Clarity in sound · Brilliance in design · Simplicity in use

Dear colleagues,

WELCOME TO THE 9TH CONGRESS OF THE EUROPEAN FEDERATION OF AUDIOLOGY SOCIETIES IN TENERIFE, SPAIN

It is a great honour and a real pleasure for me to host this academic congress. From the very start, we have devoted ourselves to providing you with a scientifi c programme that includes the most relevant issues in audiology. To this aim, we have contacted professionals of this fi eld across the World. With these lines I would like to show my gratitude to all of them for their collaboration.

The opening lecture will be given by Prof. Rafael Rebolo, a senior researcher at the Astrophysics Institute of the Canary Islands. His research on the origin of the universe has led him to pioneer the discovery of the brown dwarfs in our galaxy.

The welcoming party will be held at Lago Martiánez, a collection of sea-water pools designed by the famous Canarian artist César Manrique.

On Monday we are visiting Teide, the island’s highest volcano whose last eruption took place in 1798. Eruptions are said to happen every century and only last year, after de-tecting a high emission of gases, the Government of the Canary Islands declared a yellow alert. However, it is very unlikely that an eruption takes place during our visit to Teide. But you never know!

On our way back from the volcano, we will make a stop at the beautiful town of La Oro-tava, home to many of the island’s noblest families who settled here after the Spanish Conquest. We will enjoy a typical Canary dinner at the Victorian Gardens.

The Gala Diner on Tuesday will take place at Casino Taoro. A musical group from The Carnival of Tenerife will off er us a Brazilian batukada.

On Wednesday afternoon an interesting visit to La Laguna and Santa Cruz is planned. La Laguna declared world Heritage site by the UNESCO in 1999 has been the fi rst seat of the University of the Canary Islands. Santa Cruz is the present capital of the island with a very cosmopolitan fl avour.

In summary, we have tried to combine a very interesting academic programme with an attractive social eventss.

Welcome to all of you to Tenerife.

José Barajas

Congress President, 9th EFAS Congress

Contents

3 9th EFAS Organizing Committee

5 Social programme

6 General Information

7 Scientifi c Programme

11 Programme at a Glance

13 Sunday 21 June

14 Monday 22 June

20 Tuesday 23 June

27 Wednesday 24 June

29 STRUCTURED SESSION

59 INVITED SPEAKERS

63 FREE PAPERS

121 ROUND TABLE

125 POSTER SESSION

153 AUTHOR INDEX

3The 9th European Federation of Audiology Societies Congress | 21–24 June 2009 | Tenerife, Canary Islands, Spain

9th EFAS Organizing CommitteePresident: José Juan Barajas de Prat. Scientifi c Secretariat: Franz Zenker Castro

Antonia Angulo JerezDolores de la Torre LópezJonathan Delgado HernándezRafael Fernández BeldaBeatriz González RodríguezMª del Carmen Hernández CorderoJosé Ignacio Mijangos LinazaRosa Mora EspinoJuan Mora FernándezAngel Ramos MaciasEnrique Salesa BattleAmparo Tomás Ruíz

Board of the Spanish Audiology Society

Chairman: Antonia Angulo JerezVice Chairman: Juan de Díos García MiraGeneral Secretary: Franz Zenker CastroTreasurer: Gonzalo Rubio TorresOther Executive Committee members:

Alberto Sánchez Riesco, Silvia Aybar Alcalá, Teresa Heitzmann Hernández, Amparo Postigo Madueño.

Congress Secretariat

Magna Congresos

Avda. de los Menceyes 293, edif. Cristina 2ºA38320 La Cuesta – La Laguna – S/C de TenerifeCanary Islands – SpainEmail: [email protected]: +34 922 656 262Fax: +34 922 670 188

4 Final Programme and Abstract Book

Board of the European Federation of Audiological Societies

Honorary Offi cers

Chairman: Kajsa-Mia Holgers (Sweden)Vice Chairman: Linda Luxon (United Kingdom)Past Chairman: Joseph Attias (Israel)General Secretary: Elania Pace Balzan (Malta)Treasurer: Norbert Dillier (Switzerland)

Auditors

Alexandru Pascu (Romania) , Wieslaw Sulkowski (Poland)

Nominations Committee

Theresa Pitt (Ireland), George Tavartkiladze (Russia), Kurt Stephan (Austria)

Scientifi c Advisory Board

Austria Kurt StefanBelgium Jan Wouters, Heleen LutsCroatia Borut MarnCzech Republic Jarka PrhodovaEstonia Katrin KruustilkFinland Martti Sorri, K. HuttunenFrance Lionel Collet, Rene DaumanGermany Thomas Lenarz, Jurgen Kiessling, Birger Kollmeier, Manfred GrossGreece George GavalasHungary Joseph PytelIreland Theresa PittIsrael Joseph Attias, Hillel PrattItaly Alessandro Martini, Edoardo ArslanLatvia Ligija KiseLithuania Ingrida UlozieneMalta Elania Pace BalzanNetherlands Ad Snik, Bert Van ZantenNorway Einar LaukliPoland Wieslaw Sulkowski, Mariola Sliwinska-KowalskaPortugal Margarida SerranoRomania Alexandru PascuRusia George TavartkiladzeSerbia Branca MikicSlova Republic Milan ProfantSlovenia Jagoda Vatovec, Dusan ButinanSpain José Juan Barajas de Prat, Franz Zenker, Antonia Angulo JerezSweden Kajsa Mia Holgers, Ulf Rosenhall, Konrad KonradssonSwitzerland Norbert Dillier, Thomas SpillmanTurkey Ahmet AtasUkraine Tatiana KulakovaUnited Kingdom Guy Lightfoot, Mark E. Lutman, Linda Luxon, Adrian Davis, Ewa Reglan


Social programme

Sunday 21 June at 19:30

Welcoming Reception at Lago Martiánez.The Lago Martiánez designed by famous Canarian artist César Manrique, is a vast and beautiful collection of open air salted-water pools, built right on the edge of the town on reclaimed land to the sea. These various seawater pools forms an extraordinary spot for bathing and resting. Harmonising his architecture with the exotic vegetation of the volcanic coast César Manrique created his most beautiful project.

Price: free of charge.

Monday 22 June at 17:00

Excursion to the National Park of Las Cañadas del TeideThis National Park off ers a fascinating landscape, created by the elementary forces of the volcano Teide. With a height of 3.718 meters the Teide is not only the highest mountain of Spain, but as well the highest elevation in all the Atlantic Ocean. A cableway takes visitors up to 3.600 meters. On clear days you have a fantastic view. Equally impressive is the volcano’s immense crater, with a circumference of approximately 80 kilometers. At the side of Teide there is a large fl at area called Las Cañadas, having been used by the island’s original population, the Guanches, as-pastureland. Today it is covered with petrifi ed lava of very peculiar forms. In this area exist some endemic species of plants and insects. On our way back from the volcano, we will make a stop at the beautiful town of La Orotava, home to many of the island’s noblest families who settled here after the Spanish Conquest. We will enjoy a typical Canary dinner at the Victorian Gardens.

Price per person: 75€. Book this excursion at the registration desk.

Tuesday 23 June 2009

Visit to Loro Park (Acompaying persons only)Loro Park is a man-made paradise featuring parrots, killer whales, sea lions, dolphins, penguins, gorillas, chimpanzees, jaguars, ti-gers, alligators, sharks and many other animals. The permanent mild climate in Tenerife allows to easily host these tropical animals. Located in Puerto de la Cruz, Loro Park is home to the world’s largest collection of parrots, an aquarium with a shark tunnel, a planet of penguins, and shows of dolphins, sea lions and parrots which makes it the popular holiday attraction in Tenerife.

Gala Dinner at Casino TaoroUp on a high hill above the center of Puerto is located Casino Taoro surrounded by a beautiful garden. The building served fi rst as an hotel. From the terrace and the garden you overlook a magnifi cent view of the town.

Price: free of charge.

Wednesday 24 June at 16:00

Visit to San Cristobal de La Laguna and Santa Cruz de Tenerife La Laguna declared World Heritage Site by the UNESCO in 1999 was the ancient capital of Tenerife. Has been the fi rst seat of the University of the Canary Islands. La Laguna urbanity plans follow the XVI Century Castilian towns and was the model that was follow the cities founded in America.

Santa Cruz is the capital of the island. Is a cosmopolitan city with a very busy harbour that is the principal connection within Africa, America and Europe. Along the centuries Tenerife has diff erent attempts to be conquested. On July 22, 1797 the Royal Navy tries to attack the port of Santa Cruz. Launched by Rear-Admiral Horatio Nelson, the assault was heavily defeated, and on 25 July the re-mains of the landing party withdrew under a truce with the loss of several hundred casualties. Nelson himself had been wounded in the arm, which was subsequently partially amputated.

Price: free of charge. Book this excursion at the registration desk.


General InformationCONGRESS LOCATION

Hotel Semiramis.

C/ Leopoldo Cologan Zulueta, 1238400 Puerto de la Cruz (Tenerife) ESPAÑA. Tel. +34 922 373 200 · Fax +34 922 373 193 e-mail: [email protected] GPS: 28.416111, -16.535 | 28° 24’ 58” N, 16° 32’ 6” W

REGISTRATION

Sunday, June 21, from 09:00 to 18:00. Monday, June 9, from 07.00 and throughout Symposium hours. The desk will be located at the Hotel Semiramis, Puerto de la Cruz. On registering you will receive your symposium portfolio including your name badge. You are kindly requested to wear your badge at all time during the Symposium. The Delegated and Student Registration includes: Admission to all scientifi c sessions, access to the exhibition area, conference programme, certifi cate of attendance, coff ee breaks and lunches, welcome Reception on Sunday, June 21st and Gala Dinner on Tuesday, June 23rd.

BADGESEach participant will receive a name badge upon registration. For security reasons all participants are requested to wear their bad-ge during all the congress activities and social events.

CERTIFICATE OF ATTENDANCE

All participants will receive a certifi cate of attendance at the registration.

BANKS

Banks are open between 09.00 and 14.00 on weekdays.

LOCAL TRANSPORTATION

The main mode of public transportation used throughout Tenerife is the public bus system. This is operated by TITSA. The buses in Tenerife are modern, usually run effi ciently and on-time. Fares are inexpensive, with discounts for seniors and children. The Bono Bus discount ticket (€12 or €30) allows heavily discounted fares. Purchase from bus stations, bookshops or other outlets carrying the green circle logo; simply tell the driver the destination and put the ticket in a machine which deducts the fare from the initial payment; put it in the machine twice for two people etc.

TIME

Tenerife and the rest of the Canary Islands maintain Greenwich Mean Time (GMT/UTC) which is identical to the UK. One hour be-hind of most European countries and mainland Spain.

CLIMATE

The average annual temperature varies between 18ºC (64ºF) and 24ºC (75ºF). In June the temperature range is usually between 19ºC (66ºF) and 27ºC (81ºF).

CAR HIRE

For information about Car hire, please contact the Conference Secretariat Desk. Theoretically you need an International Driving license to rent a car in the Canary Islands. However, you can rent a car with a valid standard driving license.

WIFI ZONEFree WiFi will be available in Room Islas Canarias, Tenerife, La Palma and El Hierro.


Scientifi c ProgrammeCHECK IN

Check the programme for the name of your session’s chairperson and be in your allocated session room 10 minutes before the start your session to meet with your chairperson. Do not wait until the session begins to check-in.

Presenters in morning sessions: please report to the Preview Room the day before the presentation. For Afternoon Sessions: report to the Preview Room in the morning, at latest by 11:00 am.

STRUCTURED SESSIONS

Structured sessions are dedicated to specifi c scientifi c topics which are characterized by the diversity and interdisciplinary aspect of audiology. The sessions are moderated by experienced scientist who summarize the problem area and introduce the invited speakers.

POSTER EXHIBITION

All posters will be on display during the whole meeting. Poster may be put in place from Sunday afternoon, June 21 and don’t need to be removed until Wednesday, June 24 at 14:00. Poster presenters are requested to stand by their posters during a scheduled poster session. Please, if you are presenting a poster check the time table in this book to know your session day.

FREE PAPER SESSIONS

DURATION

10-min talk

Your oral presentation should be a maximum of 10 minutes in duration (including discussion). Please plan your talk duration carefully.

Session chairpersons will be instructed to maintain a very strict time schedule:Talks will be cutoff at 8 minutes.

At 7 minutes, you will be given a 1-minute warning; at 8 minutes, if your talk continues, you will be stopped.

Discussion time will be allotted following each presentation (approximately 2 minutes).

The Preview Room will be located on Room El Hierro at Level 16th .


SponsorsWe would like to thank all exhibitors for their participation, especially the main sponsors of the EFAS2009 Congress.

LOCAL SPONSORS

GOLDEN SPONSORS

PLATINUM SPONSORS

Ayuntamiento delPuerto de La Cruz

Ayuntamiento deLa Orotava

Ayuntamiento deSanta Cruz de Tenerife


Industry ExhibitionThe industry exhibition takes place at the 17 fl oor of the Semiramis Hotel. The industry exhibition is opened during the entire con-gress (Sunday from 16:00 to 20:00, Monday to Tuesday from 08:00 to 20:00 and Wednesday from 08:00 to 16:00). Short presentation of company representatives will be given in the Room Islas Canarias on Monday and Tuesday from 14:00 to 14:30.

Booth 1: Oticon Booth 2: Oticon Booth 3: Otodynamics Booth 4: Ahead III Booth 5: Coff ee Booth 6: ISA Booth 7: HöRTech Booth 8: Advanced Bionics Booth 9: Advanced Bionics

Booth 10: Phonak Booth 11: Plural Publishing Booth 11: Coff eeBooth 14: OtologicBooth 15: Path MedicalBooth 16: GN OtometricBooth 17 and 18: WidexBooth 19 and 20: CochlearBooth 21 and 22: Medel


Programme at a Glance

SATURDAY 20th SUNDAY 21st MONDAY 22nd TUESDAY 23rd WENESDAY 24th

Room IC IC TF IC TF IC TF IC TF

7:00-7:30 AEDA 2009REGISTRATION

REGISTRATION EFAS 20097:30-8:00

8:00-8:30

ANNUALCONVENTION OF

THE SPANISHSOCIETY OFAUDIOLOGY

Lecturesin Spanish

SS01

HEARING

AIDS

SS02

TINNITUS

SS04

COCHLEAR

IMPLANTS

SS05

HEARCOM

SS07

PSYCHO

ACOUSTICS

SS08

HEARING

SCREENING

8:30-9:00

9:00-9:30

9:30-10:00

10:00-10:30 COFFEE BREAK

10:30-11:00 SS03

ISMADHA

FP

TINNITUSSS06

MEI

FP

COCHLEAR

IMPLANTS IFP

COCHLEAR

IMPLANTS V

FP

SCREENING11:00-11:30

11:30-12:00 FP

HEARING

AIDS I

FP

NIHL12:00-12:30 FP COCHLEAR

IMPLANTS II

FP

ELECTRO

AUDIOLOGY

EDUCATION12:30-13:00

13:00 -13:30LUNCH

CLOSING CEREMONY

13:30 -14:00LUNCH

14:00 -14:30 POSTERS/SCP POSTERS/SCP

14:30 -15:00 IS IS IS IS

15:00 -15:30 FP

HEARING

AIDS II

FP

AUDITORY

PROCESSING

FP

COCHLEAR

IMPLANTS III

FP

AUDIOLOGICAL

MEDICINE

15:30 -16:00

16:00 -16:30MED-EL

SATELLITEMEETING

(16:15-17:45)VISIT TO LA LAGUNA

AND SANTA CRUZ

16:30-17:00

EXCURSION TO EL TEIDE

COFFE BREAK

17:00-17:30 FP COCHLEAR

IMPLANTS IV

FP SPEECH

AUDIOM17:30-18:00

18:00-18:30OPEN CEREMONY

EFAS GA18:30-19:00 AEDA

GeneralAssembly

19:00-19:30

WELCOMERECEPTION

19:30-20:00

20:00-20:30

GALA DINNER20:30-21:00

21:00-...

IS: INVITED SPEAKER RT: ROUND TABLE FR: FREE PAPERS SCP: SHORT COMPANY PRESENTATION P: POSTERS TF: ROOM TENERIFE SS: STRUCTURED SESSIONS IC: ROOM ISLAS CANARIAS


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IASSunday 21 June

REGISTRATIONTime 7.00–15.30

MED–EL SATELLITE MEETINGTime: 16.15–17.45

Room: Islas Canarias

OPENING CEREMONYRAFAEL REBOLO LÓPEZTime: 18.00– 19.00

Prof. Rafael Rebolo has pioneered in Spain experimental research on Cosmic Microwave Background, the radiation from the Big Bang which pervades the Universe, on nucleos-ynthesis processes in the Cosmos and on the formation processes of low luminosity ob-jects like brown dwarfs, exoplanets and black holes. He is Research Professor at the High Council for Scientifi c Research (CSIC) and External Professor of the Max Planck Institute for Astronomy in Heidelberg. Co-investigator of the space mission Planck recently launched by ESA to investigate the Cosmic Microwave Background and of several international teams involved in the deve-lopment of the most advanced astronomical instrumentation including the future 42m ELT, the European project for the world largest optical infrared telescope. He is member of several boards for coordination of Astronomy in Europe and USA (EARA, OPTICON, AURA) and of the Spanish Academy of Sciences. He has been Head of Research of the Instituto de Astrofísica de Canarias, one of the largest institutions for Astronomy in Europe. Prof Rebolo has been awarded several of the most important research prizes in Spain for his studies on the radiation from the Big Bang, for the discovery in 1995 of brown dwarfs (astronomical objects intermediate between stars and giant planets, billions exist in our Galaxy) and for his studies on the origin of stellar black holes. He is currently leading several projects aimed to search for gravitational waves in the Big Bang and to detect terrestrial planets in nearby stars from the observatories of the Instituto de Astrofi sica de Canarias.

