professionals and more. Withqualified candidates at your fingertips, you can search by experience level,s a l a ry or education. Plus, you can:• Post and manage opportunities as they become available• S e a rch the resume database and receive applications online• View the amount of activity each job posting generates.

To Find Real Talent, Start With HearCareersL e t ’s say you need to hire an audiologist for your company. Start by going

to w w w. a u d i o l o g y. o r g. Click on H e a r C a r e e r s and that will take you to the wel-come page. Since you’re Searching for a Qualified Audiologist, click on thatlink and it will take you to the employer area.

To get started, complete the online Registration Form. You’ll only have to dothis once to set up your account, then it’s just a matter of logging on to yourCompany Account with your username and password. You’ll be asked for billing

information and have the chance to pro-vide your web site URL and a companyprofile. After you complete this informa-tion and agree to the Terms, Conditionsand Policies of the site you’ll be loggedinto your new H e a r C a r e e r s account andcan start Posting Jobs right away. We ’ l le-mail your Login and Password so youcan access the Job Posting area onreturn visits.

Whenever you log in, you’ll see as u m m a ry of your company’s activities,i.e., how many jobs are posted, activeand inactive job applications and how

many searchable resumes you have to work with. To post a new job, click J o b son the menu bar or click on the shortcut Post A Job at the bottom of thescreen. You’ll be asked for the position title, internal job and purchase ordern u m b e r, a description of the position, salary requirements and more detailedinformation that will help you zero in on the ideal candidate. Once you’ve inputall of the required information, you’ll P r e v i e w the job (for any last minutechanges) before clicking on a button to proceed to the secure credit card pro-cessing screen and Post your job. Once the position has posted, you can editor delete any jobs that are posted or pending by returning to the J o b s menu.

Now that you’ve posted your job, you’ll want to take a look at the talent that’salready out there. Click on R e s u m é s to search candidates by experience, edu-cation, salary and more. You can also visit this area to create a Search Agentthat will use your specified criteria and find resumes that match. The results willbe e-mailed to you daily. This is really handy if you’re tasked with filling multi-ple positions. For instance, you could have one Search Agent for entry levelaudiologists, one for university professors and another for more experiencedaudiologists seeking a research setting. The possibilities are endless.

In the To o l s area, you can view and purchase the different pricing packagesavailable. Payments can be made online using our secure server and a creditcard. All postings are priced on a per-month basis, and multiple postings earna substantial discount. (For large companies with more than 10 position list-ings a month, you’ll want to click on Bulkpost Specs for more ways to save.)


You’re part of afantastic organizationand can’t hire goodaudiologists fastenough. How do youlet the profession’sbest and brightestknow what you have to offer?

MANAGE YOUR EMPLOYEE SEARCHMANAGE YOUR EMPLOYEE SEARCH

SEARCH FOR A JOBSEARCH FOR A JOB


You can also edit your company’s profile and run a “search” as a job seekerwould do to see how your listing comes up.

The R e p o r t function is the most effective way to gauge your recruitingefforts. With just a few keystrokes, you can view all the applications for bothactive and inactive jobs that you’ve listed. You can group them in order by job,by date - or a range of dates. The Active Job Statistics will show you the kindof activity each job is generating including the number of times it’s beenviewed, how many individuals applied for it, as well as the number of “applyclicks” and “emailed to a friend” responses to your postings.

JUST THE FAQS, PLEASET h e r e ’s an extensive list of Frequently Asked Questions for employers

(click on Customer Support) and candidates (click on Jobseeker Help) alike.And if you run into trouble or have a technical question, help is just a toll freephone call (1-888-491-8833) away. So what are you waiting for? Take advan-tage of our low introductory pricing and make your next career connectiononline with H e a r C a r e e r s at w w w. a u d i o l o g y. o r g! !

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The October 24, 2001 issue of the Journal of the American MedicalA s s o c i a t i o n included a report by the U.S. Preventative Services Task Fo rc e(USPSTF) that brings into question the effects of newborn hearing scre e n-i n g. The task forc e, which advises the Department of Health and HumanServices, concluded there is good evidence that screening newborns leadsto identification and treatment of hearing problems earlier than would hap-pen without scre e n i n g, but little data showing that earlier interventionleads to improvement in the speech and language skills of affected ch i l d ren.

The American Academy of Au d i o l ogy fully supports universal hearings c reening for infants and issued the following press release to thousands ofn ew s p a p e rs, wire services, internet new s g roups, web sites and mediaa c ross the United States:

The American Academy of A u d i o l o g y, the professional orga n i z a t i o nrepresenting over 7,000 audiologist clinicians, educators andresearchers, has raised several concerns related to the US

P r eve n t a t ive Service Task Force (USPSTF) study of newborn hearingscreening programs (w w w. a h r q . g ov / c l i n i c / 3 r d u s p s t f / n ew h e a r r r. h t m) andthe corresponding article published today in the Journal of the A m e r i c a nMedical Association. Although the press release and journal article raiseimportant issues regarding identification and treatment of hearing loss ini n fants, some of the recommendations may be confusing or misinterpretedby consumers, if taken out of context.

The primary recommendation by the USPSTF is that there is a need foradditional published research to determine the effi c a cy of universal new-born hearing screening of infants and newborns. The USPSTF is a panelof independent, private-sector experts in prevention and primary care med-icine that reached its conclusion based on a report by the Evidence-basedPractice Center at Oregon Health and Science Unive r s i t y, which is sup-ported by the A g e n cy for Healthcare Research and Quality (AHRQ).

The USPSTF rev i ew examined two key questions: 1) the eff e c t ive n e s sand success of existing universal hearing screening programs, and 2) theevidence that children whose hearing loss is detected and treated earlierh ave better speech and language outcomes. The USPSTF reported good

evidence that universal screening leads to earlier identification and treat-ment of infants with hearing loss. That said, according to USPSTF, ex a m-ination of published literature to date is inconclusive whether this earlieri d e n t i fication and subsequent treatment leads to long-term improve m e n t sin speech and language skills.

The Chair of USPSTF, Alfred O. Berg, MD, is quoted in today’s pressrelease as saying, “Universal newborn hearing screening programs in morethan 30 states provide an excellent opportunity to collect additional datathat may help us determine the impact of screening on important clinicalo u t c o m e s .” What is needed is additional prospective research and fundingfor hearing aids so that all infants identified with sensorineural hearing lossmay be fit with hearing aids and/or cochlear implants with minimal delays.

Another issue raised by the USPSTF was the concern over high “fa l s ep o s i t ive” results from many newborn hearing screening programs with“...as many as 7 percent of infants diagnosed as having permanent PHLmay eventually prove to have normal hearing.” This statement is mislead-ing, in that infants are not “diagnosed” with permanent hearing loss untilthe audiologist conducts a complete audiologic evaluation subsequent tothe failure of the initial screening. Further, a rev i ew of the recent literaturer eveals much lower referral rates for programs that utilize audiologists andstate-of-the-art test protocols (e.g.Vohr et al, Journal of Pe d i a t r i c s .139(2):238-44, 2001; Gorga et al, Journal of the American Academy ofAu d i o l og y. 12(2):101-12, 2001). These studies and others suggest that alli n fants can be screened for hearing loss in a cost-eff e c t ive manner.

American Academy of Audiology President David Fa b r y, said,“Although we agree with USPSTF’s statements regarding the need for fur-ther research, we also think it is important to build on the progress made toensure that all babies born with hearing loss are fit with hearing aids asearly as possible to minimize speech and language delays.”

The American Academy of Audiology continues to support the JointCommittee on Infant Hearing (JCIH) in its recommendations of new b o r nhearing screening and early intervention for hearing loss. The JCIH Ye a r2000 Position Statement may be found at: w w w. a u d i o l o g y. o rg /p r o f e s s i o n a l / p o s i t i o n s / j c i h - e a r l y. p d f

American Academy of Audiology Voices Concerns Over USPSTF Findings Related to Newborn Hearing Screening


As many as 3 of every1,000 babies are born inthe United States eachyear with hearing loss.

The first year of life is critical tothe development of normal speechand language. Thus, it is impera-tive that every baby’s hearing betested before 3 months of age sothat intervention may begin assoon as possible, if needed. Tohelp explain the reasons why everyp a rent should have their new-b o r n ’s hearing tested before leav-ing the hospital, the American

Academy of Audiology is pleasedto introduce “Newborn HearingS c r e e n i n g ” — the newest addi-tion to our collection of exception-al educational publications.

Newborn Hearing Screeningupdates and replaces the informa-tion found in The Academybrochure “Hearing Loss in Infantsand Neonates,” and includes thehearing milestones parents shouldlook for their baby to achieve. Thebrochure offers detailed informa-tion on why a baby’s hearing

should be screened, how thescreening test will be done andwhat to do if the baby doesn’tpass the test.

“Newborn Hearing Screening”is available in packages of 100 ($40 for American Academy of Audiology members; $50 for non-members).To order, visit the Academy Storeat w w w. a u d i o l o g y. o rg to down-load a Publications Order Formor contact The Academy at 1-800-AAA-2336.

N e w b o r nH EA R I NG

Sc ree n i n g

An Updated Newborn Hearing Screening Brochure

B ecause Ba b ies Can’t Te ll Us If Th ey C a n’t H ea r



C O N V E N T I O N 2 0 0 2 N E W S

D E S T I N ATION PHILADELPHIAEA R LY T O RE G I S T E R, EA R LY T O RI S E& YO U’L L EN J O Y PH I L LY. . . WE A LT H Y & WI S E!

In response to requests from our members,we’re pleased to be opening both registration ANDhousing for Convention 2002 earlier than everbefore. You’ll be able to register and make your hotelr e s e rvations online at www. a u d i o l o g y.org in earlyDecember 2001. The Preliminary Program &Registration Book (in a colorful, new easy-to-useformat) will be arriving in the mail this month soyou’ll have plenty of time to review the varied offer-ings and make some decisions about the most effec-

tive way to enjoy Convention 2002.You’ll want to register early to take full

advantage of the event and all of the excitingnew additions to Convention 2002. TheR e s e a rch Posters are being moved out of theExhibit Hall and into their own special area.We’ll also be hosting our first ConsumerWorkshop on We d n e s d a y, April 17. Otherhighlights include both State and UniversityOpen Houses and a bloodmobile. Plus, we’ve

moved the Opening Night Reception to 6-8pmon We d n e s d a y, so you can look forward to arelaxing evening of cool jazz, good food andgreat times.

We’ve also added more hotel rooms so youwon’t have to worry about seeing your hotel“sold out” during the first few weeks of registra-tion. Plus, by using the Academy’s OfficialHousing Bureau to make your hotel reserv a-tions, you can enjoy the special rates we’venegotiated for you. And, you won’t have tow o r ry about any unauthorized charges thathotels outside of The Academy block might passalong to their guests. You’ll also receive exclu-sive shuttle service between our official hotelsand the Pennsylvania Convention Center.

Take advantage of the new earlier dates, reg-ister for Convention 2002 early and use TheA c a d e m y ’s Housing Bureau. You’ll enjoy signifi-cant savings, plus, if you pre-register, onWe d n e s d a y, April 17, you can pick-up yourbadge holder and convention bag right in thelobby of the Philadelphia Marriott or LoewsPhiladelphia hotels! No lines...no waiting...now o r r i e s !

R E G I S T R ATION FEES E A R LY A D VA N C E O N - S I T EOn or Before 2/15/02 On or Before 4/3/ 02 After 4/3/02 and On-Site

M e m b e r $ 2 9 5 $ 3 6 0 $ 4 0 0N o n - M e m b e r $ 4 3 0 $ 4 9 5 $ 5 3 5Candidate Member,

or a Fellow Member Enrolled inDistance Learning AuD Program $ 1 1 0 $ 1 2 5 $ 1 4 0

Student Non-Member $ 2 1 0 $ 2 2 5 $ 2 4 0One Day (includes Exhibits) $ 1 5 0 $ 2 0 0 $ 2 5 0International discount of $50 applies to Canada and countries outside the U.S.

Pre-Con. Workshops: M e m b e r N o n - M e m b e r S t u d e n tFull Day $125 $180 $ 7 5Half Day $ 7 5 $ 1 3 0 $ 5 0



D E S T I N ATION PHILADELPHIA

How do they do it? Every year, theConvention Program Committee comes upwith an intriguing speaker for the GeneralAssembly at the American Academy ofA u d i o l o g y ’s Annual Convention &Exposition. From the well-versed politicianto the widely admired athlete to the occa-sional celebrity, you can bet they’ll find a

speaker of interest to just about everyaudiologist in the audience.

WH A T’S TH E I R SE C R E T? When it comes to selecting a great speaker,i t ’s not what you know, it’s who you know.We can thank our members for connectingus to most of the personalities we’ve had atthe last few conventions: Chicago BearMichael Singletary...Rocker Huey Lewis...even Health & Human Services SecretaryTommy Thompson. They all became ourspeakers as a result of their connection tosomeone in our Academy membership.

SO, WH O DO YOU KN O W?Do you have an interesting celebrity or wellknown sports figure who just happens to be a

patient of yours? Think about it... would theymake a good convention speaker? Do theyhave a motivational message or timely topic todiscuss? Could they somehow tie in their rela-tionship with hearing loss? These are the peo-ple we’re looking for, and we want to hear fromyou. Send us the name of your exceptionalpatient and tell us why you think he or shewould make a good speaker for Convention2002 and who knows, you could be introduc-ing one of your patients to a standing-room-only crowd in Philadelphia next April!

Got a hot prospect? E-mail Program ChairBarbara Packer at [email protected] orConvention Director Cheryl Kreider Carey atc c a r e y @ a u d i o l o g y. o r g .

WH E N IT CO M E S TOFI N D I N G GR E AT

SP E A K E R S, IT AL L CO M E S DO W N

TO WH O YO U KN O W!

