1D1YPSU

Meet one of your most demanding customers.
When a child needs to be fitted with a
hearing instrument, he or she can be
one of the toughest customers on earth.
Fortunately, nearly 50 years of making custom
earpieces for ears of all shapes and sizes have
taught us a few things.
We understand the challenge of convincing a
youngster that they need to wear their hearing
instruments. The comfort and precise fit of
Westone custom earpieces are the biggest
steps you can take toward that goal.
For most young patients, the instrument and
earpiece have to be cosmetically appealing—
and the smaller the instrument, the better.
Westone’s lightweight, supremely comfortable
earpieces make more open fit and mini BTE
options available to your kiddos. And, our
various venting options allow you to fit
a wider range of hearing losses with
these instruments. A custom-fit earpiece
also offers the retention a young patient
needs and no standard mushroom tip
can match.
Countless Westone customers we served
as children are now grandparents. If you
work with children, contact us and put that
experience to work for you. You’ll find that
satisfying your most demanding customers
can be mere child’s play.
800.525.5071
westone.com
westone@westone.com
ISO 9001:2000

22
32
38
46
58
Gordon Hempton,
acoustic ecologist and sound recordist, is this year’s AudiologyNOW! ® General
Assembly keynote speaker. Hempton was able to spend a few tranquil
moments with AT to discuss his search for a nice quiet place to rest.
With 50
years of active clinical involvement, Luterman discusses his professional life
as a diagnostic and rehabilitative audiologist.
Tele-audiology, which
may include the full scope of audiological practice, offers one way of
addressing the disparity between the need and the availability of hearing
health services.
This opinion editorial provides guiding principles that
recommend that audiology programs and industry work together to identify
and manage potential conflicts of interest to ensure that the relationship
remains both successful and ethical.
Audiologists can learn to externalize and personify a patient’s
hearing loss without practicing psychotherapy. This approach causes the
practitioner to focus on the human side of hearing loss and treat the person,
not the disorder.

8 20,000 Hours of Listening By Kris English
10 The Buck Stops Here By Cheryl Kreider Carey
14 How to Bring Metrics to Marketing | Delegate Your Way
to Success
18 Academy and Other Audiology-Related Deadlines
20 What's New on the Academy's Web Site
67 Audiology Beyond the Classroom By Cherysse Lanns
68 What Do Supporting Cells Do By Lisa L. Cunningham
71 Providing Services to Medicare Beneficiaries—
The Options By Annette A. Burton
73
FAQs About Claims-Based Reporting
76 What Type of Impression Is Your Office Making
By Tracey Irene
78 Suggested Areas of Standardization: AuD Student Clinical
Practicum Experiences By Maureen Valente
81 Higher Education Is on the Move By Doris Gordon
82 I Can See the Future By James W. Hall III
Academy News
84 Become an Advocate at AudiologyNOW! ® By Melissa Sinden
85 Celebrate this Year's Academy Honors Recipients
89 Welcome New Members of the Academy
and Student Academy
90 Practice Guidelines Open for Review | Committee
Accomplishments
92 Partnership with Etymotic | ARO Travel Award Recipients
| University AuD Programs | AudiologyNOW! Events

let your patients
capture every
moment!
The New Passion440 from Widex combines the ultimate performance of
Mind hearing instruments inside a sensationally small Passion RIC model!
Passion440 features include:
Dual Integrated Signal Processing
Directional Microphones – 15 Channel High
Definition Locator
TruSound compression system that enhances clarity
of sound, regardless of input
10 kHz bandwidth – helps patients experience
sounds in greater detail
Multi-Directional Active Feedback Cancelling
Speech Enhancement
Zen – a revolutionary harmonic sound program that
uses fractal technology to help patients relax*
Audibility Extender – helps to extend the
audibility range into high frequencies
SmartSpeak – a signaling mechanism that informs
wearers of hearing aid functions
Stable Sound Delivery TM – the first truly closed
instant-fit solution
Sound Harmony – the unique Widex sound
processing strategy that optimizes hearing aid
performance for open fittings
NanoCare Wax Guard System provides valuable
moisture and wax protection
A wide variety of stylish colors
1.800.221.0188 www.widexPro.com
INDICATIONS FOR USE: The Zen program is intended to provide a relaxing sound background for adults (21 and older) who desire to listen to such a background in quiet. It may be
used as a sound therapy tool in a tinnitus treatment program that is prescribed by a licensed hearing healthcare professional (audiologists, hearing aid specialists, otolaryngologists) who
is trained in tinnitus management.

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

Performance.
Design.
Innovation.
Value.
It’s time you heard
of Hansaton.
RED DOT DESIGN AWARD
INTERNATIONAL FORUM DESIGN AWARD
In our 50 years as a European leader in hearing aid design, we’ve
learned a few things about what it means to listen. It’s how we
deliver more of what you want. It’s how we provide the best
available technology and the best possible value. And we do it
simply. Great products. Transparent pricing. Extraordinary service.
We’re listening.
Become a Hansaton dealer today.
The most sound decision you’ll make this year. To learn more about Hansaton products
email info@hansaton.com, call 888.984.7432 or visit www.hansaton-usa.com
Visit our booth at AudiologyNOW! in San Diego April 14-17

Don’t you love how kids love words
First, they want to know the names
of things, and then words that
describe those things (colors, shapes,
ownership—“mine!”). Along the way,
they start noticing the sounds of the
words. Some words have the same
sounds at the end. “Yep,” grown-ups
explain, “those words rhyme.” But,
other words have the same sounds at
the beginning, such as ball, birthday,
beach, boy, beach boy, ba-ba-ba,
ba-Barbara Ann…. Hmm. What’s the
deal with that “buh” sound, anyway
Sometimes, it’s in the middle
of a word, too, like baby. The child
ponders these details, and an amazing
thing starts to happen: the brain
becomes aware of phonemes.
Why is an audiologist talking
about phonemic awareness To
encourage pediatric audiologists to
participate on their patients’ “literacy
team.” To learn to read, our patients’
brains need to engage in five to six
years (about 20,000 hours) of relentless
auditory attention—noticing
speech sounds and contrasting one
sound with another. The brain needs
all that input before it is ready to
make the uniquely human amazing
leap: connecting those sounds to
letters of the alphabet. You’ve heard
Carol Flexer talk about this! Without
those 20,000 hours of listening,
children are less ready to read and
learn with their peers—and they may
never catch up.
Consistent access to sound via
amplification depends on parent commitment,
and we can always improve
our communication with parents
about the hearing-listening-reading
connection. Audiologists are not literacy
experts, but we do need enough
information to convey this connection
to parents. Speech-language pathologists,
early interventionists, and
educators bring their expertise to the
learning process, and we are likely to
“leave it to them” because we lacked
training in preliteracy skill development.
Yet, success ultimately depends
on access to sound, and that’s where
we come in!
The Academy’s “Hear to Read”
initiative was established to support
pediatric audiologists as members
of the literacy team. The first step
was to develop a brochure for audiologists
to share with parents. This
brochure is now available on the
Web site through the Academy Store.
Next steps include expert presentations
at AudiologyNOW! ® (see page
80 for the Marion Downs Lecture in
Pediatric Audiology) and articles in
AT. Eventually we will see chapters
on basic literacy information for
audiologists in pediatric audiology
textbooks.
Fast forward to the near future:
Your patient starts school. Her
teacher says, “Children, this is the
letter B. It makes the sound ‘buh.’
Can you think of some words that
start with that sound” And, your
patient is ready with examples. She’s
ready because she’s been thinking
about “buh” for thousands of hours.
Kris English, PhD
President
American Academy of Audiology
P.S. While you’ve been reading
silently to yourself, your temporal
lobes have been active, as if you
were listening to somebody speak!
It’s called “the silent voice”—see
S. Dehaene, Reading in the Brain:
The Science and Evolution of a Human
Invention (2009).

OAE
“
Testing a child’s hearing is
so much faster and easier
with the Otoport!
”
Whether you need a fast DPOAE handheld
instrument, a clinical quality instrument
with configurable stimulus settings,
or a simple TEOAE newborn screener,
we have an Otoport that will satisfy your
needs for speed and accuracy.
Now with
INDUSTRY LEADING
PROTECTION
2 year
Otoport Warranty
Call for Details!
OAE testing has never been easier. Call or visit www.otodynamics.com today.
Otodynamics
www.otoport.info www.otodynamics.com 1 800 659 7776
Booth 1130

Looking ahead to the annual Academy
Business Meeting (page 94) in San
Diego, I’d like to provide a framework
for the Academy’s business operation.
Serving our membership of 11,000
audiologists with a $7 million budget
and a staff of 34, the Academy has a
robust accounting system to ensure
fiscal responsibility. Here are three
areas I hold paramount in overseeing
the Academy’s finances:
To maintain fiscal
integrity, the internal controls
within our accounting department
ensure separation of duties,
e.g., no one individual both cuts
and signs checks. We undergo an
annual audit by an outside audit
firm that is vetted by the Audit
Committee and approved by the
Board of Directors. Neither the
treasurer nor I are voting members
of the Audit Committee.
Following a
fiscal year (July 1–June 30), Amy
Benham, CPA, senior director
of finance and administration,
produces financial statements
in accordance with Generally
Accepted Accounting Principles.
These financial statements
are reviewed monthly by our
Treasurer, Gary Jacobson, PhD, as
well as the Finance Committee,
and are reviewed quarterly by

®

the board. Amy also oversees
the Academy’s investments, in
accordance with the Academy’s
investment policy. The boardapproved
audit is posted on our
Web site annually (November) for
members to review (go to www.
audiology.org, search key words
“annual report”). Additionally,
the Academy annually submits a
Form 990 (Return of Organization
Exempt from Income Tax) to the
IRS, providing them with our
financial information.
The Academy
staff follows best practices to maximize
the Academy’s resources. We
solicit bids from multiple vendors
before selecting one. Drawing
upon our association management
experience, we negotiate contracts
prudently to provide savings to
the Academy. We are constantly
looking for ways to make the most
of our limited resources. The weak
economy has added a new dimension
to our financial situation. This
year, we have frozen staff salaries
and are not making the discretionary
contribution to their 401k plans.
Incorporated in the state of
Delaware (1997), the American
Academy of Audiology is a not-forprofit
with a 501c(6) designation
from the IRS. In return for not taxing
our revenue, the IRS stipulates what
we “may” and “may not” do as a
not-for-profit. At the end of the year,
any revenue surplus is placed in the
Academy reserves rather than paid
out to stockholders as is done in forprofit
organizations.
We were excited to recently add
the Student Academy of Audiology
to our mix of entities, which
also includes our Political Action
Committee and the American Board
of Audiology. I also serve as the
executive director of our Foundation,
the American Academy of Audiology
Foundation, which has a 501c(3) IRS
tax designation. This necessitates a
separate set of books and Form 990
to the IRS.
As the individual hired by the
Academy’s Board of Directors to
ensure the financial and legal
integrity of the Academy, I take
this responsibility seriously. Using
operating ratios to benchmark the
Academy against other associations,
we strive daily to handle the
Academy’s financial resources in a
most careful manner.
Cheryl Kreider Carey, CAE
Executive Director
American Academy of Audiology

the board. Amy also oversees
the Academy’s investments, in
accordance with the Academy’s
investment policy. The boardapproved
audit is posted on our
Web site annually (November) for
members to review (go to www.
audiology.org, search key words
“annual report”). Additionally,
the Academy annually submits a
Form 990 (Return of Organization
Exempt from Income Tax) to the
IRS, providing them with our
financial information.
The Academy
staff follows best practices to maximize
the Academy’s resources. We
solicit bids from multiple vendors
before selecting one. Drawing
upon our association management
experience, we negotiate contracts
prudently to provide savings to
the Academy. We are constantly
looking for ways to make the most
of our limited resources. The weak
economy has added a new dimension
to our financial situation. This
year, we have frozen staff salaries
and are not making the discretionary
contribution to their 401k plans.
Incorporated in the state of
Delaware (1997), the American
Academy of Audiology is a not-forprofit
with a 501c(6) designation
from the IRS. In return for not taxing
our revenue, the IRS stipulates what
we “may” and “may not” do as a
not-for-profit. At the end of the year,
any revenue surplus is placed in the
Academy reserves rather than paid
out to stockholders as is done in forprofit
organizations.
We were excited to recently add
the Student Academy of Audiology
to our mix of entities, which
also includes our Political Action
Committee and the American Board
of Audiology. I also serve as the
executive director of our Foundation,
the American Academy of Audiology
Foundation, which has a 501c(3) IRS
tax designation. This necessitates a
separate set of books and Form 990
to the IRS.
As the individual hired by the
Academy’s Board of Directors to
ensure the financial and legal
integrity of the Academy, I take
this responsibility seriously. Using
operating ratios to benchmark the
Academy against other associations,
we strive daily to handle the
Academy’s financial resources in a
most careful manner.
Cheryl Kreider Carey, CAE
Executive Director
American Academy of Audiology

Marketing is an essential component
of the success of any practice, yet
without a thorough and quantifiable
system for measuring the effectiveness
of a campaign, marketing is
in danger of becoming a budgetary
black hole. Metrics define the
return on investment of a marketing
campaign, helping practices determine
which initiatives yield the best
results and, equally importantly,
exposing the underperforming
programs that need to be overhauled
or cut altogether. Through
the studied implementation of
metrics, marketing is transformed
from a blind expense into a calculated
investment. Yet measuring the
performance of a marketing initiative
is not a transparent process.
What follows are several strategies
and considerations to introduce
accountability into your marketing
department.
The first step to implementing a
marketing analytics program is to
cover the basics. Define the target
market and craft a message that
will be distinctly relevant to it. Also
pay close attention to the medium
in which you elect to advertise,
using effectiveness, rather than
cost, as the main arbiter. Approach
your campaign from your potential
patients’ perspective and ask yourself
what message would resonate
with them, and what problem of
theirs you are solving.
When setting up a marketing
campaign with performance measurement
in mind, it is also critical
to define the goals of the campaign.
How else will you measure its effectiveness
Are you trying to increase
leads Conversions Revenue Or is
it a brand-building exercise Added
precision in pinning down the
goals of your marketing initiatives
will improve the accuracy of your
metrics and bring the goals closer to
becoming a reality.
Thinking broadly about marketing’s
impact is critical, but, then
again, so is thinking about the
details. Performance metrics should
compile as much data as possible,
ideally through multiple channels so
that the information can be crossreferenced
and synthesized. One
way involves tracking customer
responses with promotion codes.
Every bit of data associated with the
campaign should be recorded, organized,
and analyzed according to the
specific marketing goals to which it
relates.
Web analytics are slippery, and can
never be relied upon to offer 100
percent accuracy. When selecting
a Web analytics program, be sure
that it filters out internal traffic, as
well as visits from spiders and bots
that could skew the results. Also be
sure that the program uses verified
first-party cookies to track unique
visitors. Also be sure to audit your
system for accuracy, given that Web
analytics applications have been
known to overstate actual results by
as much as 400 percent.
Finally, it is essential that you act
on the results of your performance
metrics. This means that you must
have the flexibility and humility to
tinker with your strategies, or to pull
the plug on a campaign that simply
isn’t working.
It’s like giving to charity—everyone
knows they should do more of
it, and no one can think of a good
reason why they don’t. Delegation

holds the unique value of increasing
your practice’s productivity while
at the same time reducing your
own personal workload. The most
common objections to delegation—
“In the time it takes to explain
how to do it, I could do it myself”
and “If you want a job done right,
do it yourself”—are, at best, shortsighted,
and, at worst, patently false.
Learning how to delegate effectively
is an elusive but essential management
skill that will empower your
employees by demonstrating your
trust and confidence in them, and
it will ultimately help train them to
be effective managers themselves,
ready and poised to transition
into new leadership roles as your
practice grows. Here are six steps
for developing, implementing, and
overseeing your delegation strategy.
One of the most common fears cited
by managers who refuse to delegate
is that the end product will not be
satisfactory. Managers who have
experienced this firsthand will be
especially gun-shy about delegating
again. An inadequate result is
not necessarily an indicator of poor
workers. It can just as often reflect
poor management, most frequently
rooted in vague communications
and unclear expectations. Define
the goal of the project with the
employee who will be overseeing
it, and make the timetable realistic.
Make sure that the employee understands
both the technical elements
of the project and how it meshes
with the big picture. Without seeming
overbearing or condescending,
overcommunicating at the outset
of a project is not necessarily a bad
thing, as the surest way to guarantee
that a project will fail is to leave
the responsible employee uncertain
of your expectations.
Delegation means letting go.
Somewhat. When you’re entrusting

one of your employees with a project,
remember that you’re doing
just that—entrusting them. You
hired these people because of their
intelligence, sound judgment, and
competence. When you’re delegating
a project to them, remember
that they are still possessed of
those qualities, and for that reason,
the project will be a success. This
means that you have to let them
find their own way, and trust and
support them as they are doing it.
Within legal and ethical bounds, of
course, it is the end product that
is the yardstick of success, not the
path by which the goal is achieved.
Assuming that yours is the only way
is a hallmark of micromanagement,
and a surefire way to torpedo your
delegation initiative.
Delegating means that you can let
your employees take the lead in
developing a plan, and, ideally, this
process can be completed with minimal
oversight. That said, it is your
job to make sure that they do, in fact,
have a plan. The methods can be left
up to them, but you will sleep easier
knowing that there is a roadmap
to complete the project, and your
employees will have a much better
chance of succeeding. For complicated
projects, it can be useful to set
reporting schedules to keep employees
on pace. Breaking a single, large
project into smaller, more manageable
tasks is an effective way to
ensure that the ultimate deadline is
met, while simultaneously relieving
you of the anxiety that comes from
micromanaging.
Set your employees up for success
by pairing them with a project
that is a good match for their skills
and competencies. At the same
time, remember that one of the
main reasons that you delegate is
to develop your employees. Giving
all the challenging projects to one
particularly capable worker will
engender resentment from all
sides. The chosen employee will
feel put upon, while the rest of
your staff will feel neglected and
unappreciated. Know also that
some employees may require more
oversight than others. But part of
your skill as a manager is identifying
your employees’ strengths and
weaknesses, and accentuating the
former while developing the latter.
A finely attuned delegation program
can be your best ally in achieving
this goal.
Delegation often fails when
managers dole out tasks and responsibilities
without giving staff the
authority to make decisions. Keeping
a stranglehold on decision-making
authority will undermine the confidence
of your staff, and create the
appearance that, rather than trusting
and believing in your employees,
you simply want to slough off work
on them while keeping overall
control for yourself. This is a flawed
strategy. For your employees to really
develop, they have to be given a long
enough leash to make mistakes and
know that it’s okay—as long as they
fix them and learn from them.
This is the fun part! Again, remember
that development is central to
delegation. You’re trying to bring
your employees up and prepare them
for the next level. This means that
feedback must go directly to the
employee whom you have placed
in charge of the project. The natural
tendency of your staff will be to
come to you, but, in keeping with
their status as the project lead, the
employee(s) you have put in charge
must be the hub of all feedback concerning
the project, both positive and
negative.
Whether you can do the job faster
or more effectively than one of your
employees can isn’t the question.
What if you want to take a vacation
Or expand your practice beyond your
ability to manage it single-handedly
Or retire These are all questions
that keep small business owners
up at night, but they are also questions
that have a common answer.
Delegating tasks will demonstrate to
your staff that you trust them, and
your reward will be more capable,
self-assured, and well-rounded
employees ready to take the reins
and drive the business whenever you
call on them.
Articles © Copyright 2010 Information, Inc.
Illustrations by Johanna van der Sterre

Hear.
There and Everywhere.
TM
Every note of the flute solo in a child’s music recital.
The sound of an arriving text message. A toddler’s
first laugh. The cheers from teammates. The peeps,
calls and trills in the backyard.
Life is a composition of finely detailed sounds.
MED-EL’s industry-leading cochlear implant innovations
with FineHearing allow its recipients to hear
*
and appreciate the most obvious and the most
elusive of them all.
It’s a noisy world out there.
Enjoy it.
Help your patients hear life the way it was meant to sound.
Begin their cochlear implant journey with MED-EL.
MAESTRO cochlear implant system
features the thinnest and lightest
speech processor available today.
* FSP is not indicated for use by pre-lingual children in the US.
hearLIFE
COCHLEAR IMPLANTS :: MIDDLE-EAR IMPLANTS
TOLL FREE (888) MEDEL-CI (633-3524) :: V/TDD PHONE (919) 572-2222
www.medel.com

Hear.
There and Everywhere.
TM
Every note of the flute solo in a child’s music recital.
The sound of an arriving text message. A toddler’s
first laugh. The cheers from teammates. The peeps,
calls and trills in the backyard.
Life is a composition of finely detailed sounds.
MED-EL’s industry-leading cochlear implant innovations
with FineHearing allow its recipients to hear
*
and appreciate the most obvious and the most
elusive of them all.
It’s a noisy world out there.
Enjoy it.
Help your patients hear life the way it was meant to sound.
Begin their cochlear implant journey with MED-EL.
MAESTRO cochlear implant system
features the thinnest and lightest
speech processor available today.
* FSP is not indicated for use by pre-lingual children in the US.
hearLIFE
COCHLEAR IMPLANTS :: MIDDLE-EAR IMPLANTS
TOLL FREE (888) MEDEL-CI (633-3524) :: V/TDD PHONE (919) 572-2222
www.medel.com

Hear.
There and Everywhere.
TM
Every note of the flute solo in a child’s music recital.
The sound of an arriving text message. A toddler’s
first laugh. The cheers from teammates. The peeps,
calls and trills in the backyard.
Life is a composition of finely detailed sounds.
MED-EL’s industry-leading cochlear implant innovations
with FineHearing allow its recipients to hear
*
and appreciate the most obvious and the most
elusive of them all.
It’s a noisy world out there.
Enjoy it.
Help your patients hear life the way it was meant to sound.
Begin their cochlear implant journey with MED-EL.
MAESTRO cochlear implant system
features the thinnest and lightest
speech processor available today.
* FSP is not indicated for use by pre-lingual children in the US.
hearLIFE
COCHLEAR IMPLANTS :: MIDDLE-EAR IMPLANTS
TOLL FREE (888) MEDEL-CI (633-3524) :: V/TDD PHONE (919) 572-2222
www.medel.com

Dr. Musiek discusses the
distinction and overlap
of neuropathy/auditory
dys-synchrony and
hyperbilirubinemia.
Sexton discusses the
CARE Project (training
in Counseling, Aural
Rehabilitation and
Education), the seven stages
of grieving related to hearing
loss, and more.
Soltes discusses service
dogs, hearing dogs, and child
advocacy dogs.