Lago Martiánez

WELCOME RECEPTIONTime: 19.30–21.30


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Room: Islas Canarias Structured Session - SS1

NOISE REDUCTION IN HEARINGS AIDS AND ITS EVALUATIONTime: 08:00 -10:00Moderator: Einar Laukli & Jürgen Kiessling

Hearing Aid Noise Reduction Based On SII-Optimization - Theoretical Foundations and Clinical Results SS101Karolina Smeds

ORCA Europe, Stockholm, Sweden.

Advanced Digital Noise Reduction SS102Eric Branda

Siemens Audiological Engineering Group, Erlangen, Germany.

Latest Developments in FM Technology SS103Hans Mülder

Phonak, Switzerland.

Open Canal Hearing Aids- Performance in Noise? SS104Marte Rønningen, Tanja Skjersli Lønseth, Elisabeth Ellingsen.

Evaluation of Noise Reduction Algorithms: Methods and Strategies SS105Jürgen Kiessling

Justus-Liebig University Giessen, Germany.

10:00 –10:30 COFFEE AND EXHIBITION Room: Islas Canarias Structured Session - SS3

REALISTIC ASSESSMENT OF SPEECH AMPLIFICATIONTime: 10:30 -11:30Moderator: Todd Fortune

A New International Speech Test Signal (ISTS) for the Assesment of Speech Amplifi cation in Hearing Aids SS301Marcel Vlaming

VU University Medical Centre, Amsterdam, The Netherlands.

Derivation and Application of a Set of StandardAudiograms for Testing Hearing Devices SS302Nikolai Bisgaard

GN Resound, Copenhagen, Denmark.

New standard test method for the characterization of hearing devices SS303Todd Fortune

GN Resound, Bloomington, USA.

Room: Islas Canarias Free papers

HEARING AIDS ITime: 11:30 - 13:00Moderator: Verschuure JSecretary: Mora R

The use of genetic information and psychophysical characteristics to determine hearing aid amplifi cation strategy FP-01Leijendeckers J, Bosman A, Pennings R, de Leenheer E, Plantinga R, Bom S,

Snik A, Huygen P, Kunst H, Cremers C.

Department of Otorhinolaryngology / Audiology, University Medical Cen-

tre St Radboud, Nijmegen

Interactive fi ttings versus prescriptive fi ttings in hearing aids FP-02Boymans M, Dreschler WA.

Academic Medical Center, Amsterdam, The Netherlands.

Prescriptions for modern hearing aids - comparison ofacoustical characteristics FP-03Smeds K, Larsson J, Hertzman S, Bergman N.

ORCA Europe, Widex A/S, Stockholm, Sweden.

Objective hearing aid fi ttings using auditory steady-state evoked responses FP-04Shemesh R, Attias J, Hassan M, Doa G.

Department of Communication Disorders, University of Haifa, Haifa, Israel.

The prescription of hearing aids features from the auditory steady state responses FP-05Zenker F (1,2), Fernández Belda R (3,1,2), Mora Espino R (4,1) and Barajas

de Prat JJ (4,2,1).

(1) Clínica Barajas (2) Fundación Dr. Barajas (3) Hospital Universitario

Nuestra Señora de la Candelaria (4) Universidad de La Laguna. S/C de Te-

nerife, Spain.

Noise reduction in modern hearing aids – short-term measurements using speech FP-06Smeds K, Bergman N, Nyman T.

ORCA Europe, Stockholm, Sweden.

Innovative approach to hearing device fi ttings FP-07Krause L (1), Holmes A E (2), Shrivastav R (3), Siburt H (4).

(1)Audigence Inc; (2,3,4)University of Florida.

New technologies for adults with pre-lingual profound hearing loss FP-08Smith J.

Audiological Consultancy, South Yarra, Australia.

13:00 – 14:00 LUNCH 14:00 – 14:30 POSTER SESSION I & SHORT COMPANY

PRESENTATIONS

Time: 14:30–15:00 Invited Speakers

BINAURAL WIRELESS SYNCHRONISATION/PROCESSING AND EXTENDED BANDWIDTH IN HEARING INSTRUMENTS: EVIDENCE OF BENEFIT IN SPATIAL PERCEPTION AND SOUND QUALITY. Ravi Sockalingam

Oticon A/S, Denmark

Room: Islas Canarias Free Papers

HEARING AIDS IITime: 15:00–16:30Moderator: Kiessling JSecretary: Fernandez R

Almost a free lunch: feedback control and high quality sound FP-09Nesgaard J, Mecklenburger J, Hernvig L, Stender T.

GN ReSound A/S, Lautrupbjerg 9 PO Box 130, DK-2750 Ballerup, Denmark.

Monday 22 June


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and production in school-age children FP-10Smith J, Dann M, Brown PM.

University of Melbourne, Australia.

The infl uence of microphone position on sound localization with hearing aids FP-11Van den Bogaert T, Carette E, Wouters J.

ExpORL, Dept. Neurosciences, K.U.Leuven, O&N2, Herestraat 49/721,

B-3000 Leuven, Belgium.

Can an in-the-ear fi tting be truly open? FP-12Jespersen CT, Moeller KN.

GN ReSound AS, Lautrupbjerg 9, 2750 Ballerup, Denmark.

Wireless technologies to enhance telephone use with hearing instruments FP-13Chalupper J (1), Ricketts T (2), Picou E (2).

(1) Siemens Audiologische Technik, Germany; (2) Vanderbilt University,

USA

Music appreciation of hearing aid users FP-14Looi V, Rutledge K.

The Department of Communication Disorders. The University of Canter-

bury. Christchurch, New Zealand.

Evaluation of subjective and functional outcome measures in hearing rehabilitation in the dispenser’s practice FP-15Kaandorp MW (1), Goverts ST (1), Drok T (2), Kramer SE (1), Festen JM (1).

(1) ENT-Audiology, VU University Medical Center, Amsterdam, The Nether-

lands; (2) Hinkgroep, Amersfoort, the Netherlands.

Motivation of potential fi rst time hearing aid users FP-16Nielsen C.

Eriksholm Oticon Research Centre. Denmark

Cognitive development and reading performance in hearing-impaired children with hearing aids FP-17Lyxell B(1), Uhlén I (2), Sjödin C (2), Mårtensson I (2), Johansson A (2),

Wass M (1).

University of Linköping, Swedish Institute for Disability Research HEAD,

Sweden; (2) CLINTEC, Karolinska Institutet, Stockholm, Sweden.

17:00 EXCURSION TO EL TEIDE


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TINNITUS: MECHANISMS AND TREATMENTTime: 08:00-10:00Moderator: Carlos Herraiz

Auditory neural plasticity in normal hearing and in tinnitus SS201Larry Roberts

Department of Psychology, Neuroscience, and Behaviour, McMaster Uni-

versity, Hamilton, Ontario, Canada.

Somatosensory Tinnitus: mechanisms, clinical characteristics and management SS202Tanit Sanchez

Otolaryngology University of São Paulo, São Paulo, Brazil.

Pharmacology for Tinnitus management. An update SS203Carol Bauer

Southern Illinois University School of Medicine. USA.

Sound therapies for Tinnitus treatment SS204René Dauman

Otolaryngology Department, Unit of Audiology, University of Bordeaux

and University Hospital, Bordeaux. France.

Treatment of Tinnitus with repetitive transcranial magnetic stimulation (rTMS) SS205Tobias Kleinjung

Department of Otorhinolaryngology, University of Regensburg, Germany.

10:00 – 10:30 COFFEE AND EXHIBITION Room: Tenerife Free Papers

TINNITUSTime: 10:30-11:30Moderator: Dauman RSecretary: Blanco J

A postal survey of tinnitus management in general practice- results of a pilot study FP-18Sriskandarajah V, Jayarajan V.

Dept of Audiological Medicine, Royal Surrey County Hospital, Guildford,

UK.

Comparison of tinnitus severity between patients with nearly normal hearing and those with hearing impairment FP-19Geczy BB, Vatovec J, Zargi M.

Department of Otorhinolaryngology and Cervicofacial Surgery, University

Medical Center Ljubljana, Slovenia.

Tinnitus matching in feigned tinnitus FP-20Adelman C (1,2), Priner R (1,2), Fraenkel R (2), Levi H (1,2).

(1) Speech and Hearing Center, Hadassah University Hospital, Jerusalem,

Israel; (2) Department of Communication Disorders, Hadassah Academic

College, Jerusalem, Israel.

Evaluation of the cochlear and eff erent function in normal hearing tinnitus subjects: analysis of multiparametric global features and time-frequency fi ne structure of otoacoustic emissions FP-21Paglialonga P (1), Tognola G (1), Parazzini M (1), del Bo L (2), Ravazzani

P (1).

(1) CNR Institute of Biomedical Engineering, Milan, Italy; (2) Fondazione

Ascolta e Vivi, Milan, Italy.

Psychometric properties of a Chinese (cantonese) version of the Tinnitus Questionnaire FP-22Kam ACS (1), Cheung APP (2), Cahn PYB (3), Leung EKS (4), Wong TKC (4),

Tong MCF (1), Van Hasselt C(1).

(1) Department of Otorhinolaryngology, Head & Neck Surgery, Chinese

University of Hong Kong, Hong Kong; (1) 1 Institute of Human Commu-

nicative Research, Chinese University of Hong Kong, Hong Kong; (2) 2 Yan

Chai Hospital, Hong Kong; (3) 3 Pamela Youde Nethersole Eastern Hospi-

tal, Hong Kong; (4) Prince of Wales Hospital, Hong Kong

Eff ects of repetitive transcranial magnetic stimulation on chronic tinnitus: an egyptian study FP-23El-Nabil LM(1), Khalil LH (2), Amal F (1).

(1) Department of Neurology and Psychiatry, Ain Shams University, Cairo,

Egypt (2) Department of Audiology, Ain Shams University, Cairo, Egypt.

Room: Tenerife Free Papers

NOISE INDUCED HEARING LOSSTime: 11:30- 13:00Moderator: Sliwinska-Kowalska MSecretary: Mora J

Mechanisms of noise induced hearing loss and its alleviation FP-24Adelman C (1,2), Tamir S (3), Perez S (3), Weinberger J (4), Sohmer H (2)

(1) Speech and Hearing Center, Hadassah University Hospital; (2) Dept. of

Physiology, Hebrew University-Hadassah Medical School; (3) Dept. of Oto-

laryngology and Head & Neck Surgery, Shaare Zedek Medical Center; (4)

Dept. of Otolaryngology and Head & Neck Surgery, Hadassah University

Hospital; Jerusalem, Israel

Low DPOAES with normal audiograms and the risk of early hearing loss at noise exposure : predictive value of an otoacoustic vulnerability index FP-25Job A(1), Raynal M (2), Kossowski M (2).

(1) CRSSA centre de recherches du service de santé des armées, France; (2)

Hopital d’instruction des Armées de Percy, France.

Prevalence of 6 KHz “notch” in populations of adolescents and young adults FP-26Le Prell CG (1), Guire K (2), Hall JW (1), Holmes AE (1).

(1) University of Florida; (2) University of Michigan, USA.

Developing hearing conservation program for rolling stock plant workers FP-27Sliwinska-Kowalska M (1,2), Zamojska M (1), Dudarewicz A (1), Kotylo P

(1), Pawelczyk M (1), Pawlaczyk-Luszczynska M (1).

(1) Nofer Institute of Occupational Medicine, Lodz, Poland; (2) Medical

University of Lodz, Poland.

Monday 22 June


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EDPOAES and susceptibility to tinnitus in normal hearing subjects exposed to noise FP-28Job A (1), Raynal M (2), Kossowski M (2).

(1) CRSSA centre de recherches du service de santé des armées, France; (2)


Modeling noise induced hearing loss FP-29Tronstad T V, Kvaloy O.

SINTEF ICT, Norway.

High frequency audiometric notch: an outpatient survey FP-30Yeoh LH, Osei-Lah V.

St Helier University Hospital, UK.

Occupational noise-induced hearing loss in poland: epidemiology and statistics throughout 1999 - 2008 FP-31Sulkowski WJ (1), Szymczak W (2).

(1) Clinic of Occupational Diseases and Toxicology; (2) Department of

Environmental Epidemiology. Nofer Institute of Occupational Medicine,

Lodz, Poland.

Dynamic hearing protection for people with hearing loss FP-32Mülder HE, Goldbeck F.

Phonak Communications AG, Switzerland.

Oral D- Methionine (MRX-1024) signifi cantly protects against Cisplatin- induced hearing loss: a phase II study in humans FP-33Campbell KCM (1), Nayar R (2), Borgonha S (2), Hughes L (1), Rehemtulla

A (3), Ross B (3), Sunkara P (3).

(1) Southern Illinois University School of Medicine, Springfield, IL, USA;

(2) St. John’s National Academy of Sciences, Bangalore, India; (3) Molecu-

lar Therapeutics, Ann Arbor, Michigan, USA.

13:00 – 14:00 LUNCH 14:00 – 14:30 POSTER SESSION I & SHORT COMPANY

PRESENTATIONS Time: 14:30 - 15:00 Invited Speakers

THE MEANING OF LANGUAGE AS EMBODIED REPRESENTATIONS IN THE BRAINManuel de Vega

La Laguna University - Canary Islands


AUDITORY PROCESSINGTime: 15:00 - 16:30Moderator: Rudner MSecretary: Zenker F

Recognition of dichotic double digits in young and elderly cantonese-speaking listeners FP-34Kam ACS (1), Keith RW (2).

(1) Department of Otorhinolaryngology, Head & Neck Surgery, Chinese

University of Hong Kong, Hong Kong and Institute of Human Communi-

cative Research, Chinese University of Hong Kong, Hong Kong; (2) De-

partment of Otolaryngology, University of Cincinnati, US.

Normative values for Polish dichotic digit test FP-35Senderski A (1), McPherson D (2), Kochanek K (1), Piotrowska A (1), Skar-

zynski H. (1)

(1) Institute of |Physiology and Pathology of Hearing Warsaw, Poland; (2)

Brigham Young University Provo, USA.

Dichotic digits test – what it can tells us about learning and communication abilities of school age children FP-36Senderski A (1), McPherson D (2), Kochanek K (1), A.Pilka A.(1), Skar-

zynski H.(1)

(1) Institute of Physiology and Pathology of Hearing Warsaw, Poland; (2)


Plasticity of the auditory system in the elderly FP-37Lavie L, Attias J, Karni A.

University of Haifa.

On the surprisingly prolonged developmental trajectory of (central) auditory processing FP-38Banai K.

University of Haifa, Israel.

Eff ect of age on unilateral and bilateral edulink fi tting in normal hearing subjects FP-39Mukari SZ, Umat C, Abdul Razak UA, Mannan NH, Mohamad S.

Department of Audiology & Speech Sciences, Universiti Kebangsaan Ma-

laysia, Malaysia.

Presbyacusis – what is a reason for decreasing speech intelligibility? FP-40Marn B.

Children’s University Hospital Zagreb, Croatia.

Types of hearing impairment - defi nitions changing over time FP-41Neumann K (1), Stephens D (2).

(1) Department of Phoniatrics and Pediatric Audiology, University of

Frankfurt, Frankfurt am Main, Germany; (2) School of Medicine, Cardiff

University, Cardiff, Wales.

Comparison of conventional auditory processing evaluation with a newly developed non verbal auditory processing battery in a pediatric population FP-42Iliadou V (1), Ferguson MA (2), Kaprinis St (1), Moore DR (2).

(1) Clinical Psychoacoustics Laboratory, Medical School Aristotle Univer-

sity of Thessaloniki, Greece; (2) MRC Institute of Hearing Research, Not-

tingham, UK.

17:00 EXCURSION TO EL TEIDE


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POSTER SESSION PITime: 14:00 -14:30Moderator: Mora J.

Distortion product otoacoustic emissions and extended high-frequency (ehf) audiometry in normal-hearing patients with unilateral tinnitus P101Fabijanska A (1), Smurzynski J (2), Kochanek K (1), Skarzynski H (1).

(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland; (2)

Department of Communicative Disorders, East Tennessee State University,

Johnson City, TN, U.S.A.

Application of the auditory brainstem response for scaling impulsive and continuous noise P102Kochanek K (1), Zera J (2,3), Pilka A (1), Mlynski R (2), Skarzynski P (1).

(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland;

(2) Central Institute of Labour Protection – National Research Institute,

Warsaw, Poland; (3) Faculty of Electronics and Information Technology,

Warsaw, Poland.

Long-term clinical outcomes of tinnitus treatment based on acoustic stimulation P103Tavora-Vieira D, Bellekom S, Miller S.