American Academy ofAudiology PACHelping Audiologists to be Heard on Capitol Hill

During this time ofredefining health care,

reevaluating health caredelivery systems and

the relationship of theseto our aging population,

we in audiology needproper representation

and a strongCongressional voice tospeak for our positions.

The American Academyof Audiology

Political Action Committee(Audiology PAC)

provides this voice.

Please contribute to The Academy’s political effort with at least $10…it’s a small amount but it will help so much!

Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Company _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Occupation _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Address _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

City _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ State _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Zip _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Amount of Contribution ______________________________________________________________

l Enclosed is my check made payable to the American Academy of Audiology PAC

or

l Please bill my l MasterCard l Visa l Amex Exp. Date

Card Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name of Card _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Signature _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Contributions to the AMERICAN ACADEMY OF AUDIOLOGY PAC are not tax deductible as charitable contributions nor are they deductible as a business expense.Please consult your tax advisor for further assistance. Corporate contributions are prohibited. No corporate checks or credit cards can be accepted.


PRE-CONVENTION WORKSHOPSYou wo n ’t want to miss the exciting Pre-

C o nvention workshops scheduled forWe d n e s d a y, April 17, 2002. These full orhalf-day sessions present an excellent oppor-tunity to discover the latest advances in thefield of audiology. Due to limited space,participants must pay and pre-register asindicated in the convention packet. Pleaset a ke a moment to consider participating inthe following wo r k s h o p s :

WE D N E S D AY, AP R I L 1 78 : 3 0A M- 1 2 : 3 0P MEX C E P T I O N A L CU S T O M E R SE RV I C E = $$$P re s e n t e rs: Holly Hosford-Dunn, Tu c s o nAu d i o l ogy Institute, Inc.; Gyl Kasew u r m ,P rofessional Hearing Services, Ltd.; Fra n kButts, Hearing Clinics of Vi rginia

Excellence in customer service is thehallmark of business success and can be thekey differentiator between competitors ina ny field. When a company ’s service isexceptional, customers are more likely top e r c e ive benefit and to spread favo r a b l eword-of-mouth impressions. Three ex p e r i-enced private practitioners will discuss sev-eral ways to create superlative customerservice as a means of improving patient sat-i s faction. The presenters will discuss amodel for creating a team approach to cus-tomer service and will provide informationon portraying exceptional customer servicethrough advertising and marketing efforts. Inaddition, the presentation will provide practi-cal insight into ensuring that ex c e p t i o n a lcustomer service touches the heart of thebusiness and remains the highest priority forthe practice and staff.

9 : 0 0A M- 5 : 0 0P MDI A G N O S I S & IN T E RV E N T I O N F O RIN FA N T S W I T H HE A R I N G LO S SP re s e n t e rs: Wendy Hanks, To w s o nU n i v e rsity; Patricia M. Chute, Merc yC o l l ege; Allan Diefendorf, Indiana Univ.S chool of Medicine; Michael Gorga, BoysTown National Research Hospital; Te re n c ePicton, Potman Research Institute, Baycre s tCenter for Geriatric Care; Vishakha Rawool,B l o o m s bu rg University; Ja ckson Roush,U n i v e rsity of North Carolina

As Universal Newborn Hearing screeningprograms are becoming a reality in manystates, audiologists are realizing a need to re-tool and update their practice skills in thisimportant area. This workshop will provide a full day of education in physiologic andb e h avioral assessment approaches, amplifi c a-tion approaches including assistive listeningd evices and cochlear implants and fa m i l y -centered counseling approaches.

The morning session will focus on phy s i-ologic and behavioral assessment approachesas well as family counseling, while theafternoon session will focus on prov i d i n goptimal amplification and validating theappropriateness of amplification for infa n t s .

AU D I O L O G Y HI G H E R ED U C AT I O N: FR O M ST U D E N T RE C R U I T M E N T T O... P re s e n t e rs: Robert Sev i e r, StamatsCommunications, Inc.; Karen Ke rs h e n s t e i n ,KWK Enterprises

This session will focus on emerging trendsthat will impact our ability to recruit students,raise dollars, and market our training pro-grams. The first part of the program (90 min-utes) will focus on the creation of an integ r a t-ed marketing strateg y. The second portion ofthe morning (90 minutes) session will focuson developing a brand to attract students and

donors to the profession and our respectiveu n iversity programs. A panel of leaders inaudiology professional education will beassembled to discuss emerging issues foreducation. Discussions will include: • State Licensure Issues • The Fourth Year of Tr a i n i n g• Recognition of Doctor of Audiology as a

First Professional Degree • Preserving the Integrity of the Research

Doctorate • E m e rging Issues Related to A u d i o l o g y

Education

VE S T I B U L A R GR A N D RO U N D S: DI A G N O S T I C& TR E AT M E N T CH A L L E N G E SP re s e n t e rs: Rich a rd Gans, The A m e r i c a nInstitute of Balance; Gary Jacobson, HenryFo rd Health System

The diagnosis and treatment of ve s t i bu l a rand balance disorders is among the mostinteresting and challenging specialties foraudiologists. A Grand Rounds format will beused to present a variety of interesting andchallenging cases with children and adults.Cases to be presented will include:• Ve s t i bular Migraine• Mal de Debarquement Syndrome• BPV of Infa n cy • Horizontal Migration of Posterior Canal BPPV• Chiari Malformations• Idiopathic Downbeat Nystagmus.

Another segment of the presentation willdescribe the epidemiology of falls in the eld-e r l y, endogenous and exogenous risk fa c t o r sassociated with falls, assessment tools andi n t e r vention methods.

1 : 3 0P M- 5 : 3 0P MAC H I E V I N G OP T I M A L RE I M B U R S E M E N TP re s e n t e rs: Paul Pessis, N. Shore Au d i o -Ve s t i bular Lab; Alan Freint, Northshore ENT

By fa r, the biggest hurdle that practicingaudiologists face is keeping abreast of changesin reimbursement, legislation and insurancecoding. At frequent intervals, rules and reg u l a-tions are revised, potentially impacting ourdaily lives. Since there is no publication thatsummarizes this information, this wo r k s h o pwill distill the various items into a wo r k a b l ecourse. The seminar will ex a m i n e :• Medicare Provider Status • Rules of Proper Billing • ICD-9 Coding• Establishing a Fee Structure• Maximizing Pa y m e n t s• Electronic Billing• R e l evant Anti-Kickback, Safe Harbor, and

Stark Law Legislation.


ED U C AT I O N EX P L O S I O N AT CO N V E N T I O N 2002 IN PHILADELPHIA!!

You spoke and the Program Committee listened! Hundreds of learned speakers have been assembled to present cutting-edgei n formation on the fo l l owing topics: Amplification, Auditory ProcessingDisorders, Cochlear Implants, Diagnostics, Hearing Conservation, HearingScience, Practice Management, Professional Issues, Rehabilitation,Tinnitus/ Hyperacusis, and Ve s t i bular Assessment and Management.Regardless of your focus or practice setting, there is certain to be somethingto excite and inspire you!


A M P L I F I C AT I O NWH E N TR A D I T I O N A L AM P L I F I C AT I O N I SNO T T H E AN S W E RP re s e n t e rs: Catherine Pa l m e r, ElaineMormer; Michael Valente; ChristopherS chweitzer; Leisha Eiten

One of the exciting parts of being an audi-ologist is finding unusual solutions to uniquecommunication difficulties. Attendees willfind many of these solutions in this FeaturedSession. Solutions will include hearing assis-tance technology in adults, transcranialC ROS for profound unilateral hearing loss,bone anchored hearing aids for conductivelosses, frequency transposition for indiv i d u a l swho cannot benefit from high frequencya m p l i fication and assistance for children withminimal hearing loss.

NO I S E RE D U C T I O N OP T I O N S I NAM P L I F I C AT I O NP re s e n t e rs: Cynthia Compton; Ruth Bentler;M i chael Nilsson; Todd Ricketts

Listening in noise continues to be themost troublesome communication setting forpersons with hearing loss. The purpose ofthis special session is to ove r v i ew currentoptions for making those environments lessp r e c l u s ive to eff e c t ive communication.Options ranging from directional and arraymicrophones, to FM and other assistive tech-nologies, to current digital noise reductionschemes will be ove r v i ewed.

PL U S. . .• The Hearing Aids-Rehab Link:

Persuading Users, Pa yers, and Us! • Application of New A m p l i fi c a t i o n

Technologies in the Classroom • Implantable Hearing Aids - The Pa n e l

& Some Patients • W h a t ’s That Baby Doing in My

Clinic? Pediatric Fittings• Fitting Digital Hearing Instruments to

C h i l d ren

COCHLEAR IMPLANTSCO C H L E A R IM P L A N T S: FR O M T H E LA B T O T H E CL I N I CP resenter: Robert Shannon

Modern cochlear implants are complexd evices with dozens of adjustable parame-ters. A c h i eving an optimal setting of theseparameters is a complex and time-consum-ing task, especially in children. This presen-tation will summarize the latest researchfindings on cochlear implants with particularattention to their application in the clinic.Topics will include electrode interactions,the effect of amplitude mapping, temporalprocessing, stimulation rate, number of elec-trodes, and electrode designs.

AU D I T O RY NE U R O PAT H Y A N D CO C H L E A RIM P L A N T S, A N UP D AT EP re s e n t e rs: Jon Shallop; Colin Driscoll; Ann Pe t e rs o n

Adults and children with auditory neurop-a t hy present a unique clinical challenge toaudiologists. Once these children have beeni d e n t i fied, it is essential to evaluate theirpotential benefits from conventional amplifi-cation when needed. When the degree ofhearing loss and auditory dysfunction ex c e e dthe potential benefits of conventional amplifi-cation, cochlear implants may need to be con-sidered. This presentation will highlight theoutcomes of AN patients who have received acochlear implant at Mayo Clinic, Rochester.

D I A G N O S T I C SST E A D Y- STAT E EV O K E D PO T E N T I A L S F O RPE D I AT R I C HE A R I N G EVA L U AT I O N SP resenter: Barbara Cone-We s s o n

Auditory evo ked potentials for tonesmodulated at >60 Hz can be used to estimatethe audiogram in infants and young childrenat risk for hearing loss. The underlying theo-ry and physiology of this potential and itsclinical applications will be presented. T h eemphasis of this course will be on illustratingh ow SSEP can be used as a diagnostic toolfor those newborns that have failed UNHS.

SU D D E N SE N S O R I N E U R A L HE A R I N G LO S S:ME D I C A L EM E R G E N C Y? P re s e n t e rs: Donald Vogel; Ja ck Wa z e n

Ranging from reversible idiopathic to pro-g r e s s ive and life threatening, the sudden sen-sorineural hearing loss can be a clinician’senigma. This type of hearing loss presentsunique issues from identification and man-agement perspectives. Working together, theaudiologist and physician take on these casesto acquire a clear differential diagnosis andthen treatment. Rev i ewed here will be audio-logical protocol, medical evaluation, anda u d i o l o g i s t / p hysician team managementoptions with case history illustrations.

PL U S. . .• Pediatric Audiology:

Management of Challenging Cases • Assessing Auditory Behavior in Infants

and Toddlers • Genetics & Deafness • Fluctuating & Pro g re s s ive SNHL in

C h i l d ren • Adult Diagnostic Grand Rounds• New Developments in Middle Ear

Assessment • H ow Hair Cells Build Au d i o g r a m s

Dissecting Clinical Data

HEARING SCIENCENE U R A L RE S P O N S E S T O SP E E C H:IM P L I C AT I O N S F O R HE A R I N G AI D SP resenter: Eric Daniel Yo u n g

Hearing aids have generally beendesigned and evaluated using humanperceptual performance as the measure ofq u a l i t y. Because the primary lesion in sen-sorineural hearing loss is in the cochlea, theseresearchers are studying the neural represen-tation of sounds in the auditory nerve as amore direct index of the pathologies and thee ffects of signal processing algorithms. T h i stalk will describe the insights gained fromstudying auditory nerve responses in normaland acoustically traumatized ears.

TA L E S F R O M T H E CRY P T: MI D D L E EA RCE L L PR O L I F E R AT I O N & RE C O V E RYP resenter: Allen Ryan

Using in vivo and in vitro model systems,researchers have identified several grow t hfactors that participate in the middle ear’sresponse to otitis media. The widespreadoccurrence of apoptosis during mucosal recov-ery has been confirmed. This session willdiscuss how growth factor and apoptotic cellsignaling pathways invo l ved in otitis media arepotential targets for pharmacological agents


EDUCATION EXPLOSION AT CONVENTION 2002 IN PHILADELPHIA!!

FE AT U R E D SE S S I O N S

Featured Sessions are invited topic-speaker sessions that have been identifiedby the Program Committee to represent areas of special interest to allaudiologists. Outstanding researchers, scientists, entrepreneurs and business leaders have been invited to present close to 40 Featured Sessions for this year’s Convention. Some of the highlights include:


that may help to ameliorate this condition.

PL U S. . .• Animal Models of Auditory System

Function & Dysfunction • B e h avioral Measures and Cochlear

Non-linearity • Regeneration of the Mammalian

Auditory System? • H ow Hair Cells Build Au d i o g r a m s

Dissecting your Clinical Data • R e s e a rch Session: Clinical Research in

Au d i o l o g y

PRACTICE MANAGEMENTLI A B I L I T Y CO N C E R N S F O R T H EAU D I O L O G Y PR O F E S S I O NP resenter: John Spro a t

Audiologists have a professional andl egal responsibility to conform to acceptedstandards of care to protect their clients fromi n j u r y. Standards of care are establishedthrough codes of ethics, state licensure law s ,scopes of practice and clinical practice state-ments. The presentation includes a rev i ew ofthe civil legal system, complaints reportedby state licensing boards, claims filed withthe leading liability insurance broke r, ands p e c i fic examples of liability stemming fromexternal and middle ear trauma.