First Senior Friendly Television
With hearing aid connectivity
“1st Senior Friendly TV”
-­‐New York Post
“Must Zzz TV”
-­‐New York Post
A TV “engineered for
simplicity.”
-­‐Senior Housing News
TV Ears TV
Model # 10510
Located in Booth # 1801
at AudiologyNOW
As featured by:
Engadget
TV Ears TV is a 32 inch LCD 1080i television that is easy to use, easy to hear, and

The Sound Tracker:
One Man’s Quest
for Natural
silence
BY DAVID FABRY
gordon hempton is an acoustic ecologist
and Emmy award-winning sound recordist.
He will be the General Assembly keynote
and featured session presenter at this year’s
AudiologyNOW! ® AT was able to spend a few
tranquil moments with Hempton recently to
discuss his search for a nice quiet place to rest.

The Sound Tracker: One Man’s Quest for Natural Silence
question:
If a tree falls in the forest but there is too much noise
to hear it, is there still sound Gordon Hempton aims
to find out. Hempton is an acoustic ecologist and
Emmy award-winning sound recordist. For more than
25 years, he has provided professional audio services
to musicians, galleries, museums, and media
producers. He has amassed a three-terrabyte library
of natural sound recordings, with specific expertise
in recording “quiet” environments that has fostered a
passion for preserving what he refers to as “natural
silence” in a noisy world.
On Earth Day 2005, Hempton founded the One
Square Inch Foundation as a means of highlighting
the need for preserving quiet, which in turn helps
us to hear and listen. More than a metaphor, One
Square Inch is indeed a physical location in the
Hoh Rain Forest, part of Olympic National Park—
arguably the quietest place in the United States. It,
too, however, is endangered, and Hempton has
become a tireless advocate for the preservation
of silence in our national parks. Hempton will be
the General Assembly keynote and a featured session
presenter at this year’s AudiologyNOW! ® , one
week prior to the 40-year anniversary of Earth Day.
Audiology Today was able to spend a few tranquil
moments with Hempton recently to discuss his
search for a nice quiet place to rest.

The Sound Tracker: One Man’s Quest for Natural Silence
GH: That’s correct. Your meeting presents a particular challenge
for me as a speaker, because I know that everyone in
the audience will be better educated than I am about audiology.
Instead, my role as a speaker will be to bring the fine
line between the hearing and nonhearing world into focus.
My career has been to develop my listening skills and
record the sounds of wilderness “soundscapes.” My work
as a listener is now 30 years in the making and has taken
me three times around the globe. I have probably the largest
collection of sound recordings of natural places that
have been recorded in this way.
I record binaurally in digital format, providing a 360 degree
recording under headphones that preserve the cues that
form the acoustic images. It is a very precise art in that
the placement of the binaural head produces profound
differences in terms of what is heard. My presentation will
include a lot of recordings that I think everyone will enjoy
and illustrate my point better than my words can.
Yes, my interest is in the sounds of what it is like for a
human being to be there and take it all in. Interestingly,
about a year ago, I fell in love with a woman named

The Sound Tracker: One Man’s Quest for Natural Silence
Rebecca. What is interesting about Rebecca, and what she
has really brought into my life, is an understanding not
only of how special my hearing world is, but how profoundly
different the nonhearing world is. While Rebecca
considers herself to be “hearing impaired,” for a hearing
person, she is deaf. She can be in a room with a smoke
alarm going off, with the tea kettle going, while calmly
reading a book because she is unaware of the commotion
going on. On a lighter note, however, she wakes up to my
snoring, so vibrations remain a very strong part of her
sensitivity.
It is, however, an example of how profoundly sound
affects the way we think and even organize the world.
We hear 24/7; we don’t have “earlids” that naturally block
out sound. There are no higher vertebrate species that do
not have the ability to hear, although there are vertebrate
species that are blind. Hearing is essential for survival.
But, while animals hear, not all listen, and those that do
not are usually eaten by those that do. Hearing, more than
any other sense, is required for survival.
Just like water may be an unappreciated drink, because it
is so essential, so basic, that we don’t even think about it.
In my presentation, we will literally listen to sounds
from all over the planet. I will demonstrate with acoustic
images the way that objects and sounds behave.
Generally, when we look out our window, we see that
there are very few translucent or transparent objects—
generally, most stuff is opaque. If we want to see 360
degrees, we need to actually turn our heads. Therefore,
our view of the world is linear, with one object in front of
the other. There is a timeline, a set of priorities, and this
I have found is the way that “visual” people organize the
world.
It’s down to the basic essential way of listening. Unlike
vision, very few sounds entirely mask the detection of
another sound. In other words, all these sound events
accommodate each other in arriving at my ears. I use
what I call a “soup pot” method, and I just let everything
arrive, take it all in, and use it to decide how things sound.
It is really beyond hearing—I am listening to the world.
Well, I may challenge some of your members with how I
lost my hearing for an 18-month period. I was surprised

The Sound Tracker: One Man’s Quest for Natural Silence
to discover that as I went through a series of audiologists,
I wasn’t being “heard.” As an audio engineer and acoustic
ecologist, I could describe the frequencies and decibels of
my loss. Statements were made first—not by an audiologist,
but by a physician—that we should test my hearing
to see if I had a hearing loss. I knew I had a hearing loss,
but listening to the world is really a fundamentally different
experience.
It was very frustrating, but really only a small frustration
compared to frustration of not hearing. Ultimately, I
recovered on my own after 18 months. When most people
think about listening, they think about listening skills;
they focus their attention on a particular acoustic event,
like tones in a hearing test. When you listen, you let it all
in. What I hope to convey to the audience is that was our
general mode of operation. Before I went to school and was
taught to listen.
The basis for this work is that with all the noise present
in the modern world, we have created a lot of meaninglessness.
If we were to simply step outside in New York or
Miami and take all of the sounds in, we would go crazy.
Couplers for
Audiometer
Calibration
Let G.R.A.S. help you with your audiometer
calibration needs. Visit us at AudiologyNOW
– booth 2913 – and see our extensive
program of ear simulators and couplers.
For more information go to gras.dk
US office
2285 East Enterprise Parkway · Twinsburg · OH 44087, USA · E-mail: sales@gras.us · www.gras.us

The Sound Tracker: One Man’s Quest for Natural Silence
When we live in cities, we “close down” our listening
experience. Not so when we visit our national parks and
other places around the planet that are set aside to have
the experience of nature. These places are needed to
restore our senses and “open up.” This is the standard of
“true listening.”
One Square Inch is located in the Hoh Rain Forest, part
of Olympic National Park—arguably the quietest place
in the United States. The exact location is marked by a
experience is almost a supernatural sense of perception.
“Natural silence” is the absence of noise pollution. One of
the things that I will try to convey in my presentation is
that natural silence is not the absence of anything but the
presence of everything.
Yes, it is very different from the experience of excluding
the noises or your immediate environment for a couple of
minutes. When you live and breathe the environment for
When you live and breathe the environment for
a period of hours or days, you feel remarkably
different; you think different thoughts.
small red-colored stone placed on top of a moss-covered
log at 47° 51.959N, 123° 52.221W, 678 feet above sea level.
Directions to the site can be found in the links section of
the Web site (www.onesquareinch.org).
Using my sound level meter (Bruel and Kjaer SLM 2225),
the 60-second Leq is approximately 27 dBA.
Even at that level, there still is a lot of central sound
occurring. You are still able to hear the murmur of winged
insects, the small hemlock needles lightly falling on the
forest floor, birds singing quarter or half mile away, or
the elk bugling from eight or nine miles away. A listener’s
horizon is really quite distant, and so your sonic view
of the place that you are in is extremely expansive. The
a period of hours or days, you feel remarkably different;
you think different thoughts. All of those trivial items on
my “to-do” list fall off, they simply erode from my being,
and I am left with what essentially matters to me. I leave
the place with just a wonderful feeling.
People ask me how I can think for a moment that I will
be able to preserve a place—save silence—against all the
noise intrusion of the world. And I tell them that silence
tells me so. It is a powerful force of encouragement,
listening to nature. That is essentially what I believe our
National Parks are all about: a place to rejuvenate our
senses and our spirits to become more productive, healthier,
modern people. Unfortunately, although Olympic
National Park is likely the quietest place in the lower 48,
the noise levels have eroded substantially.
The modern measure of silence today is the “noise free
interval,” in minutes, between audible noise intrusion,
and it has shrunk from several hours just 10 years ago to
about an hour today. In 2008, I experienced 45 minutes
of continuous jet traffic overhead at the One Square Inch

The Sound Tracker: One Man’s Quest for Natural Silence
location. Many of the examples that I will present in
the keynote speech and in the featured session will be
examples of the type of sounds that we would miss with
this elevated noise floor due to the intrusions. I hope that
the recording will serve as an affirmation that we are all
entitled to have a right to quiet.
Yes. We can trace the increase in listening loss in modern
literature. You can read incredible descriptions of nature’s
music in the 1800s that literally almost evaporates in the
writings of today. I will cite the works of Mark Twain and
of John Muir, who describe “snow melting into music.”
Even as a professional listener and nature sound recordist,
the first time I heard that phrase I thought it was remarkable
poetic license. I’m sure that it doesn’t really melt
into music; it’s nothing that I would want to dance to or
hum all day, but Muir had a neat way of putting words to
it that I could remember. In my presentation, I will play a
recording I made that captures what Muir was describing;
whether we call it reggae or jazz, you won’t play it just
once (also listen at www.audiology.org).
Yes, silence has become an endangered species in our
modern world. Alarmingly, in my 30 years of searching,

The Sound Tracker: One Man’s Quest for Natural Silence
natural silence can be found in only a dozen or fewer
remote locations. The evaluation period is right before
dawn, when sound travels the furthest through natural
environments because it is least likely to contain wind and
often the atmospheric layers are set up into temperature
layers, and so sound travels much further than predicted.
There are 12 areas that I have identified, and have made
none public except Olympic National Park because they’re
still virtually unprotected except by their anonymity.
Once we get some laws into place—one in particular
that would ban all aircraft over just a handful of our most
pristine national parks—it would deliver the noise-free
experience that we have all been waiting for. The cost,
according to the figures provided by the Air Transport
Association, would amount to less than a dollar per passenger
to route traffic around Olympic National Park.
Further, this would cost less than a minute in travel time—
far less of a consideration than weather and normal traffic
delays. Presumably, the same figures would generally
apply to avoid flying around other national parks as well.
The featured session is not entirely removed from the
keynote address. Basically, the focus of the featured session
will be to get participants to recognize and accept that they
are “listening impaired” even if they have hearing within
the normal range. Once we are willing to accept the fact
that we are listening impaired, the session will focus on
teaching participants to “lip read” nature. I draw a lot of the
inspiration for this session from the special relationship
that I have with my fiancée Rebecca. She shares a love of
Olympic Park as I do—her love is of the scenic wonders, and
mine is of the sonic events. The context of the session will
be to tie in visual events to sonic events.
Yes, in plant pathology. My training is in botany, and I
found it worked very well for me with my work as an
acoustic ecologist. Because the land and vegetation form
the structure of the amphitheatre of wildlife, it is closely
associated with the vegetation. From that, you can pretty
much guess what the acoustics are going to be and what
kind of wildlife is going to be audible.
David Fabry, PhD, is the content editor for Audiology Today.
He is also the managing director of AudioSync Hearing
Technologies.
I have recorded underwater whales and dolphins, and will
actually be leaving this week to record the songs of the humpback
whale off the Kona Coast of Hawaii's Big Island. Noise
intrusion certainly applies to aquatic animals as those on land.
References

Visit us at
booth 227
Discover BestSound Technology.
A new dimension in hearing.
Take us for a test drive at AudiologyNOW! 2010.
www.usa.siemens.com/hearing
Copyright © 2010 Siemens Hearing Instruments, Inc. All rights reserved. SHI/11082-10.

RUMINATIONS
OF AN OLD MAN
A
YEAR
PERSPECTIVE
ON CLINICAL
PRACTICE
BY DAVID LUTERMAN

I have been blessed with 50 years of active
clinical involvement. I began my professional
life as a diagnostic audiologist and morphed
into a rehabilitation audiologist, specializing in
helping families of newly diagnosed children
with hearing impairments make the transition
to their new reality. I feel incredibly fortunate to
have stumbled into my life work, and have found
a niche that nourishes me and, at the same
time, benefits others. Immersed in my life journey,
it seemed disjointed; from this vantage point it
seems inevitable. At this stage in my life, I find
myself more reflective with a strong desire to look
back, distill my clinical experience, and pass it
on to current and future generations of clinicians.

Ruminations of an Old Man: A 50-Year Perspective on Clinical Practice
HERE, THEN, IS THE LUTERMAN 10:
At heart, we are grief workers. We are dealing with
people undergoing transitions in their lives because they
have lost the life they thought they were going to have,
whether this is the parent of an autistic child, the spouse
of an aphasic patient, or the adult child of a nursing home
patient. Grief is not culture bound or disability specific—it
is endemic to disability. While many things have changed
in our profession, the human equation is unchanging—
we are dealing with clients who are emotionally upset,
not emotionally disturbed. Grieving and the concomitant
feelings are a normal response when a person is suddenly
confronted with a life challenge in which there was no
preparation. As a profession, we need to give ourselves
permission to do the necessary grief work. While technology
may have altered the therapeutic landscape, it
doesn’t bypass the need to interact with our clients on an
emotional plane.
When people are emotionally upset they cannot process
information well. I had to learn this the hard way as a
practicing diagnostic audiologist. After making the diagnosis
of hearing loss in a child, my notion of counseling at
that time was to give information. I rapidly developed set
speeches about the audiogram, hearing aid maintenance,
and educational options. I gave these minilectures without
recourse to the parent’s emotional state. What I learned
on subsequent evaluations, much to my dismay, was that
they retained almost nothing of what I had said. They were
much too upset to retain much content, and, in fact, I had
overwhelmed them with information and contributed to
their fear and anxiety. Especially in the early stages of diagnosis
people are helped best by being allowed to grieve.
I have found that people are seldom allowed to grieve,
as most people conspire to make them feel better. They do
this by instilling hope (“They will find a cure”), or by positive
comparisons (“It could be worse, he could have…”).
All this serves to do is to emotionally isolate the person
and deny him or her the right to grieve. What people in
emotional pain often need the most is to be listened to
and have their feelings validated. This is counterintuitive
for most people as the tendency is to want to take
the pain away by solving the problem or distracting them.
I have learned that I cannot take the pain away; these
disabilities represent a loss, and that loss will always be
there despite anything I might say or do. What I can take
away is “feeling bad about feeling bad.”
Once, as I was beginning to facilitate a support group
for parents of newly diagnosed deaf children, one mother
looked at me and said, “you are going to make me cry,”
and I said to her, “No. I am going to give you permission
to cry,” whereupon she started to cry. In the past I would
have felt guilty that I caused that parent to cry. What I
have come to understand is that I am not putting the
feelings in, but creating the conditions that enable the
feelings to emerge. What I have also come to understand
is that feelings just are—you do not have to be responsible
for how you feel but always for how you behave. This
notion has enabled me to enter the realm of feelings with
clients to their benefit because embracing painful feelings
is the first step in healing. The current emphasis on evidence
based practice I find worrisome because emotional
growth does not readily lend itself to measurement, yet it
is in the emotional realm where a great deal of the action
takes place. Communications is best achieved when there
is both content and affect components present. I hope we
can learn as a profession to balance our content counseling
with our affect counseling and value both equally.
The purpose of counseling is not necessarily to make
people feel better—the entertainment industry does
that. The goal of counseling should be to empower clients
so that they can make self-enhancing decisions for
themselves and their family members. In the course of
the counseling experience, painful feelings will emerge,
including anger. I have always seen the emergence of the
painful feelings as a positive sign because these clients
are not in denial, and if I am mindful of my role they will
take ownership of the communication disorder. There
can be no meaningful change without ownership of the
problem by the client. Ceding responsibility to the client
is often painful for clients in itself, as frequently they
prefer a passive role in the habilitation process, hoping
and expecting the professional to “fix” it.