Medical Audiology Services

Impact of tinnitus on quality of life among tinnitus counselling clinic patients P104Joyce Lim JBH (1), Peter Lu KS (1), David Koh SQ (2), Eng SP (1).

(1) Changi General Hospital, Singapore; (2) National University of Singa-

pore, Singapore.

Changes in short-term auditory memory following the use of edulink in children with auditory processing disorders P105Umat C (1), Zamratol-Mai Sarah Mukari S (1), Farhana Badrul Ezan N (1),

Normah Che’ Din C (2).

(1) Department of Audiology & Speech Sciences, Faculty of Allied Health

Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; (2)

Health Psychology Unit, Faculty of Allied Health Sciences, Universiti Ke-

bangsaan Malaysia, Kuala Lumpur, Malaysia.

Screening with AAAST in 6-7 year old children in elementary schools in Poland P106Coninx F (1), Senderski A (2), Kochanek K (2), Lorens A (2),

Skarzynski H.(2)

(1) Institut für Audiopädagogik, at the Univ. of Cologne, Germany; (2)

International Center for Hearing and Speech, Kajetany/Warsaw, Poland.

Results of hearing screening in school age children in eastern Poland P107Skarżyński H (1), Kochanek K (1), Senderski A (1), Sułkowski W (2)

(1) Institute of Physiology and Pathology of Hearing Warsaw Poland, ( 2)

The Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland

SSW: Right-handed versus left-handed P108Araújo S, Conceição T, Ferreira S, Marques D, Mateus T, Pedrosa S, Serrano M

Escola Superior de Tecnlogia da Saúde de Coimbra. Viseu, Portugal.

Development of a monosyllabic adaptive speech test for the identifi cation of central auditory processing disorder P109O’Beirne GA, McGaffin AJ.

University of Canterbury, New Zealand.

Students at the University of Santiago de Compostela and personal music players listening P110Vazquez C, del Oro Saez CP, Gigirey LM.

Audilogy Unit. University of Santiago de Compostela.

Use of self-assessed questionnaires as dual sensory screening tools in galician government nursery homes P111Vazquez C, del Oro CP, Gigirey LM.

University of Santiago de Compostela, Spain.

Eff ect of occluding the round window on noise induced hearing loss P112Sichel J Y (1), Perez R (1), Freeman S (2), Sohmer H (2).

(1) Dept. of Otolaryngology and Head and Neck Surgery, Shaare Zedek Me-

dical Center; (2) Dept. of Physiology, Hebrew University-Hadassah Medical

School, Jerusalem, Israel.

Comparison of the speech and pitch perception skills of children using a cochlear implant, hearing aids, or bimodal stimulation P113Looi V (1), Radford C (1), Peryman P (2,1).

(1) Department of Communication Disorders, University of Canterbury,

Christchurch, New Zealand; (2) Van Asch Deaf Education Centre, Christ-

church, New Zealand.

The infl uence of additive noise and reverberation on listening diffi culty: reaction time study P114Blaszak MA (1), Majewska N (2), Rydzewski B (3).

(1) Adam Mickiewicz University, Poznan, Poland; (2) Karol Marcinkowski

Medical University, Poznan, Poland; (3) ENT Department, Franciszek Ras-

zeja Municipal Hospital, Poznan, Poland.

Adult-list equivalency testing and comparison of speech recognition between male and female voice P115Trimmis N (1), Markatos N (1), Malaperdas K (1), Papadas T (2)

(1) Department of Speech Pathology. Technological Educational Institute

of Patras; (2) Department of Otolaryngology. University Hospital of Patras.

Development of a nonsense speech recognition test in Modern Greek P116Trimmis N (1), Makri V (1), Markatos N (1), Gouma P (2)

(1) Department of Speech Pathology. Technological Educational Institute

of Patras; (2) 251 General Air Force Hospital.

Cortical auditory evoked potentials (CAEPS) in children with cochlear implant and children with normal hearing P117Mukari SZ (1), Umat C (1), Chan SC (1), Zakaria MN (2), Mohd Yusoff N

(1), Ali A (1).

(1) Dept of Audiology and Speech Sciences, Universiti Kebangsaan Malay-

sia, Kuala Lumpur, Malaysia; (2) Dept of Audiology & Speech Pathology,

Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Time-frequency analysis of click-evoked otoacoustic emissions recorded with linear and nonlinear protocols P118Jedrzejczak WW (1), Smurzynski J (2), Kochanek K (1), Skarzynski H (1).



Johnson City, USA.

Technical aspects of stimulus presentation through the hearing aid for ASSR recording P119Bronyakin SA, Belov OA, Tavartkiladze GA.

National Research Centre for Audiology and Hearing Rehabilitation,

Moscow,Russia.

Monday 22 June


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Papakonstantinou A, Riedel H, Kollmeier B.

Carl von Ossietzky University of Oldenburg, Germany.

How well do ABR thresholds in newborns predict behavioral thresholds at 6-18 months? P121Uhlén I, Geng R.

Karolinska University Hospital, Stockholm, Sweden.

Benefi t of the bone-anchored hearing aid with diff erent auditory profi les P122van Wieringen A (1), Bosman AJ (2), De Voecht K (3), Wouters J (1).

University of Melbourne, Australia. (1) ExpORL, Department of Neuros-

ciences, KULeuven, Herestraat 49 bus 721, B-3000 Leuven, Belgium; (2)

Department of Otorhinolaryngology, University Medical Centre St. Rad-

boud, Nijmegen, The Netherlands;(3) ENT-dept, UZLeuven, Kapucijnen-

voer 33, B-3000 Leuven, Belgium.

The speech-test changes in patients with binaural hearing aid P123Golubok-Abizova T (1), Deyeva Y (2).

(1) Kiev Regional Hospital, Ukraine;(2) Bogomolet`s Natiomal MedicalU-

niversity, Ukraine.

Universal neonatal hearing screening programm: 5 years results P124Díaz FJ, García-Alvarez G, García-Dueñas J, Seguí P, Jiménez M, Masegosa P.

ENT Department, Complejo Hospitalario Universitario de Albacete, Spain.

Universal neonatal hearing screening in the institute of child and adolescent health P125Sargsyan A (1), Movsesova N (2), Gevorkyan A (2), Shukuryan A (1), Baba-

yan L (2), Manukyan T (2).

(1) State Medical University of Armenia; (2) Institute of child and adoles-

cent health. Yerevan, Armenia.

Screening neonates with MSSR to simultaneously presented bone- and air- conducted stimuli P126Pérez Abalo MC, Hernández MC, Santos E, Rodríguez E, Hernández O, To-

rres A.

Cuban Neuroscience Center, La Habana, Cuba.


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COCHLEAR IMPLANTS AND OTHER AUDITORY IMPLANTSTime: 08:00 -10:00Moderator: G. O’Donoghue & Thomas Lenarz

Signal processing for speech and music SS401Norbert Dillier

Laboratory of Experimental Audiology, ENT Department, University Hos-

pital Zurich, Switzerland

Quality assurance in a growing cochlear implant programme SS402J. Müller-Deile

HNO-Klinik, Christian-Albrechts-Universität, Kiel, Germany

Complications and follow-up in cochlear implantation SS403Angel Ramos Macias

Hospital Universitario Insular de Gran Canaria, Spain

Hybrid Implants and new modes of stimulation of the cochlear SS404Thomas Lenarz

Medical University of Hannover, Department of Otolaryngology, Hannover,

Germany

Quality of life and cost-benefi t issues in cochlear implantation SS405O’Donoghue G.

10:00 – 10:30 COFFEE AND EXHIBITION Room: Islas Canarias Structured Session - SS6

ACTIVE MIDDLE EAR IMPLANTS IN CONDUCTIVE AND MIXED HEARING LOSSTime: 10:30 -12:00Moderator: Ad Snik

First results with the DACS (direct acoustic cochlear stimulation) implantable hearing system SS601Kompis M (1), Stieger C (1), Bernhard H (2) and Haeusler R (1).

(1) Department of ENT, Head, Neck Surgery, University of Berne, Switzer-

land; (2) Helbling Technik Bern AG, Liebefeld, Switzerland.

Vibroplasty surgery, surgical aspects and audiological results SS602Colletti V

ENT Department, University of Verona, Italy.

Incus vibroplasty versus round window vibroplasty; Hannover results SS603Lenarz T

Dept. of Otorhinolaryngology, Medical University of Hannover, Germany.

Cochlear windows positioning of the Vibrant Soundbridge: results from Meran SS604Giarbini N, Costanzo S, Streitberger C

ENT and Head-Neck Surgery Department, Hospital of Meran, Italy.

Otologics fully implantable hearing device phase II clinical trials SS605Jenkins HA, Lupo V, Claycomb S

University of Colorado Denver School of Medicine, USA.

Room: Islas Canarias Free papers

MIDDLE EAR AND COCHLEAR IMPLANTS IITime: 12:00 - 13:00Moderator: Dillier NSecretary: Mora R

Binaural hearing with BAHAS. Re-evaluation of Nijmegen data FP-43Snik A, Mylanus E, Bosman A, Cremers C.

ENT department, University Medical Centre St Radboud, Nijmegen, The

Netherlands.

Privileges and limitations of implantable hearing aids in an audiological long term surveillance FP-44Mojallal H, Hinze A, Stöver T, Schwab B, Lenarz T.

Department of Otorhinolaryngology, Medical University of Hannover.

A new signal enhancement algorithm for cochlear implant users with hires120: results of a pilot study FP-45Saalfeld H (1), Brendel M (1,2), Litvak L (3), Frohne-Buechner C (1,2),

Lenarz T (1), Buechner A (1)

(1) Medical University of Hannover, Department of Otolaryngology, Han-

nover, Germany; (2) Advanced Bionics GmbH, Hannover, Germany; (3) Ad-

vanced Bionics LLC, Valencia, USA.

Preference and performance with hires and hires 120 during the fi rst three months after fi rst fi tting FP-46Saalfeld H (1), Lenarz T (1), Lesinski-Schiedat A (1), Frohne-Buechner C

(1,2), Buechner A (1)


nover, Germany; (2) Advanced Bionics GmbH, Hannover, Germany.

Cross-over study for evaluation of the strategy HIRES 120 in new users FP-47Brendel M (1,2), Buechner A (1), Saalfeld H (1), Frohne-Buechner C (1,2),

Lenarz T (1)



The new BTE processor for Advanced Bionics’ fi rst generation cochlear implant: the C1 Harmony FP-48Brendel M (1,2), Rottmann T (1), Buechner A (1), Frohne-Buechner C (1,2)

Lenarz T (1)



13:00 – 14:00 LUNCH 14:00 – 14:30 POSTER SESSION II & SHORT COMPANY

PRESENTATIONS

Time: 14:30–15:00 Invited Speaker

CONTROVERSIES IN COCHLEAR IMPLANTATIONManuel Sainz

Granada University

Tuesday 23 June


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COCHLEAR IMPLANTS IIITime: 15:00 - 16:30Moderator: Lenarz TSecretary: Mora J

A 3D force measurement system: application in the development of a minimally traumatic electrode array FP-49Lenarz T

Medical University of Hannover, Department of Otolaryngology, Hannover,

Germany

Resistance changes in the CI electrode array channels during the fi rst year of rehabilitation FP-50Tavartkiladze GA, Kruglov AV.

National Research Centre for Audiology and Hearing Rehabilitation. Mos-

cow, Russia.

Digital implementation of a fast response acoustic impedance meter for the fi tting of speech processors in patients supplied with CI FP-51Stephan K, Lanziner-Furtenbach R.

Department for Hearing, Speech and Voice Disorders. Innsbruck Medical

University. Innsbruck, Austria

Intracorporeal cortical telemetry: the cochlear implant as EEG device? FP-52Beynon AJ, Luijten BL, Snik AFM.

Auditory Evoked Potential Lab.Radboud University Nijmegen Medical Cen-

tre. Donders Institute for Brain, Cognition and Behaviour. The Netherlands.

Electrophysiological measurement of the perceptual distance of neighbouring electrodes in cochlear implant systems FP-53Hoppe U (1), Wohlberedt T (1), Danilkina G (1), Lerahn J (1),

Hessel H (2).

(1) University of Erlangen, Dept. of Audiology, Waldstr. 1, D-91054 Erlan-

gen, Germany; (2) Cochlear GmbH, Hannover, Germany.

Factor analysis of hearing preservation after cochlear implantation FP-54Piotrowska A, Lorens A, Jedrzejczak WW, Skarzynski H.

Institute of Physiology and Pathology of Hearing, Warsaw, Poland.

Long term and short term results of partial deafness cochlear implantation (PDCI) FP-55Skarzynski H, Lorens A, Podskarbi-Fayette R, Piotrowska A.

Institute of Physiology and Pathology of Hearing, Warsaw, Poland

Design considerations and initial clinical experience with a prototype totally implantable cochlear implant research device FP-56Cowan RSC (1, 3), Briggs R (1, 3), Plant KL (1, 2), Eder HC (1, 2), Seligman

PM (1, 2), Dalton J (1, 2), Money DK (1, 2), Patrick JF (1, 2)

(1) The HEARing CRC, Melbourne, Australia; (2) Cochlear Limited, Mel-

bourne, Australia; (3) The Department of Otolaryngology, University of

Melbourne, Australia.

Sparse processing for Cochlear Implants FP-57Lutman ME, Li G

Institute of Sound and Vibration Research, University of Southampton, UK

Simulated interaural place mismatch of cochlear implant electrodes leads to breakdown of the ability to suppress refl ections FP-58Seeber BU.

MRC Institute of Hearing Research, Nottingham, UK.

Results of the European adult multi-centre HIRES ® 120 study FP-59Buechner A (1), Lenarz T (1), Boermans PP (2), Frijns J (2), Mancini P (3),

Filipo R (3), Fielden C (4), Cooper H (4), Eklof M (5), Freijd A (5), Lombaard

S (6), Meerton L (6), Pickerill M (7), Vanat Z (7), Wesarg T (8), Aschendorff

A (8), Kienast B (9), Arnold L (9), Boyle P (9), Meyer B (10), Sterkers O

(11), Mueller-Deile J (12), Ambrosch P (12), Helbig S (13), Frachet B (14),

Gallego S (15), Truy E (15), Jeffs E (16), Morant A (17), Marco J (17)

(1) Medical University of Hannover, Germany; (2) Leids Universitair Me-

disch Centrum. The Netherlands; (3) University of Rome “La Sapienza”,

Italy; (4) Birmingham Adult Cochlear Implant Programme, UK; (5) Karo-

linska University Hospital, Huddinge, Sweden; (6)RNTNE Cochlear Implant

Programme London, UK; (7) The Emmeline Centre, UK; (8) Albert-Lud-

wigs-Universität Freiburg, Germany; (9) Advanced Bionics, France; (10)

St Antoine, France; (11) Beaujon Clichy, France; (12) Christian-Albrechts-

Universität zu Kiel, Germany; (13) Klinikum d J W Goethe Universität,

Frankfurt, Germany; (14) Avicenne, France; (15) Hopital Edouard Herriot,

France; (16) Nottingham Cochlear Implant Program, UK; (17) Hospital Cli-

nico Universitario, Spain.

16:30 –17:00 COFFEE AND EXHIBITION Room: Islas Canarias Free Papers

COCHLEAR IMPLANTS IVTime: 17:00-18:00Moderator: Sainz MSecretary: Angulo A

Speech perception scores and self-assessment of sound perception after cochlear implantation FP-60Hast A, Wohlberedt T, Digeser F, Hoppe U.

Department of Audiology, ENT clinic, University Hospital Erlangen, Medi-

cal School, Waldstraße 1, 91054 Erlangen, Germany.

Language perception of infants with cochlear implants FP-61Gerrits E.

Maastricht University Medical Centre, The Netherlands.

What can we expect of spoken language development after infant cochlear implantation? FP-62Gerrits E.

Maastricht University Medical Centre, The Netherlands.

Adult cochlear implant users’ vowel confusions during four years of CI use FP-63Välimaa T (1),Sorri M (2), Laitakari J (2), Sivonen V (2,3)

(1) Faculty of Humanities/Logopedics;(2) Department of Clinical Medi-

cine/Otorhinolaryngology, University of Oulu, Finland;(3) Department of

A&S Psychology, University of Louisville, USA.

Speech based optimization of cochlear implants FP-64Krause L (1), Holmes AE (2), Shrivastav R (3), Siburt H (4)

(1) Audigence Inc; (2,3,4) University of Florida.

Methodological aspects of evaluation of frequency discrimination in cochlear implant listeners FP-66Digeser FM (1), Pogorzelski J (1), Hast A (1), Hessel H (2), Hoppe U (1).

(1) Department of Audiology, ENT Clinic, University Hospital Erlangen,

Germany; (2) Cochlear GmbH, Hannover, Germany.