MA R K E T I N G: WH AT WO R K S, WH AT WO R K S BE T T E RP resenter: Howard Neal Gutnick and otherm a r keting ex p e r t s

In competitive environments, it is increas-ingly difficult to satisfy the needs of our cur-rent patients while we recruit new patients.In this Featured Session, experts in the fi e l d sof external marketing, internal marke t i n gand web marketing will discuss practicals t r a t egies with take home value. The sessionwill close with time for attendees to presents p e c i fic marketing campaigns and strateg i e sthat have been eff e c t ive (and have not beene ff e c t ive) in their practices.

PL U S…• N ow That I Have Data About the

Practice, What Do I Do With It? • P resenting A d vanced Hearing

Instruments to Patients

PROFESSIONAL ISSUESCH A L L E N G E S I N UN I V E R S A L NE W B O R NHE A R I N G SC R E E N I N GP re s e n t e rs: Gail Lim; Roger Marsh; C a rol Knightly

M a ny eff e c t ive screening programs havebeen implemented, with low fa l s e - p o s i t iverates and comprehensive follow-up. Butchallenges remain. Some hospitals have seri-ous deficiencies in the quality of screeningprograms. Many audiologists lack the train-ing and experience to diagnose and rehabili-tate young infants. This session will feature apresentation on the results of screening180,000 infants. Panelists will then discusstheir perspectives on quality assurance andpossible initiatives to increase these infa n t s ’access to diagnosis and habilitation.

JAVA I S N O FL A S H O N T H E NE T:DR E A M W E AV I N G F O R AU D I O L O G I S T SP re s e n t e rs: Michael Wynne; Brad Ingra o ;Jason Galster

Although the Internet is not the fi r s t“technology” that has affected our profes-sion, it will radically transform us as it hasr evolutionized other industries and profes-sions. The ‘net is leading to an evolution ofn ew communication processes and commer-cial practices. This presentation will analyzeh ow e-Commerce is impacting other profes-sions and industries. The discussion willassess its implications for our service deliv-ery models, organizational structures, pro-gram policies, market strategies, bu s i n e s spractices and educational opportunities.

PL U S. . .• Harmony Between Audiology and

E N T: Is it Possible? • Making the Grade: Critical Eva l u a t i o n

of the Evidence Base in Au d i o l o g y• Au d i o l o g i s t s ’ Assistants: Their Role in

S e rvice Delivery • Selecting a PhD Program • Ethics in Audiology: Report of the

P residential Task Fo rce • Audiologic Rehabilitation: Measuring

Outcome on Quality of Life

A U D I T O RY PROCESSINGD I S O R D E R SCH A L L E N G I N G CA S E S I N AD U LT AU D I T O RYPR O C E S S I N G DI S O R D E R SP re s e n t e rs: Frank Musiek; Linda Hood;

Charles Berlin

There has been an increase in the interestin the assessment and treatment of adultauditory processing disorders. Though ourk n owledge has increased, many clinicalcases present challenges to the clinician.This presentation will center on several casesof central auditory problems that requirednot only careful assessment using behav i o r a land electrophysiologic tests but also insight-ful interpretation.

EF F E C T S OF DY S L E X I A & ADHD O NAU D I T O RY TE M P O R A L PR O C E S S I N GP re s e n t e rs: Lincoln C. Gray; Joshua I. Bre i e r

S i g n i ficant deficits in auditory processing inreading disabled (RD) children have been dis-c overed, but only in tasks involving rapidlychanging speech or speech-like sounds.Comorbid attention deficit disorder (ADHD)causes additional hearing deficits. The effects ofRD and ADHD on auditory processing seema d d i t ive, and deficits in many tasks are onlyseen in children with both RD and A D H D .ADHD also causes an increase in fa l s e - a l a r mrates in the presence of a distracting maske r.

R E H A B I L I TAT I O NBE Y O N D DI A G N O S T I C S & FI T T I N G S: OU RCO U N S E L I N G RE S P O N S I B I L I T I E SP re s e n t e rs: John G. Clark; Kris English

Despite the widespread acceptance ofcounseling as a critical adjunct to clinicalpractice, surveys continually reveal thataudiologists feel ill prepared to address thecounseling needs of the patients they serve .This presentation will examine the reasonsfor our discomfiture with counseling, placeour counseling role into a more palatableconstruct, and examine three of the primarycounseling theories and how they may bee m p l oyed in clinical practice.

UP D AT E O N CL A S S R O O M AC O U S T I C SP re s e n t e rs: Joseph Smaldino; Carl Cra n d e l l

The acoustical environment of a class-room is an important variable in the psycho-educational and psychosocial achievement ofchildren with normal hearing and hearingimpairment. This discussion will prov i d epractical, “hands on” information concerning(1) the effects of classroom acoustics onacademic achievement, (2) measurementprocedures to evaluate classroom noise/r everberation, (3) acoustical modifications inclassrooms and (4) effi c a cy measurementsfor acoustical treatments. Informationconcerning the Federal Standard for class-room acoustics will also be addressed.


EDUCATION EXPLOSION AT CONVENTION 2002 IN PHILADELPHIA!!


The term “audiologist assistant” todescribe support personnel super-vised by audiologists has been usedfor many years. This term clearlyc o nveys the nature of the employ e e

- one who works under the supervision of alicensed audiologist to complete non-profes-sional duties - and will be used in this paper.

The role of audiologists’ assistants haslong been debated; how eve r, the tasks to bed e l egated have not been resolved. The 1997Academy of Audiology Position Statementon Support Personnel in Audiology defi n e dthe roles and tasks for audiology assistantsas being competency-based and specific tojob performance. Support personnel wered e fined as persons who, after appropriatetraining, perform tasks that are prescribed,directed and supervised by an audiologist.While 29 states regulate audiology supportpersonnel through either licensure or reg i s-tration, most do not have specific educa-tional requirements. The scope of practiceand training are often left to the discretionof the supervising audiologist.

Changes in health care delive r y, reim-bursement and the expanding role of audi-ologists in service delivery have reinforcedthe desire of many audiologists to proac-t ively define the scope of duties that wo u l dbe assigned to an audiologist’s assistant.The term “audiologist’s assistant” serves asa reminder that the assistant is not designedto be a less-skilled replacement for theaudiologist, but rather an individual whoworks under direct supervision of alicensed audiologist.

PU R P O S EO F T H ES U RV E Y

Gyl Kasewurm and Clyde Byrne pre-sented their experiences with assistants inp r ivate practice and in the military, respec-t ive l y, at The A c a d e m y ’s Convention 2001.K a s ew u r m ’s assistants perform tasks suchas troubleshooting hearing aids and teach-ing patients basic hearing aid care and use.The military teaches assistants to performduties such as cerumen removal, pure tonea i r, bone, speech and immittance testing.Military audiologists supervise the “ENT/audio technicians.” The actual tasks per-formed by the technicians vary dependingupon the supervising audiologist and thenature of the caseload at that fa c i l i t y. T h i srepresents dive rgence in opinions amongaudiologists on which duties are considered“technical” in nature, as was described byK a s ewurm in the September/October 2001issue of Au d i o l ogy To d a y. This survey wa s

u n d e r t a ken to further define the tasks audi-ologists consider appropriate for an audiol-o g i s t ’s assistant.

SU RV E YR E S P O N D E N TS

An invitation to take the on-line, web-based survey was sent via email to 2440Academy members (one-half of Th eA c a d e m y ’s email list), and to 159 membersof the Florida Academy of A u d i o l o g y. T h es u r vey was hosted at w w w. z o o m e r a n g . c o m.346 responses were obtained. Respondentswere audiologists in virtually every state,working in a variety of practice settings,with most having more than 15 years ex p e-rience. Nearly 1/4 (24%) currently use ana u d i o l o g i s t ’s assistant in their practice, andanother 21% had used an assistant in thepast. 22% currently work with a hearing aiddispenser in their practice.

OP I N I O N SO NS C O P E O F P R ACT I C E

O F T H E AU D I O L O G I ST’S AS S I STA N T

Examples of potential tasks for an audi-o l o g i s t ’s assistant were listed, and therespondents were asked to indicate if they :

• would ask their assistant to completethat task

• b e l i eved the task was within the scope ofpractice of an assistant, but would notpersonally ask their assistant to do thatt a s k

• b e l i eved the task was not within an assis-t a n t ’s scope of practice.

The following tasks were considered tofall within the scope of practice for an audi-o l o g i s t ’s assistant by the majority (greaterthan 50%) of the respondents:

• Performing daily audiometer biologicalcalibration checks

• P r oviding patients with a case historyform and clarifying the questions

• Performing independent pure tone hear-ing screenings

• Performing tympanometry

• Performing air conduction thresholdtesting as part of a periodic hearingc h e c k

• Assisting the audiologist with VRA andother pediatric testing

• Performing ABR neonatal screeningi n d e p e n d e n t l y

• Conducting otoacoustic emissionsscreening independently.

Those who had experience working withan assistant (present or past) were more

l i kely to believe the different tasks shouldfall within an assistant’s scope of practice.H ow eve r, the only additional tasks that atleast 50% of those who had wo r ked withassistants believed should be in an assis-t a n t ’s scope of practice were:

• Performing otoscopic inspection

• Performing pure tone air- c o n d u c t i o naudiometry on a new patient.

At least 50% of both the overall respon-dents and those with experience with assis-tants felt that an audiologist’s assistantshould be able to conduct the following spe-cial testing tasks:

• Clean / abrade skin for ENG / A B Rt e s t i n g

• Test electrode continuity and calibratean ENG system

• Conduct ABR testing using an auto-mated protocol, notifying the audiolo-gist when the testing is complete.

In regard to dispensing tasks, at least 50%felt that the assistant should be allowed to:

• M a ke earmold impressions

• Instruct the patient in the insertion andr e m oval of a hearing aid or earmold

• Perform basic hearing aid orientation,including instructing patients on how tochange a battery, use the telephone, etc.

• Modify the earmold/shell

• Complete the hearing aid sale, includingdiscussing costs and completing thesales forms

• Administer self-assessment forms ofcommunication and hearing aid benefi t ,such as the APHAB or SADL

• Discuss assistive listening device options

• E valuate hearing aids presented forr e p a i r, clean hearing aids, and make in-o ffice repairs

• Use electroacoustic analyzers

• Determine when hearing aids requirem a n u facturer repair.

NE E DF O R AU D I O L O G I STS’ AS S I STA N TS

40% of respondents reported diffi c u l t yhiring audiologists in their geographic area.28% of those who did not currently have anassistant reported that they would considerhiring an assistant. The proposed salary leve lfor an audiologist’s assistant ranged from$11,000 to over $61,000. The respondentsindicated that an entry-level audiologistwould earn approximately $15,000 more.

SC O P E O F PR A C T I C E F O R AU D I O L O G I S T S’ AS S I S TA N T S: SU RV E Y RE S U LT S

Teri Hamill and Barry Freeman, N O VA University, Ft. Lauderdale, FL


TR A I N I N G O F AS S I STA N TS

Roughly one-third of respondentsfavored audiologist-guided on-the-job train-ing for assistants; 50% recommended ajoint audiologist and university training pro-gram. The remaining 14% preferred the uni-versity conducting all of the training.

Those who would consider using a uni-versity training program were asked theiropinions on the level of education thatshould be obtained. 42% favored an associ-a t e ’s degree, defined as including generaleducational coursework in addition to audi-o l o g i s t ’s assistant courses. 11% preferredthat the assistant receive a bachelor’sd egree, while 32% preferred a certifi c a t i o nof training and 15% had no preference orwere uncertain.

Preference for training format was alsoexplored. Most respondents felt that trainingat local universities would offer the best for-mat. The authors concur that this would beideal; how eve r, the low number of persons tobe trained, and the preference for joint audi-ologist / university training models make sdistance education models more feasible.

Respondents rated distance technologiesthat provided more audio and video compo-nents higher than text-based training pro-grams. Respondents did not favor a text andworkbook correspondence format.

CO M M E N TS P ROV I D E DW I T H

T H E S U RV E Y

Brief comments were accepted at the endof the survey; 73 of the 346 respondentsshared their experiences and opinions. Anumber cautioned against allowing a scopeof practice that included basic eva l u a t i o ntechniques and/or hearing aid dispensingresponsibilities, believing that these audiolo-g i s t ’s assistants would be hired to wo r kunder the general supervision of phy s i c i a n s ,at the expense of quality of care, and poten-tially undermining the scope of practice ofaudiologists. The limited scope of practicedescribed above, which is acceptable to themajority of audiologists, suggests that thereis general consensus in that regard. Mostaudiologists favor restricting the audiolo-g i s t ’s assistant to a relatively narrow scopeof practice that invo l ves technical servicep r ovision. How eve r, other respondentsopined that the assistant, working under thesupervision of the audiologist, should bea l l owed to complete any tasks the assistantis trained to do, and is capable of doing, solong as the supervising audiologist remainsl egally responsible for the services rendered.

Favorable comments were receive d

from those who have used technicians,including in neonatal hearing screeningprograms and in the military. Others vo i c e dconcerns about the capabilities of thosewith limited training.

S everal comments urged the A m e r i c a nAcademy of Audiology to work ex p e d i e n t l yto provide a framework for audiologists’assistants, rather than allowing physicians tod e fine the scope of practice of support per-sonnel. Some believe that by defining thetraining required to perform specific tasksunder the supervision of an audiologist,medical professionals would realize thatsimilar levels of training would not ade-quately prepare technicians to perform“basic testing” under indirect phy s i c i a nsupervision.

WH E R ED O W E G OF RO MH E R E?As this survey indicates, audiologists are

currently utilizing assistants. Some statelicensure laws govern the training and scopeof practice of assistants. Those who decideto use assistants must ensure that therequired training is provided, that the assis-

tant performs only the legally permittedtasks, and that the supervision of the assis-tant meets state requirements.