Ruminations of an Old Man: A 50-Year Perspective on Clinical Practice
As a beginning clinician, I assumed my professional role was
to give information and direction to the client, that I needed
to be a very active participant in the therapeutic process. I
had a “lesson plan” mentality with specific goals in mind,
and my scripted minilectures were designed to ensure that
clients left our encounter with the information I thought they
needed. In retrospect, I can see that the set speeches and
advice giving were a reflection of my own insecurities and
need to limit the clinical interaction in predictable, contentbased
ways that I could manage. By listening to the client
without a preconceived “lesson plan” enables the client to
participate more fully in the therapeutic endeavor—it forces
the client to be active in the relationship. Listening for client
affect and reflecting it back enables the client to identify their
feelings and express them in a safe relationship; this attenuates
client isolation and validates their feelings. Listening
deeply to our clients is a great gift we can give them.
As I have become more self-confident in my clinical skills,
I have been able to cede more and more control of the therapeutic
process to the client. Learning proceeds best when
the learner is an active participant in the process. Listening
enables the clients to reveal themselves, allowing me to find
ways to be most helpful. The client will teach us if we listen. I
had to learn to cultivate the art of not doing and at the same
time being present for the client. The irony here is that often
the less I do, the more the client learns.
In the early stages of diagnosis, clients are usually overwhelmed
and feeling inadequate to cope with the disability.
This is a critical juncture for the clinician because the
tendency is to want to rescue the client from their actual
and felt inadequacy. If we rescue by advice giving and taking
responsibility from the client, we can contribute to their
fear and sense of inadequacy. It is very easy to teach helplessness
and create the dependent client who then accepts
a passive role, expecting the clinician to fix it. I have had to
learn how to be responsible to my clients rather than being
responsible for them. Finding the therapeutic equator of
helping is not easy because it is constantly shifting with
each client and at different times with a client. I have had to
learn to trust clients to eventually make the best decision
for them, and that wisdom, which is the best use of information,
resides within the client and not in me. My role is to
judiciously share my information as a client needs and asks
for it. I avoid giving advice and assuming responsibility for
the client at all costs. Enhancing a client’s self-esteem is the
Also of Interest
premier goal of the therapeutic encounter, thereby creating
the independent client who no longer needs us.
Enjoy the
rewards of
practice growth!
Call
(866) 432-7500
or go to
MyEarQ.com
Click on Member Login
User Name: GrowMyPractice
Password: Today
Apply
Today!

Ruminations of an Old Man: A 50-Year Perspective on Clinical Practice
It is hard for me to conceive of a program that does not
include a support group. Having a catastrophic event in
your life becomes emotionally isolating because almost
everyone in the client’s everyday life is invalidating their
painful feelings while seldom understanding what the client
is experiencing. The support group is usually the one
place that individuals are understood, feelings can be validated,
and help can be given and received. Professionals,
by nonjudgmental listening, can validate feelings but lack
the instant credibility that members of a support group
have. Support groups are not disability specific.
I think they are especially helpful for the families of
clients who are often on the periphery of clinical services.
Mixed support groups, where there are clients and family
members, are very challenging to facilitate but usually
helpful in promoting family unity. My major clinical role
over the past 45 years has been as a group facilitator for
parents of young children with hearing impairments. I
have found this to be an immensely rewarding activity.
Every group has presented unique challenges and invariably
taught me something valuable
It is unfortunate that students in our training programs
are seldom exposed to a family-centered model of service
delivery. The individual pullout model seems to be one
of choice. I think this is an easier model to select for the
beginning therapist as he or she need only focus on the
identified patient. Unfortunately this is the least efficient
way of working with clients. By working with the family
unit we can extend the goals of therapy to the home and
create an environment that is supportive of change. This
model requires a greater skill set of a therapist because it
mandates working with family members who do not have
an overt communication disorder. Families also need
to be broadly defined to include the environment of the
client, whether this is a hospital setting or a classroom.
Training programs need to see that the pull-out model
is a way to start the training, but students need to be
quickly exposed to and trained in the broader model of
a family-centered approach to service delivery. Familycentered
therapy needs to be the gold standard.
Words spoken mechanically without feeling and/or out
of context will never be helpful. “This too shall pass”
were the words the wise men came up with for the king
who wanted something to say for all occasions. There
are counseling words that are equally useful, which I
call affirmations. “It must be so hard” is an empathetic
remark that validates the client’s experience, while
“that’s okay” gives sanction to the client’s feelings. Even
more useful is “uh huh,” which says to the client, “I hear
you. Tell me more.” In a long counseling career, probably
the most useful words to the clients are the ones I haven’t
said.
I have come to see that clinical mistakes are inevitable.
Even after 50 years, I still have my occasional gaffes. I
have had to learn to be gentle with myself and accept the
fact that errors are an inevitable consequence of clinical
growth. I think any learning and growing clinician needs
to be pushing at the boundaries of their comfort zone;
however, in that boundary region reside errors. I have
learned that the “mistake” is a useful marker for what I
need to learn. I learn best from my blunders, and it is only
a mistake if I do it twice. Fortunately we are not brain surgeons,
clients usually recover from the gaffes, and there
is often an opportunity to apologize, correct the error, and
move on, if the fundamental relationship is strong and
can withstand errors.

Ruminations of an Old Man: A 50-Year Perspective on Clinical Practice
On the surface, a counseling relationship looks conventional
in that two people are dialoging. The reality is
that one person—the counselor—is helping the other by
practicing selfless, deep listening. The mantra for the
counselor needs to be “it’s not about me.” Deep listening
requires that the counselor put aside all personal agendas
and be there in the service of the other. This is not
an easy thing to do and is rarely experienced outside of
a counseling relationship. Being in service to the other is
very demanding, and, while in many cases technology
has altered the clinical landscape, the most important
clinical “tool” is still the clinician. Clinical tools need
periodic care, and much like the audiologist sending the
audiometer out to be recalibrated, clinicians must take
periodic timeouts to recalibrate themselves. To be a selfless
listener requires a personal centering that mandates
that clinicians have a fulfilling personal life. We need to
be able to give to our clients from our abundance. Too
often one sees in the helping profession clinicians with
strong needs to be needed that they try to fulfill by
creating dependent relationships. Clinical burnout is a
consequence of clinicians who do not practice good selfcare
and have many dependent relationships.
Fifty years seems like a long time, yet it has gone by bewilderingly fast. It has been a
marvelous ride, much better than I ever expected. I am often asked how I have been
able to remain clinically active for so long amid so much pain and suffering without
burning out. For me it’s a matter of practicing good self-care, avoiding developing
dependent relationships with clients, and, above all, understanding that personal
growth is often forged in the crucible
of the pain of these disabilities. I do not
see these disabilities as tragedies but,
rather, as powerful teachers that promote
transcendence. We give to life what life
demands, and the disabilities often force
clients to develop capacities that would
otherwise lie latent. I love being able to
participate in promoting growth, and when
you love what you do, it is not work. I have
often been amazed that they actually
pay me to do it. To participate in and
facilitate the personal growth of clients
provides moments of grace that make our
profession so worthwhile. I would love to
be around for another 50 years, but the
actuarial tables are against me.
David Luterman, DEd, is professor emeritus at Emerson College
and director of the Thayer Lindsley Family-Centered Program.

PROVIDING REMOTE HEARING HEALTH CARE
BY DE WET SWANEPOEL

The need for audiological services globally far outweighs
the current capacity to deliver these services. Tele-audiology,
which may include the full scope of audiological practice,
offers one way of addressing the disparity between the need
and availability of hearing health services.

Tele-audiolog y: Providing Remote Hearing Health Care
Advances in technology and connectivity
are rapidly changing the
way people live and interact. Health
care is no exception with technologies
revolutionizing the precision
and accuracy of diagnostics and
intervention options. But technology
is not only improving health-care
equipment and devices, it is changing
the very way in which health
services are offered. Using information
and communication technology
(ICT) in health care may improve
access to health care, enhance service
delivery quality, improve public
health and primary care effectiveness,
and address the global
shortage of health professionals
through training (Wootton et al,
2009). One of the uses for information
and communication technology
is telehealth. A variety of terms has
been used to refer to this field of
study, including telemedicine, telecare,
e-health, and so on.
The term telehealth literally means health-care provision
at a distance (Wootton et al, 2009). It encompasses the
full range of health care including screening, diagnosis,
intervention, management, and education of personnel,
patients, and the general population. Services may be provided
in real time through a synchronous model whereby
a live assessment is done with a video link, for example.
Asynchronous services are not provided in real time but
may, as an example, include e-mailing results to a professional
for interpretation. Telehealth service-delivery
models may well incorporate synchronous and asynchronous
aspects, referred to as a “hybrid” model, depending
on the nature of the services required and resources
available (Krumm, 2007).
Tele-audiology is the utilization of telehealth to provide
audiological services and may include the full scope of
audiological practice. A recent systematic review of teleaudiology
reports have indicated that limited numbers of
studies have been conducted in this field, but those that
are available span audiological services, including screening,
diagnosis, and intervention (Swanepoel and Hall,
forthcoming). Screening applications have included otoacoustic
emissions (OAE), automated auditory brainstem
response (ABR), pure-tone audiometry, and speech-innoise
in a range of populations including infants, children,
and adults using synchronous, asynchronous, and hybrid
models. Reports on diagnostic procedures through
telehealth include video-otoscopy, pure-tone audiometry,
hearing-in-noise testing, ABR, intraoperative monitoring,
and balance evaluation. Intervention services through
telehealth have included reports of hearing aid fitting
and verification, cochlear implant programming, tinnitus
therapy, and hearing aid counseling (Swanepoel and Hall,
forthcoming). Despite the promising findings of initial

Tele-audiolog y: Providing Remote Hearing Health Care
reports, there is a dearth of research reports on audiological
practice and education facilitated through telehealth.
Much work remains to be done to develop and validate
the relatively new field of tele-audiology, but the impetus
is increasingly apparent.
The need for audiological services globally far outweighs
the current capacity to deliver these services (Swanepoel,
Clark, et al, forthcoming). Globally almost 10 percent of
the world population is estimated to have a mild or greater
degree of hearing loss (World Health Organization [WHO],
2006). One in every four adults globally over the age of 45
has a hearing loss, with 27 percent of men and 24 percent
of women in this age group estimated to be affected
(Lopez et al, 2006; WHO, 2008). It is not surprising that it
is ranked as the most prevalent chronic disability globally,
and with increasing global life expectancy, its prevalence
is expected to increase significantly (WHO, 2008).
In the face of the overwhelming prevalence and
burden of hearing loss on a global scale, there is a severe
paucity of hearing health-care professionals to provide
the necessary services. Surveys indicate that in developing
countries the ratio of audiologists to the general
population varies from 1 to 500,000 to as high as 1 to
6.25 million (Goulios and Patuzzi, 2008; Fagan and Jacobs,
2009). In the continent of Africa, with more than 48 countries,
professional tertiary qualifications in audiology are
only available in two countries. It is not only in developing
countries that there is a dearth of hearing health-care
services, however. A recent report indicated that the
estimated number of audiograms required in the United
States with the capacity of current professionals in the
field showed an annual shortfall of 8 million audiograms,
estimated to increase to 15 million by 2050 (Margolis and
Morgan, 2008). Apart from the mismatch between the
need for, and capacity to deliver, services, the availability
of professionals is often unequally distributed. In the
United States, for example, underserved areas may be in
inner cities or rural communities spread across vast geographical
areas (e.g., Alaska) where professionals are not
available to deliver on-site hearing health care.
Globally it is clear that the demand for audiological
services is extensive and the capacity to deliver these services
limited. Tele-audiology offers one way of addressing
this disparity between need and availability of hearing
health services. The ability to evaluate patients remotely
can increase health-care efficiency but also enables populations
to be reached that may have been unable to access
services previously. Integration of automated testing
for use with asynchronous tele-audiology may further
optimize resources by allowing audiologists to interpret
results remotely while reserving more time-intensive
synchronous testing for complex cases. The possibilities
seem limitless, and the growth in connectivity, especially
through cellular networks, is making access in
remote areas such as central Africa a reality (Swanepoel,
Olusanya, et al, forthcoming).
A recent study reported the first systematic validation of
intercontinental pure-tone audiometry using a synchronous
telehealth configuration (Swanepoel, Koekemoer,
et al, forthcoming). The audiologist conducting the
assessment was in Dallas, Texas, and the subjects being
tested were in Pretoria, South Africa. At the patient site,
a facilitator established connectivity, ensuring that the
audiometer, which is PC-based, was operational and that
the earphones were placed correctly ().

Tele-audiolog y: Providing Remote Hearing Health Care
A 3G cellular network Internet connection was used at
the remote site with a netbook running the audiometer
the computer in Pretoria to facilitate remote testing. The
audiologist conducting the test could see the subject and
Initial findings demonstrate that remote
audiometry across continents is feasible and
equivalent to conventional audiometry.
software (). The computers at both sites were
configured with interactive video software, and remote
computing was performed through application sharing
software whereby the audiologist in Dallas controlled
gave instructions before commencing pure-tone air-
conduction audiometry ().
Thirty subjects were evaluated remotely and with
a conventional face-to-face setup. The tele-audiology
thresholds corresponded within 5 dB or less of conventional
audiometry thresholds in 96 percent of the 420
comparisons. The threshold correspondence was even
better when compared in cases of hearing loss. The patient
response times were also very similar with a range of 503–
676 msec poststimulus response time for conventional
audiometry and 481–732 msec for remote audiometry. In
terms of time efficiency, the remote testing on average
required a 20 percent longer test duration to complete both
ears and is probably attributable to the slight transmission
delay in the connection (Swanepoel, Koekemoer, et
al, forthcoming). Further investigations using air and bone
conduction are still required, but initial findings demonstrate
that remote audiometry across continents is feasible
and equivalent to conventional audiometry.
In a certain respect, the mainstay of audiology, pure-tone
audiometry, has always been conducted at a distance.
The patient is seated inside the sound booth while the
audiologist is outside. With tele-audiology, the distance
separating clinician from patient is just increased, and
in some cases they are on opposite sides of the globe.
Conducting services at these distances may require some
adaptation to conventional equipment features. Teleaudiology
assessments or interventions require PC-based
equipment. Objective test procedures like OAE and ABR
may therefore be more easily suited to tele-audiology
since they are software operated from a PC interface.
Remote audiometry therefore ideally requires a
PC-based audiometer. Employing innovative features
can make such an audiometer uniquely telehealth
compliant. The audiometer used in the intercontinental

Tele-audiolog y: Providing Remote Hearing Health Care
audiometry study (Figure 1), for example, employs
several novel features that make it especially suited
to remote testing (Swanepoel, Koekemoer, et al, forthcoming).
For quality control purposes, it includes a
microphone on the outside cup of the circumaural
earphone to monitor the environmental noise levels. An
additional microphone on the inside of the earphone
provides a measure of the attenuation of the environmental
noise. This is particularly useful in underserved
areas, where sound booths may be unavailable, and
provides a way of ensuring that the environmental
noise is acceptably low. Additional attenuation is furthermore
provided by using insert earphones covered
by circumaural earphones (Figure 1). Software features
include visual feedback on patient responses; a
green marking on the audiogram means the patient
responded within 1.5 msec after stimulus presentation
while a yellow marking indicates no response within
that time frame (Figure 3). These features provide a
means of quality control and active feedback from the
patient site to bridge the limitations of not being present
on-site with the patient. Similar features may easily be

Tele-audiolog y: Providing Remote Hearing Health Care
employed in other audiological devices for screening,
diagnostic, and intervention purposes.
PC-based audiometry offers a further advantage in
underserved areas with the inclusion of an automated
test paradigm. In a region like Africa where there are very
few audiologists and an overwhelming need for services,
automation can be integrated with an asynchronous
tele-audiology configuration (Swanepoel, Olusanya, et
al, forthcoming). Automated pure-tone audiometry may
be supervised by a facilitator and the results interpreted
by remote audiologists, for example. A recent report
evaluated the effectiveness of automated pure-tone
air-conduction audiometry using a telehealth-compliant
PC-based audiometer (Swanepoel, Mngemane, et al,
forthcoming). Findings demonstrate close correspondence
between manual and automated thresholds, especially in
hearing-impaired subjects where 98 percent of thresholds
corresponded within 5 dB or less of each other. A combination
of asynchronous and synchronous tele-audiology
services must be designed according to the specific needs
of each context. These services are in the very early
stages, however, and pilot studies are required to validate
models of service delivery while providing evidence-based
guidelines.
Advances in technology and connectivity make tele-
audiology a very real service-delivery option for audiologists.
The advantages include increasing the reach and
capacity of audiological services, distributing services
more equally across regions and into remote or underserved
areas, and conducting humanitarian outreaches
that are sustainable and cost-effective across continents.
Remote audiological services, which can cross state and
national borders, however, also pose a unique set of
questions related to licensure, jurisdictional responsibility,
certification, reimbursement, and quality control
(Swanepoel, Clark, et al, forthcoming). Professional
organizations provide basic guidelines and benchmarks
for tele-audiology but should be expanded to also consider
cross-country service delivery (American Speech-
Language-Hearing Association [ASHA] Working Group
on Telepractice, 2005; American Academy of Audiology
[AAA], 2008). A recently formed nonprofit organization,
the Tele-Audiology Network (www.teleaudiology.org), was
set up with the aim of providing audiologists around the
world the opportunity to volunteer their professional
services through tele-audiology applications to remote
clinics in developing countries (Swanepoel, Clark, et al,
forthcoming).
Nonetheless, the application of telehealth to hearing
health care is an emerging field with a broad scope of exciting
application possibilities including training/education,
screening, diagnosis, and intervention. As audiologists it
is necessary to actively direct and monitor the development
of tele-audiology, rethinking existing service-delivery
models and embracing the potential benefits that improved
connectivity and technology may afford to provide quality
services to as many people, in as many places, as possible.
De Wet Swanepoel, PhD, is associate professor in the
Department of Communication Pathology, University of
Pretoria, South Africa, and adjunct professor in the Callier
Center for Communication Disorders, School of Behavioral and
Brain Sciences, University of Texas at Dallas.
References

Tele-audiolog y: Providing Remote Hearing Health Care
Also of Interest

Neither academic
programs nor industry
are bound by the same
ethical framework
as members of a
professional organization.
The purpose of this
document is to propose
guidelines that could be
voluntarily adopted by
academic programs and
industry. This article
is an opinion editorial
developed by the
authors listed and has
not been endorsed by
any organization.

Guiding
Interaction
FOR THE
BETWEEN
Programs
Industry
AND
BY IAN M. WINDMILL, BARRY A. FREEMAN, JAMES JERGER,
AND JACK M. SCOTT
IN
It is imperative that both audiology programs and industry work together to identify
and manage potential conflicts of interest to ensure that the relationship remains both
successful and ethical, and thereby assures that the welfare of the consumer (including
students and clinical patients) is paramount in their interactions.