18:00 – 20:00 EFAS GENERAL ASSEMBLY 20:00 GALA DINNER


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HEARING AND COMMUNICATIONTime: 08:00 -10:00Moderator: Marcel Vlaming

Hearing screening tests by telephone and internet: HEARCOM implementations in European countries SS501M. Buschermöhle (1), K.C. Wagener (2), M. Downs (3), M. E. Lutman (4),

B. Larsby (5), M. Hällgren (5), J. Lyzenga (6), E. Ozimek (7), J. Wouters (8)

and B. Kollmeier (1), (2), (9)

(1) HörTech gGmbH Oldenburg, Germany; (2) Hörzentrum Oldenburg

GmbH, Germany; (3) Executive Director of Science and Enterprise, RNID,

London, United Kingdom; (4) Institute of Sound and Vibration Research,

University of Southampton, United Kingdom; (5) Linköping University,

Department of Clinical and Experimental Medicine, Division of Technical

Audiology, Linköping, Sweden; (6) Department of ENT Communication, VU

Medical Center, Amsterdam, The Netherlands; (7) Institute of Acoustics,

Adam Mickiewicz University Poznan, Poland; (8) ExpORL, Department of

Neurosciences, K.U.Leuven, Belgium and (9) Medizinische Physik, Carl von

Ossietzky Universität Oldenburg, Germany.

Development and application of an “auditory profi le” for the classifi cation of hearing impairments SS502Wouter A. Dreschler (1), Thamar van Esch (1), Birgitta Larsby (2), Mathias

Hällgren (2), Mark E Lutman (3), Johannes Lyzenga (4), Matthias Vorman

(5), Birger Kollmeier (5)

(1) Academic Medical Center, Amsterdam, The Netherlands; (2) Linköping

University, Linköping, Sweden; (3) Institute for Sound and Vibration Re-

search, Southampton, United Kingdom; (4) VU University Hospital, Ams-

terdam, The Netherlands; (5) HörTech GmbH, Oldenburg, Germany.

Multilingual hearing diagnostics for Europe SS503Birger Kollmeier (1),( 2),( 3); K.C. Wagener (2); M. Buschermöhle (1); M.

Vormann (2); M. Zokoll (3); M. E. Lutman (4); B. Larsby (5), J. Lyzenga (6);

T. Van Esch (7) and W. A. Dreschler (7)

(1) HörTech gGmbH D- Oldenburg; (2) Hörzentrum Oldenburg GmbH,

D- Oldenburg; (3) Medizinische Physik, Carl von Ossietzky Universität

Oldenburg, D-Oldenburg; (4) Institute of Sound and Vibration Research,

University of Southampton, UK-Southampton; (5) Linköping University,

Department of Audiology, S-Linköping; (6) Department of ENT Commu-

nication, VU Medical Center, NL- Amsterdam and (7) Academic Medical

Center, NL-Amsterdam.

Perceptual evaluation of standard and new signal enhancement strategies SS504Heleen Luts (1), Koen Eneman, Jan Wouters, Michael Büchler, Norbert

Dillier, Wouter Dreschler, Matthias Froehlich, Giso Grimm, Niklas Harlan-

der, Volker Hohmann, Rolph Houben, Sofie Jansen, Arne Leijon, Anthony

Lombard, Dirk Mauler, Marc Moonen, Henning Puder, Michael Schulte, Ann

Spriet, Matthias Vormann.

(1) ExpORL, Dept. Neurosciences, K.U.Leuven, Belgium

A wireless public announcement system for use with hearing devices SS505Marcel Vlaming (1), J. Sainz (2) and B. Grover (3)

(1) VU University Hospital, Amsterdam, Netherlands; (2) Moviquity, Ma-

drid, Spain, Sweden; (3) The Royal National Institute For Deaf People,

London, United Kingdom. 10:00 – 10:30 COFFEE AND EXHIBITION


COCHLEAR IMPLANTS ITime: 10:30-12:00Moderator: Ramos ASecretary: Hernández Cordero MC

Transient deafness in young candidates for cochlear implants FP-66Attias J (1,2), Raveh E (3)

(1) Department of Communication Disorders, University of Haifa, Haifa;

(2) Institute for Audiology and Clinical Neurophysiology; (3) Department

of Otorhinolaryngology, Schneider Children’s Medical Center of Israel and

Rabin Medical Center, Petah Tiqwa, affiliated with Sackler Faculty of Me-

dicine, Tel Aviv University, Tel Aviv, Israel.

Quality of life outcomes for adult cochlear implant recipients and their signifi cant other FP-67Looi V, Mackenzie M, Bird P.

The Department of Communication Disorders. The University of Canter-

bury. Christchurch, New Zealand.

Results of application of FSP coding strategy in children – satisfaction and preference study FP-69Lorens A, Zgoda M, Skarzynski H.


Teachers’ perspective on reading and writing abilities of children with a cochlear implant FP-70Stephen AA, Umat C, Zamratol-Mai S, Mukari S.

Department of Audiology & Speech Sciences, Faculty of Allied Health

Sciences, Universiti Kebangsaan Malaysia 50300 Kuala Lumpur, Malaysia.

Reading ability and academic performance in malay language in children with a cochlear implant FP-71Stephen AA, Umat C, Zamratol-Mai S, Mukari S.

Department of Audiology & Speech Sciences, Faculty of Allied Health

Sciences, Universiti Kebangsaan Malaysia 50300 Kuala Lumpur, Malaysia.

Perception and training of emotional aff ectation in speech by CI users FP-72James CJ, Laborde ML, Orreteguy L, Riviere A, Fraysse B.

Hôpital Purpan, CHU Toulouse, France.

Development of auditory memory in cochlear implanted children over time FP-73Mikic B, Miric D, Ostojic S, Asanovic M, Mikic M.

Clinical Center of Serbia, Insitute of ENT. Belgrade, Serbia.

Room: Tenerife Free papers

AUDITORY ELECTROPHYSIOLOGYTime: 12:00 – 13:00Moderator: Laukli ESecretary: Delgado J

Evaluation of low frequency otoacoustic emissions in subjects with normal and impaired hearing FP-74Jedrzejczak WW, Lorens A, Piotrowska A, Kochanek K, Sliwa L, Skarzynski H.

Institute of Physiology and Pathology of Hearing, Warsaw, Poland

Tuesday 23 June


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EDistorsion product otoacoustic emission (DPOAE) examinations in patients with type-1 diabetes mellitus FP-75Tóth F, Várkonyi TT, Sevacsek Zs, Rovó L, Lengyel Cs, Légrády P, Jóri J,

Kiss JG.

Department of Otolaryngology, Head and Neck Surgery; (1) 1st De-

partment of Medicine, University of Szeged, Szeged, Hungary.

Application of automated OAE and ASSR algorithms to evaluation of hearing sensitivity in normal-hearing and hearing impaired subjects FP-76Sliwa L (1), Jedrzejczak WW (1), Hatzopoulos S (2), Kochanek K (1), Pilka

E (1), Skarzynski H (1)


University of Ferrara, Italy.

Eff ect of peer review on accuracy of reported ABR hearing thresholds in newborn hearing screening programme referrals FP-77Raglan E, Radomskij P, Sudhagar K.

St George’s Healthcare NHS Trust. London, UK.

Auditory Steady-State responses in dyslexic readers: a defi cit in auditory temporal processing? FP-78Poelmans H (1), Luts H (1), Boets B (2), Vandermosten M (2), Ghesquiére

P (2), Wouters J (1)

(1) ExpORL, Dept. Neurosciences, K.U.Leuven, Belgium; (2) Center for Pa-

renting, Child Welfare and Disabilities, K.U.Leuven, Belgium.

Uncomfortable loudness levels in normal hearing adults derived from the Auditory Steady State responses FP-79Mora Espino R (1,2), Zenker F (1,2), Fernández Belda R (3,1,2), and Bara-

jas de Prat JJ (4,2,1)

(1) Fundación Dr. Barajas, S/C de Tenerife, Spain;(2) Clínica Barajas, S/C de

Tenerife, Spain; (3) Hospital Universitario Nuestra Señora de la Candela-

ria, S/C de Tenerife, Spain; (4) Universidad de La Laguna. S/C de Tenerife,

Spain.

Auditory steady-state responses in young infants: thresholds and latencies FP-80Alaerts J (1), Luts H (1), Van Dun B (1,2), Desloovere C (3), Wouters J (1)

(1) ExpORL, Dept. Neurosciences, K.U.Leuven, Belgium;(2) SCD-SISTA,

Dept. of Electrical Engineering (ESAT), K.U.Leuven, Belgium;(3) Dept. Oto-

Rhino-Laryngology, Head and Neck Surgery, University Hospitals Leuven,

Belgium.

Cortical auditory steady-state responses and speech understanding FP-81Alaerts J, Luts H, Hofmann M, Wouters J.

ExpORL, Dept. Neurosciences, K.U.Leuven, O&N 2, Herestraat 49/721,

B-3000 Leuven, Belgium 13:00 – 14:00 LUNCH 14:00 – 14:30 POSTER SESSION II & SHORT COMPANY

PRESENTATIONS Time: 14:30–15:00 Invited Speakers

GENETICS OF HEARING LOSSEnrique Salido

Research Unit, Hospital Universitario de Canarias, S/C de Tenerife,

Spain


AUDIOLOGICAL MEDICINETime: 15:00 - 16:30Moderator: Luxon LSecretary: Fernández R

Audiovestibular manifestations in hyperlipidaemia FP-82Jayarajan V, Prasher D, Topass N, Vangapalli S.

Royal Surrey County Hospital, Guildford, England

A proportional meta analysis study of hearing loss in Turner’s Syndrome FP-83Dasgupta S (1), Das VK (2)

(1) Manchester Royal Infirmary, UK; (2) University of Manchester, UK.

A suggested mechanism for the air-bone-gap in superior canal dehiscence syndrome FP-84Sichel J Y (1), Perez R (1), Sohmer H (2)

Major and minor head injuries – a clinical study on the eff ects on the human temporal bone FP-85Fenech AJ (1), Camilleri MT (2)

(1) Audiology unit, Department of Otolaryngology Mater Dei Hospital

Malta; (2) Department of Anatomy, University of Malta.

Fractures of the human temporal bone - a new plane of sectioning FP-86Fenech AJ (1), Camilleri MT (2), Michaels L (3)

(1) Anatomy Department, University of Malta and Department of Oto-

laryngology, Mater Dei Hospital, Malta; (2) Anatomy Department, Univer-

sity of Malta; (3) University of London, United Kingdom.

The importance of the audiological assessment combined with the paediatric ent assessment FP-87Willis-Lorrier RMS, Vinck S, Homans NC, Verschuure J.

Audiological Centre, ENT Department, Erasmus Medical Centre. Rotter-

dam, The Netherlands.

Autoimmune inner ear diseases and channelopathies as possible aetiologies for tinnitus and meniere’s disease; a review FP-88Refaie AE.

Bristol University; UK.

DPOAES in patients with defi nite Ménière’s disease FP-89Al-Saif S (1), AbdelTawwab MM (2).Consultant of ORL, KFMMC Hospital, Dhahran, KSA, Egypt (1); Lec-turer of Audiology, ENT Department, Faculty of Medicine, Mansoura University, now Audiological Physician in KFMMC Hospital, Egypt (2).

Aetiology of benign paroxysmal positional vertigo FP-90Pace Balzan E, Borg C, Farrugia E.

Audiology Unit, Department of Otolaryngology and Head and Neck Sur-

gery, Mater Dei Hospital, Msida, Malta.

Bilateral vestibular failure FP-91Cvjetko T, Aras I, Vlahovic S, Celap M.

Polyclinic for speech and hearing rehabilitation,Zagreb Croatia,Department

of Otorhinolaryngology. Zagreb, Croatia.

Eff ects of hearing impairment on psychosocial health and need for recovery after work in adults aged between 18-70 years: results from an internet-based national survey on hearing FP-92Nachtegaal J (1,5), Smit JH (2,5), Smits C (1,5), Goverts ST (1,5), Anema

JR (3,4,5), Festen JM (1,5), Kramer SE (1,5)

(1) Department of ENT/Audiology, VU University Medical Center, Ams-

terdam, The Netherlands. (2) Department of Psychiatry, VU University

Medical Center, Amsterdam, The Netherlands. (3) Department of Public

and Occupational Health, VU University Medical Center, Amsterdam, The

Netherlands. (4) Research Centre for Insurance Medicine, AMC – UWV – VU

University Medical Center, Amsterdam, The Netherlands. (5) EMGO Institu-

te for Health and Care Research, VU University Medical Center, Amsterdam,

The Netherlands.


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Jóri J.University of Szeged, Department of Otolaryngology and Head and Neck Surgery; (1) University of Szeged, Department of Image Proces-sing and Computer Graphics; (2) Sun Microsystems Hungary Ltd.

16:30 – 17:00 COFFEE AND EXHIBITION


SPEECH AUDIOMETRYTime: 17:00 –18:00Moderator: Kollmeier BSecretary: Zenker F

Development and evaluation of two speech intelligibility tests for francophone listeners FP-94Jansen S (1), Luts H (1), Wagener K (2), Kollmeier B (3), Frachet B (4),

Wouters J (1)

(1) ExpORL, Department of Neurosciences, KULeuven, Herestraat 49 bus

721, B-3000 Leuven, Belgium; (2) Hörzentrum Oldenburg, Germany; (3)

Carl von Ossietzky University of Oldenburg, Germany; (4) Hôpital Avicen-

ne, Université Paris XIII, FrancePresbyacousie, France.

Speech discrimination in spatially separated noise in the group of unilateral deaf children fi tted with BAHA and conventional CROS systems FP-95Piotrowska A, Lorens A, Mrowka M, Olszewski L, Charukiewicz A, Skar-

zynski H.


Sound localization and speech perception in bilateral users of Vibrant Soundbridge (VSB) FP-96Koci V, Sprinzl G, Zorowka P.

Innsbruck Medical University, Austria.

The eff ect of a carrier phrase and response alternatives on speech intelligibility in quiet for two monosyllabic tests FP-97Sukowski H (1), Brand T (1), Wagener KC (2), Kollmeier B (1,2)

(1) Medizinische Physik, Universität Oldenburg, Germany; (2) Hörzentrum

Oldenburg, Germany

Clinical applicability of adaptive speech testing: a comparison of the administration time, accuracy, effi ciency and reliability of adaptive speech tests with conventional speech audiometry FP-98O’Beirne GA, Sincock BP, Starfinger C.

University of Canterbury, New Zealand.

The cochlear discrimination test in very young children FP-99Cuda D, Murri A, Guerzoni L, Briccola E, Frontera P.

Department of Otolaryngology, “Guglielmo da Saliceto” Hospital, Piacen-

za, Italy.

Greek speech audiometry test-phase 2 FP-100Iliadou V (1), Eleftheriadis N (2)

(1) Medical School, Aristotle University of Thessaloniki; (2) Audiological

Center Agias Sofias 23 Thessaloniki. Greece.

Development of a paediatric audio-visual speech test in noise FP-101Arnold L (1), Canning D (2), Dykmans P (1), Vanpoucke F (1)

(1) Advanced Bionics Europe; (2) Hear2Learn Ltd. 18:00 – 20:00 EFAS GENERAL ASSEMBLY

20:00 GALA DINNER


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POSTER SESSION PII Time: 14:00 -14:30 Moderator: López Vázquez M

Sensitivity to interaural cues in children with bilateral cochlear implants P201Van Deun L (1), Van Wieringen A (1), Scherf F (2), Offeciers FE (3), Des-

loovere C (4), Van de Heyning PH (2), Dhooge I (5), Deggouj N (6), Wouters

J (1)

(1) ExpORL, Dept.Neurosciences, K.U.Leuven, Belgium ; (2) Univ.Dept.

ORL, Antwerp University Hospital, University of Antwerp, Belgium; (3)

Dept.ORL, AZ St Augustinus, Wilrijk, Belgium; (4) Dept.ORL, UZLeuven,

Belgium; (5) Dept.ORL, UGent, Belgium; (6) Service ORL, Clinique St-Luc-

UCL Bruxelles, Belgium.

Sentence comprehension in adult cochlear-implant users as revealed by late ERPS P202Hahne A (1), Wolf A (1), Müller J (2), Friederici AD (1)

(1) Max-Planck-Institute of Human Cognitive and Brain Sciences, Ger-

many; (2) Julius-Maximilian-Universität Würzburg, Germany.

FM systems in cochlear implants users. Benefi t over speech recognition in noise P203Mora Espino R (1,2), Zenker F (1,2), Fernández Belda R (3,1,2), and Bara-

jas de Prat JJ (4,2,1)

(1) Fundación Dr. Barajas, S/C de Tenerife, Spain;(2) Clínica Barajas, S/C de

Tenerife, Spain; (3) Hospital Universitario Nuestra Señora de la Candela-

ria, S/C de Tenerife, Spain; (4) Universidad de La Laguna. S/C de Tenerife,

Spain.

Perception of speech in reverberant conditions using AM-FM cochlear implant simulation P204Drgas S, Blaszak, M.A.

Adam Mickiewicz University, Faculty of Physics, Institute of Acoustics,

Poznan, Poland.

Comparison of imaging plates & high-resolution CCD for X-Ray micro-focus imaging of cochlear implants P205Xu J (1, 3), Stevenson AW (2), Cowan RSC (1, 4)

(1) The HEARing CRC, Melbourne, Australia; (2) CSIRO Materials Science

and Engineering, Australia; (3) The Bionic Ear Institute, Melbourne, Aus-

tralia; (4) The Department of Otolaryngology, University of Melbourne,

Australia.