Those wishing to utilize formal trainingprograms may enroll their assistants intraining courses such as those approved bythe Council for Accreditation inOccupational Hearing Conserva t i o n( C AOHC). Nova Southeastern University isd eveloping a program to provide audiolo-g i s t ’s assistant training via distance educa-tion. This program will provide structuredcourse content and immediate feedback onconcept mastery. Innova t ive technologywill be incorporated, such as the use of anaudiometer simulator to teach air conduc-tion audiometry. Clinical training by anaudiologist will be incorporated.

This survey supports the need fora u d i o l o g i s t s ’ assistants who are trained andsupervised by audiologists to completelimited technical tasks. These support per-sonnel will serve to bolster the services ofaudiologists as the demand for health careservices grows in the new millennium.

SC O P E O F PR A C T I C E F O R AU D I O L O G I S T S’ AS S I S TA N T S: SU RV E Y RE S U LT S

The authors of the Au d i o l og i s t ’s Assistant Scope of Practice Survey are grateful for theinput provided by Bill Beck and Gyl Kasewurm in developing the questionnaire, and ack n o w l-e d ge the support of The Academy National office to conduct the survey.

E v e rything you want to know about Audiology available with a single click:

REAL AUDIOLOGYRIGHT NOW!

w w w. a u d i o l o g y. o rgN e w sProfessional Resources • Consumer ResourcesStudent/University ResourcesConventions • Academy Store • About The AcademyWeb SearchAAA Membership Directory

—Addresses, Phone Numbers, Personal Email Links for Direct Messaging

The American Academy of AudiologyCaring for America’s Hearing


WH AT I S T H E AAA PAC? AN D W H Y I SI TI M P O RTA N T

T H AT YO U PA RT I C I PAT E?As you may know, the American Academy of

Audiology has created a Political Action Com-mittee (PAC). We are now one of the 4,500 orga n i-zations participating in the political process with aPAC. Our goal is simple: to support candidatesthat support audiology.

The Federal Election Campaign Act, passed byCongress in the 1970s after the Wa t e rgate crisis,r egulates political contributions to candidates forPresident, the Senate and the House of Repre-s e n t a t ives. The Federal Election Commission is thea g e n cy that administers and enforces the A c t .

Federal law dictates the amount of money thatPACs can give and receive. For example, PAC sthat have multicandidate status, like AAA PAC ,can give a maximum of $5,000 to a federal candi-date per election — primary, general and special election. T h e r e f o r e ,the most that such a PAC can contribute to one candidate is $10,000:$5,000 for the primary and$5,000 for the general election.A PAC can receive up to$5,000 from an individual orother PAC; corporate contribu-tions are illegal and may not be made to a PAC or to ac a n d i d a t e .

Since the creation of thePAC system, their importanceand role in election campaignsh ave increased dramatically.From January 1, 1999 throughDecember 31, 2000 (the lastcampaign “cycle”), PAC sraised over $600 million, up20% over the previous cycle.I n d ividual candidates foroffice must now raise so muchm o n ey that the candidateshave come to rely more andmore on political action committees for their support.

In the 2000 election, the average House winner raised $921,000(for a two year term); the average Senate winner raised $8.1 million(for a six year term). That means that the average Member ofCongress must raise $9,210 every week they are in office to stay ino ffice. The average Senator needs to raise $27,000 per week, eve r yweek, for six years. While this system is, in my opinion, completely

out of control, it is “the system,” and a well-fund-ed PAC is now an important part of an orga n i z a-t i o n ’s political arsenal.

In the last five years, the American Academy ofAudiology has made significant strides in the evo-lution of our political eff e c t iveness. We are now apresence on Capitol Hill and at the agencies. In1999 our keynote speaker was Congressman EdW h i t field (R-KY), a key member of the HealthSubcommittee, and in 2000 our keynote speake rwas Secretary Tommy Thompson.

H ow eve r, our PAC is way too small to be eff e c-t ive. While many Academy members are makingdirect contributions to individual candidates, in thelast election cycle (1999-2000) the AAA PACmade only 8 contributions, totaling $5,250. Bycomparison, the ASHA PAC made 222 contribu-tions totaling $242,000. According to A S H A’sFEC year-end PAC report, ASHA contribu t e d

$168,000 to Democratic candidates and $73,000 to Republican can-didates during the last cycle.

It is time, therefore, tocomplement our politicale ffort by invigorating andfunding the AAA PAC. It isnot necessary to be as large asthe ASHA PAC to be effective,but a $5,000 PAC will not dothe job!

I am asking every A c a d e m ymember to contribute at least$10.00 to our PAC. If T h eAcademy could average just$10 per member, our PACwould raise $70,000 per yearon $140,000 per cycle. T h i samount would enable T h eAcademy to fully participate inthe political process. As part ofyour membership renewal therewill be a space on the form fora AAA PAC contribution. Of

course, these contributions are voluntary and The Academy will notfavor or disfavor anyone based upon whether or not they contribu t e .

Please support the The A c a d e m y ’s political effort by contri-buting at least $10…it’s a small amount but it will help so much!

If you’d like to contribute to AAA PAC, please fill out and fax ormail the form on page____ or visit www.audiology.org/profession-al/members and click on Audiology PAC.

WA S H I N G T ON WAT C HTH E POW E R O F MO N E Y: AAA PAC

Submitted by M a rshall L. Matz, Esq., and Robert Hahn, Esq., Olsson, Frank and Weeda, PC, Washington, DC and C raig Jo h n s o n, A A AG overnmental A ffairs Chair, Baltimore, MD

C O N T R I B U T I O NC A N D I D AT E A M O U N T

Sen. Ted Kennedy ( D - M A ) $ 1 0 , 0 0 0

Rep. David Bonior ( D - M I ) $ 1 0 , 0 0 0

Rep. Dave Obey ( D - W I ) $ 1 0 , 0 0 0

Sen. Jean Carnahan ( D - M O ) $ 1 0 , 0 0 0

Sen. Steve Roth (R-DE) (Defeated) $ 9,500

Rep. Jim Walsh ( R - N Y ) $ 9,000

Sen. John Ensign ( R - N V ) $ 8,000

Rep. Sherrod Bro w n ( D - O H ) $ 7,500

The largest A S H A contributions went to:

Marshall Matz


A M O M E N T O F S C I E N C E

Audiologists are well aware of the traditionalapproaches to hearing protection (attenuatethe noise source, and/or wear earplugs ormuffs). But, ear protection through pharma-ceutical agents? That’s big news!

Scientists and clinicians recently met at theUniversity of Washington to discuss themechanisms underlying acoustic injury, pro-tection and recovery. Participants at the“Biology of Noise-Induced Hearing Loss”symposium discussed various pharmaceuticalapproaches to hearing conservation. Forexample, when ears are exposed to intenselevels of sound, there is a period of timebetween acoustic exposure and the onset ofpermanent injury. This window of opportunityis what attracts scientists for possible preven-tion strategies. Numerous animal studiesshow that “antioxidants” such as vitamins Aand E, mitochondrial protectors (the cellularorganelle responsible for turning sugars intoenergy), neural inhibitors and calcium channelblockers minimize the amount of permanent

threshold shift following noise exposure. Inother words, pharmaceutical agents can pre-vent cell death. Whether or not these agentscan help prevent hearing loss in humans hasyet to be determined. However, if stimulusagents can be delivered to the human audito-ry system in a way that poses minimal sideeffects, then pharmaceutical agents may be anew approach to hearing protection.

Do we need a hearing protection pill?Advocates for pharmaceutical approaches tohearing protection are not suggesting that wereplace earplugs with pills. But rather, scien-tists and clinicians acknowledge thatearplugs and muffs are inadequate for somepopulations. Police officers, military person-nel and other high-risk populations cannotanticipate acoustic injury. Furthermore,wearing ear protection may attenuate warn-ing sounds that are critical to human safety.For these people, alternative forms of hearingprotection, such as a pharmaceutical agent,might be helpful.

Henderson D, McFadden SL, Liu CC, Hight N, Zheng XY. Therole of antioxidants in protection from impulse noise. Ann NY Acad Sci. 1999 Nov 28;884:368-80.

Kopke RD, Weisskopf PA, Boone JL, Jackson RL, We s t e rDC, Hoffer ME, Lambert DC, Charon CC, Ding DL, McBrideD. Reduction of noise-induced hearing loss using L-NAC andsalicylate in the chinchilla. Hear Res. 2000 Nov;149( 1 - 2 ) : 1 3 8 - 4 6 .

Kopke R, Allen KA, Henderson D, Hoffer M, Frenz D, Van deWater T. A radical demise. Toxins and trauma share commonpathways in hair cell death. Ann N Y Acad Sci. 1999 Nov28;884:171-91.

National Institute on Deafness and Other CommunicationDisorders (NIDCD) - WISE EARSw w w. n i d c d . n i h . g o v / h e a l t h / w i s e / i n d e x . h t m

National Institute for Occupational Safety and Health(NIOSH) www.cdc.gov/niosh/homepage.html

Occupational Safety and Health Administration (OSHA)www.osha.gov

Biology of Noise-Induced Hearing Loss Symposiumw w w. d e p t s . w a s h i n g t o n . e d u / ~ h e a r i n g /

NO I S E IN D U C E D HE A R I N G LO S S — PR E V E N T I O N I N A PI L L?Kelly Tremblay and Lisa Cunningham, UNIVERSITY OF WASHINGTON, Seattle, WA

IN T E R ES T I N G R E AD I NG

R E L ATE D W E BS I T E S

CO L O R A D O HE A R I N G FO U N D AT I O N

35THOTOLOGY AUDIOLOGYCONFERENCE

P rogram Committee: David Lim, MD, Marion Downs, DHS, Jerry Nort h e rn, PhD1 5 0 - w o rd abstracts due by Nov. 30, 2001 by fax (213-483-5675) or by e-mail tod l i m @ H E I . o rg. Room re s e rvations must be made no later than November 30,2001 at Copper Mountain Resort, (800) 458-8386 - ask for Colorado HearingFoundation special room rates. For Additional Conference Information contactPatsy Meredith at (303) 372-3190

Copper Mountain Resort • Febru a ry 16-21, 2002 Call for Papers & Registration

NOVEMBER/DECEMBER 2001

a closed shop, where non-union members are not allowed to wo r k .N ever mind that the audiologists hold appropriate degrees and arelicensed to practice audiology by the state in which they wo r k .Another fact is that there is a persistent myth perpetuated among stu-dents that ASHA CCC’s are required to practice audiology, when it isthe audiology license issued by individual states that is the only realrequirement. Without requirements for elevating certification stan-dards over the years the sole purpose of the ASHA CCC-A has theappearance of sustaining membership and generating millions of dol-lars of revenue for the organization. That, to me, lies at the heart ofa u d i o l o g i s t s ’ disagreement with ASHA at the present time.

Audiologists who are interested in a certification that was cre-ated for audiologists, by audiologists do have an option. BoardC e r t i fication from the American Board of A u d i o l o g y. In 1998 theA BA began accepting application for board certification in audi-o l o g y. Certification is awarded based on: (a) successful comple-tion of a graduate program in audiology from a regionally accred-ited college or unive r s i t y, and the attainment of a Master’s deg r e eor a Doctoral degree, (b) a score of 600 or higher on a nationalexamination in Audiology approved by the A BA, and (c) comple-tion of a minimum of 2000 hours of professional practice withina two year time period. After three years, recertification is accom-plished by demonstrating 45 clock hours of continuing educationwith two hours in professional ethics. The A BA does not and hasn ever required membership in any professional orga n i z a t i o n . T h eAmerican Board of Audiology operates as an independent certi-fying body. Presently, the A BA offers a single level of certifi c a-tion. Programs for specialty certification are in deve l o p m e n t .T h ey are intended to advance the professional status of audiolo-gy among our patients and colleagues.

In an accompanying article in the current AT, you will find a listof some 325 audiologists certified by the A BA. A number ofapplications are under rev i ew, and more are received daily. T h e s ei n d ividuals represent audiologists who recognize the need for anindependent practicing profession with an independent certifi c a t i o nbased on a higher standard. The number of Board Certified audiolo-gists is small compared to the numbers who are eligible. Manyi n d ividuals have not applied for A BA certification for a variety ofpersonal reasons including, among others, finances, lack of informa-tion, intimidation, a wait-and-see attitude, disinterest, etc.

Now is the time! For the ABA certification program to succeed,and for our profession to become an independent practicing profes-sion, we need hundreds (no – thousands!) of audiologists willing tobe invo l ved. Through greater numbers we are better able toapproach state agencies, to gain greater recognition by third partyinsurers, and to gain recognition among the persons with disordersof hearing and balance whom we serve. If you have been thinkingabout applying for certification, now is the time. You do haveoptions, you can make your will known and in the future we can saywith confidence that Board Certification by the American Board ofAudiology is the nationally accepted standard for audiologists.Apply now. You can receive information by calling MarilynWeissman, Director of Certification at 1-800-222-2336 or emailingher at: [email protected]. If you like you can contact me,I’ll be happy to talk with you. – Robert Keith, Chair, AmericanBoard of Audiology

The Time is NOW!R o b e rt Keith, University of Cincinnati Medical center, Cincinnati, OH

For several days I havebeen pondering the jointstatement between ASHAand AAO-HSNS. In thatstatement ASHA and A AO -HNS agreed that (amongother things) “The nationallyaccepted certification stan-dard for audiologists is theASHA Certificate of ClinicalCompetence (CCC-A).” Oneinterpretation is that much ofthe rhetoric is self-serving tothe organizations that enteredinto the agreement. ASHA ish e avily invested in the CCCsand the A AO-HNS is aggres-s ively pursuing a plan to con-trol the profession of audiolo-g y. My bet is that a strawvote would find that a major-ity of audiologists do notagree with the joint state-ment. If that is the case then Iwonder if, in fact, the CCCsare indeed the standard thataudiologists would choose torepresent them.