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
he American Association of Medical
Colleges (AAMC, 2008) recently
published a report titled Industry
Funding of Medical Education. The AAMC
recognized the necessity of an
effective relationship between
medical schools and industry, and
produced a set of guidelines that
could be used by member schools
to reduce potential conflicts of
interest and to establish rules
that define appropriate interaction
with industry. The report of the AAMC focuses on issues
between clinical faculty and pharmaceutical companies
but also includes sections on relationships with manufacturers
of medical devices.
Members of professional organizations are subject
to codes of ethics and ethical practice guidelines. While
individual faculty or employees of industry may be members
of a professional organization, and therefore subject
to these codes of ethics, neither academic programs nor
industry are “members,” and thus are not similarly bound
to the same ethical framework. Therefore, academic
programs and industry must voluntarily adopt guidelines
that assure appropriate interaction. In addition, those
guidelines should assure that those individual faculty or
employees of industry who are members of professional
organizations are not placed in positions whereby their
individual ethical standing is compromised.
The AAMC report served as a template for the development
of these guidelines for the relationship between
academic programs in audiology and industry. More
importantly, these guidelines were developed with input
and consensus of individuals from both academia and
industry. The purpose of these guidelines is to provide a
framework by which academic programs and industry can
continue to work together to advance the diagnosis and
treatment of hearing and balance disorders, to provide
educational support for future generations of audiologists,
and to assure public confidence in the relationship.
Over the past 20 years, the relationship between universities
and various forms of commercial enterprises has
grown substantially. While there are the more obvious
partnerships for sponsorship of football stadiums and
basketball arenas, there are many more partnerships
that have evolved as the direct result of partnering with
industry for teaching and research endeavors. In fact,
universities are actively engaging business ventures and
partnerships both for expanded funding and for increasing
academic standing.
Therefore, it is not surprising that partnerships have
also evolved between academic programs in audiology and
industry. Many of the product development advancements
and clinical enhancements realized over the past 40 years
would not have been possible without a close working relationship
between industry and universities. The emphasis
on development of evidence-based clinical practice and
research necessarily encompasses a relationship between
engineers, scientists, clinicians, and consumers. Those
industries that serve the hearing and balance areas are recognized
leaders in the development of both new techniques
and technologies and partner with universities in product
development and validation. Restrictions on these relationships
can seriously hamper technological advancements.
In addition, industry often provides economic and
other resources for training programs and research
within audiology programs. In a broad sense, this partnership
is fundamentally necessary to ensure continued
advances in the prevention, diagnosis, and treatment of
hearing and balance disorders. Examples of some of the
health benefits derived from the close working relationships
between academe and industry include advances in
amplification, cochlear implants, and electrophysiologic
test procedures.
Audiology programs have increasingly sought industry
support for many aspects of their core educational
missions. While support is most commonly sought for
research activities, financial or in-kind support has also
been sought for student scholarships, learning labs, guest
lectures, teaching equipment (e.g., computers, projectors,
software, etc.), clinical equipment (e.g., audiometers,
verification systems, etc.), furniture, and even bricks and
mortar. This relationship, though common, must be conducted
in such a manner as to assure the objectivity and
integrity of academic teaching, learning, and practice.
Both audiology programs and industry require public
confidence and trust to be successful and, therefore,
must be mindful to avoid those activities that may create
an apparent conflict of interest. In addition, industry
and university relationships should be transparent to
students. The university must present an ethical model
that can serve as a model for students who will graduate
and may have similar relationships with industry
in their careers. As there are fundamental differences
between academic programs and commercial enterprises
in terms of both missions and financial obligations, it is

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
possible that potential conflicts of interest could arise in
the course of their interactions. It is imperative that both
audiology programs and industry work together to identify
and manage these potential conflicts to ensure that
the relationship remains both successful and ethical, and
thereby assures that the welfare of the consumer (including
students and clinical patients) is paramount in their
interactions.
While the relationship between pharmaceutical
companies and physicians has received much attention
over the past several years, practitioner relationships
with other sectors of industry, including medical device
manufacturers, also have the potential for conflict of
interest. While pharmaceuticals and medical devices
are fundamentally different, there is a risk of inappropriate
influence on students and patients if guidelines are
not developed to assure a fair and balanced approach to
education. Clinical and academic content decisions must
be made by university faculty based on student education
and clinical training needs rather than on the relationship
with the commercial enterprise. Universities must avoid
a perception of motivation for financial gain rather than
objective, patient-centered practice and clinical education.
The relationship between academic programs and
industry is more complex than that between private
practitioners and industry. There are four areas in which
potential conflicts of interest may arise for academic
programs in their interactions with industry: (1) with
academic and clinical faculty; (2) with students; (3) with
the clinics associated with the program; and (4) with the
program itself.
The relationship between individual faculty and industry
is perhaps the most obvious and common relationship.
Faculty often relies on industry to provide funding for
research activities and publications, a practice that has
occurred for decades. These opportunities for faculty
often lead to advancements in the university, including
promotion and tenure. Conversely, industry relies on
ES3 Automatic
In a tough economy, get the most for your money!
You can with every Earscan® audiometer.
Coming Soon...
arscan4
®
Optional Dual station automatic audiometry– conduct
2 tests at once.
Integrated bioacoustic simulator– no other
hardware to buy.
USB connectivity & audio capability– hook up as
many audiometers as you need with USB hubs.
ES3M Manual
Optional sound room monitoring.
ES3S Screening
Audiometer control software included.
Optional database management software.
www.microaud.com
866-327-7226
Micro Audiometrics
C O R P O R A T I O N
®
Designed & Manufactured in the USA.
See us at Booth #2437
AudiologyNOW! 2010
San Diego, CA
A family owned business since 1980.
Celebrating our 30th Anniversary!

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
faculty to conduct independent research, often with an
eye toward verification of findings or development of new
strategies that may benefit the commercial enterprises
of the company. In this regard, faculty and industry must
strive to manage these relationships to ensure the integrity
of the results of such ventures.
Beyond the obvious relationship of funding for
research, faculty can have other relationships with industry.
These include being an invited speaker for continuing
education courses, providing consultation with industry,
or being an instructor on recently developed technologies.
In each of these cases, the opportunities for conflicts of
interest arise as they can with the other more historically
commonplace practices. Whether it be accepting royalties
from a textbook that then becomes a required text in
a course taught by the author, or accepting desk copies
of textbooks considered for adoption for classes, these
activities all present a potential conflict of interest.
Paradoxically, the impressionable nature of students
would appear to make them most vulnerable to conflicts
of interest from industry, yet they are not, for the
most part, in any position to exercise decisions regarding
industry. Students could be influenced by gifts, trips,
scholarships, and other benefits from industry, but as
they are unlicensed and hold no decision-making roles
within academic programs or clinics, they are perhaps
not in a position to be conflicted, but they certainly may
be impressionable. However, the potential does exist that
relationships established prior to graduation may carry
over to practice after graduation. Therefore, university
programs and preceptors have a responsibility to discuss
ethical guidelines and to model best practices to students,
to assure that students understand the potential impact of
relationships that could be established prior to graduation.
The one area that would seem most likely to give rise
to conflicts is the patient care activities associated with
academic programs. While academic programs may operate
a teaching clinic as part of their training program, and
clinical faculty may provide services in those clinics, it is
most often the case that neither the clinic nor the faculty
operates as a traditional for-profit business. That is, the purpose
of the clinic is not to maximize profits, but rather, to
provide a consistent and controlled teaching environment
for students. Similarly, faculty compensation is generally
not tied to the profitability of the clinic and therefore
would be less likely to be influenced by industry or other
external forces. However, exceptions do exist, such as faculty
practices. These issues will, however, likely pertain to
clinical environments external to the university as well as
to preceptors within those environments. As it is possible
that students may rotate through these clinical environments,
preceptors should be advised of their responsibility
to model best ethical practices for the students.
Universities, in general, and academic programs specifically,
establish relationships with industry, often with an
eye toward funding basic teaching endeavors. Academic
programs will solicit donations from industry to fund
faculty salaries, continuing education programs, classroom
technology, scholarship programs, or teaching
laboratories. Industry often provides funding or in-kind
gifts in this regard. The question is whether these gifts
could influence a program in a way that might influence
patient care activities or students. The obvious concern
to academic programs in audiology is that the program
may exert influence on the clinical entities of the program
to make patient care decisions based on these gifts.
For example, a gift from a hearing instrument manufacturer
for classroom technology may result in patients
being counseled toward that particular device or students
gravitating toward those manufacturers and their
products, rather than other devices that may be available,
after graduation.
Audiology programs and industry share the goal of
educating students to provide quality hearing and balance
care to patients, as well as advancing knowledge in
auditory and vestibular sciences. The basic principles that
should guide decisions regarding interactions between
academic programs in audiology and industry include:
• The interaction should serve the interests and legitimate
missions of both the academic program and industry.
• From the academic program’s perspective, the interactions
must serve legitimate educational or research
purposes.
• Any interactions should serve to enhance the hearing
or balance health of the public.
• All interactions should be disclosed and transparent.

LEADING THE WAY
ONE INNOVATION AT A TIME
© 2009 Starkey Laboratories, Inc. All Rights Reserved. 6/09
StarkeyPro.com

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
• The interactions should involve open communication
between knowledgeable parties.
• The interactions should support and enable the free
exchange of information in appropriate settings in a
manner consistent with professional behaviors.
• Interactions should not involve any quid pro quo
between the program and industry beyond that consistent
with fair market value of products used by the
academic program and/or clinic and associated services.
• Audiology programs should adopt and implement guidelines
that address specific interactions between faculty,
students, clinical sites, and industry. These guidelines
should be designed to assure that a principled relationship
occurs that promotes the educational mission of
programs, enhances the experiences of students, and
advances knowledge of hearing and balance disorders.
• Guidelines should be applied with fairness and consistency,
keeping in mind that relationships evolve over
time. Guidelines should govern all interactions with
any sector of industry and should not discriminate
based on the size of the company, the financial opportunities
involved, or personal relationships.
• “Industry” includes all vendors and/or prospective
vendors including manufacturers of diagnostic equipment
or treatment technologies, classroom or learning
technologies, publishing companies, or other such
industries that are related to student education, clinical
services, or research.
• Guidelines should adhere to the rules and regulations
of the institution of the academic program.
• Compensation for services, including reimbursement
for expenses, honoraria, or serving in an advisory
capacity, should be at fair market value and commensurate
with the participation of the faculty or program.
• Industry must recognize their obligation to permit
university programs and faculty to make independent
decisions regarding industry products.
• There is a recognized and necessary interaction
between manufacturers and practitioners (which
includes university faculty), including
The collaborative processes in the innovative and
creative development of devices;
The training, instruction, education, services, and
technical support provided to practitioners to
assure the safe and effective use of products; and
The needed support for research and education
provided to develop technologies that better serve
the public.
There is a growing body of evidence from the social sciences
that gifts of any value may affect the objectivity of clinical
decision making. One-on-one gifting relationships of all
kinds engender feelings of reciprocity that can unwittingly
bias decision making, by recipients in favor of donors’ interests.
These concerns are particularly targeted at clinical
decision making whereby the objectivity of the audiologist
in patient care activities could be called into question.
The clinical arm of audiology programs is not immune
to the potential of bias in clinical decision making.
However, many academic audiology clinics are often operated
in a manner that is atypical of for-profit clinics and
often rely on a variety of resources to maintain their operations,
including direct state funding, grants, in-kind gifts,
donations of equipment, and direct or indirect financial
gifts. Important in this regard is to separate “gifts” that
are provided for legitimate educational purposes versus
gifts that potentially induce bias, particularly if the gift
is directed at an individual (e.g., clinical audiologists) as
opposed to the academic program as a whole. Individuals
who provide clinical service, even within this environment,
must maintain objectivity in clinical decision making and
in regard to the preparation of future clinicians.
• Audiology programs should establish and implement
guidelines on the type and extent of gifts that may be
accepted by faculty from industry. These guidelines

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
should include a definition of what constitutes a gift
(e.g., dinner with industry representatives, anatomical
models, textbooks, travel grants, etc.), as well as any
value limits on those gifts.
• Gifts provided to the academic program in general
should serve a legitimate educational purpose. In this
regard, such benefits may include, but not be limited
to, enhancing the curriculum, expanding service
delivery, developing research programs, improving
infrastructure, or augmenting faculty development
programs.
• Any gift that establishes a quid pro quo should be
prohibited.
• All gifts should serve legitimate educational purposes.
• Honoraria for services provided should not be considered
gifts but should be equivalent to fair market
values for compensation for the services or time
rendered.
Equipment and devices are used extensively in the
provision of services to patients with hearing or balance
disorders. Representatives of industry can play an
important role in introducing new technologies as well as
provide training and support on the proper use of devices
by practitioners, and thus may have legitimate reasons
to be present in the clinics or classrooms of academic
programs in audiology. Frequently, their presence is
essential when devices are initially used with patients.
Also, industry representatives may participate in the educational
mission of an academic program through direct
or indirect instruction. Nonetheless, there is the potential
that certain interactions with industry representatives
can also compromise independence of decision making
and professionalism.
• Student interaction with industry representatives
should be primarily for the purpose of education.
• Industry representatives who are invited to observe or
participate in interactions between patients and the
faculty and staff of an audiology program clinic, or
participate directly or indirectly in the instructional
endeavors, should be identified by the program as
consultants and not as part of the faculty. Industry
representatives in patient care activities should be
sanctioned by the program, and their presence should
be fully disclosed and consented to by patients before
the representatives are permitted to be present during
patient care interactions.
Industry is a common source of funding or speakers for
continuing education activities associated with academic
programs in audiology. The credibility of audiology
programs requires that CE programs sponsored by the
academic program be legitimate, academically oriented,
and open to a variety of viewpoints.
• Academic programs and industry should be able to
sponsor and/or plan CE programs together. Programs
that serve as marketing vehicles for industry should be
identified as such.
• Industry funding sources should be directly acknowledged
in all announcements and literature about
particular CE offerings, in the presentations and
forums as required by CE agency standards, and in all
publications about the programs.
• Meals, travel, and lodging can be provided for participants
so long as those items are consistent to the
scope of the program and are offered without expectation
of quid pro quo.
• Access for industry representatives should be based
on guidelines and procedures that are well considered,
clearly interpreted, and consistently and fairly
applied. Faculty, staff, and students of an audiology
program, along with industry representatives must be
made aware of and held accountable for abiding by the
guidelines and procedures in this regard.
• Academic programs offering CE programs should
familiarize themselves with standards for continuing
education and strive to assure programs with industry
sponsorship or participation meet those standards.
Approved continuing education credit should be
offered when available. Programs not approved for CE
credits should be identified as such.

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
Industry often takes the lead in the development of new
technologies, expanded applications of existing technologies,
or advances in the diagnosis and/or treatment
of hearing and balance disorders. The dissemination of
this information to the audiology community is critical
to assuring appropriate understanding and use of these
developments. As such, industry has a responsibility to
provide educational programs to faculty whose role it is
to teach the next generation of practitioners. Educational
events in which information is transferred between
industry and academic faculty and students, whether at
the academic institution or at another location, serves to
assure that advances in knowledge and technology are
available in a timely manner. Thus, students have the
opportunity to learn about the most contemporary developments
in hearing and balance health care.
Faculty are often called upon to participate in industrysponsored
educational programs due to their expertise or
experience. In fact, the credibility of these programs may
be enhanced due to the reputations of the faculty speakers
and their academic institutions. These programs may
provide legitimate educational opportunities to those
in attendance. However, faculty should be cautious in
participating in industry-sponsored programs whose sole
purpose is marketing, the enhancement of the reputation
of the company, or for which a quid pro quo is expected.
It is important to note that this caution does not extend
to programs where faculty present to peers the results of
industry-sponsored research provided there is the opportunity
for critical review and discussion.
Students can benefit from the expertise, clinical skills,
and technology available from industry. To not allow students
to attain these benefits is to deny the contributions
of industry to auditory and vestibular science. However,
students are also vulnerable and impressionable, so it is
the responsibility of the faculty, academic programs, and
industry to protect students from those situations that
could potentially exploit their naïveté.
• Audiology programs should develop guidelines that
define appropriate and acceptable levels of involvement
of faculty and students in industry-sponsored
educational programs.
appropriate use of faculty names and affiliations
for use in industry-sponsored educational activities.
Audiology programs should require full transparency
and disclosure by their faculty with respect
to their role in industry-sponsored educational
programs.
Audiology programs should develop guidelines
with respect to faculty participation in speakers
bureaus.
• Academic programs should assist students in differentiating
those industry-sponsored programs that serve
a legitimate educational purpose from those that do
not. Faculty should also provide insight and advice to
students to assure they understand the purpose of their
participation.
• Audiology programs should require that payments
to faculty for participation in industry-sponsored
Upcoming Web Seminars
MARCH 2010
Global Audiology: Humanitarian Audiology
for Beginners
APRIL 2010 (LIVE FROM AUDIOLOGYNOW!)
Marion Downs Lecture: Optimizing Early Word
Learning In Infants with Hearing Loss
Multidisciplinary Clinical Model for Managing
Patients with Tinnitus (Tier 1)
MAY 2010
The Internet Pharmacy—Looking for Drug
Information in All the Right and Wrong Places
JULY 2010
CEUs
Hearing Aid Reality Check .2
Visit www.eAudiology.org for dates and to register.
.1
.1
.3
.2
Programs should develop guidelines regarding the

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
educational activities be only at fair market value and
consistent with models of compensation for the services
or time provided.
teaching material, etc.) when the faculty member,
program, or student is providing a legitimate service for
which the expenses are necessary should be permitted.
• Meals, travel, lodging, and other trip-related expenses
should be at levels that are commensurate with the participation
of the faculty in the programs.
Industry has historically been a source of financial support
for students, most commonly in the form of scholarships
or assistantships associated with research endeavors.
University programs and preceptors have a responsibility to
discuss ethical issues with respect to this financial support
to assure that the support is offered without strings
attached and serves a legitimate academic purpose.
• Industry should be free to offer financial or in-kind support
to academic programs for research funding, student
scholarships, or educational funding.
• To ensure transparency, such services should be rendered
in accordance with terms specified in professional
services agreements, which may include compensation
for services that are customary and reasonable in academic
practice.
Ghostwriting is defined as the provision of written material
that is officially credited to someone other than the
writer(s) of the material. Transparent writing collaboration
with attribution between faculty and persons in industry
is not considered to be ghostwriting, provided each author
legitimately contributes to the endeavor.
• Academic programs in audiology should not permit their
faculty or students to allow their presentations or publications
to be written by others. Faculty and students
should not receive credit for work to which they did not
substantially contribute.
• All scholarships or other educational funds from
industry should either be given directly to the audiology
program or, if given directly to the student, clearly identified
as a scholarship or assistantship to support their
academic training.
• Universities that allow students to accept any assistantship,
scholarship, or educational fund must assure that
there are no expectations of a quid pro quo. Any funding
that establishes a quid pro quo should be prohibited.
Expenses associated with CE programs, teaching activities,
or research endeavors may accrue to faculty, students, or
the program in audiology in general. While these may be
covered in a professional services agreement with a specific
company, many times they can occur with no more than a
verbal understanding between industry and the faculty or
academic programs.
• Reimbursement of expenses associated with travel
or the provision of services (e.g., copying expenses,
• Industry should not permit their employees to receive
credit for work to which they did not substantially
contribute.
Purchasing decisions made by audiology programs may
present major challenges in efforts to prevent the intrusion
of financial self-interest and inappropriate bias. In the case of
the purchase of devices and equipment, those with experience
and information relevant to purchasing decisions may
have financial or other ties to the manufacturer or provider.
• At a minimum, audiology programs should ensure that
each participant in the purchasing process discloses all
potential conflicts of interest.
• To the extent an individual’s expertise is necessary in
evaluating any product, that individual’s financial ties to
any manufacturer of that or any related product should
be disclosed to those charged with the responsibility for
making the decision.

Guiding Principles for the Interaction Between Academic Programs in Audiology and Industry
There is value in permitting audiology faculty to interact
with industry, including faculty participation on industry
boards of directors and scientific advisory boards as well as
through professional services agreements and consulting
contracts, provided such activities are conducted with full
disclosure and in compliance with the rules and regulations
of the parent institution.
• Faculty should provide full disclosure of participation
on boards of directors or advisory boards of industry, or
consulting services for industry.
• Compensation for these activities should reflect the fair
market value of the services provided.
Acknowledgments. This document began with a discussion by the
faculty at the Starkey Student Summer program (2008) in response
to the AAMC’s report, Industry Funding of Medical Education. That
publication served as the starting point for a discussion regarding the
complex yet symbiotic relationship between industry and academic
programs in audiology, and with respect to evolving ethical standards
that impact such relationships. The authors would like to thank the
following individuals who contributed to the thought process and
stimulated the writing of this document: Patricia Dabrowski, AuD;
David Berkey, PhD; Jason Galster, PhD; Brandon Sawalich; Paul
Pessis, AuD; Jerry Northern, PhD; and Jerry Yanz, PhD.
Reference
Ian M. Windmill, PhD, is chief of the Division of Communicative
Sciences at the University of Mississippi Medical Center. Barry
A. Freeman, PhD, is senior director of education and training
for Starkey Laboratories. James Jerger, PhD, is a distinguished
scholar-in-residence at the University of Texas at Dallas. Jack M.
Scott, PhD, is an assistant professor and clinical supervisor in the
School of Communication Sciences and Disorders at the University
of Western Ontario.
Also of Interest
Help
PUSH
the
PAC.
Stop by the
Advocacy Booth at
AudiologyNOW! ® 2010
or contribute online.
Visit www.audiology.org,
search key words
“PUSH the PAC.”

Audiologists can learn to externalize
and personify a patient’s hearing loss
without practicing psychotherapy. This
approach causes the practitioner to
focus on the human side of hearing loss
and treat the person, not the disorder.
Emphasizing that hearing loss affects
a person but is not part of that person
helps to reduce the patient’s shame for
being hearing impaired.