Application of the diary of early language (DI-EL®) in monitoring language development in infants using cochlear implants and hearing aids P206Cowan RSC (1, 5), Nott P (1, 2), Brown M (3), Wigglesworth G (4)

(1) The HEARing CRC, Melbourne, Australia; (2) Advisory Council for Chil-

dren with Impaired Hearing, Melbourne, Australia; (3) The Department of

Early Learning, University of Melbourne, Australia; (4) The Department

of Linguistics, University of Melbourne, Australia; (5) The Department of

Otolaryngology, University of Melbourne, Australia.

Issues in translating new materials and technologies to clinical applications P207Cowan RSC (1, 2)

(1) The HEARing CRC, Melbourne, Australia; (2) The Department of Oto-

laryngology, University of Melbourne, Australia.

A musical journey through the rainforest: a resource to develop musical pitch in children with cochlear implants P208Rocca C (1,2), Driver S (3), Stark E, Gazibegovic D, Arnold L(2).

(1) Mary Hare Schools, UK; (2) Advanced Bionics Europe; (3) Guy’s and St.

Thomas’ Hospital, UK.

STAR2 validation working group: testing cochlear implant users in real-life listening conditions P209Arnold L, Joffo LM, Boyle P.

Advanced Bionics, Clinical Research Department.

Postmeningitic ossifi ed cochleas. Implications for Cochlear Implantation P210Seguí Moya P (1),Blanco Cabañero AG (2), Diaz Fernández J (1), Villar

García M (2)

(1) Servicio de ORL del Complejo Hospitalario Universitario de Albacete;

(2) Servicio de Radiología del Complejo Hospitalario Universitario de Al-

bacete.

Preliminary results using the “Fitting to Outcomes Expert” (FOX®) P211Govaerts PJ (1), Buechner A (2), Nunn T (3), Brendel M (2,4), Vaerenberg B

(1), Ceulaer GD (1), Daemers K (1), Jiang D (3), Lenarz T (2), O’Connor AF (3).

(1) The Eargroup, Antwerp, Belgium; (2) Medical University of Hannover,

Department of Otolaryngology, Hannover, Germany; (3) Guy’s and St. Tho-

mas’ Hospitals; (4) Advanced Bionics GmbH, Hannover, Germany.

Evaluation of speech perception and speech development in children using HIRES 120 P212Akhmetshin (1), Attias J (2), Cervera J (3), Della Volpe A (4), Driver S (5),

Ernst A (6), Hanvey K (7), Jones J (8), Kameswaran M (9), Manoj MP (10),

Marco J (11), Neumann K (12), Niemczyk S (13), Sainz M (14), Vadhera M

(15), Vaid N (16), Gazibegovic D (17)

(1) Rep. Children Hospital, Ufa, Russia, (2) Schneider Children’s Medical

Center, Tel-Aviv, Israel, (3) Hospital del Nino Jesus, Madrid, Spain, (4) Os-

pedale Santobono, Neaples, Italy, (5) St. Thomas’ Hospital, London, UK,

(6) Unfallkrankenhaus Berlin, Berlin, Germany, (7) Aston University Day

Hospital, Birmingham, UK, (8) Oxford Cochlear Implant Program, Oxford,

UK, (9) Madras ENT Research Foundation, Chennai, India, (10) Dr.Manoj’s

Superspeciality Institute and Research Centre, Calicut, India, (11) Hospital

Clinico Universitario de Valencia, Valencia, Spain, (12) Klinikum der J.W.

Goethe Universität, Frankfurt, Germany, (13) University Clinic, Warsaw,

Poland, (14) Hospital Clinico San Cecilio, Granada, Spain, (15) Meenakshi

Speech and Hearing Clinics, Delhi, India, (16) KEM Hospital and Research

Center, Pune, India, (17) Advanced Bionics, Clinical Research Department.

Cochlear implant in patient with Waardenburg syndrome P213Kosanovic R, Stojanovic S, Petrovic-Lazic M, Babac S.

ORL Clinic City Hospital, Belgrade, Serbia.

Multidimensional acoustic analysis of patients before and after training in self-perceiving voice by hearing P214Petrovic-Lazic M, Babac S, Vukovic M, Dobrota N.

Faculty for Special Education and Rehabilitation, University of Belgrade, Serbia

The electrically-evoked acoustic change complex in cochlear implant users P215Beynon A, Keck TN, Snik AFM.

Auditory Evoked Potential Lab, Radboud University Nijmegen Medical

Centre Donders Institute for Brain, Cognition and Behaviour, Centre for

Neuroscience, Dept of Otorhinolaryngology. Nijmegen, The Netherlands.

Tuesday 23 June


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recipients with residual low-frequency hearing P216Incerti P, Parkinson A, James C, Gorrie J, Pesch J, Plant K, Bouchataoui I.

Cochlear Ltd, Sydney, Denver, Toulouse, Melbourne, Hannover and Meche-

len.

Newborn Hearing Screening P217Falcón González JC, Borkoski Barreiro S, Rodríguez Jiménez MC, Lopez

Cano Z, Chicarro Soria I, Ramos Macías A

Unidad de Hipoacusia. Servicio de Otorrinolaringología y Cabeza y Cue-

llo. Complejo Hospitalario Universitario Insular Materno Infantil de Gran

Canaria, Spain.

Long-term follow up of psychophysical parameters in cochlear implant users P218Kiss JG, Tóth F, Szamosközi A, Torkos A, Jarabin J, Rovó L, Jóri J.

University of Szeged, Department of Otolaryngology and Head and Neck

Surgery, Szeged, Hungary.

Genetic fi ndings of selected patients with non-syndromic hearing loss, and their relatives P219Nagy AL (1), Csáki R (3), Tóth F (1), Klem J (2), Tálosi G (4), Rovó L (1),

Kovács K (2), Jóri J (1), Kiss JG (1)

(1) University of Szeged, Department of Otolaryngology, Head and Neck

Surgery, Szeged, Hungary; (2) University of Szeged, Department of Bio-

technology, Szeged, Hungary; (3) Alfa-Biosoft Ltd., Szeged, Hungary; (4)

University of Szeged, Department of Pediatrics, Szeged, Hungary.

Acoustic voice measurement in patients with Broca’ s Aphasia P220Vukovic M, Petrovic Lazic M.

Faculty of Special Education and Rehabilitation, University of Belgrade,

Serbia.

Help apheresis in sudden hearing loss treatment P221Bianchin G, Renna L, Guastamacchia P.

Otolaringology Department. Santa Maria Nuova. Hospital of Reggio Emi-

lia. Italy.

Genetic variants of GJB2-related deafness in north caucasus P222Bozhkova V (1), Khashaev ZK (1), Umanskaya TM (2)

(1) Institute for Information Transmission Problems of RAS, Russia; (2)

Faculty of Defectology of Moscow State Pedagogical University, Russia.

Vestibular rehabilitation – an eff ective management for acute unilateral vestibular dysfunction P223Zupan L.

ENT Department, General Hospital Celje, Oblakova ulica 5, 3000 Celje,

Slovenija.

Diagnosis dead regions in children P224Malicka A

The University of Manchester, UK


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PSYCHOACOUSTICS, SPEECH PERCEPTION AND AUDITORY SIGNAL PROCESSINGTime: 08:00 – 10:00Moderator: Birger Kollmeier

Suprathreshold processing defi cits in hearing-impaired listeners as revealed in the “auditory profi le” SS701Wouter A. Dreschler

The Netherlands

Processing of temporal fi ne structure information by hearing-impaired listeners SS702Christian Lorenzi

Equipe Audition (LPP CNRS-Paris 5 #8158). Dept d’Etudes Cognitives. Ecole

Normale Supérieure 29 rue d’Ulm. 75005 Paris, France

Use of a loudness model to derive a method for fi tting hearing aids with extended high-frequency bandwidth SS703Brian Moore

Department of Experimental Psychology, University of Cambridge, Dow-

ning Street, Cambridge, CB2 3EB, UK.

Modelling speech intelligibility in steady and fl uctuating noise for normal and hearing impaired listeners SS704Thomas Brand

Carl von Ossietzky Universität Oldenburg, Germany.

Modelling sensorineural hearing loss with a nonlinear auditory front-end SS705Torsten Dau

Centre for Applied Hearing Research, Department of Electrical Enginee-

ring, Technical University of Denmark, DK-2800 Lyngby,Denmark.

Modeling binaural speech intelligibility of hearing-impaired listeners in adverse conditions SS706Rainer Beutelmann, Brand T, Kollmeier B

Medizinische Physik, Universität Oldenburg, Germany.


Room: Islas Canarias Free Papers

COCHLEAR IMPLANTS VTime: 10:30 – 13:00Moderator: Tavartkiladze GASecretary: Angulo A

Music listening software for adult cochlear implant users FP-102Geffriaud G (1), Rocca C (2)

(1) Institut Saint-Pierre, Service d’Audiophonologie, 34250 Palavas les

flots, France. Hospital Gui de Chauliac, Service ORL, 34000 montpellier,

France. (2)Mary Hare School, United Kingdom. Advanced Bionics Europe,

France.

Subjective rating of music perception with two generations of the Advanced Bionics cochlear implant system FP-103Kreibohm K (1), Adams D (1), Brendel M (1,2), Ruehl S (1), Lesinski-Schie-

dat S (1), Buechner A (1), Lenarz T (1).



Evaluation of music perception in adult users of HIRES® 120 and previous generations of Advanced Bionics® sound coding strategies FP-104Gazibegovic D (1), Arnold L (1), Rocca C (1,2), Boyle P (1).

(1) Advanced Bionics Europe, France; (2) Mary Hare, London, UK.

Custom program for improving the music perception with Advanced Bionics’ system FP-105Boyle P (1), Wansbury V (3), Gazibegovic D (1), Rocca C (1,2)

(1)Advanced Bionics Europe; (2) Mary Hare, London, UK; (3) Portland,

London, UK.

The Neuro-Compensator: a hearing compensation algorithm based on cochlear modeling and machine learning FP-106Becker S (1), Pango P (2), De Laat JAPM (3)

(1) McMaster University of Toronto, Canada; (2) VitaSound Audio, Ontario,

Canada; (3) Leiden University Medical Center, Netherlands.

Longitudinal outcomes of children with hearing impairment (LOCHI): nterim research fi ndings on language development FP-107Mahler N,Ching T, Brower A, Cook C, Cornick S, Crowe K, Day J, Flynn C, Hou

S, Krynda G, Law C, McGhie K, Mahler N, Martin V, Street L, van Buynder

P, Youn S, Zhang V.

National Acoustic Laboratories. Brisbane, Australia.

Clinical outcomes of the European MP3000™ optimization study in Freedom™ recipients FP-108Beynon A (1) ,Szyfter W (2) ,Allum J (3) ,Brokx J (4) ,Burdo S (5) , Cuda D

(6) , Dhooge I (7) , Dillier N (8) , Estrada Leypón E (9) , Eyles J (10), Falcón

González JC (11) , Festen J (12), Frachet B (13) , Fürstenberg D (14), Gen-

tine A (15) , Gräbel S (16), Grolman W (17) , Hey M (18) , Hoppe U (19) ,

Huarte Irujo A (20) , Leone C.A (21) ,Mazzoli M (22) , Meyer B (23) , Morera

Pérez C (24) , Müller-Deile J (25) , Müller-Mazzotta J (26) , Niemczyk K

(27) , Offeciers E (28), Paludetti G (29) , Quaranta A (30) , Roux-Vaillard

S (31) , Steffens T (32) , Triglia J (33) , Uziel A (34), VandeHeyning P (35)

, Wesarg T (36) , Pesch J (37) , Rypkema G (37) , Killian M (37), Büchner

A (38).

(1) Nijmegen-NL; (2) Poznan-PL; (3) Basel-CH; (4) Maastricht-BE; (5)

Varese-IT; (6) Piacenza-IT; (7) Gent-BE; (8) Zurich-CH; (9) Barcelona-ES;

(10) Southampton-UK; (11) Las Palmas-ES; (12) VU Amsterdam-NL; (13)

Bobigny-FR; (14) Köln-GE, (15) Strasbourg-FR; (16) Berlin-GE; (17) AMC

Amsterdam-NL; (18) Halberstadt-GE; (19) Erlangen-GE; (20) Pamploma-

ES; (21) Naples-IT; (22) Padua-IT; (23) Paris-FR; (24) Valencia-ES; (25)

Kiel-GE; (26) Marburg-GE; (27) Warsaw-PL; (28) Wilrijk/Antwerp-BE; (29)

Rome-IT; (30) Bari-IT; (31) Angers-FR; (32) Regensburg-GE; (33) Mar-

seille-FR; (34) Montpellier-FR; (35) Antwerp-BE; (36) Freiburg-GE; (37)

Cochlear-EU; (38) MHH Hannover-GE.

Evaluation of everyday listening situations of children and adolescents and their use of accessories to improve hearing with cochlear implants FP-109Kreibohm K (1), Adams D (1), Brendel M (1,2), Ruehl S (1), Lesinski-Schie-

dat A (1), Buechner A (1), Frohne-Buechner C (1,2), Lenarz T (1)



13:00 – 13:30 CLOSING CEREMONY 13:30 – 14:30 LUNCH

16:00 – 20:00 VISIT TO LA LAGUNA AND SANTA CRUZ

Wednesday 24 June


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HEARING SCREENING IN ADULTSTime: 08:00 -10:00Moderator: Ferdinando Grandori

The European Project AHEAD III on assessment of hearing in adults and the elderly SS801Grandori F

Institute of Biomedical Engineering CNR, Milan, Italy.

Main eff ects of age related hearing loss SS802Walger M

ENT University Hospital, Department of Audiology and Cochlear Implant

Center, Cologne, Germany.

Strategies of intervention after screening for hearing in adults/elderly SS803Kramer SE (1), Davis A (2) Parazzini M (3), Thodi C (4), Smith P (2), Ste-

phens D (5), Anteunis L (6), Grandori F (3 )

(1) VU University Medical Center, Department of ENT/Audiology, Ams-

terdam, The Netherlands; (2) University of Manchester, MRC Hearing and

Communication Group, United Kingdom; (3) Institute of Biomedical Engi-

neering, Milan, Italy; (4) CH & M Cyprus Audiology Center Interacoustics

Ltd, Cyprus; (5) Cardiff University, Cardiff, Wales; (6) Maastricht University

Medical Centre, Dept. of ORL, Div. Audiology, The Netherlands.

Hearing screening in adults: a conceptual model SS804Davis A, Smith P

University of Manchester, MRC Hearing and Communication Group, United

Kingdom.



NEWBORN HEARING SCREENINGTime: 10:30 -12:00Moderator: Raglan ESecretary: Hernández Cordero MC

Hearing diagnostics in children using DPOAE and pure-tone thresholds FP-110Janssen T (1),Bohnert A (2),Heller O (3), Schirkonyer V (1), Oswald H (4),

Zoth P (4), Keilmann A (2)

(1) Technische Universität München, Germany; (2) Universität Mainz,

Germany; (3) Universität Würzburg, Germany; (4) Path medical GmbH,

Germany.

Assessment of usefulness of objective and audiometric methods in hearing screening of schoolchildren FP-111Sliwa L (1), Kochanek K (1), Pilka A (1), Senderski A (1), Sulkowski W (2),

Skarzynski PH (1)


Nofer Institute of Occupational Medicine, Lodz, Poland.

Diagnosis after a universal neonatal screen FP-112Verschuure J, Willis-Lorrier RMS, Homans N, Brocaar MP, de Gier HHW,

Hoeve LJ.

Hearing and Speech Center, ENT department, Erasmus MC.

A decade of universal hearing screening in Flanders, routine and cobble-stones FP-113Van Kerschaver E.

Kind en Gezin, Brussels, Belgium.

Expected advantage of combined audiological and genetic screening of newborns FP-114Tavartkiladze GA (1), Polyakov AV (2), Markova TG (1)

(1) National Research Centre for Audiology and Hearing Rehabilitation,

Moscow, Russia, (2) Moscow Medical Genetic Research Centre, Moscow,

Russia.

Strategic issues in newborn hearing screening programs planning and implementation FP-115Tognola G (1), Tavartkiladze G (2), Grandori F(1)

(1) CNR Institute of Biomedical Engineering,Milan, Italy; (2) National Re-

search Centre for Audiology and Hearing Rehabilitation, Moscow, Russia.

Universal new born hearing screening program in KFMMC Hospital FP-116Al-Saif S (1), AbdelTawwab MM (2)

Consultant of ORL, KFMMC Hospital, Dhahran, KSA, Egypt (1); Lecturer of

Audiology, ENT Department, Faculty of Medicine, Mansoura University,

now Audiological Physician in KFMMC Hospital, Egypt (2).

Strategic issues in newborn hearing screening programs planning and implementation FP-117Tognola G (1), Tavartkiladze G (2), Grandori F(1).

(1) CNR Institute of Biomedical Engineering,Milan, Italy; (2) National Re-

search Centre for Audiology and Hearing Rehabilitation, Moscow, Russia.

Audiometric screening of 8-14 year old children - results of the German environmental survey for children (GERES IV) FP-118Babisch W, Schulz C, Seiwert M, Becker K, Conrad A, Zigelski C, Kolossa-

Gehring M.

Federal Environment Agency, Dessau/Berlin, Germany.