In order to make a point, Iwant to share my ex p e r i e n c ewith the CCCs. In 1962 orso, while working as an audi-ologist at the Unive r s i t yHospital in Iowa City with aBA in Speech and Hearing, I

r e c e ived a certificate from ASHA called “Basic Hearing.” T h e r ewa s n ’t any examination or other requirement. Subsequently, I wa sg ra n d f a t h e re d a certificate in “A d vanced Hearing” and when theCCCs became available I was again g ra n d f a t h e re d a CCC inA u d i o l o g y. Fair enough, as I was making my living as an audiologist.But no examination for competency was required; no requirement ofa ny kind was raised during the intervening years, other than paymentof ASHA dues. In theory, I could have maintained my ASHA CCC-Afor nearly 40 years without earning a single CEU, without seeing a sin-gle patient, without progressing beyond Békésy audiometry and SISItesting! So much for A S H A’s claim that the Certificate of ClinicalCompetence (CCC-A) sets a national standard for certification of audi-ologists. Never mind that the ASHA rules for holding the CCC-A havechanged; the rules changed because of the activities of the A m e r i c a nAcademy of Audiology and the American Board of A u d i o l o g y.

The A S H A / A AO-HNS joint statement does offer a partial truth.A S H A’s certification program was created many years ago, and has al evel of recognition among various agencies. Through rules that manyfind objectionable, a tight circular network connects accredited train-ing programs and audiologists who are required to hold ASHA CCCsin order to teach and supervise. This “requirement” is reminiscent of

In theory, I could

have maintained

my ASHA CCC-A

for nearly 40 years

without earning a

single CEU, with-

out seeing a single

patient, without

p rog ressing bey o n d

B é késy audiometry

and SISI testing!

38 AUDIOLOGY TODAY

Melissa D. AlbrightEdward L. AleoPhillip Lance AllredPatti L. AllyEllen P. BakerKevin BallardJoseph Manford Barber IIIE. Kimberly BarryAnn E. BarschSherwin A. BasilJane H. BaxterJames A. BeauchampWilliam G. BeckKathy K. BeitzelDarcy BensonDavid A. BerkeyFred H. BessAustin C. BlackDiane G. BlaisingSusan C. BoggiaOssama I. BoulosDebra A. BoyerDiane E. BradyMilton BrodkowitzJana L. BrownDouglas F. BryantKim C. BryantVickie F. BunkTodd S. BurdetteTerry L. BurkeJoilyn D. BushChanda Jo CampbellKathleen C. CampbellCynthia Campos-MackinsTeresa Lee CannonT. Walter CarlinKorie L. CarlsonJennifer CassellJoseph CastellanoChris D. CaudleJudith A. CaudleSusan G. ChadwickBettie B. Champion-BortonSteve R. CharltonWallace Phil ChristensenDeborah W. Clark

John Greer ClarkTeresa M. ClarkGloria V. ClevelandJohn C. CobbAnn L. Cola-SchuhJohn R. ColemanDennis A. ColucciAnnette CookKathleen A. CostaCatherine Cowan-OberbeckRichard K. CraigTerry Lane CummingsFriedel B. CunninghamKarrie J. CuttlerJoan E. D’AlessandroMelissa Y. DanchakJames M. DavenportJames E. DavisRose-Marie S. DavisBen W. Dawsey Jr.Donna M. DennyGinger K. DerrickRobert M. DiSograKenneth G. DonnellyDenise L. DulaneyLaurian K. DuncanTammy L. DunnWilliam H. EagenBruce M. EdwardsJohn H. ElmoreMichelle B. EmmerTony D. EvansDavid A. FabryKathleen M. FaloonGina Ferguson-LogiJoseph R. FerritoMaryfrances C. FettingerGordon L. FletcherDavid M. FloydCraig A. FossCydney M. FoxGregory J. FrazerAmy M. FreedBarry A. FreemanStefan Olafur FridrikssonSharon E. Fujikawa-Brooks

Susan Barth FuscoRobert A. GanceRichard E. GansBarbara B. GarrettCarolyn M. GennaAlan B. GertnerMary GibsonPhyllis GildstonDebra K. GilstrapRobert A. GilmoreAnne Pratt GirouxRobert G. GlaserStephen D. GlasserSusan Brown GoodSusan M. GoodHerbert J. GreenbergBeverly J. GriffinAllison M. GrimesWilliam A. GrimmLisa GuilloryKathleen M. HaaschEric N. HagbergCharles L. HarneyPatricia Harrington-GansDianna Brainerd HarrisLoren S. HartDennis L. HatherillMary M. HathootElias M. HawaDavid B. HawkinsLynne M. HawleyVeronica H. HeideFrancine Helfner- M i t c h e l lSharon T. HepfnerRobert A. HerringMelanie E. HerzfeldRichard J. HetskoLora A. HillLynne Raney HillStuart A. HornSusan M. HouckCaroline C. HydeSusan M. HymanAtif IkramGary P. JacobsonEmily G. JaffeCarolyn S. Jaret

Barbara H. JenkinsCheryl DeConde JohnsonClayton R. JohnsonJay P. JohnsonHoward C. JonesJulibeth M. JonesMary Lou JonesAntony R. JosephDarlene M. KauM. Catherine KeeterRobert W. KeithDiane KenworthyKimberly R. KingJennifer K. KloftLisa D. KlopJane K. KnightLisa M. KochSuzanne KosMitchell B. KramerPatricia B. KricosValerie Pinto KrineyBarbara L. KurmanDale T. LalonePatricia K. LambertDavid J. LaneMarilyn K. LarkinMary Anne LarkinSveinar Y. LarsenDana C. LathamJennifer Fargo LathropKimberly H. LawlessJulie M. LauridsenElizabeth M. LeadbitterDiane T. LeeworthyLynn M. LehmanElona LennittPerry H. LernerSharon L. LichtmanTerence A. LimbSusan R. LloydAngela LoavenbruckJenni K. LoefflerLarry J. LoveringJohn J. LutolfMaureen E. Ly n c hKerry Hartman Ly o n

Matthew H. Ly o nMelissa B. Ly o nKelley R. MachanJane R. MadellKeryn E. MaionchiToni D. MannMichael W. MarionTammey MarschStephen T. MartinezAnne C. McCartyThomas A. McCartyMark T. McDowallJanet L. McGuireEugene R. McHughJane E. McNicholasMark R. McShaneDorith Avram MegedDeanna MeinkeKeith A. MeldaCynthia T. MerrittEvelyn A. MetzgarCurtis C. Miller IIErin L. MillerHeather A. P. MillerMaurice H. MillerNancy E. MillerKaren L. MillsDavid MizeKristi M. MohrPatricia L. MoisanChristi L. MoncavageDenise A. MonteAnne V. MooreRobert J. MossVivian L. MuccioBeverly S. MurphyShirley A. NavratilRobert E. NeighAnn B. NewmanJacquelyn D. M. NiedringhausMichael L. NorrisThomas J. NorwoodWayland Reed NorwoodKevin O’FlahertyDebra F. OgilvieRobert J. OlssonDaniel J. Orchik

Kerry D. OrmsonJessica A. OrrahoodDaniel E. Ostergren, Jr.Sharon H. OswaldWalter C. OttoJohn R. OwenBarbara PackerCarie L. PageRichard L. PalmerSusan S. ParrTerrey Oliver PennElena M. Pizarro-ZeiglerShirley D. PollakJane Wofford PorterTodd H. PorterCarol W. PowellShelby QuintanaBrook L. RaguskusShann RandGeorgine RayDouglas A. RichardsJohn E. RietcheckLinda S. RemensnyderAndrea J. ReynenJames B. RobertsonKaren R. Rothwell-Vi v i a nFrederick M. RuffenCarol R. RunyonTerry Alicia RutzRobert H. W. Saltsman Jr.Demetrio Enriquie SanchezNydia I. SantiagoRichard S. SaulRobert J. ScharberMeredith G. ScharfDianne SchindlerDebbie SchiricoLawrence Michael SchmidbauerDaniel C. SchneiderHoward Christopher SchweitzerMark H. ScoonesSteven D. SederholmW. Stephen SeippPatricia L. Shelly-LohmanLawrence ShotlandTerri M. Siegel

Donna M. SimmonsCindy Ann SimonRosemary R. SimpsonJames M. SingletonYvonne S. SiningerMindy W. SirlinBethany S. SmartAlan K. SmithKenneth G. SmithKimberly A. SmithGail E. SollidMelvin J. SorkowitzLisa K. StandaertSharon Z. StarrRobert N. StatonRobert L. B. StevensonCarolyn StoneDeborah J. StroudEdward E. ThompsonJacob A. Ti n g l u mRobert M. Tr a y n o rJohn S. Tu n n e l lMelinda M. Tu r n e rKatherine Tackett Tu r p e nJune M. Uyehara-IsonoGary R. Va l e n z aKaren A. Van DoorneJeffrey K. Van Ta s s e lDennis D. Van VlietMary G. Ve r z y lDonald A. Vo g e lDouglas Vo g e l s o nCami Wa d eHelen M. Wa t e r sDonna Mallory We a v e rRobert J. We i s s m a nLauraine Kastner- We l l sGail M. WhitelawLisa A. WildmoMelodie S. WillihnganzPhillip Lee WilsonIan M. WindmillMargaret E. WinterRobert W. Wo o d sCatherine Wo r t hJoan H. Ya b l o nJohn T. Zeigler

A u d i o l o g y, and our rate of growth is increas-ing. The American Board of Audiology ispleased to recognize these audiologists who

voluntarily sought Board Certifi c a t i o nin Audiology to demonstrate theircommitment to providing qualityhearing health care. As we celebratethese pioneers, we urge you to inve s-t i gate A BA board certification as onemore option you can exercise in yourprofessional life. If you want to joinyour professional peers and obtainBoard Certification in A u d i o l o g y, youcan obtain an application by contact-ing Marilyn Weissman, Director of

C e r t i fication. You can reach her at m w e i s s m a n @ a u d i o l o g y. o rg; 8300 Greens-boro Drive, Suite 750, McLean, VA 22102;or by calling 1-800-222-2336.

Specialty Certification will allow you onemore avenue to demonstrate your specialskills to patients and colleagues.

As of October 1, 2001, there were 329audiologists who hold Board Certification in

E d u c a t i o n . . . E x p e r i e n c e . . . E t h i c a lPractice. These are the hallmarks of BoardC e r t i fication in A u d i o l o g y. Since its incep-tion the Board has been committedto elevating the profession by granti-ng certification to those audiologistswhose knowledge base, clinicalskills, and ethical practices are con-sistent with professionally estab-lished standards, and who continueto advance their professional know l-edge through continuing education.On January 1st, 2002 the A m e r i c a nBoard of Audiology will celebrate itsthird anniversary of granting certifi-cation to audiologists. Board certification iscrucial to future growth and the success ofaudiology as an independent practicing pro-fession. Our plans for the development of


ABA CelebratesThree Years of Excellence in Audiology

BOARD CERTIFIED AUDIOLOGISTS C e rtificants as of 10/1/01


The growing population of mature Americans and thea bundance of services and products consumed by themm a kes for a stark comparison to the utilization of hearingcare services and products. In fact, although the number of

persons that could benefit from hearing aids continues to increase, thenumber of hearing aids fitted each year does not. This is a signifi c a n tproblem that continues to plague our profession. The reality is suchthat if we don’t provide our patients with hearing aids, we fail toa fford them the primary tools that will help them hear better. So, whyd o n ’t patients that need hearing aids get them? To answer this ques-tion, we can examine the variables that are invo l ved in the decision-making phase and the hearing aid fi t t i n g .

TH E PRO D U CTRecent technological advancements such as CIC aids, digital

signal processing, multiple microphones and advanced compressionare providing our patients with increased opportunities to achievea u d i b i l i t y, comfort and speech intelligibility in a variety of listeningsituations. The increased complexity of selecting, programming andfitting these products requires that many of us expand our skills andk n owledge of concepts that have been previously left to the manufa c-turing process. The hearing aid manufacturers continue to researchand refine the end product with impressive results, albeit at a consid-erable cost to practitioners and consumers. In order to achieve theexpected outcome of increased user satisfaction, audiologists arefinding the need for continuous education and training on newproducts and their unique features and benefits. Those that don’td evelop the skills needed to implement advanced technology and/orfail to properly promote the value of current technological improve-ments risk denying their patients a chance at better hearing. This is achallenge that we all must face as the and patient ex p e c t a t i o n sbecome more sophisticated.

TH E PAT I E N TEach patient brings individual circumstances and a distinct set of

priorities into the audiology arena. Sometimes it’s easy to determinew hy he or she chooses not to use hearing aids. Other times, it’s notreadily apparent and the audiologist needs to employ eff e c t ive com-munication skills to determine the barrier. Common objections tousing hearing aids include:þ Denial þ Lack of Motivation/Higher Prioritiesþ Lack of Educationþ C o s tþ Tr a n s p o r t a t i o nþ Bad Experienceþ Fear of Handicapþ Other Physical A i l m e n t s

From the patient’s perspective, any one of these barriers can justifythe decision to do nothing or choose not to use hearing aids. Ourresponsibility as hearing healthcare professionals is to help patients andtheir families identify these barriers, work through them, and to recog-nize the benefits of amplification, as well as the consequences ofuntreated hearing loss. This presupposes that we have the inclinationand the counseling skills to facilitate an interactive and educational ses-sion, and that we possess the commitment and discipline to invest timein doing so. Do patients have a choice? Of course they do, but the keyword is “informed” — informed choice occurs when we demonstratethe effort, patience and willingness to reach out to the hearing impairedand their families. When we tell patients that it’s okay to leave hearingloss untreated or to come back “when they ’re ready,” we relinquish ourroles as advocates for the hearing impaired. On the other hand, whenwe convey the importance of restoring good communicative ability andgain the trust and confidence of our patients, we can make a tremen-dous impact on the quality of their live s .