Externalizing and Personifying Hearing Loss: A Psychological Tool for Audiologists
Howard” was a 67-year-old man with a progressive
severe-to-profound hearing loss, beginning approximately
10 years prior. He came, in his words, “to get my wife off
my back.” A familiar refrain.
“What’s your wife on your back about” I asked.
“Oh, she wants me to get hearing aids.”
I knew where this was going, and I suspected Howard
did as well. Sure enough, he complained that “Betty”
yells at him to turn down the TV volume, to stop asking
“What” all the time, to stop being so irritable, and to get
therapy.
“It sounds like a battle between you and your wife,” I said.
“I hear fine,” Howard protested. “It’s really her problem.
She often mumbles and speaks to me with her back
turned.”
This wasn’t going to work. And if I suggested too
quickly that Betty was absolutely right—that getting evaluated
for hearing aids would be a good idea—he would
politely, or not so politely, thank me for my time and give
me a version of “Don’t call me, I’ll call you.”
A new approach: I assured Howard that I wouldn’t try
to badger him to get hearing aids, and instead I asked him
if he thinks he’s affected by hearing loss.
“Yeah, sure, I have hearing loss, but who doesn’t have it
at my age”
“Not many people,” I replied. “But it sounds like it has
you, not that you have it.”
“Huh”
“Bear with me, would you Imagine, please, that the
hearing loss is sitting in the empty seat in front of you. It’s
so smart that it can even sit! What does it look like How
big is it What color What’s it wearing Is it friendly or
mean What’s its name”
Howard didn’t expect these rather strange questions,
and I’m sure he became dubious of my mental stability at
this point. Nevertheless, with a fair amount of prodding,
he accommodated my line of questioning. “It’s dark and
heavy, real strong, over six feet tall, has bulging muscles,
and is wearing an Army uniform. And it’s mean, real
mean. His name is ‘Joker.’” Howard let out a smile.
In this manner, I personified Howard’s hearing loss
and externalized it as separate from him.
I then asked him to switch seats and to role-play the
hearing loss. By this time, he was enjoying this “unorthodox
approach,” as he now put it, and was in a more playful,
imaginative mood. He flexed his muscles, scowled, and
made mean, intimidating faces. It would have made the
Joker proud. In turn, I role-played an investigative reporter
whose task was to ask the hearing loss about all the ways
that it had succeeded in disrupting Howard’s life:
• Its influence in the different areas of the Howard’s life
(e.g., its effects on his relationships with others, its
impact on his feelings, its interference in his thoughts,
its effects on Howard’s story about who he is a person,
and so on);
• The strategies, the techniques, the deceits, and the
tricks that the hearing loss has resorted to in its
efforts to get the upper hand in Howard’s life;
• The special qualities possessed by the hearing loss
that it depends on to undermine Howard’s knowledge
and skills, including an inquiry into the powerful
ways that the hearing loss imposes its authority on
his life; and
• The plans that the hearing loss has ready to put into
action should its dominance be threatened.
Initially, Howard responded to my question with the
familiar phrase, “my hearing loss,” and I immediately
countered, “The hearing loss clearly affects you but isn’t
you.” That refrain would become important in our work.
The hearing loss is a condition that influences him but is
separate from him. An important tenet: The person is not
the problem; the problem is the problem.
Howard responded: “You wanna know how the hearing
loss has succeeding in disrupting my life It turns my wife
into a nag, shuts me out from family gatherings, makes
me feel lousy and depressed and angry and makes the
title of the story of my life ‘Howard Is a Loser.’ I don’t know
how the hearing loss gets the upper hand, as you say.
Maybe one of the hearing loss’s strategies or tricks is that
it makes me think that people are mumbling, not talking
loud enough, purposely trying to make my life difficult, or
don’t care about me.
“The hearing loss is very smart and real tricky. I can’t
put my finger on him. Like sometimes I can understand
people, and other times I can’t. It’s random. So sometimes
I don’t think I have a hearing loss, and others doubt me
as well. The hearing loss wants control of me, probably
because it has nothing better to do or wants to feel more
powerful. He screws up my relationships so even my
wife makes me come here to play this stupid game—no
offense, doc.” He gave a half smile.
“No offense taken,” I smiled back.
It was time to switch gears. I then asked him to continue
role-playing the hearing loss, but at this juncture, I
would begin to investigate how the hearing loss had failed
to disrupt Howard’s life:

Externalizing and Personifying Hearing Loss: A Psychological Tool for Audiologists
• The aspects of Howard’s life that Howard still controls,
despite the hearing loss’s influences;
• The countertechniques, counterstrategies, and tricks
that Howard has developed that have at times been
effective in preventing the hearing loss from getting
the upper hand and imposing its authority;
• The special qualities, knowledge, skills, and “self-talk”
that Howard uses that have proven difficult for the
hearing loss to undermine and disqualify;
• Who stands with Howard (relatives, friends, acquaintances,
teachers, therapists, and so on), and the part
they have played in denying the hearing loss’s desires
and wishes; and
• The options that are available to Howard for taking
advantage of the hearing loss’s vulnerabilities and for
reclaiming his own life.
Predictably, Howard had fewer responses than he did
with the previous discussion. After a long silence, he
finally said, “It took away my music, but it hasn’t stopped
me from collecting stamps or taking pictures of my
grandkids so they’ll have a photo album of their lives. My
‘countertechnique’ against the hearing loss, as you put it,
is to do things that I don’t need hearing for.”
“What do you say to the hearing loss while you employ
this strategy”
“You can’t control everything!” he shouted toward the
empty seat with his fist raised and a smirk.
“This doesn’t sound like part of the ‘Howard Is a Loser’
story,” I remarked.
Howard nodded his head somewhat tentatively. I then
asked, “When you succeed in outsmarting the hearing
loss like that, what do you title your story”
“Maybe something like ‘Sometimes, Howard Is a Fighter.’”
One’s story or narrative about oneself is inextricably
related to one’s identity (White, 2007). Howard’s dominant
narrative had been that he is a loser. But now, for the first
time, we excavated another narrative of himself, another
“title” for his identity—sometimes a fighter. It would be
important to embellish this previously dormant narrative
with details, to make it more dominant, to put more “meat”
on it. Any version of “Tell me more” would’ve done, but
typically one’s narrative or identity is related to a previous
relationship that has the capacity to be useful in the present.
I therefore asked Howard, “Who taught you to fight”
After a pause, Howard told me that his long-decreased
grandfather had been a second lieutenant in World War I.
I asked Howard several questions about his grandfather’s
life, about why he joined the armed forces, about his
bravery, what his fears might have been, how he might
have felt going to battle. We spent over half a session
on old war stories. He commented that he often thought
of his grandfather when watching footage of the war in
Iraq. Finally, I wondered aloud whether his grandfather
was psychologically present when Howard was able to
shout to the hearing loss, “You can’t control everything!”
Howard looked at me quizzically but, after some thought,
tentatively nodded his head.
I asked him if he would talk to his grandfather about
how he could help him prepare for battle against the
hearing loss. I motioned to the last remaining empty chair
in my office. Again, after some awkwardness and nervous
laughter, he complied with my request. “Do you have any
advice for me” he asked the empty seat.
At this point, I asked him to switch seats and be his
grandfather while I took over asking the questions. “You
must have some advice for your grandson on how he can
prevent the hearing loss [I motioned to the hearing loss
seat] from getting the upper hand in his life.”
“Howard, you should learn as much as you can about
its weaknesses, its vulnerabilities,” he responded, with
a deep voice, confidence, and conviction. His advice
reminded me of General Westmoreland’s famous statement
that the inability to understand the enemy was “the
basic error” in the conduct of the war in Vietnam.
“What weaknesses of the hearing loss can Howard
exploit” I asked.
He shrugged his shoulders, “I don’t know.”
“Guess.” (My standard response when anyone says, “I
don’t know.”)
“Hmmm, well the hearing loss doesn’t do well with soft
noises. So Howard can maybe get people to speak louder,
he can turn the volume up on the TV, get his wife to stop
calling him from the other room.”
“A good start,” I responded. “Speaking of Howard’s wife,
help me understand something about your grandson. He
came to therapy to get Betty off his back about hearing
aids. In your opinion, would getting hearing aids be an
effective weapon against the hearing loss”
Pause. “Yeah, probably,” he said, somewhat hesitantly.
“So why won’t Howard listen to Betty” I asked.
“Howard’s always been a bit stubborn. He digs in his
heels. He never has wanted to lose a battle—just like me.”
“Chip off the old block. But Howard’s fighting the battle
against the wrong person!”
“What do you mean”

Externalizing and Personifying Hearing Loss: A Psychological Tool for Audiologists
“The enemy is the hearing loss, not Betty! You know
what I bet that one of hearing loss’s tricks is to get
Howard to fire artillery at his own forces!”
“The hearing loss is very cunning,” the lieutenant
agreed, now nodding his head.
“Exactly. The real war is Howard and Betty against the
hearing loss! Do you have any thoughts about some of the
other tricks and deceits that the hearing loss uses against
Howard”
“It makes him feel ashamed, very down on himself, and
it makes him think that hearing aids will make him more
ashamed and even depressed.”
“Astute observation, lieutenant! How do you think
Howard could maneuver around the forces of the hearing
loss to get hearing aids”
“Shock and awe!” he yelled, now enjoying this discussion.
“Regime change! He could blow hearing loss out of
the water!” the Lieutenant proclaimed. I had a foreboding
sense that Donald Rumsfeld had just entered the room.
“I bet he would! What strategy do you think the hearing
loss is using to prevent Howard from blowing it out of the
water with hearing aids”
“Oh, I bet the hearing loss is convincing Howard that
hearing aids will make him look old, that people will pity
him, that they cost too much.“
“The hearing loss is a formidable enemy. Simple sanctions
obviously aren’t going to work. Howard, Betty, and
you need to join forces and launch a full-scale military
campaign with covert and overt special combat operations
against the hearing loss! Maximize your firepower
with air, naval, and land invasions to strategic targets.” I,
too, was enjoying myself at this point. I asked him, “Can
the three of you be ready to present a comprehensive
battle plan in my office tomorrow at 14 hundred hours”
“Yes sir!” he saluted. I saluted him back.
The next day at 14 hundred hours, I entered the waiting
room, not knowing who would be present: Howard, his
grandfather, Rumsfeld, the hearing loss, or Betty. It was
Howard and Betty. We formulated a battle plan:
How is this clinical vignette relevant to audiologists I’m
not necessarily suggesting that you buy more office chairs
so you can stage imaginary discussions with hearing
losses and patients’ deceased relatives, but it might not
be a bad idea. In another publication (Harvey, 2009), I propose
that the first step to motivating resistant adolescents
is to connect beyond the presenting problem, to share a
fun moment or commonality that doesn’t have to do with
hearing or amplification. This principle isn’t restricted to
that age group but applies to treating any patient who is
“dragged” to our offices.
Howard introduced himself to me by saying that his
wife made him come. My immediate internal reaction
was “Ugh, here we go again. One of a thousand unmotivated
men who start therapy this way,” and I felt mild
irritation and boredom. Undoubtedly, Howard also felt
mild irritation and boredom with me, and due to audiological
factors and/or to his psychological resistance, he
didn’t understand my speech. I privately predicted that
he expected me to ask about his feelings, perhaps to talk
• Receiving an audiological evaluation to learn more
about the hearing loss (“reconnaissance mission”);
• Putting aside monies to purchase hearing aids (“weaponry”)
and batteries (“ammunition”);
• Taking speech reading classes (“combat training”); and
• Negotiating communication rules (“code of conduct”).

Externalizing and Personifying Hearing Loss: A Psychological Tool for Audiologists
about his childhood, and to side with Betty about his
needing to get hearing aids. But if I followed this predicted
script, our reciprocal irritation and boredom with
each other would only have increased, and therapy would
have been doomed from the start.
Therefore, my first task was to introduce an element
of surprise that is beyond the presenting problem, that is
“fun,” and that would also be potentially beneficial. In this
case, I used a psychotherapy technique of externalizing
and personifying a problem (White, 2007): Howard’s hearing
loss. Humor was important and deliberately utilized.
Soon enough, we were both smiling. We achieved what
would be the first building block of our alliance or rapport.
This technique of externalizing and personifying
Howard’s hearing loss can be used by audiologists
Externalizing and personifying a patient’s hearing
loss can effectively illustrate how the person is not
the problem, the hearing loss is the problem.
without exceeding their level of expertise by practicing
psychotherapy. Although not initially apparent, this
approach is consistent with audiologist David Luterman’s
(2008) reminder to look at the human side of hearing
loss and treat the person, not the disorder. Emphasizing
that hearing loss affects a person but is not part of that
person—the person is not the problem; the problem is the
problem—helps to reduce one’s shame for being hearing
impaired. Stated differently, externalizing Howard’s
hearing loss, in addition to introducing levity and humor,
was an effective means of reducing what psychologist
Beatrice Wright (1983) referred to as “spread”. Howard’s
hearing loss had “spread” to nullify his competencies and
therefore cause him to experience shame. In contrast,
when his hearing loss became the hearing loss, he could
begin changing his relationship with it. He could put the
hearing loss in its place and reclaim his own integrity.
I became an “investigative reporter” whose job it was to
learn about how the hearing loss sabotaged Howard’s life
and how Howard could resist its influences. This investigative
stance is critical for audiologists who work with people
who deny the need for amplification. The task was to learn
more about how the hearing loss operated, including its
successes and failures; the task was not to help at this
point. A reporter’s job is to seek information, not to help.
The importance of listening and curiosity—investigative
reporting—is an important principle of Motivational
Interviewing by Miller and Rollnick (2002). Premature
attempts to offer advice are not helpful and often backfire
by increasing a patient’s denial or resistance (Beck and
Harvey, 2009). In that regard, it is important to note that
Howard was at the “Contemplation Stage”: he acknowledged
his hearing loss but was ambivalent, at best, to
address it. It would have been an error to jump on the
change bandwagon by attempting to convince him to get
hearing aids, as I would have been colluding with Betty
against Howard.
Methods of determining the cast of characters in a
patient’s “relevant system” (nuclear family, extended
family, friends, etc.) and then connecting with the “protagonist”
who has the clout to effectively support your
audiologic recommendations have been described elsewhere
(Harvey, 2003a, 2003b, 2009). A standard question
is to ask patients whether other family members have
benefited from amplification, with the goal of increasing
the credibility of your recommendations, “If hearing
aids helped Uncle George, maybe they’ll help me.” Taking
this line of questioning a step further, you can also ask
a patient to imagine what advice an influential family
member, living or deceased, would give, or might have
given, to the patient about amplification, for example,
“What might Uncle George say to you about getting hearing
aids”
When Howard shouted to the hearing loss in the seat,
“You can’t control everything!” his countenance changed;
he raised his fist, seemingly inspired to fight. Something
had shifted! I privately wondered what phantom people
had entered the room. Who else was now psychologically
present with Howard, the hearing loss, and me Could
they help Howard outsmart the hearing loss Stated
more technically, what past or present protagonists in his
family or relevant system could assist him in doing battle
with the now externalized and personified hearing loss
It was when he referred to himself as “sometimes
a fighter” that I considered using a battle metaphor to

Externalizing and Personifying Hearing Loss: A Psychological Tool for Audiologists
inquire about a protagonist. When I asked Howard who
taught him to fight, he introduced me to his grandfather.
With Howard then thinking like his grandfather, I solidified
a collusion of Betty, Howard, and his grandfather
against the hearing loss.
The importance of matching a patient’s metaphors
cannot be overstated. Consistent with the self-world view
narrative of Howard’s grandfather, which was shaped by
the military, battle metaphors were abundant in Howard’s
emerging narrative of his own identity. He emerged as a
fighter like his grandfather. Howard was strongly supportive
of the United States invading Iraq, so it was no
surprise that, while role-playing his grandfather, he
envisioned “shock and awe” tactics against the hearing
loss. My reference to Donald Rumsfeld was reflective of
my own negative bias against that war. Here my task was
to ensure that my sentiments did not interfere with my
alliance with Howard. On the contrary, I spent some time
between our sessions Googling military terms, such as
“reconnaissance mission,” “full-scale military campaign,”
and “special combat operations.”
In summary, this illustration seems relevant for
audiologists in that it offers possibilities of how to playfully
connect with those patients who are “dragged” in
by a significant other. Externalizing and personifying a
patient’s hearing loss, in whatever adaptation fits your
style, can effectively illustrate how the person is not
the problem, the hearing loss (in the empty chair) is the
problem. It can properly demarcate that the participants
in the power struggle do not include you or the spouse
of the person with hearing impairment but that the
struggle is, in fact, between the individual patient and
the hearing loss. As a result, you will increase the likelihood
that previously resistant patients will follow your
recommendations.
Howard and I met for eight visits, and interestingly
enough, the final meeting was with his wife—previously
the enemy, now his ally. They had been successful in
battle. Howard showed me his hearing aids and, while
playfully rolling his eyes, remarked that the audiologist
had two empty seats in her office reserved for the hearing
loss and his grandfather! (I had given her a heads-up).
As we prepared to say our goodbyes, he hesitated a
bit and asked Betty to open her pocketbook. He took out
several photos of his grandfather and the medals he was
awarded, one by one, taking time to show me all the
details. Perhaps he was trying to teach me about military
honor. I don’t know, but I said to Howard that I wish
Attending
AudiologyNOW ®
Searching for a
Job
Need to Hire an
Audiologist
The HEARCareers
Employment Center at
AudiologyNOW! 2010 provides
employers and job seekers a
place to connect.
Job Seekers:
ß View HEARCareers job postings
ß Find employer contact information
ß Leave your contact information for employers
ß Post resumes on-site
Employers:
ß View attendee resumes
ß Find job seeker contact information
ß Leave your contact information for job
seekers
ß Post jobs on-site
Visit www.audiologynow.org to
learn more about the HEARCareers
Employment Center at AudiologyNOW!

Externalizing and Personifying Hearing Loss: A Psychological Tool for Audiologists
I could have met his grandpa. Betty quickly responded,
“You’ve already met him several times.”
Michael A. Harvey, PhD, ABPP, is a clinical psychologist and a
consultant faculty at Salus University. His most recent books
are The Odyssey of Hearing Loss: Tales of Triumph and
Listen with the Heart: Relationships and Hearing Loss,
both published by Dawnsign Press. Feedback is welcome at
mharvey2000@comcast.net.
References
Exclusive Savings.
Without the firewall.
See how much you could save on auto, home, renters insurance and more.
AAA members could get an additional discount
on car insurance. Get a free quote today.
1-800-368-2734

Hometown: Pickering,
Ontario, Canada
Education: BS, Biology,
Susquehanna University,
Selinsgrove, PA
Current School: Northeast
Ohio AuD Consortium –
The University of Akron,
Akron, OH
About Me: I’m currently
doing my fourth-year
externship in a hospital
setting and enjoying the
diversity of cases that we
see, so my next step is to
look for a job placement
that offers the same type
of variety.
Quote to Live By: “Learn
from yesterday, live for
today, hope for tomorrow.
The important thing is
not to stop questioning.”
—Albert Einstein
hat I have valued about my program at the Northeast Ohio AuD Consortium
(NOAC) is the faculty encouraged me to go beyond the classroom and participate
in other opportunities, such as conventions, membership in audiology
organizations, and, most importantly, doing service in the community. Expanding my
horizons outside of class has been a priceless experience for my growth as a future
audiologist.
By doing service projects in my neighborhood, I have gained a better perspective
about the impact of audiology in the community. Since my first year in graduate school, I
have participated in the NOAC audiology student group, which gave me the opportunity
to volunteer at local events. These occasions allowed me to teach others about hearing,
but also gave me the chance to witness the exceptional commitment that families have
for their hearing-impaired children. Being outside of clinic also provided a relaxed environment
for parents to express their accomplishments and struggles with hearing loss. It
did not take much effort for us to spend an afternoon with the community, but the effect
it had on the parents and children was encouraging.
I am currently finishing my fourth-year externship in a metropolitan city hospital.
At one of our clinics, we see a large cultural population who lack trust of health-care
professionals and are resistant to the idea of hearing aids. This can be frustrating, as we
often see children fall through the cracks, despite our counseling about the benefits of
immediate intervention.
One day, my supervisor had the audiologists participate in screenings at the local
health fair. We were able to meet neighborhood residents and counsel them on their
hearing concerns. I was impressed that the adults were open to learning about audiology
services and enlightened by our advice. The few minutes counseling them provided
tools to follow up for further assistance. Our interaction was short, but I feel that the
time spent was absolutely worthwhile if we influenced only one person to seek a better
quality of life. Additionally, it made a step toward fostering a trusting relationship with
the community.
It has been personally gratifying to volunteer in the community throughout graduate
school. As a member of society, I believe it is everybody’s responsibility to spend time
contributing to helping the lives of those we can serve.