Room: Tenerife Round Table

EDUCATION IN AUDIOLOGYTime: 12:00 - 13:00Moderator: Kajsa-Mia HolgersPanelists: Birger Kollmeier, Linda Luxon, Tiago Ferrão

13:00 – 13:30 CLOSING CEREMONY 13:30 – 14:30 LUNCH 16:00 – 20:00 VISIT TO LA LAGUNA AND SANTA CRUZ

Wednesday 24 June

STRUCTURED SESSION


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1SS01NOISE REDUCTION IN HEARINGS AIDS AND ITS EVALUATION

Monday 22nd / 08:00 am / Room Islas Canarias

The latest development in hearing aid technology has introduced several new options related to noise suppression and speech enhancement. The modern microprocessor-controlled instruments have improved during the last 5-10 years, and today we would expect a better performance for the hard of hearing users. Is that so?

Technology itself may develop in many positive ways, but the important thing is that the users will have the necessary benefi t from this development.Modern signal processing on one side and the validation results on the other must be correlated in a way so that we can verify the technical improvements.

This session consists of two parts, fi rst three papers from diff erent companies presenting signal pro-cessing algorithms and then three papers with validation results, partly by speech in noise testing and also by questionnaire studies.

Moderator:Einar Laukli (Norway) [email protected]

Jürgen Kiessling (Germany) [email protected]

Speakers:Karolina Smeds (Sweden)

HEARING AID NOISE REDUCTION BASED ON SII-OPTIMIZATION - THEORETICAL FOUNDATIONS AND CLINICAL RESULTS Eric Branda (Germany)

ADVANCED DIGITAL NOISE REDUCTION Hans Mülder (Switzerland)

LATEST DEVELOPMENTS IN FM TECHNOLOGY Marte Rønningen (Norway)

OPEN CANAL HEARING AIDS - PERFORMANCE IN NOISE? Jürgen Kiessling (Germany):

EVALUATION OF NOISE REDUCTION ALGORITHMS: METHODS AND STRATEGIES

Mary Rudner (Sweden)

SELF-RATED EFFORT, COGNITION AND AIDED SPEECH RECOGNITION IN NOISE


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SS101

HEARING AID NOISE REDUCTION BASED ON SII-

OPTIMIZATION–THEORETICAL FOUNDATIONS AND

CLINICAL RESULTS

Karolina SmedsORCA Europe, Stockholm, Sweden.

Maximizing speech intelligibility is a fundamental underlying ratio-nale for gain prescription, and the rationale has been implemented for instance in NAL-NL1, a well-known prescription for nonlinear hearing aids. The NAL-NL1 prescription is based on optimization of the speech intelligibility index (SII) in quiet for an average speech spectrum.

Modern hearing aids normally incorporate single-microphone noise reduction algorithms. Using multi-channel adaptive amplitude com-pression, the gain in each channel may be determined not only by the total signal level, but also by the speech audibility in that chan-nel. Frequency-specifi c gain adaptations are then applied to reduce the gain in any time segment and any frequency band where the speech audibility is temporarily low. However, measurements at our laboratory have shown that noise reduction algorithms from various hearing aid manufacturers work in very diff erent ways, and they are probably based on very diff erent underlying rationales.

The noise reduction system implemented in a recent hearing aid mo-difi es a prescribed, baseline, hearing aid gain using SII-optimizations. These optimizations are made based on the hearing loss of the hea-ring aid wearer and on short-term estimates of the speech and noise spectra. The gain can be modifi ed relative to the baseline prescribed gain, and the algorithm tends to lead to large gain reductions in the low-frequency range, and to some increased gain at high frequencies for certain signal-to-noise ratios.

In the current presentation, an SII-based rationale for the noise re-duction system implemented in a recent hearing aid will be presen-ted in addition to clinical results where the particular noise reduction system is evaluated in the fi eld and in the laboratory.

[email protected]

SS102

ADVANCED DIGITAL NOISE REDUCTION

Eric BrandaSiemens Audiological Engineering Group, Erlangen, Germany.

It is generally accepted that a common concern among hearing ins-trument wearers is the use of amplifi cation in noisy environments. The various types of noise as well as loudness levels can impact the amount of annoyance perceived by the hearing instrument wearer. It has also been supported that the basic skill required for speech understanding in noise is “auditory stream segregation” (Bregman 1990), which refers to the capability to sort environmental sounds and identify their original sources.

With the growth of digital hearing instruments over the past several years, algorithms to address the noise issue have grown as well. Ad-vanced digital noise reduction (DNR) techniques have become more or less “standard” in today’s hearing aids. The methods of detection and implementation can vary for diverse types of noise.

However, even advanced DNR techniques do not separate speech from noise, but rather reduce noise when noise is dominant. These implementations are generally found not to increase intelligibility in noise, but to help increase the listening comfort in noise. Additiona-lly, DNR might be capable of supporting auditory stream segregation and thus, improve ease-of-listening and decrease cognitive eff ort for speech perception.

An understanding of the behavior of DNR in hearing instruments can help the practicing clinician in adjustment of the hearing instru-ments as well as in counseling the hearing instrument wearer. This presentation will focus primarily on the technical principles of noise reduction techniques as used in hearing aids.

SS103

LATEST DEVELOPMENTS IN FM TECHNOLOGY

Hans MülderPhonak, Switzerland.

A recently developed new FM platform, Dynamic FM, combines traditional analogue FM radio waves with sub audio digital control signals, inductive two way communication between receivers and transmitter, and a digital 2.4 GHz wireless network technology bet-ween transmitters. By making use of new algorithms, the behavior of the FM system has become adaptive: the FM advantage is no longer a fi xed value, but depends on the ambient noise level. The result is a signifi cant improvement of the signal to noise ratio beyond that of traditional FM systems. An outline of the new platform and its main features, including sound samples, will be presented.


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SS104

OPEN CANAL HEARING AIDS- PERFORMANCE IN NOISE?

Marte Rønningen, Tanja Skjersli Lønseth, Elisabeth Ellingsen.

This is a study performed by two Bachelor students in Trondheim, Norway, about open canal hearing aids. The aim of the study was to investigate if these hearing aids improve the perception of speech in noise. The question in matter was Do open canal hearing aids impro-ve speech perception in noise? Users of open canal hearing aids were objectively tested in a sound fi eld. The subjects were tested with and without their hearing aids with the Hearing in Noise Test (HINT), which presents sentences in noise.

The subjects were tested with three lists of 20 sentences, with and without hearing aids. The average result shows an improvement in SNR threshold and a paired t-test indicates that this improvement is signifi cant.

SS105

EVALUATION OF NOISE REDUCTION ALGORITHMS:

METHODS AND STRATEGIES

Jürgen KiesslingJustus-Liebig University Giessen, Germany.

The evaluation of noise reduction algorithms in hearing instru-ments can be structured in verifi cation and validation procedures. The domain of hearing aid verifi cation includes coupler and real ear measurements testing to what extent the signal-to-noise ratio can be improved technically, and whether the hearing aid works as in-tended. On the other hand, validation procedures target on hearing aid performance, benefi t for and satisfaction of the end user. This paper focuses on methods and strategies in hearing aid validation as the verifi cation domain is covered in a separate session. Noise re-duction algorithms can be validated by SRT measurements or other speech testing in diff erent types of background noise (unmodula-ted/modulated, non-speech/speech, meaningful/meaningless etc.), assessment of listening eff ort, and sound quality measurements in the lab. The use of virtual acoustic environments can also be helpful for the evaluation of noise reduction algorithms. The most important factor, however, is hearing aid performance in everyday life to be as-sessed by questionnaires and hearing diaries. Finally, the feature of datalogging has proved to be a useful tool for the validation of noise reduction schemes as it reveals how listening programs tailored for noisy situations are actually used in the fi eld.

Email: [email protected]

SS106

SELF-RATED EFFORT, COGNITION AND AIDED SPEECH

RECOGNITION IN NOISE

Mary Rudner (1)(2), Lunner T (1)(3)(4), Behrens T (4), Thorén ES (3)(4), Rönnberg J (1)(2).(1) The Swedish Institute for Disability Research, Linköping University,

Sweden;(2) Department of Behavioural Sciences and Learning, Linköping

University, Sweden; (3) Department of Medical and Experimental Medicine,

Linköping University, Sweden; (4) Oticon A/S, Research Centre Eriksholm,

Snekkersten, Denmark.

Speech recognition in noise is an eff ortful process requiring explicit cognitive processing. It may be infl uenced by level and type of noise and by the signal processing algorithms employed when hearing is aided. These complex relationships may be understood in terms of the working memory model for Ease of Language Understanding (ELU, Rönnberg et al., 2008). This model predicts that under challen-ging listening conditions, explicit cognitive processing demands will be high and that persons with good explicit cognitive capacity will be better listeners.

Two previous studies (Behrens et al., 2004; Rudner et al., 2008) indica-ted a link between cognitive capacity and self-rated eff ort on a visual analogue scale in connection with aided speech recognition in noise under some conditions when the listening situation was particularly challenging. Although the general pattern of results was similar in the two studies it was not clear how the experimental manipulations infl uenced the relationship between cognitive capacity, performan-ce and perceived eff ort. In order to obtain more stable data and cla-rify the pattern of results, an overall reanalysis of the two studies was performed.

Preliminary results show signifi cant negative correlations between self-rated eff ort and cognitive capacity at low, but not high, SNR in both steady-state and modulated noise, suggesting that the percei-ved eff ort involved in listening with a hearing aid in noisy situations is less for individuals with good cognitive resources. Further, percei-ved eff ort correlated positively with speech recognition performance at both low and high SNR when noise was modulated but only at low SNR when noise was steady state. These fi ndings suggest that in challenging listening situations, persons with high cognitive capaci-ty may perceive that they have cognitive spare capacity available to cope with even more challenging listening situations, whereas per-sons with lower cognitive capacity may perceive that their capacity is taxed to the utmost. These fi ndings support the ELU model.

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2SS02TINNITUS: MECHANISMS AND TREATMENT

Monday 22nd / 08:00 am / Room Tenerife

The important development of tinnitus research in the last years has improved the knowledge on tinnitus mechanisms, its diagnosis and treatment. From a peripheral point of view, tinnitus is con-sidered today as a brain reaction to erroneous input activity from the auditory or somatosensorial systems. In this round table we will review diff erent aspects on diagnosis and management. The mechanisms of tinnitus, focused on the role of cortical plasticity will be a topic of discussion. An ac-curate diagnosis is crucial to design the best therapeutic options. Stimulation of the somatosensory pathways can help us to control somatic modulated tinnitus and it could be done through muscular training, electro-stimulation or pharmaceutical approaches. The concept of somatosensorial tinni-tus will be presented and discussed.

Treatment should be based on tinnitus aetiology as our fi rst step. Medical counselling is a very eff ective tool, and it should be mandatory in all the patients. Drug treatment could develop a step forward in the next years. NMDA-antagonists or GABA-agonists are some of the targets of the re-search. A review of clinical trials on pharmacotherapy for tinnitus will be presented in the round table. Auditory management is based in the fact that acoustic deprivation is the most powerful engine for tinnitus generation. Patients can be treated through passive training therapies as hea-ring aids, retraining therapies (TRT) or fi ltered music approaches. Active acoustic training through auditory discrimination is a new promising approach and so is the repetitive transcranial magne-tic stimulation over the auditory cortex. A review on acoustic treatment for tinnitus will also be presented. Lastly, we will present the mechanisms and results of repetitive transcranial magnetic stimulation for tinnitus management.

Moderator:Carlos Herraiz (Spain)

Speakers:Larry Roberts (Canada)

AUDITORY NEURAL PLASTICITY IN NORMAL HEARING AND IN TINNITUS. Tanit Sanchez (Brazil)

SOMATOSENSORY TINNITUS: MECHANISMS, CLINICAL CHARACTERISTICS AND MANAGEMENT. Carol Bauer (USA)

PHARMACOLOGY FOR TINNITUS MANAGEMENT. AN UPDATE. René Dauman (France)

SOUND THERAPIES FOR TINNITUS TREATMENT. Tobias Kleinjung (Germany)

TREATMENT OF TINNITUS WITH REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (rTMS)


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SS201

AUDITORY NEURAL PLASTICITY IN NORMAL HEARING AND

IN TINNITUS

Larry RobertsDepartment of Psychology, Neuroscience, and Behaviour, McMaster University,

Hamilton, Ontario, Canada.

One goal of our research is to understand how acoustic experience modifi es neural representations for sound in the human auditory cortex. Current fi ndings show that neural population phase is modi-fi ed in the auditory core region by such experience, while tonotopic representations are less mutable in the normal hearing brain. We are also investigating whether the rules that describe remodeling in tin-nitus are diff erent. Current research is asking whether acoustic trai-ning in the tinnitus frequency region can create a hole in the tinnitus percept for the trained sound.

SS202

SOMATOSENSORY TINNITUS: MECHANISMS, CLINICAL

CHARACTERISTICS AND MANAGEMENT

Tanit SanchezOtolaryngology University of São Paulo, São Paulo, Brazil.

It is well known that tinnitus is a symptom of many diff erent diseases. In order to have success in treating this multifaceted problem, it is important to separate tinnitus in diff erent subgroups, acting with a targeted approach, instead of generalizing the actions to all patients just because they have similar complaints. Researchers are presently working on the identifi cation and diff erentiation of such subgroups, but somatosensory tinnitus is defi nitely one of them.

Although the relation between tinnitus, TMJ and cervical spine is an old and controversial subject, recent fi ndings have demonstrated that jaw movements and other muscular contractions of head, neck and limbs can elicit tinnitus modulation (temporary change in loud-ness, pitch or localization during such movements) more often than expected. Moreover, the pressure of myofascial trigger points in the muscles of head, neck and shoulder girdle - which are characteristics of myofascial pain syndrome (chronic pain) - can also evoke tinnitus modulation almost as often as the jaw movements do. Thus, the type of tinnitus that starts with – or is aggravated by - bony and or mus-cular problems in TMJ and neck has been named somatosensory tin-nitus or somatosensory modulated tinnitus. This specifi c subgroup deserves a diff erent attention within the whole concept of tinnitus approaches because the diagnosis and treatment approaches are diff erent.

Tinnitus is, by nature, a symptom that requires a multidisciplinary team. When somatosensory modulation is present in patients with tinnitus and frequent regional pain, and nothing is found in the oto-logic fi eld that may justify tinnitus, it is worth to refer the patient to a well trained dentist/physiotherapist. A treatment attempt directed to it should be carried out before indicating other treatments to simply “manage” tinnitus.

If the underlining problem can not be treated, then the stimulation of the somatosensory pathways may help to control tinnitus. The objec-tives of this lecture will be: 1. to update knowledge on the subgroup of somatosensory tinnitus; 2. to give clinical clues to identify and treat patients with this subgroup of tinnitus.

SS203

PHARMACOLOGY FOR TINNITUS MANAGEMENT. AN

UPDATE.

Carol BauerSouthern Illinois University School of Medicine. USA.

The important development of tinnitus research in the last years has improved the knowledge on tinnitus mechanisms, its diagnosis and treatment. From a peripheral point of view, tinnitus is considered today as a brain reaction to erroneous input activity from the audi-tory or somatosensorial systems. In this round table we will review diff erent aspects on diagnosis and management. The mechanisms of tinnitus, focused on the role of cortical plasticity will be a topic of discussion. An accurate diagnosis is crucial to design the best the-rapeutic options. Stimulation of the somatosensory pathways can help us to control somatic modulated tinnitus and it could be done through muscular training, electro-stimulation or pharmaceutical approaches. The concept of somatosensorial tinnitus will be presen-ted and discussed.

Treatment should be based on tinnitus aetiology as our fi rst step. Me-dical counselling is a very eff ective tool, and it should be mandatory in all the patients. Drug treatment could develop a step forward in the next years. NMDA-antagonists or GABA-agonists are some of the targets of the research. A review of clinical trials on pharmacotherapy for tinnitus will be presented in the round table. Auditory manage-ment is based in the fact that acoustic deprivation is the most power-ful engine for tinnitus generation. Patients can be treated through passive training therapies as hearing aids, retraining therapies (TRT) or fi ltered music approaches. Active acoustic training through audi-tory discrimination is a new promising approach and so is the repeti-tive transcranial magnetic stimulation over the auditory cortex. A re-view on acoustic treatment for tinnitus will also be presented. Lastly, we will present the mechanisms and results of repetitive transcranial magnetic stimulation for tinnitus management.


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SS204

SOUND THERAPIES FOR TINNITUS TREATMENT

René DaumanOtolaryngology Department, Unit of Audiology, University of Bordeaux and

University Hospital, Bordeaux. France.

Tinnitus is the conscious experience of sound originating in the head whose characteristics are known only to the owner. This sensation so-metimes causes suff ering, i.e. most people with chronic tinnitus are not too bothered by it. In other words, sensation and suff ering are diff erent attributes of tinnitus and most treatments aim to attack one or the other. This presentation will be restricted to tinnitus suff erers.

Even though problems experienced by tinnitus suff erers vary con-siderably among individuals, sound therapies can be proposed to many of them. One could even say that sound therapies should be attempted before any further therapy that entails the risk of side eff ects.

The term of sound therapies will be discussed here with a broad meaning, including (a) enrichment of acoustical environment by the patient himself, to attenuate the detrimental eff ect of staying in ex-cessive silence; (b) selective attention to environmental sounds such as music instruments without having to wear any device; (c) noise generators to accomplish partial masking and/or retraining therapy, especially in individuals with hyperacusis; (d) hearing aids to impro-ve auditory function whether hearing impairment is disclosed by the audiogram or demonstrated by the eff orts of concentration needed to understand conversational speech; (e) fi ltered music approaches; (f ) acoustic input to cochlear implants in the few recipients who are not bilaterally deaf.