Are WeREALLYHELPINGPeople H E A RB E T T E R?

Cynthia Beyer, Hearx, West Palm Beach, FL


TH E FI T T I N G PRO C E S SMost importantly, clinician and patient

o b j e c t ives need continuous alignment, asunrealistic expectations and unrealized ben-e fits have the ingredients for fitting fa i l u r e .Clinicians that rely solely on traditionalmethods of data gathering (often limited toroutine audiometry, basic medical or audio-logic history and rudimentary gain func-tions) are missing a wealth of insight thatcan assist in appropriate management ofhearing disorders. Uncovering such infor-mation as situational listening ex p e r i e n c e s ,psychosocial considerations, extent of prev i-ous hearing aid experience and dynamicrange measurements promotes the deve l o p-ment of a well integrated hearing care plan.Such an approach entails a careful balancebetween complex subjective and objectivefactors, giving us the best chance to achievereasonable success with patient goals. W h e nwe encompass our clinical observations, per-formance measurements and patient feed-back proportionately, we become better posi-tioned to strategize and take necessaryactions, whether it be a technological modi-fication or a focused counseling approachthat is required. If we rely too heavily on anyone particular aspect of the fitting process,we may do so at the expense of the patient’soverall outcome.

TH E AU D I O L O G I STIn his book, Counseling for Hearing A i d

Fi t t i n g s, Robert Sweetow states: “We haveelected to be in a communication profession,yet we seem to be failing to communicate thes i g n i ficance of hearing aid use as a viables t r a t eg y. W hy is that?” Part of this answermay lie in the curriculum of most graduateschools, which continue to provide littlehands-on training in the applications of hear-ing aid technology and fail to instill enthusi-asm and confidence in personal amplifi c a-

tion. Beyond that, we, as audiologists, areresponsible for our own attitudes and compe-tence levels in meeting the needs of our hear-ing impaired patients. It may be that we needto require more of ourselves, that we need tolean forward a little more and seek the sup-plementary skills that will allow us to ex c e land reap our professional (not necessarilymonetary) rewards. In a profession that tendsto spend 90% of the time pushing bu t t o n sand “nailing the targ e t ,” it’s probably wo r t h-while to expand our horizons and accept thereality that if we cannot or do not get hearingimpaired patients to wear hearing aids, weare not helping them or fulfilling the require-ments of the audiology profession.

The Joint Commission on A c c r e d i t a t i o nof Healthcare Organization (JCAHO)A m bulatory Healthcare Accreditation is

very clear about the responsibilities ofhealthcare providers in educating patientsand families on assessed needs and rehabili-tation options. Defined standards of careaddress the orga n i z a t i o n ’s requirement forsupporting educational activities, allocationof resources, follow up and long range aswell as short term educational goals. Byclosely following the intent of these guide-lines and developing the processes that sup-port them, we fulfill our obligation to bothour patients and our profession.

CO N C L U S I O NThe National Institute on Deafness and

Other Communication Disorders (NIDCD)estimates that there are 28 million people inthe United States who are deaf or hard ofhearing. We can reasonably estimate thatabout 27 million of these could likely bene-fit from the use of hearing aids. There areapproximately 6 million people that ownhearing aids, leaving a very large group ofpeople that need hearing aids but do nothave them.

Recent articles by the Journal of theAmerican Medical Association (Larsen et.al, 2000) and the American Council on

Aging confirm what many of us workingwith hearing aids realize on a daily basis.Hearing aids can and do help millions ofpeople to communicate better, participatemore fully and enjoy an overall improvedquality of life. Untreated hearing loss hasbeen associated with adverse conditions ofgeneral health and well being, includingdepression, sadness, worry, anxiety, emo-tional turmoil, insecurity, reduced socialactivity and paranoia. Patients that use hear-ing aids report better relationships, betterfeelings about self, improved mental healthand greater independence and security,compared to the hearing impaired that donot use them.

Technological advancements have ele-vated and strengthened the tools that audiol-ogists have available to remediate loss of

c o m m u n i c a t ive abil-i t y. The fact remainsthat we aren’t help-ing enough people,and those of us thatare in the capacity ofidentifying hearingimpairment mayneed to acknow l-edge that a good partof that responsibilitylies with us. W h i l ethe interaction ofpotential barriers toa m p l i fication can bec o m p l ex, many ofthem can be ove r-come with good

technology skills, appropriate counselingand aural rehabilitation. When we spendtime with our patients to counsel them onhearing loss, when we share our ex p e r i e n c e sand expertise, we give them their best shot atbetter hearing and all the good things that gowith it. By committing ourselves to profes-sional growth and educating every patientthat is identified as a hearing aid candidate,there is potential for increasing utilizationand appreciation of our life’s wo r k .

RE F E R E N C E SLarsen, VD, Williams, DW, Henderson,

WG, Luethke, LE, Beck, LB, et. al.E ffi c a cy of 3 Commonly Used HearingAid Circuits: A Crossover Trial. JA M A,284:14, 1806-1813, 2000.

National Council on the Aging. The conse-quences of Untreated Hearing Loss inOlder Pe rs o n s . N C OA, Wa s h i n g t o n ,D.C., May, 1999.

S w e e t ow, Robert. Counseling for HearingAid Fi t t i n g s . Singular Publishing Group,San Diego,1999.

A re WeR E A L LYH E L P I N GPeople H E A RB E T T E R?

“The audiologist provides habilitation andrehabilitation to persons with hearing impairmentand is a source of information for family members,other professionals and the general public.Counseling regarding hearing loss, the use ofamplification systems and strategies for improvingspeech recognition is within the expertise of theaudiologist. Additionally the audiologist providescounseling regarding the effects of hearing loss oncommunication and psycho-social status in personalsocial and vocational arenas.”American Academy of Audiology Position Statement


A R K A N S A SA U D I O L O G I S T:

Audiologist wanted for busy ENTpractice in Jonesboro, AR. Responsi-bilities would be diagnostic ev a l u a-tions (audio evaluations, ABRs,D P OAEs, tympanometry) and hearingaids (mainly programmable and digi-tal) for pediatric and geriatric popu-lations. Will consider a strong CFY.Salary commensurate with ex p e r i-ence. Please send resumes toB r o o ke, Fax: (870) 932-8432; phone(870) 932-6799; or email:s m i t h a u d @ ex c i t e . c o m.

C A L I F O R N I AA U D I O L O G I S T:

F/T research position. Basicaudiological + advanced electrophys-iological testing of adults and kids.MA/MS/AuD + CCC-A. Researc hbackground/interest preferred.Contact Betty Kwong, House EarInstitute, 2100 W. Third Street, LosAngeles, CA 90057; (213) 273-8023;b k wo n g @ h e i . o r g.

L O U I S I A NAHEAD, DEPA RTMENT OF COM-M U N I C ATION DISORDERS:

Position available, Summer or Fa l l2002: Head, Department of Commun-ication Disorders, School of AlliedHealth Professions, LSU HealthSciences Center- N ew Orleans. Quali-fications: PhD in Speech-LanguagePathology or Audiology with currentASHA CCC; must hold tenure as a fullor associate professor; must presenta record of published research. Thecandidate must present evidence ofe f f e c t i ve interpersonal communica-tion skills, and document administra-t i ve effectiveness and leadershipskills. The department has proposedan AuD program and is invo l ved inplanning for a school-wide PhD pro-gram. Interviews will commence inNovember and continue until anacceptable candidate is identified.Salary is competitive. LSU-HealthSciences Center is an AffirmativeAction/Equal Opportunity Employe r.To apply, please send your vita andthree letters of recommendation from

professionals of equal or higher rankfamiliar with your accomplishments inthe above-mentioned areas to: Chair,S e a rch Committee, Department ofCommunication Disorders, School ofAllied Health Professions, LSU HealthSciences Center- N ew Orleans, 1900Gravier Street, New Orleans, LA70112-2262; Phone (504) 568-4348/4346; Fax (504) 568-4352;e-mail L G a a s @ l s u h s c . e d u.

M A RY L A N DA S S I S TANT PROFESSOR-U N I V. OF MD, COLLEGEPA R K :

The Department of Hearing &Speech Sciences invites applicants fora tenure-track position which beginsAugust 2002. Qualifications: Expertisein electrophysiologic measures andamp preferred. Applicants shoulddemonstrate a publication record,potential for developing an independ-ent research program, and have favo r-able teaching evaluations commensu-rate with experience. Responsibilities:conduct research, teach undergrad andgrad courses, mentor grad students,and participate in dept. and unive r s i t yactivities. Salary is negotiable,depending upon qualifications andexperience. The dept. offers BA, MAand PhD degrees; approval for aDoctoral Program in Clinical Audiology(AuD and PhD tracks) is forthcoming( web page: w w w. b s o s . u m d . e d u . / h e s p) .The dept. actively participates in theinterdisciplinary training program inC o m p a r a t i ve and Evolutionary Biologyof Hearing and the research program inNeuroscience and Cognitive Science oncampus. The College Park campus islocated in the Baltimore-Wa s h i n g t o nmetropolitan area in close prox i m i t yto numerous wo r l d - r e n owned medicalinstitutions and research facilities,including the National Institutes ofHealth, Veterans Administration Me d i-cal Center, Walter Reed Army Me d i c a lC e n t e r, Johns Hopkins University andthe University of Maryland School ofMedicine. Rev i ew of applications willbegin on 1/4/02, but applications willbe accepted until position is filled.Please send letter of application, offi-cial transcript of graduate studies, and

three letters of recommendation to:Sandra Gordon-Salant, PhD, Chair,S e a rch Committee, Dept. of Hearing &Speech Sciences, University ofMaryland, College Park, MD 20742. E-mail at S G O R D O N @ h e s p . u m d . e d u. The University of Maryland is an Equal Opportunity/Affirmative Action e m p l oye r. Minorities are encouraged to apply.

N E B R A S K AA U D I O L O G I S T:

Two ENT physicians in NorthPlatte, NE seeking audiologist to joinpractice. No experience necessary.Fax resume to: (308) 532-3334.

N E VA DAAUDIOLOGY POSITION:

Come to exciting Las Vegas! Busyotolaryngology (ENT) office seeks afull-time certified audiologist for ag r owing practice. Responsibilitiesinclude audiological diagnostic ev a l u-ations and complete hearing aid serv-ices. Extensive interaction withphysicians in a rewarding, profes-sional environment. Excellent commu-nication skills and the ability tointeract with a wide range of patientages are a plus. Generous salary andbenefit package. Prefer CCC-A willconsider CFY. Fax resumes to Nev a d aE ye and Ear, Attn: Paulette Patrick,(702) 896-9591.

NEW MEXICOA U D I O L O G I S T:

Duties incl: determine type anddegree of hearing impairment. Planand implement in conjunction withother professionals habilitation andrehabilitation services for patientsinclg hearing aid selection, counseling,auditory trg, hearing conservation &vestibular rehabilitation therapy.Refer patients to doctors if medicallyn e c e s s a r y. Administer and interpretvarieties of tests such as air & boneconduction testing, speech receptionand discrimination testing, electroa-coustic immittance testing, visualreinforcement audiometry, condi-tioned play audiometry & electronys-tagmography to determine type &

degree of hearing impairment, site oflesion & effects on communicationa b i l i t y. Use theoretical knowledge tos e r ve best interests of patients.Dsgn, manage and conduct FDA clinicalt r i a l s .

Qualifications for position:Master of Science in Audiology orSpeech & Hearing Sciences + 6 mosexp in job. Must have license topractice Audiology in the State ofNM or must be eligible to obtainlicense to practice audiology in theState of NM. $38,065/yr, 8.30a-5.30p, 40 hrs/wk.

Send resume to NMDOL, 501Mountain Road, NE, Albuquerque, NM87102, indicating JO#: NM1063144.

P E N N S Y LVA N I AA U D I O L O G I S T:

Full or part time for busy ENTpractice in the Pittsburgh area.Primary duties include audiometricanalysis, ENGs and hearing aid dis-pensing. Knowledge of digital andprogrammable hearing aids helpful.CFYs acceptable, we have an audiolo-gist on staff to supervise. Please faxresume to (412) 782-2387 or mail to:Allegheny Ear, Nose and ThroatAssociates, Inc., 100 Delafield Road,Suite 207, Pittsburgh, PA 15215.

A U D I O L O G I S T:Become a member of one of the

largest pediatric audiology depart-ments in the country! Responsibilitiesinclude audiological assessment, new-born hearing screening, hearing aidevaluation and dispensing, teachingand research. As part of a stimulatingprofessional environment, you willalso have the opportunity to partici-pate in the ongoing deve l o p m e n t ,r evision and refinement of clinicalprocedures and protocols.

Analytical skills and the ability towork independently are essential. Yo ushould possess a high level of skill inaudiological assessment procedurespertaining to the pediatric population.Good communication skills are inte-gral to our mission of family-centeredcare. A master’s degree in Audiologyis required, as is eligibility for PA andNJ audiology licensure.

CLASSIFIED ADS


CLASSIFIED ADSThe Department of Audiology is

part of The Center for ChildhoodCommunication. The Center forChildhood Communication was createdto provide the region’s first trulyc o m p r e h e n s i ve approach to complexchildhood communication problems.The Center consists of a multidiscipli-nary team of clinicians who offerc o m p r e h e n s i ve evaluation, treatmentand rehabilitation services ex c l u s i ve l yfor pediatric patients. Services arep r ovided at our main campus site, aswell as at several Specialty CareCenters located throughout the region.

The Children’s Hospital ofPhiladelphia offers competitivesalaries, comprehensive medical/vision/dental/prescription plans,life insurance, and employer contribu-tion retirement plan, work/life ben-efits, and a firm commitment to staffd evelopment and education.