By Lisa L. Cunningham
earing scientists have long
focused on sensory hair cells
of the inner ear because these
cells are sensitive to death caused
by a variety of stressors—including
noise trauma, exposure to ototoxic
drugs, and even aging. In the mammalian
inner ear, these cells are not
regenerated, so their death results
in permanent hearing loss and/or
balance disorder. Of course, hair cells
aren’t the only cells in the inner ear,
but they seem to be the ones that
receive the most attention. What
about all those other cells Hair cells
in both the auditory and vestibular
systems are surrounded by supporting
cells. What do those cells do
The cochlea contains several
types of supporting cells, including
Deiters’ cells, Hensen cells, Claudius
cells, pillar cells, and phalangeal cells.
They provide basic structural framework
and rigidity to the organ of Corti.
The main structural support is provided
by pillar cells and Deiters’ cells.
Supporting cells are often referred
to as “glia-like” cells, because they
surround, support, and electrically
isolate hair cells in a fashion that
is similar to the way glia surround,
support, and isolate neurons in the
central nervous system. Hair cells
quickly die in zebrafish mutants that
lack supporting cells, indicating that
supporting cells are required for hair
cell survival (Haddon et al, 1999).
Supporting cells are critical for
proper potassium homeostasis in the
cochlea. Endolymph contains high
concentrations of potassium relative
to perilymph. Movement of the
basilar membrane results in deflection
of the stereocilia and opening of
the mechanoelectrical transduction
channel. Potassium from endolymph
then rushes into the hair cell via
these channels, resulting in hair cell
depolarization and neurotransmitter
release. However, all that potassium
has to then be returned to
endolymph. Hair cells release potassium
into perilymph at their basal
surfaces. Supporting cells are then
thought to participate in potassium
recycling by taking up potassium
from perilymph and transporting
it from cell to cell, via a network of
“gap junctions” that connect supporting
cells to one another (Spicer and
Schulte, 1996; Wangemann, 2002).
Potassium is routed via these gap
junctions toward the stria vascularis,
where it is used to generate the endocochlear
potential as it is resecreted
into endolymph.
Cochlear supporting cells are also
important for the survival of primary
auditory neurons (called spiral ganglion
neurons, or SGNs). Molecular
signaling between supporting cells
and SGNs is carried out by a family of
molecules called neuregulins. Loss of
neuregulin signaling results in death
of SGNs, indicating that supporting
cells are required for the survival of
SGNs and thus the maintenance of
cochlear innervation (Stankovic et
al, 2004). Survival of SGNs is critical
to the success of cochlear implants,
which are designed to directly stimulate
SGNs in the absence of hair cells.
Recent evidence suggests that
supporting cells also actively mediate
hair cell death. In the neonatal
rat cochlea, hair cell damage results
in activation of a stress-induced

protein called ERK1/2 in Deiters’ cells
(Lahne and Gale, 2008). ERK1/2 is not
activated in hair cells in response to
this damage. Chemical inhibition of
ERK1/2 signaling in supporting cells
suppressed aminoglycoside-induced
hair cell death (Lahne and Gale, 2008).
These data suggest that supporting
cells can actually promote hair cell
death and possibly even kill hair cells.
Taken together, these data suggest
that supporting cells are much more
than passive structural components
of the cochlea. Instead they are active
participants in sensory transduction,
and they can directly influence
the survival of both spiral ganglion
neurons and hair cells. Scientists are
currently investigating the cell-to-cell
communication that occurs between
supporting cells and other cochlear
cell types. Understanding these
signals may open doors to new therapeutic
strategies aimed at protecting
hair cells and/or SGNs by targeting
supporting cells.
Lisa L. Cunningham, PhD, is an assistant
professor with the Department of
Pathology and Laboratory Medicine at
the Medical University of South Carolina.
References
You can have confidence
in the OAE capabilities and
reliability of your Echoport
Now with
INDUSTRY LEADING
PROTECTION
3 year
Echoport Warranty
Call for Details!
The #1 choice for clinical OAE testing,
the ILO292 DP Echoport provides all the
OAE tests you need: full screen analysis
for TEOAE, DPOAE, contralateral
suppression, Spontaneous OAEs,
DP Growth and binaural capability.
It also helps to know that you can safely
rely on the most trouble-free system in the
industry.
No breakdowns ... No worries!
Otodynamics
www.otodynamics.com 1 800 659 7776
Booth 1130

“
I lost my aid,
am I covered
”
With ESCO Reminder Care there is no question.
Insurance coverage for everyone.
www.earserv.com / 800-992-3726

By Annette A. Burton
he Coding and Reimbursement
Committee has received
numerous questions regarding
participation in the Medicare program.
We would like to take this opportunity
to review the enrollment options for
the Medicare program as they pertain
to the profession of audiology.
Current regulatory language in the
Social Security Act demonstrates the
intent for Medicare beneficiaries to
have widespread access to diagnostic
and therapeutic services within the
United States. Although the Centers
for Medicare and Medicaid (CMS) cannot
currently require most providers
to accept assignment for services,
CMS does require that claims for
covered services are submitted on
behalf of Medicare beneficiaries,
if requested. Claims for covered
services for Medicare beneficiaries
are to be submitted by all providers,
except in cases where the provider
has opted out of the Medicare program
and has entered into a private
contract with the beneficiary.
Each provider type has a set of
defined options of participation for
Medicare:
Also of Interest
Mandated to participate and
accept assignment.
Enroll as either a participating or
nonparticipating provider.
Opt out of the Medicare program
for a renewable, two-year period
and enter into a private contractual
arrangement with the
beneficiary to not submit claims
or receive reimbursement from
Medicare.
Audiologists currently fall within
the second category, if treating
Medicare beneficiaries; they must
enroll in Medicare and submit claims
for covered services. Audiologists
have the option to enroll as either
a participating provider who must
accept assignment of Medicare
benefits for all covered services or
as a nonparticipating provider who
may choose to accept assignment of
Medicare claims on a case-by-case
basis. Audiologists are currently not
allowed to opt out of the Medicare
program and enter into private contractual
arrangements with Medicare
beneficiaries.
There are advantages and disadvantages
to becoming either a
participating or a nonparticipating
provider. To learn more about the
differences between participating
and nonparticipating status, there
are many resources available. The
Medicare Physician Guide: A Resource
for Residents, Practicing Physicians and
Other Health Care Professionals is a free
and very helpful reference guide that
is produced by the Medicare Learning
Network. It may be downloaded at
www.cms.hhs.gov/MLNProducts/
downloads/physicianguide.pdf, or a
free copy on CD can be obtained from
CMS by visiting http://cms.meridianksi.com/kc/pfs/pfs_lnkfrm_fl.aspl
gnfrm=reqprod&function=pfs.
It is important to remember that the
mandatory claim submission requirement
refers only to covered services
as defined by Medicare. Many
services may not meet Medicare’s
definition of a covered service.
Routine procedures, services that are
directly related to the provision of
amplification, therapeutic services
that are within an audiologist’s scope

of practice but fall outside of the
narrowly defined diagnostic benefit
category determined by Medicare, are
all considered noncovered services
under the Medicare benefit.
Please remember that Medicare
does not prohibit an audiologist from
providing noncovered services to a
Medicare beneficiary. Medicare does
not restrict or prohibit billing the
beneficiary for noncovered services;
however, the beneficiary must be
notified in advance that the service
is noncovered.
There is no submission requirement
for services that are free. It is important
to note that provision of free
services cannot be only offered to
certain types of patients. For example,
it would not be permissible to avoid
the mandatory reporting requirements
just for Medicare beneficiaries
and submit claims for the same diagnostic
services to other third-party
payers. It is good practice to have
consistent billing practices for all
patients, regardless of the payer.
Annette A. Burton, AuD, is the chair
of the Coding and Reimbursement
Committee, and is the director of the
Easter Seals Centers for Better Hearing
in Connecticut.
Disclaimer. The purpose of the information
provided in this column by the
American Academy of Audiology Coding
and Reimbursement Committee is to
provide general information and educational
guidance to audiologists. Action
taken with respect to the information
provided is an individual choice. The
American Academy of Audiology hereby
disclaims any responsibility for the
consequences of any action(s) taken by
any individual(s) as a result of using the
information provided, and reader agrees
not to take action against, or seek to hold,
or hold liable, the American Academy
of Audiology for the reader’s use of the
information provided. As used herein,
the “American Academy of Audiology”
shall be defined to include its directors,
officers, employees, volunteers, members,
and agents.
The Hugh Knowles Center
for Clinical and Basic Science in Hearing and Its Disorders
at Northwestern University welcomes its two newest fellows
Andrew FishmanPamela Souza
Feinberg School of Medicine School of Communication
The center fosters interdisciplinary research, scholarship, training, and clinical services
to help people recover and protect the joy of hearing. Fellows are distinguished Northwestern
faculty who contribute their research, clinical, and educational efforts in this mission.
Current fellows
James Bartles
Ann Bradlow
Mary Ann Cheatham
Peter Dallos
Sumitrajit Dhar
Jaime Garcia-Añoveros
Dean Garstecki
Nina Kraus
Alan Micco
Ernest Moore
Claus-Peter Richter
Mario Ruggero
Jonathan Siegel
Catherine Warrier
Donna Whitlon
Richard Wiet
Patrick Wong
Beverly Wright
Inquiries from potential
doctoral students,
postdoctoral fellows,
and research scientists about the
center’s activities are welcome.
knowlescenter@northwestern.edu
www.communication.northwestern
.edu/departments/csd/
research/hugh_knowles_center

he Tax Relief and Health Care
Act of 2006 established the
Physician Quality Reporting
Initiative (PQRI), which included
incentivized payments for eligible
providers for quality measures
furnished to Medicare beneficiaries.
Since December 2007, 10 audiology
organizations have worked collaboratively
as the Audiology Quality
Consortium in developing reportable
measures under PQRI.
As of January 1, 2010, this voluntary
program allows Medicare Part
B-enrolled audiologists to participate
in the reporting of up to four
measures. Providers who meet the
threshold for the accurate reporting
of these measures may be eligible for
a two percent incentive payment.
Medicare patients of any age
referred to a physician after an
audiologic assessment determined by
one of the qualified conditions, and
who are not currently under the care
of a physician for that condition, are
measures eligible to be reported on.
However, Medicare beneficiaries are
required to have a physician referral
for a medically necessary reason.
Congenital or traumatic
deformity of the ear
have disease of the ear and mastoid
processes)
A history of sudden
or rapidly progressive hearing loss
Otitis Media with
Effusion (OME): Diagnostic
Evaluation-Assessment of
Tympanic Membrane Mobility, is
also reportable, but will have a
very limited use as it will be applicable
for those pediatric patients
who are Medicare beneficiaries, an
uncommon occurrence; the two
percent bonus will not apply.
You should report on these measures
to help maintain audiology’s
commitment to high quality care for
Medicare beneficiaries while simultaneously
supporting the recognition
of the profession as a member of the
health-care coordination process.
Care coordination is intended to
increase communication among
those professionals providing services
to Medicare patients to ensure
a standard of care and to avoid
duplication. In addition, there is an
opportunity to capture additional
A history of active
drainage from the ear within the
previous 90 days (for patients who

evenue with the two percent reporting
bonus on qualifying measures.
Successful reporting requires the following
components:
You will need to report on at
least three measures during the
reporting period. For each of the
measures, you are required to
report on 80 percent of patients
who have conditions that are
applicable to those measures.
Each measure has a numerator
and a denominator specific to
that measure. The numerator is
the action the measure requires
for reporting and the denominator
specifies the eligible patients
for each measure. There are also
denominator exclusions: patients
who are not eligible for the measure
for specific reasons.
For each measure, except for measure
#94, audiologists are required
to refer the patient to a physician
after the audiologic evaluation
reveals a condition unless the
condition meets the criteria for an
exclusion.
You will need a National Provider
Identifier (NPI) number and a
Medicare Provider Transaction
Account Number (PTAN), formerly
known as the Provider Identifier
Number (PIN).
To obtain an NPI, go to https://nppes.
cms.hhs.gov/NPPES/StaticForward.
doforward=static.instructions.
To obtain a PTAN, go to https://
pecos.cms.hhs.gov/pecos/login.do.
If you prefer, you may file a hard
copy of the 855I (www.cms.hhs.gov/
CMSforms/downloads/CMS855I.pdf)
to obtain your PTAN. If you are an
employee of, or contract with a physician,
you will need to file the 855R, to
reassign benefits to the employer or
contracted entity: www.cms.hhs.gov/
cmsforms/downloads/cms855r.pdf.
Note: If you are enrolled in Medicare
but have not submitted a CMS-855I since
2003, you are required to submit a complete
application. Providers and suppliers
should follow the instructions for completing
an initial enrollment application.
You will find the numerators,
denominators, and exclusions
for each measure in detail at
www.asha.org/uploadedFiles/
ReportingMeasuresStepByStep.pdf.
As a Part B-enrolled Medicare provider,
you will file your claim on a CMS
1500 form as is currently done for
Medicare and other third-party payer
claims. There are specific CPT, ICD-9,
and G-codes or Healthcare Common
Procedure Coding System (HCPCS)
codes that correspond with each
of the measures and can be found
here: www.asha.org/uploadedFiles/
ReportingMeasuresStepByStep.pdf.
The CPT codes describe the procedures
performed; the ICD-9 codes are
the diagnostic codes and the G/HCPCS
codes are Category II CPT codes; or
HCPCS codes. Audiology procedures
are Category I codes. It is required that
the G/HCPCS codes be reported on
the same claim as that of the patient’s
procedures and diagnosis codes.
The CPT codes are placed in box
24D, the ICD-9 codes are inserted in
box 21, and the G/HCPCS codes go in
box 24D on the CMS 1500 form.
Let’s use measure Measure #190
(history of sudden or rapidly progressive
hearing loss) as our example.
First choose one of the following CPT
codes for this particular measure and
mark it in box 24D:
• 92557
• 92567
• 92568
• 92575
*At the time of publication, CPT codes
92550 and 92570 were not finalized for
inclusion. A request to the Centers for
Medicare and Medicaid Services to include
them has been made by the Audiology
Quality Consortium.
Then you will need to choose one
of the following ICD-9 codes for this
particular measure for box 21:
• 389.00-389.06 inclusive
• 389.08
• 389.10-389.18 inclusive

• 389.20-389.22 inclusive
• 389.8
• 389.9
Finally, locate the denominator
(G/HCPCS code), which will describe
the eligible patients for this measure.
For measure #190, it is “Patients aged
birth and older with verification and
documentation of sudden or rapidly
progressive hearing loss,” and mark
that code in box 24D.
December 31, 2010. The payment will
be calculated based on the qualified
claims submitted at the end of the
reporting period and will result in
a payment to you, typically within
the first six months post–reporting
year. Remember that you must report
correctly on at least 80 percent of
applicable patients to receive the
incentive payment.
PQRI claims reporting process questions
may be addressed to Debbie
Abel, AuD, the Academy’s director of
reimbursement, at dabel@audiology.
org. Questions regarding other PQRI
processes should be addressed to
Victoria Keetay, PhD, the Academy’s
senior director of education, at
vkeetay@audiology.org.
Audiologists have an option of
reporting for the calendar year
2010—January 1 to December 31,
2010, or for the last six months of
the calendar year, from July 1 to
Also of Interest
THE BENEFITS OF
ACADEMY MEMBERSHIP
AKA VIP STATUS
CONFERENCE
CALLING
Discounted
member prices
available for
unlimited and
reservationless
conference calling.
FELLOW LOGO
Promote your
commitment to
hearing health
care through your
affiliation with
the Academy.
Download the
logo for FREE.
AUTO
INSURANCE
Discounted
member prices
may apply to you
for outstanding
rates and
24/7/365 service.
MEMBERSHIP HAS ITS BENEFITS
Learn more about all of the benefits available to Academy
members at www.audiology.org. Search key word BENEFITS.

By Tracey Irene
e often evaluate the
impression that we are
making on our patients
in terms of our professionalism, services,
and skill. A first impression can
set the stage for the entire visit. It is
important to consider the experience
you provide patients before they are
even called back for their appointment.
Is your waiting room warm and
inviting Are your patients greeted
when they walk in the door Is there
appropriate information available on
your practice, services, and staff
One way to evaluate this experience
is to spend some time sitting
in your waiting room. What do you
hear, see, and feel Is there sufficient
seating available How long
has it been since the carpet was
cleaned Is the literature in your
waiting room current, clean and
organized Can you overhear the
conversations your receptionist is
having on the phone Is the temperature
comfortable and lighting
ample Are the acoustics friendly to
individuals with hearing loss
Remember, patients will form
an impression of your office within
minutes of their arrival. You have
one opportunity to make a first
impression, so make sure it is a good
one. Here are some things to consider
when evaluating your waiting room
and patient experience:
Is your receptionist greeting
your patients when they arrive in
your office Is the wait time for your
patients reasonable Are they made
to feel welcome and comfortable Is
the check-in process clear, and have
the patients been informed of what
is needed for the appointment Is
confidentiality maintained during
the check-in process
Is the seating in your office comfortable
and functional Consider
seats with armrests so patients can
lift themselves from the chairs with
ease. Also, consider some seating
without armrests for those patients
who may require additional space.
Are the lighting and acoustics
appropriate for individuals with
hearing loss and vision loss You
may want to keep in mind that television
or music may deteriorate the
acoustics of the office; however, this

could be used as an opportunity for
your patients to try assistive listening
devices. You will need to weigh
these considerations and decide what
will work best in your office.
Is your waiting room clean and tidy
Do you have any mysterious stains on
furniture or carpet Do you have hand
sanitizer, tissues, and trash cans available
to your patients Are your surfaces
covered in dust or fingerprints
Is the reading material current
Educational materials should be current
and patient friendly. Magazines
should also be current, clean, and
organized. Consider magazines that
appeal to men, women, and children.
Try to reduce the amount of clutter
on the surfaces of counters and tables.
Is there a restroom available to
your patients near the waiting room
If not, consider a sign detailing the
restroom location.
If you find yourself overwhelmed
by this process, understand that you
are not alone. Start by making small
changes and monitor the impact it
makes on your patients. Consider
surveying your patients to determine
what areas you could improve
upon. If you are in need of a complete
redesign, an interior designer can
be helpful in determining the layout,
color scheme, size, lighting, and
furnishings of your office. Use this
opportunity as a way to improve your
patient’s experience and satisfaction
in your practice. Satisfied patients
can be invaluable to your practice,
as they may generate a number of
referrals through word-of-mouth
marketing.
Tracey Irene, AuD, is a senior audiologist
with Professional Hearing Services,
A Division of Moreland Ear, Nose, and
Throat Group, LTD, in Milwaukee, WI.
She is also a member of the Academy’s
BEST Committee.
auction4audiology
Preview Auction Items
Online Today
Bidding Is Open April 5–17
If interested in donating an item to the auction,
contact Auction HQ: tconte@audiology.org.
Proceeds from Auction 4 Audiology
support research, education, and
public awareness in the hearing
sciences through the American
Academy of Audiology Foundation.
Visit w w w.biddingforgood.com/auction4audiology
to v iew a nd bid on auction items.