Finally, reactions to the recommendation of wearing a hearing devi-ce for sound therapy will be briefl y discussed.

SS205

TREATMENT OF TINNITUS WITH REPETITIVE TRANSCRANIAL

MAGNETIC STIMULATION (rTMS)

Tobias KleinjungDepartment of Otorhinolaryngology, University of Regensburg, Germany.

The pathophysiology of tinnitus remains incompletely understood and treatment is elusive. Recent neurophysiological and neuroima-ging data suggest that some forms of tinnitus are associated with synchronized hyperactivity in the auditory cortex. Therefore targeted modulation of tinnitus-related cortical hyperactivity has been consi-dered as a new promising treatment strategy. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive method for modifying neural activity at the stimulated area and at a distance along functio-nal anatomical connections.

The technique can be applied in two diff erent ways in diagnosing and treating tinnitus patients. One approach uses single sessions of high-frequency rTMS applied to the temporal cortex. This method has shown to be successful in suppressing tinnitus transiently during the time of stimulation and could therefore be used as a predictor for treatment outcome of direct electrical epidural stimulation with implanted electrodes. Low-frequency rTMS is an effi cient method to selectively reduce the abnormally increased activity in cortical areas. Several small controlled studies demonstrated benefi cial eff ects in tinnitus patients after repeated sessions of low-frequency rTMS. In some patients consistent treatment eff ects could outlast the stimula-tion period for six months. However, results of available studies show high inter-individual variability of treatment eff ects and only mode-rate eff ect sizes.

This presentation will summarize the “Regensburg” experience with this technique.

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3SS03REALISTIC ASSESSMENT OF SPEECH AMPLIFICATION

Monday 22nd / 10:30 am / Room Islas Canarias

This structured session will describe the ISMADHA initiative. Topics will include the development and testing of the International Speech Test Signal, a new method that was used to create standard audiograms, a detailed description of a new test method and the results of round robin testing that have been completed by numerous manufacturers and independent testing facilities.

Numerous examples and comparisons of hearing aid performance obtained under the new method will be made. A summary of ANSI and IEC standardization progress will also be provided. The pri-mary purpose of the session will be to show that hearing aids amplify speech in ways that cannot be adequately assessed using current methods, and that the new method represents an important step forward that will help to better characterize what hearing aids really do when it comes to the amplifi cation of speech.

Moderator:Todd Fortune

Speakers:Marcel Vlaming (Amsterdam, The Netherlands)

A NEW INTERNATIONAL SPEECH TEST SIGNAL (ISTS) FOR THE ASSESMENT OF SPEECH AMPLIFICATION IN HEARING AIDS. Nikolai Bisgaard (Copenhagen, Denmark)

DERIVATION AND APPLICATION OF A SET OF STANDARD AUDIOGRAMS FOR TESTING HEARING DEVICES. Todd Fortune (Bloomington, USA)

NEW STANDARD TEST METHOD FOR THE CHARACTERIZATION OF HEARING DEVICES.


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SS301

A NEW INTERNATIONAL SPEECH TEST SIGNAL (ISTS) FOR

THE ASSESMENT OF SPEECH AMPLIFICATION IN HEARING

AIDS

Marcel VlamingVU University Medical Centre, Amsterdam, The Netherlands.

The technology used in hearing aids today has made the functional characterization of current hearing aids quite complex. Measurement procedures that are based on pure tones or noise are still appropriate for quality control purposes but they cannot be used to realistica-lly quantify the amplifi cation of speech. For this reason ISMADHA (a working group that was started by the Technical Committee of the European Hearing Instrument Manuafcturers Association (EHIMA) ) has been working on a new method to address this issue.

A core component of the new method is a new test signal known as the International Speech Test Signal (ISTS), an unintelligible speech-like signal based on multiple languages that may be used to characterize speech amplifi cation. Acoustic characteristics of the ISTS closely match those of real speech. This, together with a multi-lingual structure has created a versatile test signal that is not only appropriate for testing speech amplifi cation but is also international in its application. This fi rst talk of this session will focus on the deve-lopment and characteristics of this unique test signal.

SS302

DERIVATION AND APPLICATION OF A SET OF STANDARD

AUDIOGRAMS FOR TESTING HEARING DEVICES

Nikolai BisgaardGN Resound, Copenhagen, Denmark.

In order to provide a realistic test situation for the characterization of hearing aids, these hearing aids should be programmed by the corresponding fi tting software, such to defi ne the actual and com-plete hearing system. For programming the hearing aid under test a standard audiogram should be selected that is both representative of the hearing aids’ application range and also is representative for a large class of users of that hearing aid. To create such a set of stan-dard audiograms, an analysis of more than 28000 clinical audiome-tric records was performed, which ultimately led to the construction of a set of 10 audiograms that is that is truly representative of most current audiometric confi gurations. This new set of standard audio-grams serves as a reference to which the hearing aid may be pro-grammed and tested. Part 2 of the session will focus on the analysis method used to create the standard set of audiograms and on how these audiograms may be used.

SS303

NEW STANDARD TEST METHOD FOR THE

CHARACTERIZATION OF HEARING DEVICES

Todd FortuneGN Resound, Bloomington, USA.

A new method for testing speech amplifi cation that incorporates the ISTS and the standard set of audiograms has been completed. Testing is performed in a standard test chamber using either a 2cc coupler or a real ear simulator. Devices are tested as they would normally be used, i.e without the need for special testing settings or programs. Speech gain is determined by comparing time-aligned averages of 30th, 65th and 99th percentiles for the input and output signals. This method provides a realistic assessment of speech amplifi cation and is particularly useful in revealing the true eff ects of time constants, e.g. how fast compression diff ers from slow compression in terms of the amplifi cation of speech. Initially this method will be used by ma-nufactures to quantify hearing aid performance, but a clinical version is currently under discussion with several testing equipment manu-facturers. The fi nal talk of this session will describe the test method and will focus on its application i.e. how diff erent hearing aid types and confi gurations diff erentiate themselves when tested using the ISTS, a specifi c reference audiogram and the new test method.


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4SS04COCHLEAR IMPLANTS AND OTHER AUDITORY IMPLANTS

Tuesday 23rd / 08:00 am / Room Islas Canarias

The session will focus on recent issues of cochlear implantation refl ecting the issue of quality assu-rance, audiological profi le, follow-up, performance data and cost benefi t issues. The state of the art lectures will refl ect the current development of CI becoming more important treatment for patients with deafness and severe hearing loss. Becoming a routine therapy, issues such as network for pa-tient care and long-term follow-up have to be addressed.

Moderator:G. O’Donoghue (United Kingdom) and Thomas Lenarz (Germany)

Speakers:Norbert Dillier (Switzerland)

SIGNAL PROCESSING FOR SPEECH AND MUSIC Eva Karltorp (Sweden)

QUALITY ASSURANCE IN A GROWING COCHLEAR IMPLANT PROGRAMME J. Müller-Deile (Germany)

THE AUDIOLOGICAL PROFILE TO ASSESS COCHLEAR IMPLANT PATIENTS

Angel Ramos Macias (Spain)

COMPLICATIONS AND FOLLOW-UP IN COCHLEAR IMPLANTATION

Thomas Lenarz (Germany)

HYBRID IMPLANTS AND NEW MODES OF STIMULATION OF THE COCHLEAR.

G. O’Donoghue (United Kingdom)

QUALITY OF LIFE AND COST-BENEFIT ISSUES IN COCHLEAR IMPLANTATION


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SS401

SIGNAL PROCESSING FOR SPEECH AND MUSIC

Norbert DillierLaboratory of Experimental Audiology, ENT Department, University Hospital

Zurich, Switzerland

Cochlear implant systems attempt to selectively stimulate small groups of nerve fi bers with minimal channel interactions. To achie-ve this goal, adequate and suitable signal processing strategies had to be developped and appropriate mapping of signal parameters to patient-specifi c psycho-electrical stimulation conditions has to be accomplished in order to provide loudness, pitch and timbre per-cepts which mimic those of normal hearing subjects.

Most coding strategies which are used in today’s CI speech proces-sors divide the input signal into a number of logarithmically spa-ced frequency bands and generate the stimulus signals based on the signal envelopes in these frequency bands. Depending on the approach, either a preselected fi xed number of frequency bands is selected and mapped to a corresponding number of fi xed electro-des which are stimulated with a periodic pulsatile stimulus whose amplitude varies according to the envelope fl uctuations of the co-rresponding frequency band and whose stimulation rate is constant (and preferrably as high as possible in order to convey the full range of envelope variations) or a number of frequency bands is selected depending on the energy within each band in decreasing order up to a preselected number.

In all of these strategies, the fi ne temporal structure which is genera-ted in addition to the envelope fl uctuations when a signal is passed through a set of bandpass fi lters is ignored. This does not seem to be a major problem for the discrimination of diff erent speech sounds. Many implanted subjects reach excellent performance levels when tested with standard open set speech tests. However, most subjects still experience diffi culties in acoustically challenging situations such as in reverberant rooms or in the presence of environmental noise or competing talkers. Some of these problems can be alleviated by pro-per signal preprocessing, directional microphones or induction loop and FM systems. But there seems to be a more fundamental limita-tion of cochlear implants when it comes to the appreciation of music. The insuffi cient frequency resolution of a cochlear implant and the lack of preservation of phase information in stimulation patterns are some of the reasons for the poor sound quality perception and weak performance in music feature discrimination and identifi cation tasks of CI recipients. Current research is seeking new solutions for these challenges.

SS402


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SS403 SS404

Partner inquiries for TinniTool distribution in Spain/ Portugal and Latin America are welcome

Ringing in the ears

T inni tus The treatment of Tinnitus (ringing in the ears) and similar inner ear disorders, such as partial deaf-ness due to Tinnitus, ear pressure, morbus Ménière (dizziness), acu-te hearing loss and hearing distortion is completely safe and painless and can be carried out at home. The laser beam even penetrates the deeper subcuta-neous layers and works as cura-tive bio-stimulation directly on the metabolism in the connecti-ve tissue. This leads to rapid regeneration of the hearing cells, stimulation of the immune

system, acceleration of cell division and activation of spe-cific defensive molecules. Many disorders arise through a deficiency of ATP (adenosine triphosphate), the cell energy, necessary for life. ATP deficiency leads to cell damage and destruction. Ho-wever, concentrated MedicLa-ser light (650 nm wavelength) stimulates glucose combustion to improve the ATP supply. The Tinnitus treatment centre in the ENT department of the clinic in Piacenza conducted a dou-ble-blind study on 46 Tinnitus pa-

tients. The results show a treat-ment success amongst 88% of the patients, 62% even achieved a distinctive improvement. TinniTool EarLaser: EUR 330.- DisMark GmbH, Rellikonstrasse 7 8124 Maur, Switzerland Phone: ++41 (0)43 366 06 66 eMail: [email protected] Web: www.tinnitool.com Interested in becoming a distri-bution partner of TinniTool? Ask us for terms and conditions.

More than 20’000 successfully treated patients with the Swiss Soft Laser, TinniTool EarLaser for self treatment.


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5SS05HEARING AND COMMUNICATION

Tuesday 23rd / 08:00 am / Room Tenerife

As our society is becoming more and more communication oriented and people live longer, hearing problems are an important problem that may cause economic and social exclusion. Early detection of problems by hearing screening, followed by eff ective diagnostics and rehabilitation will be of high importance for the future development of the European Union.

This session focuses on a number of results from the EU FP6 funded HearCom project. The talks will relate to telephone and Internet based hearing screening for Europe, multilingual speech diagnos-tics, the concept and implementation of an Auditory Profi le, the benefi t of signal processing strate-gies and the use of wireless communication devices in the public domain.

Moderator:Marcel Vlaming (Netherlands)

Speakers:Michael Buschermöhle (Germany)

HEARING SCREENING TESTS BY TELEPHONE AND INTERNET Wouter Dreschler (Netherlands)

DEVELOPMENT AND APPLICATION OF AN AUDITORY PROFILE FOR THE CLASSIFICATION OF HEARING IMPAIRMENTS

Birger Kollmeier (Germany)

MULTILINGUAL HEARING DIAGNOSTICS FOR EUROPE

Heleen Luts (Belgium)

PERCEPTUAL EVALUATION OF STANDARD AND NEW SIGNAL ENHANCEMENT STRATEGIES

Marcel Vlaming (Netherlands)

A WIRELESS PUBLIC ANNOUNCEMENT SYSTEM FOR USE WITH HEARING DEVICES


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HEARING SCREENING TESTS BY TELEPHONE AND INTERNET:

HEARCOM IMPLEMENTATIONS IN EUROPEAN COUNTRIES

M. Buschermöhle (1), K.C. Wagener (2), M. Downs (3), M. E. Lutman (4), B. Larsby (5), M. Hällgren (5), J. Lyzenga (6), E. Ozimek (7), J. Wouters (8) and B. Kollmeier (1), (2), (9).(1) HörTech gGmbH Oldenburg, Germany; (2) Hörzentrum Oldenburg

GmbH, Germany; (3) Executive Director of Science and Enterprise, RNID,

London, United Kingdom; (4) Institute of Sound and Vibration Research,

University of Southampton, United Kingdom; (5) Linköping University,

Department of Clinical and Experimental Medicine, Division of Technical

Audiology, Linköping, Sweden; (6) Department of ENT Communication,

VU Medical Center, Amsterdam, The Netherlands; (7) Institute of Acoustics,

Adam Mickiewicz University Poznan, Poland; (8) ExpORL, Department of

Neurosciences, K.U.Leuven, Belgium and (9) Medizinische Physik, Carl von

Ossietzky Universität Oldenburg, Germany.

In many instances, a slowly developing hearing loss is detected many years after a person may fi rst notice that their hearing is not as good as it used to be. This can lead to an unnecessary delay in providing a patient with hearing aids. Anonymous hearing screening tests that are off ered to the general public can improve this situation especially if the technology is easy to use and if the test can be performed wi-thin a short amount of time. HearCom developed a battery of three hearing screening tests that fulfi l these requirements.

The Digit Triplets Test estimates the speech reception threshold for triplet combinations of spoken digits in the presence of background noise [1]. In its telephone implementation, it is presented unilaterally while the Internet implementation provides bilateral stimuli. Due to a relatively small impact of presentation level on the SRT [2], there is no need for absolute level calibration as long as the stimuli are audible. The Digit Triplets Test is available by telephone in the Netherlands, the United Kingdom, Germany, Switzerland, France and Poland. Fur-ther telephone implementations are being prepared for Sweden, Greece and Wales. An Internet version is available in Dutch, English, German, Swedish, French and Polish.

The Minimum Audible Angle Test uses virtual acoustics to estimate the smallest angle in the horizontal plane that a person can distin-guish when presented from the frontal direction. It has been found that the virtual acoustics eff ect using crosstalk cancellation is relati-vely robust against changes in room acoustics and that it also works for typical PC speakers [3]. Although the test itself is language inde-pendent, the surrounding web pages are currently available in En-glish, Dutch, German, Polish and Swedish.

The HearCom Questionnaire estimates the subjectively experienced restrictions due to hearing defi ciencies. Users can answer 18 ques-tions relating to everyday hearing experiences with one of fi ve pos-sible answers (not applicable, almost never, occasionally, frequently, almost always) [4]. Based on the responses, an algorithm decides which of the three result categories to display. The HearCom Ques-tionnaire is currently available in English, Dutch and German.

All three tests have been validated in reference studies and give one of three possible test results to the user: good, intermediate or poor. Users are informed that these are to be regarded as screening tests that can only give indicative results of certain aspects of their hea-ring. Even if one or all of the tests give a good result, the users are still advised to seek professional care when in doubt about their hearing.

Up to now, the screening tests in the various countries and on the Internet have reached more than half a million people. A summary of the data accumulated by the various screening tests and a compari-son between the tests will be given in this presentation.

References

[1] Smits, Kapteyn, et al. (2004). “Development and validation of an automatic speech-in-noise screening test by telephone.” International Journal of Audiology 43(1): 15-28.[2] Wagener, Brand (2005). “Sentence intelligibility in noise for listeners with normal hearing and hearing impairment: Infl uence of measurement procedure and masking parameters.” International Journal of Audiology 44(3): 144 - 156.[3] Buschermöhle, Berg, et al. (2009). “User-group specifi c performance in screening tests in diff erent countries.” HearCom Report D-1-8[4] Koopman, Goedegebure, Lyzenga (2008). “Development of a screening questionnaire” HearCom Report D-11-5


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SS502

DEVELOPMENT AND APPLICATION OF AN “AUDITORY

PROFILE” FOR THE CLASSIFICATION OF HEARING

IMPAIRMENTS

Wouter A. Dreschler (1), Thamar van Esch (1), Birgitta Larsby (2), Mathias Hällgren (2), Mark E Lutman (3), Johannes Lyzenga (4), Matthias Vorman (5), Birger Kollmeier (5)(1) Academic Medical Center, Amsterdam, The Netherlands; (2) Linköping

University, Linköping, Sweden; (3) Institute for Sound and Vibration Research,

Southampton, United Kingdom; (4) VU University Hospital, Amsterdam, The

Netherlands; (5) HörTech GmbH, Oldenburg, Germany.