Apply online at: w w w. c a r e e r s .c h o p . e d u or fax your resume to (215)590-3184. Use reference ID 44 in allcorrespondence. EOE

T E N N E S S E E

A U D I O L O G I S T: M.A., CCC-A:Full-time twe l ve-month clinical

supervisory position in Unive r s i t yf a c i l i t y. Duties include student super-vision and provision of services in theareas of adult and pediatric audiologi-cal assessment and amplification.Participate in teaching clinical courses.A minimum of two years clinical ex p e-rience is required and supervisionexperience is desirable. Applicantsmust be eligible for Tennessee licensein Audiology. The rev i ew of applica-tions will begin November 1, 2001 andwill continue until the position hasbeen filled. Send letter of application,

resume, and three letters of recom-mendation to Jack Ferrell, Departmentof Audiology and Speech Pathology,South Stadium Hall, University ofTennessee, Knoxville, TN 37996-0740.The University of Tennessee is anE E O / A A / Title VI/ Title IX/Section504/ADA/ADEA institution in thep r ovision of its education and employ-ment programs and services.

T E X A SCLINICAL FAC U LTY POSITIONIN AUDIOLOGY:

Department of Speech and HearingScience at the University of NorthTexas seeks a nine-month, non-tenure-track clinical supervisor in Audiology.The position requires a minimum of am a s t e r ’s degree and CCC-A. An audiol-ogist with at least three years clinicalexperience, history of supervising stu-dent clinicians, and clinical ex p e r i e n c ein the following areas preferred: ampli-fication, e l e c t r o n y s t a g m o g r a p h y,evo ked potential testing, otoacousticemissions and aural rehabilitation.Responsibilities will include clinicalsupervision, and departmental service.Salary is competitive with ex c e l l e n tbenefits and availability of start-upfunds. Faculty will be available at thisye a r ’s ASHA convention to meet withpersons interested in the position. Thisappointment begins August of 2002with summer employment preferred.R ev i ew of applications will beginJanuary 15, 2002, and continue untilthe position is filled. Interested par-ties should send a letter of application,curriculum vitae, three letters of rec-ommendation, and official transcriptsto Miriam Henoch, PhD, Chair, Searc hCommittee, Department of Speech andHearing Sciences, PO Box 305010,Denton, TX 76203-5010. Email:m h e n o c h @ u n t . e d u. The University ofNorth Texas is an AA/ADA/ EOE andencourages applications from wo m e n ,minorities, and persons with disabili-ties because it is committed to an eth-nically and culturally diverse unive r s i t yc o m m u n i t y.

WA S H I N G TO NA S S I S TANT PROFESSOR, A U D I O L O G Y:

Permanent, tenure-track, 9-month appointment; summer teachingpossible. Doctorate in audiology orclosely related field required. CCC-Aud, experience in university teachingand mentoring students preferred.Reduced teaching load; teach primari-ly at the graduate level in auditoryp e rception, pediatric audiology, ande l e c t r o p h y s i o l o g y, dependent onbackground and interest; deve l o pr e s e a rch program and direct master’sr e s e a rch. The graduate program willm ove into the new Health SciencesBuilding on the Washington StateU n i versity Spokane Rive r p o i n tCampus, Fall 2001. Salary commen-surate with qualifications and ex p e r i-ence. Rev i ew of applications willbegin January 11, 2002. Position openuntil filled. Start date is August 16,2002. Send letter of application,curriculum vitae, three letters of ref-erence to: Jeffrey D. Nye, M.S., Chair,Audiology Search Committee,Washington State Unive r s i t yS p o kane, 601 West First Ave n u e ,S p o kane, WA 99201-3899; (509)358-7589; Fax (509) 358-7600;n ye @ w s u . e d u. Washington StateU n i versity is an equal opportunity/a f f i r m a t i ve action educator ande m p l oye r. University information isavailable at w w w. w s u . e d u.

I N T E R NAT I O NA LAU S T R A L I ARARE OPPORT U N I T Y:

Imagine your lifestyle in beauti-ful Melbourne, Australia. Audiology/Hearing Aid practice in “Top-End” oft own. FOR SALE: Highly profitable,“ u p - m a r ket” private practice, estab-lished 13 years ago by AmericanAudiologist with successful NYCc a r e e r. Retiring after 32 ye a r s .Contact Marie-Louise Hekel (Muir) byemail: m l h e ke l @ m e l b p c . o r g . a u.

For information or to place a classified ad in Audiology To d a y,please contact Patsy Meredith at 303-372-3190 or Fax 303-372-3189.


N E W S&a n n o u n c e m e n t sFrank Musiek has accepted a position asDirector of Auditory Research in the Depart-ment of Communication Disorders at theU n iversity of Connecticut. Musiek will bei nvo l ved in the AuD-PhD graduate pro-grams at UCONN and hold a concurrent fullProfessorship in the UCONN MedicalSchool in Farmington, CT. He will remainin his present position at the DartmouthHitchcock Clinic on a part-time basis andb egin full-time UCONN responsibilities inSeptember of 2002.

Susan W h i c h a r d has been appointed Vi c ePresident of Sales and Marketing for InSonusMedical located in Newark, CA. InSonus willd evelop and market the wo r l d ’s smallest andmost inconspicuous hearing devices that oper-ate continuously for up to six months inside theear canal. The user wears the InSonus hearingd evice continuously even during sleep, show e rand swimming. Whichard is a past President ofthe Academy of Dispensing Audiologists.

Holly Blocke r and L a u ren Linden h ave joinedthe audiology staff at the Hearing ProfessionalCenter in Dallas, TX. Blocker was previously agraduate teaching assistant at the University ofArizona and Linden earned her audiologyd egree from Louisiana State Unive r s i t y.

p a s s a g e sp a s s a g e sp a s s a g e s

SI L M A N A N D AR I C K RE C E I V E MI L L I O N

DO L L A R NIH GR A N TShlomo Silman, Professor of Audiology at Brooklyn College/CUNY and Daniel Arick, oto-

l a ryngologist, received a $1,000,000 NIH grant to test feasibility and to conduct clinical trialsfor the use of non-surgical techniques for treatment of middle-ear effusion in young children.Silman will direct the research project at Brooklyn College and Arick will direct the medicalaspects of the research. For many years, Arick and Silman worked together to develop newtechniques for treatment of middle-ear effusion and hearing loss, recognizing that surgeryand medication did not appear to alleviate the otitis media. In fact, in some cases, the condi-tion was worsened. They invented a small, battery-operated, hand-held device based on thetraditional Politzer maneuver (Audiology To d a y, 12:4, pg. 29). The new device was engineeredto control for airflow by introducing a constant volume-velocity and pressure that is easily tol-erated by children and yet yields satisfactory results. The device was designed to coordinateflow with the child’s swallow of a drop of water so that the Eustachian tube will open at thesame time, permitting airflow into the middle ear. To be included in the clinical trials, a childmust present with middle-ear effusion with hearing loss verified by an otolaryngologist andaudiologist for a period of 8 weeks. There will be a control group of those children who optto use the device if the results of the experimental group demonstrate positive results. Silmanand Arick will create a model clinic where audiologists and otolaryngologists work togetherin one institution providing an equal contribution for the benefit of children with otitis media.

AG BE L L AN N O U N C E S2002 CO N V E N T I O N

AG Bell has announced that their 2002 Convention will be held in St.Louis, MO, July 27-July 2. The 4-day event will offer parents, profes-sionals and people of all ages with hearing loss with an opportunity toshare experiences and educate one another in a collaborative, supportivee nvironment. Over 100 presentations and short courses will be scheduledon a wide variety of topics related to hearing and management of personswith hearing loss. Further information is available from AG Bell at 202-337-5220 or by e-mail at w w w. a g b e l l . o rg.

NHCA Hosts 2002Conference in Dallas

The National Hearing Conserva t i o nAssociation (NHCA) will hold its 27th A n n u a lConference, February 21-23, 2002 in Dallas, T X .The conference will feature national and interna-tional speakers discussing the latest break-throughs in occupational hearing conservation inworkshops, platform and poster session formats.For information, contact NHCA at 303-224-9022or by e-mail at w w w. h e a r i n g c o n s e r va t i o n . o rg

AM E R I C A N AU D I T O RY SO C I E T Y ( A A S )Annual Meeting - March 14-16, 2002

C A L L F O R P A P E R S

The American Auditory Society’s annual meeting will be held March 14-16at the Holiday Inn SunSpree Resort, Scottsdale, Arizona. All podium

paper submissions will be managed electronically this year from the AASWeb Site. Even if you are not submitting a paper please look at our

newly-constructed web site at: w w w. a m a u d i t o ry s o c . o r g.The meeting will feature a series of already selected Special Sessions, the

Carhart Memorial Lecture, Podium Papers, and Technology Updates.Registration rates and hotel information are being finalized. Watch theAAS web site and future e-mail messages from the AAS relative to the

final program and registration.Mark your calendar now! March 14-16, 2002 in Scottsdale, Arizona.


N E W S&a n n o u n c e m e n t s

The Academy Pa s t - P r e s i d e n t ’sCouncil held their annual break-fast meeting to discuss currentaudiology issues during the recentSan Diego Convention. From leftright, Linda Hood, Robert Glaser,David Fa b r y, Barry Fr e e m a n ,Angela Loave n b r u ck, Je r r yNorthern, Sharon Fujikawa, CarolF l e xe r, Fred Bess and RobertKeith. Not pictured are LucilleB e ck and Deborah Hayes.

Past President Robert Glaser

holds forth at the recent

Academy Board of Director’s

meeting. The Board is

responsible for all Academy

policy decisions as well as the

oversight and management of

more than $3,200,000 of

annual revenues.

Olin E. Teague Aw a rd Goes to Douglas Noff s i n g e rDouglas Noff s i n g e r, Chief of Audiology and Speech Pathology Service, VA Greater Los A n g e l e s

Health Care System, has been selected to receive the 21st Olin Teague Award. Dr. Tom Garthwaite, theVeterans Health Administration Under Secretary for Health, called Dr. Noffsinger to tell him that he wa sselected and to congratulate him. Noffsinger is the first audiologist to receive the honor.

The Olin E. Teague Award Program was developed to pay tribute to the late Honorable Olin Te a g u e ,a strong congressional advocate for ve t e r a n s ’programs. This award is one of the highest awards given bythe VA and honors the employee who has made exemplary contributions in the area of rehabilitation andi m p r ovement in the quality of life of wa r-injured veterans. The award ceremony was held September 12,2001, at the Cannon House Office Building, Washington, DC, and was attended by senior VA/VHA offi-cials, members of ve t e r a n s ’ service organizations and congressional representative s .

N o ffsinger was honored for his career work in furthering the mission of the VA in clinical service,education and research. The award synopsis cites the national impact of his basic and clinical research,his role in creating clinical guidelines and algorithms for hearing and hearing aid measurement tools ina u d i o l o g y, his work to refine education and training programs in the VA and the development of policiesto assure veterans equal access and eligibility for hearing health care and hearing aids at VA facilities inhis region. Noffsinger is currently the President of the Association of VA Audiologists and Chair of theVA’s National Field Advisory Council for Audiology and Speech Pa t h o l o g y. His academic appointmentis in the Division of Otolaryngology-Head and Neck Surgery at UCLA School of Medicine.Douglas Noffsinger


N E W S&a n n o u n c e m e n t sAt a September 4th meeting

held at La Meridian Hotel, adja-cent to Heathrow InternationalAirport, plans were finalized tom e rge three well-establishedaudiology journals into a singleworld-wide publication. Au d i o l-og y, British Journal of Au d i o l-og y and Scandinavian Au d i o l-og y, published by the Interna-tional Society of A u d i o l o g y, theBritish Society of A u d i o l o g yand the Nordic Society ofAudiology respective l y, willbecome the International Jo u r-nal of Au d i o l og y b eg i n n i n gJanuary 2002.

The three journals representover 100 years of publication ofs c i e n t i fic and clinical work inhearing, hearing impairment,hearing science and audiology.Combining resources from thethree publications will result in a journal that will be distributed wo r l dwide, representing work being conducted across the wide variety ofdisciplines invo l ved in hearing, hearing disorders and treatment ofhearing loss.

The process of merging the three journals took over a year. In con-sidering the merger the three societies developed the following mis-sion statement:

The International Journal of Au d i o l ogy (IJA) is committed to fur-

thering development of a scien-t i fically ro bust evidence basefor audiolog y. It aims toa ch i eve this through publica-tion of high-quality papers ofre l evance to the science andclinical practice of audiolog yand its component disciplines.As a high impact journal with awide international re a d e rs h i p ,I JA will ensure critical,thoughtful, speedy and thor-ough rev i ew of all submittedp a p e rs. IJA aims to be re c og-nized as the leading Journal in audiolog y.

I JA will be available througha variety of mechanisms to allthose wishing to have access toit. All members of the threeowning societies will receivethe publication as a memberb e n e fit. The publisher, BC

D e c ker Medical Publishers, Inc, will promote the journal to non-mem-bers through an international advertising campaign.

Stig Arlinger of Linkoping University Hospital, Sweden, wa sappointed as the first Editor-In-Chief. His appointment will beg i nimmediately and will extend through 2003. With the first issue in2004, Ross Roeser of the University of Texas at Dallas/Callier Centerfor Communication Disorders, Dallas, TX, will assume the Editor- I n -Chief post.

IN T E R NAT I O NA LAU D I O L O GYJO U R NA L SME RG E

Members of the editorial board met in London, England to finalize plansm e rging three audiology journals. Included are (from left to right) StigArlinger the newly appointed Editor-In-Chief of the I n t e r n a t i o n a lJournal of Au d i o l og y, Agnete Parving (Editor-In-Chief of S c a n d i n a v i a nAu d i o l og y), John Bamford (Editor-In-Chief of the British Journal ofAu d i o l og y), Ross Roeser (Editor-In-Chief Elect of the I n t e r n a t i o n a lJournal of Au d i o l og y), Vivienne Oaks (BJ Decke r, Inc.) and Jean-MarieAran (Editor-In-Chief of Au d i o l og y) .