By Maureen Valente
he doctor of audiology (AuD)
degree is a rigorous, four-year
clinical degree whereby rich
practicum experiences are interwoven
with challenging course work and
exposure to research and the corresponding
literature. Students develop
skills, knowledge, and competencies
throughout the intensive program to
ultimately serve as highly competent,
autonomous, compassionate clinicians
upon graduation. The Academy’s
Education Committee is delighted to
have formulated a new Subcommittee
on Research in Audiology Education,
so that research in professional education
may be enhanced and so that
the profession may move forward
based on the evidence. Initiatives will
collaboratively dovetail with other
research- and education-oriented
outcomes of the recent Gold Standards
Summit (GSS) and similar conferences.
Much discussion has taken place,
casually and within more formal
venues, regarding the possibility of
a greater degree of standardization
with regard to clinical education.
These discussions appear to primarily
center around the fourth-year externship.
Until we have an opportunity
to view and make transformations
based on research outcomes, it may
be beneficial to continue brainstorming
and discussing via venues such as
this Audiology Today column and many
others. As the Education Committee
has held conference calls to help
provide leadership in carrying out the
many, massive initiatives suggested
after meetings such as the GSS, one
recurring reminder discussed is “that
we have to roll up our sleeves, dig in,
and begin somewhere.”
In this spirit and with the above
foundation, this co-chair wishes to
put forth these thoughts based on
personal experience within her own
AuD program in managing clinical
practicum experiences of all four
years and in placing an average of
12 fourth-year externs per year at
various sites across the country. In
addition, thoughts stem from a more
global, national perspective following
much discussion with teams of
professionals across the country
(students, preceptors, and faculty),
after much committee discussion on
a national level, and following recent
Council on Academic Accreditation
in Audiology and Speech-Language
Pathology and Accreditation
Commission for Audiology Education
accreditation processes. Thoughts
expressed are only that, intended to
suggest guidelines without becoming
too narrowly focused, with further
discussion highly encouraged.
Types and number of experiences
may vary from program to program,
although some best practice guidelines
may include:
Begin with clinical practicum
experiences as soon as possible
upon enrollment.
Develop close integration of clinical
practicum experiences with
course work.

Provide specified development and
assessment of skills, knowledge,
and competencies as a function of
each academic year of study,
Include diagnostic and (re)habilitative
services across the life span
and audiology’s scope of practice.
The program should not rely upon
the fourth-year externship for the
majority of its clinical education.
Create and enable ongoing
teamwork among the student,
preceptor, site, and university.
This includes extensive teamwork
during the placement process and
also during the academic term.
Criteria for site selection should
be predetermined by the educational
program and may include
such factors as environment
conducive to learning, learning
opportunities available, state-ofthe-art
equipment and techniques,
population diversity, utilization
of best practice, and geographic
proximity.
Specify criteria for selection and
include such factors as experience
in the profession, area(s) of
expertise, communication and
interpersonal skills, precepting
and mentoring skills, and
accessibility.
Assessment of the student should
take place via daily feedback, formative
assessment, and summative
assessment. The student should play
a key role in assessment, performing
self-assessment of his/her own
progress and assessment of the
preceptor(s). An affiliation agreement
should always be in place
between the site and the university;
all parties, including the student,
should be aware of and have access
to its contents.
The fourth-year externship has
replaced the clinical fellowship year
(CFY) model, with the fundamental
difference being that the student is
still a student during the externship
year. By this time, the student has
successfully completed earlier practicum
rotations, most if not all course
work, and (very likely) any capstone
project that may be required.
The spirit of the externship is for
the student to immerse himself
or herself in a full-time clinical
experience. A depth and breadth of
experiences is optimal, although this
depth and breadth should also have
been achieved via earlier rotations,
whenever possible. If this is the case,
discussion and advising may take
place if the student wishes to specialize.
The educational program should
not rely upon the fourth-year externship
placement for the majority of its
clinical education.
Continued teamwork is essential
among all parties, including the
student, site, preceptor, and university.
Sites are strongly encouraged
to make use of the Academy’s
Externship Registry and universities/
students are encouraged to seek valuable
site information through this
and other resources. The university
should guarantee student placement
(and extensive support in securing
placement), and students should not
be left to secure their own externship
sites. University personnel should
make first contacts and should provide
ongoing mentoring throughout,
including resume writing, interviewing
skills, and other important
aspects. Protocols and timelines may
vary from university to university,
with some encouraging a year-long
rotation at one facility and others
encouraging rotation at several facilities
throughout the year.
Much variability continues to exist
with regard to timelines implemented
by sites and by university
programs. Areas where variability
exists include submission/acceptance
of applications, review of applications,
interviewing, and making/accepting
of offers. The Academy has developed
a recommended timeline for externship
placement (see Figure 1). It would
be optimal if such a timeline could
be followed closely for standardization
purposes; if this is not possible,
feedback for possible revision and
updating should be forwarded to the
Academy. Criteria for site selection
and preceptor qualifications should
follow the same guidelines as outlined
above. There is a great need for
ongoing preceptor training, according
to feedback received after the GSS
and other conferences, especially in
the area of supervision. This should
continue to be addressed by the profession
as an ongoing initiative.
Several years ago, an Academy task
force was formulated to explore
issues related to payment for the
fourth year. A white paper was written,
resulting in many controversial
comments and little consensus.
Although there is great variability at
the current time regarding payment,
it was decided at that time that this
issue should be one between university
and site. General suggestions put
forth by this author at the current
time included:
That any payment should be made
with the clear stipulation that
the student is clearly known as a
student and not an employee.

That a site be selected based on
its merit, depth, and breadth of
experience. A site should not be
selected based solely on financial
merit, nor should an excellent site
be disregarded solely because of
an inability to pay.
That the student not be placed in
uncomfortable or risky situations
regarding third-party reimbursement
or other professional issues.
Teamwork should continue and the
university should be in touch with
the student and preceptor on a very
regular basis. This author implements
such contact on at least a monthly
basis. The university representative
should visit the site whenever
feasible, and contact should be
more frequent if difficulties arise.
Assessment of the student should
occur as outlined above and within
the framework of fourth-year student
competencies, skills, and knowledge.
It has often been suggested by
preceptors that a uniform assessment
tool should be developed for use
among programs, and this possibility
is currently being explored by the
Clinical Education Subcommittee.
Level of direct supervision should
diminish throughout the fourth year,
as the student approaches graduation
and is well on his or her way toward
becoming a competent and independent
clinician.
This very dynamic process will,
undoubtedly, further evolve as we
collectively discuss and gather the
evidence related to “what is currently
working” and “what areas are in need
of constructive change.”
Maureen Valente, PhD, is the director
of Audiology Studies, Program in
Audiology and Communication Sciences, at
Washington University School of Medicine.
She is also the cochair of the Academy
Education Committee.
LIVE FROM AUDIOLOGYNOW! ® IN SAN DIEGO!
2010 MARION DOWNS
LECTURE IN PEDIATRIC
AUDIOLOGY
OPTIMIZING EARLY WORD LEARNING
IN INFANTS WITH HEARING LOSS
FRIDAY, APRIL 16, 10:00 AM PT
PRESENTED BY MARY PAT MOELLER, PHD,
Center for Childhood Deafness at Boys Town
National Research Hospital
FREE Web seminar available through eAudiology.
Visit www.eAudiology.org to register.
Funded by the AAA Foundation with a
grant from the Oticon Foundation.

By Doris Gordon
responsibility of an
accrediting agency, such as
key
ACAE, is monitoring changes,
reforms, and general trends in higher
education today. We need to be ahead
of the curve in transforming audiology
education. Why Because we’re
evaluators who not only confirm that
academic programs are in compliance
with educational standards but
enable them to adapt to changes that
bring about genuine improvements
in student learning.
Former U.S. Secretary of
Education Margaret Spellings established
the Commission for the Future
of Higher Education in 2004–2005
to review what was happening in
universities and colleges at all levels.
Valid questions about the accountability,
access, and cost/affordability
of education were asked by the commission.
The present U.S. Secretary
of Education, Arne Duncan, is passionate
about preparing students for
higher education, mandating that
secondary educational institutions
throughout the country focus on
excellence in teaching and achieve
higher scores on standardized tests.
Molly Corbett Broad, the recent
CEO of the prestigious American
Council on Education urges us “to
think big…this is a time when the
game is changing…hunkering down
is not a smart option.”
So what is changing Our worldview,
for one. As Thomas Friedman
explains in his book, The World is Flat,
U.S. businesses, corporate structures,
and educational institutions need to
cooperate with nations around the
globe. During this past year, the rise
in international students attending
universities for postsecondary
and graduate education within the
United States has been impressive.
The Chinese are leading the way.
They have funds for tuition and
board and bring ideas and different
perspectives to graduate programs.
The international influence benefits
education for all.
Learning is changing. Robert
Zemsky, in his recent book, Making
Reform Work, reinforces the notion
that learning is the “academy’s core
business and the traditional method
of learning with detailed content is
changing to a more well-executed
learning process.” Static learning
is decreasing and dynamic learning
is more evident, in the sense
that learning processes change as
the learner gains new knowledge
and tackles new problems. Zemsky
notes that “the academy today
argues that the successful student is
much more a clever librarian—that
is, someone who knows how to ask
the right questions and to recognize
good answers.”
Technology is revolutionizing education.
In an interesting article, “How
the iPhone Can Reboot Education,”
(www.wired.com/gadgetlab/2009/12/
iphone-university-abilene/) a small
university in Abilene, Texas, recently
completed a pilot program for the
purchase of iPhones for its students.
“The traditional classroom, where
an instructor assigns a textbook, is
heading toward obsolescence. Why
listen to a single source talk about a
printed textbook that will inevitably
be outdated in a few years That
setting seems stale and hopelessly
limited when pitted against the internet,
which opens a portal to a live
stream of information provided by
billions of minds.”
What do these changes tell us
about audiology education Will we
have the vision to place audiology
on the cutting-edge of science and
education As a member of a rigorous
academic discipline, audiology has
no choice but to embrace these ideas
and include them in the learning
environment.
Doris Gordon, MS, MPH, is the executive
director of ACAE.

By James W. Hall III
BOARD OF GOVERNORS
James “Jay” W. Hall III, PhD, Chair
John A. Coverstone, AuD
Antony Joseph, AuD, PhD
Beth Longnecker, AuD
Yvonne S. Sininger, PhD
Therese Walden, AuD
Gail M. Whitelaw, PhD
American Academy
of Audiology Board of
Directors Liaison
Karen Jacobs, AuD
Past Chair
Ex Officio Member
James A. Beauchamp, AuD
ore than 20 years have passed since the now legendary “Future of
Audiology” session at the 1987 ASHA Convention in New Orleans.
During the session, James Jerger, PhD, spontaneously proffered an
idea that brought the standing-room-only crowd to their feet—audiologists
should form their own professional organization. This pivotal event in the
development of the profession of audiology was summarized in a retrospective
article published in the May/June 2008 issue of Audiology Today titled “The
Future of Audiology…20 Years Later.”
At the 1989 session, I took the opportunity to focus on two topics that were,
in my opinion, central to the future of audiology—education and certification.
On the topic of education of audiologists, I outlined a plan for a four-year
doctoral program incorporating a supervised clinical experience, which was
both extensive and intensive. The idea was not original. Even then, a number
of audiologists were enthusiastically developing plans for a doctor of
audiology-type degree. And, citing a recommendation of Raymond Carhart
made back in the 1960s, I suggested that audiology develop two levels of
Public Representative
Patty A. Keffer, MBA
Managing Director
Ex Officio Member
Sara Blair Lake, JD, CAE
For ABA information, contact:
American Board of Audiology
11730 Plaza America Drive
Suite 300
Reston, VA 20190
800-881-5410
aba@audiology.org
Hails From: Twin Cities of Minnesota
(currently), Portland, OR (originally)
Year Certified: 2006
Degree: AuD, PCO School of Audiology
What I Do for the ABA: Members of
the board set policy and direction for
the ABA, approve new applicants for
certification, and oversee specialty certification
programs. I am the new chair
of the ABA Marketing Committee and a
member of the ABA Ethics Committee.
In My Free Time: I enjoy spending
time with my family and try to play
with my two children every day. I
also enjoy softball, golf, and skiing. I
usually have a few home improvement
projects half-finished at any
time, and several Web site projects
pending. I also try to work in some
time on the guitar or piano so I don’t
completely forget how to play!
Quote to Live By: “Live a balanced
life—learn some, and think some,
and draw, and paint, and sing, and
dance, and play, and work every day
some.” —Robert Fulghum

certification—general certification and specialty certification.
We now have both. As I begin my term as chair of
the ABA Board of Governors, it seems like a good time to
once again prognosticate about the future of audiology.
The future of audiology is all around us and easy to see.
We can see the future of audiology in the clinic, sitting
in early morning patient conferences, and in the classroom.
At the Academy’s convention, AudiologyNOW! ® , we
glimpse the future of the profession hundreds of times.
The future is on duty early in the morning at the registration
desks outside lecture rooms, presenting research
posters, and especially at the ABA-sponsored Meet &
Greet event. Doctor of audiology students are the future
of audiology. Audiology tomorrow is embodied in our
students today. Embracing our future, the ABA will significantly
expand student-related activities and initiatives
throughout 2010.
The ABA’s popular Meet & Greet function, generously
supported by Thieme Publishing, grows larger each
year. Audiology students are matched with audiologists,
including some of the “big names” in our profession. In
an informal setting over lunch, mentors and mentees
have the opportunity to converse and get to know each
other. Speaking from experience, the ABA Meet & Greet
is one of the most enjoyable and stimulating events of
AudiologyNOW! Recognizing that some students will be
unable to travel to San Diego in April, the ABA will offer
a “virtual” option for the Meet & Greet event. Audiology
student mentees will be connected with audiologist mentors
to become electronically acquainted and to exchange
ideas. I encourage ABA-certified audiologists to “adopt
a student” for some virtual meeting and greeting. Go to
the ABA Web site (www.americanboardofaudiology.org)
to sign up for participation in the Meet & Greet event, or
e-mail the ABA at aba@audiology.org.
Another student-related initiative for 2010 is the
promotion and expansion of the provisional ABA certification.
Students approaching the last year of their
doctor of audiology program are encouraged to apply for
provisional certification, to set themselves apart as they
seek fourth-year externships and their first postgraduate
employment as an audiologist. I strongly encourage all
audiology students to pursue the provisional certification
option by downloading an application from the ABA Web
site. Speaking of the ABA Web site, it’s about to undergo
a major makeover. The improved ABA Web site will have
a fresh, user-friendly appearance. One of the exciting
new features of the Web site is a page devoted to student
activities and opportunities. If you’re a student, I invite
you to help us develop the student page on the ABA Web
site. We value your ideas and your creativity. Please contact
us now via e-mail at aba@audiology.org.
I’m looking forward to another very good year for
the ABA. Please join the Board of Governors, the ABA
staff, and me in contributing to the essential work of the
American Board of Audiology.
James W. Hall III, PhD, is the chair of the American Board of
Audiology.
Register Your
Clinical Site
A free tool for universities, students, and clinical sites
To register your site today, visit
www.audiology.org, search
key words “Externship Registry.”

By Melissa Sinden
he Government Relations
Committee, in conjunction
with the Academy’s advocacy
team, is excited to announce a variety
of new, interactive, informational
events at AudiologyNOW! 2010 in San
Diego. These sessions are designed to
educate Academy members on how to
become active advocates, and provide
valuable tips on engaging elected officials
and shaping public policy.
After the great success of the
inaugural Advocacy Summit last year
in Dallas, the Academy will host a
larger meeting to allow more Academy
members and interested advocates
to attend. While the summit last year
was limited to only a handful of states
to kick off the Key Contacts initiative,
this year, invitations have been
extended to all Academy members
interested in becoming the “go-to”
person in their state or congressional
district. These Key Contacts represent
the voice of audiology on issues affecting
the profession in their districts. For
more information on the Key Contacts
initiative, visit www.audiology.org,
key words “key contacts.”
This year’s AudiologyNOW! will also
feature a learning module titled “Your
Role in the Legislative Process.” Erin
Miller, AuD, chair of the Academy’s
Government Relations Committee;
John Williams, the Academy’s federal
lobbyist; and Melissa Sinden, senior
director of government relations for
the Academy, will host this interactive
presentation. Participants will learn
the “ins and outs” of the legislative
processes at the state and federal levels,
and what to expect when meeting
with elected representatives. Those in
attendance will learn how to become a
lobbyist for the profession and how to
become involved to ensure the voice of
audiology is heard.
Be sure to stop by the new and
improved advocacy booth in Academy
Central for all the latest advocacy
and PAC (Political Action Committee)
information. There, you can learn
more about the Academy’s legislative
issues, view exciting merchandise,
and find out how to PUSH the PAC!
Contributions to the PAC may be
made through the Academy Web site,
by mail, or directly at the Advocacy
Booth by cash, check, or credit
card. Remember that donors in the
President’s Circle ($500+/year) receive
an invitation to an “Insider’s Briefing”
and VIP admission to the PAC event at
AudiologyNOW! This year’s PAC event
will offer contributors the opportunity
to sample California wines at the San
Diego Wine and Culinary Center!
For more information about the
PAC, visit www.audiology.org/
advocacy/pac/Pages/default.aspx.
We look forward to seeing you at
one of our many advocacy events in
San Diego!
Melissa Sinden is senior director of
government relations for the American
Academy of Audiology.

Join us
Dr. Chermak’s name is synonymous
to many audiologists with research
in the diagnosis and management of
central auditory processing disorder
(APD). She began her pioneering work
in the 1980s, and her contributions
to the field’s knowledge base have
been seminal. It is virtually impossible
to delve into APD literature
without repeatedly encountering
her influence in the form of refereed
articles, edited monographs, book
chapters, and books. What makes
her academic record more remarkable
is that it was generated while
she was simultaneously distinguishing
herself as a teacher, university
administrator, and international
advocate for the field of audiology. As
a Fulbright Scholar in 1989, she studied
international models of health
care and shared that knowledge
through international presentations,
workshops, and articles. Her
excellence in administration and
teaching has been recognized over
and over again through awards such
as the Distinguished Faculty Award,
the Edward R. Meyer Distinguished
Professor Award, and the Faculty
Excellence Award. Dr. Chermak
has been chair of the Department
of Speech and Hearing Sciences at
Washington State University since
1990. She has made notable and
lasting contributions to our profession,
her students, and research in
audiology.
Dr. Compton-Conley has had a
distinguished career as an educator
and consumer advocate. She is
best known for expanding awareness
of assistive technology for
hearing-impaired persons. An
acclaimed expert in this specialty
area, her counsel and advice are
sought worldwide. Dr. Compton-
Conley is currently a professor of
audiology and the director of the
Assistive Devices Center at Gallaudet
University. She participates on
numerous audiology review boards,
task forces, and committees. During
her career, she has advised over
20 governmental agencies, worked
with rehabilitative institutions in
the public and private sector, and
consulted for the telecommunications,
automotive, transportation,
entertainment, retail, construction,
and hearing aid industries. The core
of Dr. Compton-Conley’s clinical and
research work has concentrated on
improving signal-to-noise ratio for
hearing-impaired listeners. Her classic
video and workbook Doorways to
Independence earned her international
recognition. In describing her contributions,
Dr. James Jerger remarked
that she “has forgotten more about
assistive technology than the rest
of us will ever know.” Dr. Compton-
Conley demonstrates a tireless
commitment to hearing-impaired
consumers. She has motivated and
inspired students for decades and is
highly esteemed by colleagues for
contributions in the lab, the classroom,
and the community.