On October 17th AAA and A DA representatives met with Medicareo fficials to discuss direct access for audiologists. As you are aware, audi-ologists currently need a physician referral for Medicare patients. One ofthe goals of the Academies is to eliminate the unnecessary burdens forconsumer access to quality hearing health care services. The A c a d e m i e sb e l i eve that direct access for consumers will lead to a higher quality ofhearing and ve s t i bular services for A m e r i c a n s .

The Academies stressed that the Federal government agencies shouldbe consistent. The Office of Personnel Management (Federal BC/BSprogram), the Veterans Administration, and Medicaid all provide fordirect access. Consequently, the Medicare program should follow thelead of other federal agencies. Our message was well received!

The Academies governmental efforts represent a process that includespolitical advo c a cy. We all need to be a part of this process. You can par-ticipate by contributing to either A A A’s or A DA’s Political A c t i o nCommittee. You can ensure that the audiologist will be recognized as the

manager of hearing health care by contributing now! Visit h t t p : / / w w w. a u d i o l o g y. o rg / p r o f e s s i o n a l / m e m b e r s / O R

w w w. a u d i o l o g i s t . o rg Your participation will count!

AU D I O L O GY ACA D E M I E S ME E T W I T H ME D I CA R E

LI M BAU G H LO S I N G HE A R I N G

Rush Limbaugh, the well-known radio talk-show host, told hislisteners recently that he had lost all his hearing in his left ear and80% of the hearing in his right ear over a 4 1/2 month period.Limbaugh was evaluated and is under treatment for his sudden hear-ing loss by the House Ear Clinic and Institute in Los Angeles. A nHEC press conference reported that Limbaugh had been diagnosedwith sudden bilateral sensorineural hearing loss caused by autoim-mune inner ear disease. HEI otologists are apparently considerings u rgery for Limbaugh’s hearing problem and are confident that theycan preserve the hearing that he still has, and perhaps even see post-treatment improvement in hearing leve l s .


Managing Business A c t iv i t i e sN ovember 23-24 - Ft. Smith, A RDecember 13-14 - West Chester, PA

American Hearing Aid Assoc., Contact: Sharon Grant 800-984-3272

Digital Te c h n o l o g yN ovember 27 - Spokane, WA

S t a r key Labs, Contact: Karen Lindberg 800-328-8602

ITE Modification & Cerumen Related RepairsN ovember 28 - Dallas, TX • November 29 - Houston, TXN ovember 30 - San Antonio, TX

Lori-Unitron, Contact: Denise Colo 800-888-8882 x3386

Mastering Beltone’s Consultative Care Pro c e s sN ovember 29-30 - Boston, MA

Beltone Electronics, Corp., Contact: Diane Russ 773-866-7545

Ve s t i bular Disorders: Diagnosis, Treatment & RehabilitationN ovember 29-30 - North Miami Beach, FL

American Institute of Balance, Contact: Richard Gans 727-398-5728

A d vanced Applications of Auditory Evo ked Responses (AERs)and Otoacoustic Emissions (OA E s )N ovember 30-December 1 - Atlanta, GA

Med-Acoustics, Inc., Contact: Janice Ollick 770-498-8075

Next Generation Cochlear Implants Symposium & PracticumN ovember 30 - December 1 - New York, NY

N ew York University Post Graduate Medical School Contact: Registration Line 212-263-5295, orh t t p : / / w w w. m e d . ny u . e d u / c m e

A d vanced Applications of Digital Te c h n o l o g yDecember 3 - Cleveland, OH • December 4 - Yo u n g s t own, OHDecember 5 - Pittsburgh, PA

Phonak, Inc., Contact: Melissa Pa c ey 800-777-7333, ext. 5291

A d vanced CantaDecember 3 - West Palm Beach, FL • December 4 - Dania, FLDecember 5 - Ft. Myers, FL • December 6 - Sarasota, FL

GN Resound, Contact: Kelly Simpson 952-769-8481

PFS and Noah Updates & Tr a i n i n gDecember 6 - New York, NY


Ve s t i bular RehabilitationDecember 5-7 - Clearwa t e r, FL

American Institute of Balance, Contact: Richard Gans 727-398-5728

Axiom Region Training CourseDecember 6-9 - Minneapolis, MN

Lori-Unitron, Contact: Denise Colo 800-888-8882 x3386

O f fice Pro d u c t iv i t y / M a r ke t i n gDecember 7 - Baltimore, MD


Pediatric A m p l i fication & FM ConsiderationsDecember 14 - Ft. Lauderdale, FL

Phonak, Inc., Contact: Melissa Pa c ey 800-777-7333, ext. 5291

Audibel Technology 2001December 14-15 - Eden Prairie, MN


O f fice Pro d u c t iv i t yDecember 15 - Kalamozoo, MI


I n n ovations in Cochlear Implant Technology: ESPrit 36, Po r t a b l eP rogram System, R126 & NRT3.0 and Optimizing Pe r fo r m a n c e :A d vanced Programming Te c h n i q u e sVarious Dates/Locations in November and December

Cochlear Corporation, Contact: Debbie Cole 303-790-9010

S u rv iving the PPS Au d i tVarious Dates/Locations in November and December

Healthcare Info. Network, Inc., Contact: Karen Blake 315-461-0456

Senso VIII: Compass 3+Various Dates/Locations in November and December

Wi d ex Hearing Aid Company, Contact: Francis Kuk 630-357-3813

Various Online Self Study Courses at Care 2 l e a rn . c o mOnline HealthNow, Inc., Contact: Edie Deane 941-795-2322

Case Study CEU Pro g r a mAmerican Institute of Balance, Contact: Richard Gans 800-245-6442

Seminars in Hearing Self StudyS e m i n a rs in Hearing, Contact: Nan Ratner 301-405-4217

E a rn CEUs from Chats/Articles at Au d i o l o g yo n l i n e . c o mAudiology Online, Contact: Barbara Beck 210-545-0133

AMERICAN ACADEMY OF AUDIOLOGY A N N UA LCONVENTIONS & EXPOSITIONS SCHEDULE

14th Annual Convention & Exposition, April 17-20, 2002P e n n s y l vania Convention Center, Philadelphia, PAB a r b a ra Pa cke r, Prog ram Chair

15th Annual Convention & Exposition, April 3-6, 2003San Antonio Convention Center, San Antonio, T XGyl Kasewurm, Prog ram Chair16th Annual Convention & Exposition, April 1-4, 2004Salt Lake City, UT

17th Annual Convention & Exposition, April 7-10, 2005Washington, DC

18th Annual Convention & Exposition, April 6-9, 2006Minneapolis, MN

AMERICAN ACADEMY OF AUDIOLOGY

CONTINUING EDUCATION CA L E N DA R


AU D I O L O G YTO D AYAuthor Index • Volume 13 • 2001

AU T H O R E D ART I C L E SAnonymous. The High Price of Hearing Aids: A

M a n u f a c t u r e r ’s Perspective. 13:2, 20.

Ashburn-Reed, S. and Arthur, D. The VibrantSoundbridge: Hear to Say. 13:2, 40.

Ault, D. Doctoral Level Audiology GraduateProgram Growth: A Surv e y. 13:5, 45.

Bankaitis, A.U. A Different Kind of CommunicationD i s o r d e r. 13:1, 12.

Berlin, C., Hood, L. and Rose, K. On RenamingA u d i t o ry Neuropathy as Auditory Dys-syn-c h r o n y. 13:6, 15.

B e y e r, C. Guidelines to Private Practice QualityImprovement. Special Issue: Private Practice,N o v e m b e r, 8.

B e y e r, C. Are We Really Helping People HearBetter?. 13:6, 40.

Bopanna, B. Audiological Assessment ofLinguistically and Culturally DiversePopulations. 13:4, 34.

B u s b y, P., Whitford, L. Patrick, J. Staller, S.Should Patients Receive Two CochlearImplants? 13:4, 29.

Butts, F. Marketing Strategy for a Private AudiologyPractice. Special Issue: Private Practice,N o v e m b e r, 15.

DiSogra, R. Adverse Drug Reactions andAudiology Practice. Special Issue, September.

Ellison, C. Loving This Business Called Audiology!Special Issue: Private Practice, November, 18.

English, K. Counseling Strategies for the PrivateP r a c t i t i o n e r. Special Issue: Private Practice,N o v e m b e r, 10.

F a b ry, D. America’s Team (President’s Message)13:4, 6.

F a b ry, D. Blueprint for the Future (President’sMessage). 13:1, 7.

F a b ry, D. President’s Opening Address: San DeigoConvention. 13:3, 18.

F a b ry, D. Medicare Coverage for Hearing Aids:Prescription for Cure or Disaster? (President’sMessage), 13:6, 11.

Freint, A. and Pessis, P. Creating a SuccessfulA u d i o l o g y / O t o l a ryngology Partnership. SpecialIssue: Private Practice, November, 13.

Goldstein, D. Hearing Aid Dispensing: An HistoricalVignette. 13:3, 39.

Gravel, J. Audiology and Autism. 13:1, 19.

Hamill, T. and Freeman, B. Scope of Practice for Audiologist’s Assistants: Survey Results.13:6, 34.

Jacobs, K. From Employee to Employer — APersonal Perspective. Special Issue: PrivatePractice, 27.

J e r g e r, J. Some Suggestions for Improving OralPresentations. 13:5, 19.

Kasewurm, G. Guest Editor: Special Issue, PrivatePractice. November, pg. 5.

Kasewurm, G. Interview with a Legend: EarlH a rford. 13:2, 15

Kasewurm, G. Using Support Personnel inAudiology Practices. 13:5, 29.

Keith, R. The Time is Now! 13:6, 32.

Loavenbruck, A. President-Elect ConventionAddress. 13:3, 24.

Metz, M. The Value of Independence in an Era ofConsolidation. 13:6, 16.

M o n t g o m e ry, J., Herer, G., and Willems, M. TheHearing Status of Athletes in Special Olympics.13:3, 46.

Northern, J. Géorg von Békésy: Nobel Laureate,1961-Forty Years Later. 13:5, 13.

Northern, J. Northern Lites: Hearing Services onthe Internet: They’re Here! 13:2, 7.

Northern, J. Northern Lites: ASHA ShocksAudiologists by Signing Pact With AAO-HNS.13:6, 7.

Riso, K. To Survive or To Flurish. 13:1, 46.

Santucci, M. Creative Endeavors in Audiology.Special Issue: Private Practice, November, 23.

Stein, J. Something Evil in the Ear Canal. 13:4, 43.

Szumowski, E. Why Are Profits Down, EvenThough Sales are Up? Special Issue: PrivatePractice, November, 20

Tr e m b l a y, K. and Cunningham, L. Infants Can’tSeparate the Trees from the Forest. 13:1, 38.

Tr e m b l a y, K. and Cunningham, L. Hair CellRegeneration. 13:2, 37.

Tr e m b l a y, K. and Cunningham, L. CochlearImplants: A Topic of Debate. 13:3, 14.

Tr e m b l a y, K. and Cunningham, L. Of Mice andMen: Genetics of Age-Related Hearing Loss.13:5, 15.

Tr e m b l a y, K. and Cunningham, L. Noise InducedHearing Loss - Prevention in a Pill? 13:6, 30.

PO S I T I O N STAT E M E N TSAmerican Academy of Audiology. The Long-Range

Strategic Plan. 13:7, 9.

American Academy of Audiology. AudiologicGuidelines for the Diagnosis and Mangementof Tinnitus Patients. 13:2, 23.

PRO F E S S I O NA L TO P I C S2001 Election Slate, 13:4, 15.

2001 Election Results, 13:6, 14.

AAA Launches New Marketing Kit (R. Sweetow).13:4, 26.

ABA Advanced Certification with SpecialtyRecognition. 13:1, 16.

ABA Celebrates Three Years of Excellence inA u d i o l o g y. 13:6, 33.

Academy Completes Salary and Benefit Surv e y.13:1, 40.

American Academy of Audiology San DiegoConvention Wrap-Up. 13:3, 16

CIAO: Clearing House for International AudiologyOpportunities at www. a u d i o l o g y.org. (J. Clarkand Northrup, B). 13:3, 13.

ICD-9-CM Coding: Code to The Highest Level ofS p e c i f i c i t y. 13:6, 20.

Got Tough Professional Questions? You Need toAsk An Audiologist! 13:1,15.

Healthy People 2010 (S. Fujikawa). 13:2, 38.

Healthy People 2010 (S. Fujikawa). 13:5, 16.

Hear Careers at www. a u d i o l o g y.org. 13:6, 23.

Proposed By-Law Changes, 13:2, 12.

The NAD Position Statement on Cochlear Implants(S. Hasenstab). 13:2, 42.

The Year in Review: Actions of the Board ofDirectors. 13:1, 35.

Wide, Wide World of International Audiology atw w w. a u d i o l o g y.org (J. Clark). 13:2, 48.

Your Academy Committees in Action. 13:3,10.

LE G I S L AT I V E IS S U E SJohnson, C. Reimbursement Status for Federal

Blue Cross-Blue Shield. 13:4, 40.

Washington Watch: A Look at the 107th Congress.13:1, 34.

Washington Watch: The Stark and Anti-KickbackLaws: Over-Utilization of Medicare andMedicaid Services. 13:2, 43.

Washington Watch: Progress at HCFA. 13:3, 50.

Washington Watch: News from HCFA on Medicare.13:4, 38.

Washington Watch. Medicare Coverage ofCerumen Removal. 13:5, 34.

Washington Watch. The Power of Money: PA C ,13:6, 36.

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