Dr. Hawkins is one of those rare
individuals who can function just
as easily in the research laboratory,
classroom, or clinic. He has
not only functioned in each of these
capacities, but also excelled. The
early portions of his career were in
academia, with a greater emphasis
on teaching and research, but never
to the exclusion of his interests in
clinical audiology. In fact, a hallmark
of the first 15 to 20 years of Dr.
Hawkins’ career is the application of
good science and research skills to
clinical issues confronting audiology,
especially in the area of amplification.
During the past 15 years of Dr.
Hawkins’ career, while serving as the
head of the audiology section and the
director of the Hearing Aid Clinic at
Mayo Clinic in Jacksonville, Florida,
greater emphasis has been placed on
clinical audiology, but never to the
exclusion of research and teaching.
Hallmarks of this more recent
period include many presentations
and publications on professional
ethics, group approaches to aural
rehabilitation, amplification, and
diagnostic audiology. Of course,
countless patients with whom he
has worked have also benefited
greatly from his services as a master
clinician. Perhaps the only thing surpassing
his many accomplishments
in research, teaching, and clinical
service is his great humility about
these accomplishments.
Dr. Kujawa is one of the field’s most
active and accomplished audiologists.
She is director of audiology
at Massachusetts Eye and Ear
Infirmary, associate professor of
otology and laryngology at Harvard
Medical School, and adjunct faculty
at Harvard-MIT Health Sciences and
Technology. Dr. Kujawa has made
major contributions to the fields
of audiology and hearing science.
Highlights of her service to the field
include two terms on the executive
board of the Academy, as well as the
board of directors of the American
Auditory Society, editorial board
and section editor for Ear & Hearing,
member of the Working Group
on Translational Research for the
NIDCD, and chair of the Academy
Research Committee. Dr. Kujawa’s
research record is stellar. Her current
work on the interactive effects of
noise exposure and aging on auditory
function has added important information
to our understanding of the
causes and progression of hearing
loss. She also studies the genetics,
intracochlear drug delivery systems,
and the efferent system. She has
published more than 40 scholarly
papers in the field’s most prestigious
journals. Finally, Dr. Kujawa is a
consummate teacher of audiology,
medical, and basic science students.
Dr. Saunders is a leader in the
development of new technologies for
cochlear implants and hearing aids.
Her academic qualifications include
a BS (Hon) in chemical physics and
MSc in clinical audiology from the
University of Manchester. After
completing her PhD at the University
of Southampton, she worked in
England as a clinical audiologist
and lecturer in audiology until she
moved to Australia in 1984, where
she continued her career as a clinical
and research audiologist. In 1996, she
became a project leader for commercialization
of new hearing-related
technologies at the Co-operative
Research Center for Cochlear
Implant and Hearing Aid Innovation
in Melbourne. As an example, Dr.
Saunders was part of the team that
developed and patented a shaped
implantable cochlear implant electrode,
subsequently commercialized
as the Nucleus ® Contour Electrode TM .

She has participated in the publication
of several scientific articles
regarding this device. Her most
recent business responsibility was
CEO and director of Dynamic Hearing
Pty (Australia), which develops sound
processing and DSP technology for
hearing aids and headsets. She has
recently left this position and is now
on the faculty of Monash University
in Melbourne, Australia.
Dr. Davis has a list of accomplishments
so long that there is not
enough room to present them here.
He initiated, developed, and still
manages the National Hearing
Service Newborn Hearing Screening
Program for England, a model that
set the benchmark for programs
all over the world. He and his colleagues
completed a national study
of hearing, which investigated the
prevalence of deafness and lifestyle
influences impacting the hearing
impaired in England. He initiated,
developed, and still manages the
NHS Hearing Aid Program for
England, which provides appropriate
and properly fitted hearing aids for
citizens of England, Scotland, and
Wales. Dr. Davis is known worldwide
as a scientist and researcher, with
over 200 referreed publications. He
serves on the managing council of
the International Journal of Audiology.
He is a frequent attendee and speaker
at AudiologyNOW!, and the ICA, and
in Asia, Europe, and South America.
He is so well respected and appreciated
in his own country that Queen
Elizabeth II awarded him the Order of
the British Empire.
Dr. Northrup is a bilingual audiologist
and faculty associate at Callier
Center for Communicative Disorders,
at the University of Texas, Dallas.
Her humanitarianism is expressed
daily in her work as an advocate for
children who have hearing loss but
cannot afford amplification. She has
fought for countless underserved
children with hearing impairment in
the Dallas area, and has led numerous
trips to her native Panama to
fit hearing aids on children. She
organized a team of experts from
North America to implant and program
cochlear implants for children
in Panama. As the president of the
Pan-American Society of Audiology,
she has connected colleagues from
Central and South America with
leaders in audiology from North
America and Europe. She has visited
many universities and professional
organizations in different countries
to aid in their development and
production of exchange materials.
Her approach is to “teach the teachers.”
Dr. Northrup started The Global
Village, a project designed to translate
audiological terms from English
to Spanish and Portuguese. She
has devoted her life to underserved
children with hearing impairment
and the international development
of audiology.

Dr. Fausti’s remarkable and prolific
career in audiology began with
research on human high-frequency
sensitivity and its assessment. He
has explored normal and abnormal
function, as well as the effects of
various physical and chemical toxins.
This led to the development of new
strategies, protocols, and equipment
for early identification of ototoxicity,
which has been a major focus in his
career. More recently, his research
has focused on tinnitus, which is
of course a major issue with the
veteran population that he serves. A
central theme in his research is rehabilitation,
and perhaps his proudest
achievement is the establishment of
the National Center for Rehabilitative
Auditory Research (NCRAR) in 1997,
located at the VA Medical Center in
Portland Oregon, where he currently
serves as director. Through
this Center of Excellence, Dr. Fausti
and his colleagues have continued
to produce vital research in the field
of auditory rehabilitation. He also
serves as associate chief of staff for
the Portland VA Medical Center, professor
at Oregon Health and Science
University, and adjunct professor at
Portland State University and the
University of Oregon.

Dr. Fausti’s remarkable and prolific
career in audiology began with
research on human high-frequency
sensitivity and its assessment. He
has explored normal and abnormal
function, as well as the effects of
various physical and chemical toxins.
This led to the development of new
strategies, protocols, and equipment
for early identification of ototoxicity,
which has been a major focus in his
career. More recently, his research
has focused on tinnitus, which is
of course a major issue with the
veteran population that he serves. A
central theme in his research is rehabilitation,
and perhaps his proudest
achievement is the establishment of
the National Center for Rehabilitative
Auditory Research (NCRAR) in 1997,
located at the VA Medical Center in
Portland Oregon, where he currently
serves as director. Through
this Center of Excellence, Dr. Fausti
and his colleagues have continued
to produce vital research in the field
of auditory rehabilitation. He also
serves as associate chief of staff for
the Portland VA Medical Center, professor
at Oregon Health and Science
University, and adjunct professor at
Portland State University and the
University of Oregon.

The Clinical Practice Guidelines for the Diagnosis, Treatment, and
Management of Children and Adults with Central Auditory Processing
Disorder are open for widespread peer review until March 12,
2010. Send your comments to Task Force Chair Frank Musiek,
PhD. To review the document, visit www.audiology.org,
Publications and Resources, Document Library, CAPD.
The Academy wishes to thank the Ototoxicity Monitoring
Task Force (under the Strategic Documents Committee)
for their dedication and support with the development of
this position statement and practice guidelines.
Task Force Members: John D. Durrant, PhD, University
of Pittsburgh (chair); Kathleen Campbell, PhD, Southern
Illinois University; Stephen Fausti, PhD, Portland VA Medical
Center; O’Neil Guthrie, Duke University; Gary Jacobson, PhD,
Vanderbilt University; Brenda L. Lonsbury-Martin, PhD, VA
Loma Linda Healthcare System and Loma Linda University
Medical Center; Gayla Poling, PhD, Ohio State University
The first half of FY2010 marked many accomplishments and
initiatives from our committees. Review a snapshot of the
list below and read more in the Academy’s Annual Report at
www.audiology.org (search key words “Annual Report”).
•
•
•
•
Planned and finalized the invited sessions.
Reviewed submissions for Learning Modules, Exhibitor
Courses, Student Hands-On Labs, Industry Updates,
Research Pods, and Research and Clinical Posters.
Developed special events and on-site activities.
Planned educational activities for San Diego outreach.
•
Worked on updating several member resources to
include The BEST Way: Reaching Physicians, Frontline
Office Training Kit, Audiogram of Familiar Sounds, and
Hearing Aid Checklist.
• Developed and contributed to a column in Audiology
Today on practice management.
• Participated in CMS meeting regarding the new
bundled and current single vestibular codes with representatives
from ASHA and AAO-HNS.
• Submitted responses to the proposed and final
Medicare Physician Fee Schedule rules.
• Fielded questions from members and provided updates
to FAQs for Web site.
• As members of the Audiology Quality Consortium,
continue to provide education for members for the
Physician Quality Reporting Initiative.
• Researched Medicare Opt Out issue, resulting in report to
Executive Committee, Board and member education article.
• Participated in meetings with other audiology associations
and in anti-trust training.
• Continued ongoing discussion on next steps related
to the Gold Standards Summit outcomes.
• Created Research in Audiology Education
Subcommittee to focus on the development of evidenced-based
instruction in AuD education.
• Created education column in Audiology Today.
• Recommended the development of a JAAA supplement
on evidence-based instruction.
• Clinical Education Subcommittee promoted and
further developed the Externship Registry.
• Revised the Guidelines for Financial Relationships with
Manufacturers of Hearing Devices in preparation for peer
review.
• Initiated revision of the Ethics in Audiology (Green) book.
• Responded to a multitude of inquiries from members.
• Continued to push for direct access, gaining 53 cosponsors
during the 65 days Congress was in session since
its introduction.
• Created a public policy resolution on pediatric audiology.
• Developed Key Contacts training materials and
resources.
• Hosted a Virtual Advocacy Day to promote direct access.
• Received and reviewed a total of 13 nominations;
selected eight honorees for 2010.

• Submitted nomination packages for the International
Award in Hearing.
• Supported the recommendation that Dr. John Durrant
from the University of Pittsburgh represent the
Academy and ASHA at the Affiliated Societies meeting
of the International Society of Audiologists.
• Supported the travel expenses of Academy representative
to the Pan-American Society of Audiologists
Conference.
• The Welcoming Subcommittee welcomed 141 new
members to the Academy.
• The Member Assistance Program Subcommittee reviewed
and approved 11 applications for AudiologyNOW! 2010.
• Announced that at year end 2009 the Academy had
reached 11,012 members—the highest in Academy history!
• Developed and launched a new fundraising campaign
titled “PUSH the PAC.”
• Planned a new fundraising event for AudiologyNOW!,
redesigned existing contributor circles, identified new
ways to thank contributors, and redesigned the PAC
portion of the Academy's Web site.
• Engaged students and provided more opportunities
for students to become involved with fundraising
initiatives.
• Attended RUC meeting and CPT Editorial Panel meeting
in October 2009.
• Participated in a CPT Panel Workgroup on
Intraoperative Monitoring.
• Identified, developed, and scheduled eAudiology Web
seminars six to eight months in advance.
• Participated in activities of the Audiology Quality
Consortium supporting PQRI.
• Drafted Standards of Practice document (to be finalized
April 2010).
•
•
Rolled out new member tools for National Audiology
Awareness Month and National Protect Your Hearing
Month.
The Recruitment Subcommittee launch on www.
audiology.org, with tips and tools for audiologists to
use when recruiting into the field in their local area.
•
•
Reviewed www.howsyourhearing.org Web site for
design, layout, and content.
Reviewed content of “Hearing Aids” and “Newborn
Hearing Screening” brochures.
•
•
•
Selected recipients of the Research Grants in Hearing
and Balance.
The ARC 2010 Program Committee continued to plan
the Academy Research Conference (ARC) on aging and
hearing health.
The ARC 2010 Program Chair and the staff liaison
successfully submitted an NIH conference grant
application.
•
•
•
•
Worked with the SAA board to recruit SAA chapters (38
chapters as of 12/31/09 ; 42 as of 2/9/10).
Restructured the advising process to merge the positions
of SAA Advisory Committee Chair with SAA
National Advisor.
Participated in the SAA’s strategic planning.
Worked with the SAA to develop a relationship with
the Special Olympics Healthy Hearing Program.
• Prepared for the 10th Annual State Leaders Workshop.
• Promoted the Active Advocate of the Year Award.
• Conducted a review of state licensure laws for the
AMA SOP Task Force.
• Five subcommittees made up of 19 task forces continue
to develop practice guidelines, position statements,
and reports.
• Published Ototoxicity Monitoring Practice Guidelines
and Position Statement in October 2009.

tymotic Research joined forces with the
Academy and the American Academy
of Audiology Foundation (AAAF) to
advocate for listening safety at the Midwest
Clinic, an international band and orchestra
conference which has been held in Chicago
every December for the past 64 years. The
conference attracts over 15,000 members of
the instrumental music education community
and is a great venue to promote the Turn
It to the Left message about noise-induced
hearing loss (NIHL).
Etymotic exhibits at the clinic every year,
and uses the conference as an opportunity
to speak to music educators and students
about the dangers of loud listening. Last fall,
Gail Gudmundsen, AuD, director of sales and
marketing at Etymotic, realized that youth
who attend the Midwest Clinic are the perfect
audience for Turn It to the Left, the soft-rap CD
with the message: “Protect your ears when
you’re near loud sounds, Get your hearing
tested and memorize this song…turn it to the
left, turn it to the left!”
“Awareness about the risks of musicinduced
hearing loss has grown exponentially
in the past few years, due to efforts of many
people in the audiology and hearing conservation
communities,” Gudmundsen said. “Since
the clinic exists exclusively
for educational purposes,
we were able to reach
music teachers,
directors, and students all in one setting. The
Turn It to the Left CD was another great way to
promote the message.”
In its efforts to increase public awareness
about NIHL, Etymotic made a generous gift to
the AAAF’s fund in support of noise-induced
hearing loss research. This contribution
ensured that copies of the CD were available
to students at the clinic at no charge. The
CDs not distributed at the Midwest Clinic
were given to audiologists and attendees of
the Illinois Academy of Audiology annual
meeting in Chicago, held January 20–22,
2010. Etymotic staff also provided Midwest
Clinic attendees with information on the
importance of audiological care, careers in
audiology, and other facts about healthy
hearing. For more information on the AAAF’s
NIHL research funding, contact Kathleen
Devlin Culver, director of development, at
800-226-2336, x1049 or
kculver@audiology.org.
Many thanks to our friends and colleagues
at Etymotic for helping the Academy and
AAAF increase awareness about how important
it is to Turn It to the Left!

Wednesday, April 14, 2010, 5:30 – 10:00pm at
AudiologyNOW! 2010 in San Diego.
Graciously hosted by Sadanand and Angie
Singh of Plural Publishing at their La Jolla home.
Sample fine wines from the Singh’s cellar and
enjoy the Pacific views at this elegant benefit
dinner party.
Limited number of tickets still available; call
703-226-1049 for more information.
Complimentary transportation from the
Hilton San Diego Bayfront underwritten by
HearUSA Hearing Care Network.
Proceeds to support audiology research
and education.
The AAAF challenges university AuD programs
to donate an item showcasing their
state or school spirit to our annual Auction
4 Audiology at AudiologyNOW! ® 2010. The
program whose item generates the most
bids will win a gift certificate for a celebration.
Have a night of food, fun, and a break
from the books. Interested in making a
STATEment Contact Tara Conte at tconte@
audiology.org.
•
•
•
•
•
•
•
•
•
•
•
•

HOW CAN THE ACADEMY
HELP YOU
Come to the 2010 business meeting and help us put the pieces together.
The 2010 Academy Business meeting
provides all members the opportunity to voice
their ideas on improving the Academy to staff
and leaders in round table discussions. It is
the responsibility of all members to help shape
the future of the Academy. The Academy is an
association of, by, and for audiologists, and we
need your help.
Mark your calendars for Saturday, April 17,
2010, at 1:00pm during AudiologyNOW! ® in
San Diego. Visit www.audiologynow.org for
more information.
Attendees will be entered to win one
complimentary registration to AudiologyNOW!
2011 (April 6–9, Chicago, IL).
Members can view the FY09 audited financials
and committee accomplishments on line.
Visit www.audiology.org search key word
“Annual Report”.

CHESTER COUNTY
OTOLARYNGOLOGY
& ALLERGY ASSOCIATES
Full-time and/or part-time Audiologist
needed for private practice in beautiful
Chester County, PA. Our practice
encompasses pediatric and adult care and
includes a growing hearing aid patient base.
Areas of Focus Include:
- Standard Audiologic Testing
- Vestibular Testing with VNG
- Hearing Aid Dispensing
Interested candidates please forward
resume to ccofps@comcast.net or
fax to 610-345-0986.
Ohio
WORK AND PLAY IN NEW ZEALAND
INTERNATIONAL OPPORTUNITIES FOR AUDIOLOGISTS
Have you got the spirit of
adventure
Bay Audiology is New Zealand’s
largest private practice, with over
60 clinics nationwide. This is a
well established company. Our
Audiologists provide hearing tests,
screenings, industrial monitoring,
hearing aid fitting, access to
rehabilitation programmes and
hearing aid accessories.
Opportunities
Opportunities for experienced
Audiologists with hearing aid
dispensing experience in
private practice.
Lifestyle
New Zealand’s reputation for
breathtaking scenery is unrivalled,
with expansive coastlines,
geothermal backdrops and alpine
peaks. You will have an adventure
playground on your doorstop, and
be welcomed by an existing network
of US Audiologists who have
relocated. New Zealand, a country
that is both family-friendly and
peaceful. Go to www.purenz.com for
a taste of what our beautiful country
has to offer.
When you join Bay Audiology
When you join, we’ll provide you
with:
• A strong commitment to
clinical development and
patient excellence
• A structured induction and
training program
• Succession planning with in
house training and development
programmes to enhance your
audiology and personal skills
• Further Education funding
• Variety
• Tailored benefits package
• Relocation assistance
Contact us now, and confidentially discuss your
future in Audiology. Join Bay Audiology and
Experience Life at Full Volume!
Contact: Alison Redfern-Daly
Senior HR Advisor
Mobile: 00 64 21 384707
Phone: 00 9 308 3723
Email: a.redfern-daly@bayaudiology.co.nz
Web: www.bayaudiology.co.nz

Classified and Employment Line Listing
Rates for Audiology Today
Classified and Employment Display
Advertising for Audiology Today
Web Employment Postings
Advertiser Index
Academy Products Index

April 14, 2010 | San Diego, CA | The first day of AudiologyNOW! ®
FEATURED TOPICS
ß Age-Related Hearing Loss: Demographics
and Risk Factors
ß Aging and the Auditory Periphery
ß Aging, Auditory Perception, and Hearing Aids
ß Aging and Central Auditory Neurobiology
ß
ß
ß
Aging and Clinical Electrophysiology
Age-Related Changes in Cognition:
Implications for Speech Perception
Implications of Cognitive Factors for Aural
Rehabilitation
SPACE IS STILL AVAILABLE! Save Money—Register by March 30
www.AcademyResearchConference.org
AUDIOLOGYNO W! APRIL 14—17, 2010

He’s one of the most renowned Audiologists of his time, and his musical talents are just as revered. The one
and only Charles “Chuck” Berlin, a Pioneer, an Audiologist and a Performer is about to come to a town near
you, first stop ....... San Diego.
On April 15th - 17th get a glimpse of what Persona Medical’s World Tour has to offer by stopping by booth
#1938. Listen to Chuck play classical piano and speak about new innovations in Audiology. Chuck will be
performing half past every hour during regular convention hours and will be available to answer questions
throughout the event. Get educated and entertained all at once by visiting Persona Medical at booth #1938.
Not attending AudiologyNow Don’t worry, Persona Medical’s World Tour featuring Chuck Berlin (with
special guest Michael Poe) is coming to a town near you. Please visit personamedical.com for locations,
dates and times. Limited seating is available and C.E.U. hours are provided.
personamedical.com | 800.789.6543