The HEARCOM (Hearing in the Communication Society) project aims at reducing limitations in auditory communication caused either by a hearing loss or by poor environmental conditions. Two of the fo-cus areas of HEARCOM are on the identifi cation and characterization of auditory communication limitations and on the development of standardized testing and evaluation procedures for hearing-impai-red persons. In this context, an ‘auditory profi le’ will be developed. This auditory profi le should be a diagnostic tool that can be assessed for each individual listener, using a standardised battery of audiologi-cal tests, in addition to the pure-tone audiogram. It will be assessable in (specialized) hearing centres or clinics or in audiological research. It will be used to characterize the individual’s auditory impairment profi le in a comparable way within Europe, and should be usable for a broad population of hearing impaired subjects. Therefore, the au-ditory profi le should include all necessary measures to describe all details and diff erences between diff erent hearing impairments, but should minimize redundancy between measures. All tests have been implemented on the same test platform: Oldenburg Measurements Applications (OMA).

Within HEARCOM, a preliminary auditory profi le has been defi ned, that contains measures of loudness perception, spectral and tem-poral resolution, speech perception, cognition, binaural hearing and subjective judgements. This preliminary auditory profi le has been evaluated in the fi rst international multicenter study in which approximately 100 subjects (both normally hearing and hearing im-paired) were measured in fi ve research centres in Germany, Sweden, UK and The Netherlands. All tests of the preliminary auditory profi le were conducted in test and retest on two diff erent days. The focus of this study was to investigate the clinical applicability (test-retest reliability, reproducibility, learning eff ects) and the relevance of the test results to characterize communication ability. The results of the multi-centre study will be presented. We investigated eff ects of test-retest and learning eff ects, eff ects of ears (left or right, poorer or better) and eff ects of centre/language. Subsequently we exami-ned the per-ear variables (outcomes of tests that were conducted monaurally) in hearing-impaired listeners (e.g. factor analysis, regres-sion analysis) and selected the most relevant per-ear variables. In a similar manner we also selected the most relevant per-subject varia-bles (outcomes of all other objective tests). Finally we evaluated the communication-performance outcome measures and their relation to the selected per-ear and per-subject variables

The focus of the second multi-center study was to investigate whe-ther the Auditory Profi le can be applied for the classifi cation of hea-ring impairments in diff erent categories using a standardized battery of audiological tests that – in addition to the pure-tone audiogram - focus on loudness perception, frequency resolution, temporal acui-ty, speech perception, binaural functioning, listening eff ort, subjecti-ve hearing abilities, and cognition. For the sake of testing time only summary tests are included from each of these areas, but the broad approach of characterizing auditory communication problems by means of standardized test is expected to have an added value abo-ve traditional testing in understanding the reasons for poor speech reception.

Finally, the Auditory profi le is expected to be also be relevant in the fi eld of auditory rehabilitation and for design of acoustical environ-ments and the relevance of a broad but well-standardized approach will be discussed.

SS503

MULTILINGUAL HEARING DIAGNOSTICS FOR EUROPE

B. Kollmeier (1),( 2),( 3); K.C. Wagener (2); M. Buschermöhle (1); M. Vormann (2); M. Zokoll (3); M. E. Lutman (4); B. Larsby (5), J. Lyzenga (6); T. Van Esch (7) and W. A. Dreschler (7).(1) HörTech gGmbH D- Oldenburg; (2) Hörzentrum Oldenburg GmbH, D-

Oldenburg; (3) Medizinische Physik, Carl von Ossietzky Universität Oldenburg,

D-Oldenburg; (4) Institute of Sound and Vibration Research, University of

Southampton, UK-Southampton; (5) Linköping University, Department of

Audiology, S-Linköping; (6) Department of ENT Communication, VU Medical

Center, NL- Amsterdam and (7) Academic Medical Center, NL-Amsterdam.

Both audiological screening and rehabilitative audiology require speech tests to be performed in each individual´s native language. Since many languages prevail in Europe, an important goal is that exactly comparable speech audiometric tests are available for as many European and non-European languages as possible. If closed-set tests are developed that can be administered in a (semi-) automa-tic way, this will not only allow to treat patients with various langua-ge backgrounds in each European location in the same way, but will also facilitate comparisons of audiological results achieved across diff erent countries.

The integrated EU-project HEARCOM therefore developed speech materials and audiological test protocols that are comparable across several languages and will be considered as a de-facto-standard for audiological tests across diff erent languages. Three formats of speech tests were considered, i.e., a digit triplet test for screening purposes, a test format with short meaningful sentences, and a ma-trix test format with syntactically fi xed, but semantical nonsense sen-tences (“Hannah likes twelve green beds”). Moreover, we defi ned a so-called “Auditory Profi le” that can be assessed for each individual listener using a standardized battery of audiological tests that – in addition to the pure-tone audiogram and speech perception - fo-cus on loudness perception, frequency resolution, temporal acuity, binaural functioning, listening eff ort, subjective hearing abilities, and cognition. For the sake of testing time only summary tests are included from each of these areas, but the broad approach of cha-racterizing auditory communication problems by means of stan-dardized test is expected to have an added value above traditional testing in understanding the reasons for poor speech reception. All tests have been implemented on the same test platform: Oldenburg Measurements Applications (OMA). The presentation will summarize the results of two international 5-center studies conducted in the Ne-therlands (2 centers), Germany, Great Britain and Sweden. The focus of this presentation will be laid on the comparability of test results across languages and centres.


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SS504

PERCEPTUAL EVALUATION OF STANDARD AND NEW SIGNAL

ENHANCEMENT STRATEGIES

Heleen Luts (1), Koen Eneman, Jan Wouters, Michael Büchler, Norbert Dillier, Wouter Dreschler, Matthias Froehlich, Giso Grimm, Niklas Harlander, Volker Hohmann, Rolph Houben, Sofi e Jansen, Arne Leijon, Anthony Lombard, Dirk Mauler, Marc Moonen, Henning Puder, Michael Schulte, Ann Spriet, Matthias Vormann.(1) ExpORL, Dept. Neurosciences, K.U.Leuven, Belgium

A lot of new digital signal enhancement techniques for hearing aids have been developed over the past decades. However, only a limi-ted number of these techniques has been thoroughly evaluated. Within the framework of the HearCom project fi ve promising signal enhancement algorithms were validated for future use in hearing aids: single-channel noise suppression based on perceptually opti-mized spectral subtraction, Wiener-fi lter-based single-channel noise suppression, broadband blind source separation, multi-microphone adaptive beamforming based on multi-channel Wiener fi ltering and binaural coherence dereverberation fi ltering. Each of the algorithms was implemented on a common real-time hardware/software pla-tform using the Master Hearing Aid and custom-designed hearing aids. This facilitates a thorough comparative perceptual validation of the algorithm performance. A multicenter study was set up across four diff erent test centers in Belgium, the Netherlands, Germany and Switzerland. Listening tests were performed in large numbers of normal-hearing and hearing-impaired subjects. Three perceptual measures were used in these evaluations: adaptive speech reception threshold tests (SRT), listening eff ort scaling and preference rating. Tests and retests were carried out in two types of acoustical environ-ments and two diff erent noise scenarios.

The results were comparable across the diff erent test sites and sub-ject groups. This indicates that the results are not infl uenced by e.g. exact room characteristics or specifi c type of loudspeaker, sound card and speech material. In a pseudo-diff use noise scenario, only the multi-microphone adaptive beamforming based on multi-chan-nel Wiener fi ltering provided a signifi cant SRT improvement relative to the unprocessed condition of on average 6.6 dB. Unlike the lack of improvement in SRT, increased preference was measured for a num-ber of algorithms compared to the unprocessed condition at all tes-ted signal-to-noise ratios. Additionally, an improvement in listening eff ort was observed at 0 dBSNR.

[This work was supported by grants from the European Union FP6 Project 004171

HearCom.]

SS505

A WIRELESS PUBLIC ANNOUNCEMENT SYSTEM FOR USE

WITH HEARING DEVICES

M. Vlaming (1), J. Sainz (2) and B. Grover (3)(1) VU University Hospital, Amsterdam, Netherlands; (2) Moviquity, Madrid,

Spain, Sweden; (3) The Royal National Institute For Deaf People, London,

United Kingdom.

Personal Communication Systems such as PDA’s and mobile Smar-tphones are rapidly developing and they provide many new mobile personal applications in the area of communication, information, navigation, and entertainment. As such, these systems have a great potential for assisting persons that have some form of disability. SubProject 4 in the EU-FP6 HearCom Project has explored the poten-tial of these devices to assist communication in particular for persons having a hearing problem, either from hearing impairment or just when in adverse acoustical conditions. One of the new potential ser-vices is the concept of a wireless public announcement system. In many public places such as airports, train stations, event-halls, and churches, auditive announcements are made that are relevant for a restricted geographical area. Understanding these messages is not always easy, in particular when having a hearing disability or when being disturbed by background sounds or attention distractions. In supplement to existing public announcement (PA) systems, a wi-reless PA system will be feasible that delivers the announcements both in auditive and textual format. These announcements can be given directly to the ear by headphone, or by hearing aid without acoustical interference, and given visually at the handheld display. These modes can also be combined when preferred. Moreover, these messages can be repeated and searched at any moment which will increase effi ciency in time and eff ect. In addition actual local infor-mation such as time-tables can be off ered as well. Such a wireless sys-tem can be deployed relatively easily based on standard local com-munication technologies such as WiFi, Bluetooth and others. Also the client application will be relatively small and downloadable to PDA or Smartphone. In this talk an outline will be given of a fi rst wireless PA demonstrator system for evaluation using hearing-impaired persons.

[This work was supported by grants from the European Union FP6 Project 004171

HearCom.]


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6SS06ACTIVE MIDDLE EAR IMPLANTS IN CONDUCTIVE AND MIXED HEARING LOSS

Tuesday 23rd / 10:30 am / Room Islas Canarias

In patients with mixed hearing loss, application of a conventional air-conduction device might be troublesome, because it not only has to compensate for the whole air-bone gap, but also for part of the sensorineural hearing loss. This implies high amplifi cation and consequently, serious feed-back problems. Furthermore, an earmould is contra-indicated when aural atresia, or chronic otitis is pre-sent. An alternative is the use of a bone-conductor, such as the BAHA, which will close the air-bone gap. However, even with a powerful Baha, little can be done to compensate for the sensorineural component. Another alternative is the use of an active middle ear implant coupled directly to one of the cochlear windows, as has recently been introduced by Colletti and co-workers.

This session will give you the state-of-the art on implantable middle ear devices. Acknowledged experts in the fi eld will address surgical issues, audiological outcomes with the Vibrant Soundbrid-ge, Otologics MET and DACS, as well as the application of such middle ear implants to patients with aural atresia and chronic otitis.

Moderator:Ad Snik (Netherlands)

Speakers:Martin Kompis (Switzerland)

FIRST RESULTS WITH THE DACS (DIRECT ACOUSTIC COCHLEAR STIMULATION) IMPLANTABLE HEARING SYSTEM

Vittorio Colletti (Italy)

VIBROPLASTY SURGERY, SURGICAL ASPECTS AND AUDIOLOGICAL RESULTS

Thomas Lenarz (Germany)

INCUS VIBROPLASTY VERSUS ROUND WINDOW VIBROPLASTY; HANNOVER RESULTS

Nadia Giarbini (Italy)

COCHLEAR WINDOWS POSITIONING OF THE VIBRANT SOUNDBRIDGE: RESULTS FROM MERAN

Herman A. Jenkins (EEUU)

OTOLOGICS FULLY IMPLANTABLE HEARING DEVICE PHASE II CLINICAL TRIALS


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FIRST RESULTS WITH THE DACS (DIRECT ACOUSTIC

COCHLEAR STIMULATION) IMPLANTABLE HEARING SYSTEM

M. Kompis (1) C. Stieger (1), H. Bernhard (2) and R. Haeusler (1).(1) Department of ENT, Head, Neck Surgery, University of Berne, Switzerland;

(2) Helbling Technik Bern AG, Liebefeld, Switzerland.

Results with the direct acoustic cochlear stimulator (DACS) implan-table hearing system are presented. This system is based on the principle of a power-driven stapes prosthesis and intended for the treatment of severe mixed hearing loss due to advanced otosclero-sis. It consists of an implantable electromagnetic transducer, which transfers acoustic energy directly to the inner ear, and an audio pro-cessor worn externally behind the implanted ear.

The device is implanted using a specially developed retromeatal mi-crosurgical approach. After removal of the stapes, a conventional sta-pes prosthesis is attached to the transducer and placed in the open window to allow direct acoustical coupling to the perilymph of the inner ear. In order to restore the natural sound transmission of the ossicular chain, a second stapes prosthesis is placed in parallel to the fi rst one into the oval window and attached to the patient’s own in-cus, as in a conventional stapedectomy.

Four patients were implanted with an investigational DACS device. The hearing threshold of the implanted ears before implantation ran-ged from 78 to 101 dB (Air conduction, pure tone average PTA, 0.5 – 4 kHz) with air-bone-gaps of 33 to 44 dB in the same frequency range.

Postoperatively, substantial improvements in sound fi eld thres-holds, speech intelligibility as well as in the subjective assessment of everyday situations were found in all patients. Two years after the implantations, monosyllabic word recognition scores in quiet at 75 dB improved by 45 to 100 percent points when using the DACS. Fur-thermore, hearing thresholds were already improved by the second stapes prosthesis alone by 14 to 28 dB (PTA 0.5 - 4 kHz, DACS swit-ched off ). No device related serious medical complications occurred and all patients have continued to use their device on a daily basis for over two years.

SS602

VIBROPLASTY SURGERY, SURGICAL ASPECTS AND

AUDIOLOGICAL RESULTS

Colletti VENT Department, University of Verona, Italy.

Background: Over the last fi ve years the application of the MED-El Vibrant Soundbridge has been extended to patients with more or less severe ossicular chain defects obtaining marginal benefi t from traditional middle ear surgery. Several clinical studies have investiga-ted the various middle ear sites where to position the fl oating mass transducer (FMT) in order to optimize the sound transmission to the cochlea: direct stapes stimulation, stimulation via a partial or total ossicular replacement prosthesis, and direct round window stimula-tions (Colletti et al., 2005; Needham et al., 2005; Colletti et al., 2006: Huber et al., 2006; Kiefer et al., 2006; Wollenberg et al.,2007; Hutten-brink et al., 2008).

Round window implantation (RWI) bypasses the normal conductive path and provides amplifi ed input to the cochlea.

Patients: Thirty-eight patients with bilateral moderate to severe mixed or conductive acquired hearing loss without cholesteatoma and bilateral ossicular chain erosion (footplate residual) were alter-nately assigned to a titanium-TORP (T-TORP) or to RWI. The results for the two groups were statistically analyzed at 36 months postoperati-vely. The following postoperative anatomic conditions were also eva-luated: 1) recurrence of infection, 2) retraction pocket, 3) extrusion rate, and 4) displacement of the prosthesis.

Results: Good functional results and stability at 36 months were ob-tained with either procedure. Hearing results were statistically better for RWI versus T-TORP. These results suggest that RWI may off er a via-ble treatment option for individuals with severe mixed hearing loss who have undergone unsuccessful ossiculoplasties.

Conclusion: Round window implantation may be suggested as the fi rst choice in hearing rehabilitation for patients with chronic otitis media and extensive destruction of the ossicular chain.


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SS603

INCUS VIBROPLASTY VERSUS ROUND WINDOW

VIBROPLASTY; HANNOVER RESULTS

Lenarz TDept. of Otorhinolaryngology, Medical University of Hannover, Germany.

The objective of this paper is a retrospective evaluation of audiolo-gical results with the application of the implantable hearing device Vibrant Soundbridge (VSB) on the round window membrane for treatment of mixed hearing loss (MHL) and with the conventional application of VSB on incus for treatment of sensory neural hearing loss (SNHL).

Two patient groups with SNHL (n=45) and MHL (n=15) were recruited for this study. The median duration of wearing the implants was 9.7 years for the SNHL-group and 2.1 years for the MHL-group. Audiolo-gical tests consisted of pure tone audiometry, free-fi eld audiometry, speech audiometry, speech-in-noise and multi frequency tympano-metry were performed pre-and postoperatively.

Patients with SNHL showed a median functional gain of about 27 dB in the free fi eld test. When using the unaided AC-thresholds in the MHL-group a median functional gain of about 48 dB were measured and with respect of bone-conduction thresholds the functional gain was about 24 dB. The improvement of the speech discrimination sco-re at 65 dB SPL for the fi rst and second groups was about 40% and 65%.

SS604

COCHLEAR WINDOWS POSITIONING OF THE VIBRANT

SOUNDBRIDGE: RESULTS FROM MERAN

Giarbini N, Costanzo S, Streitberger CENT and Head-Neck Surgery Department, Hospital of Meran, Italy

Introduction: One of the most challenging issues in middle-ear re-constructive surgery is to gain satisfactory long term functional re-sults.

The development of middle ear implantable hearing devices du-ring the last three decades, has off ered a new surgical option in the treatment of conductive and mixed hearing loss. Diff erent devices and sites of application have been tried out in diff erent middle-ear conditions, but an agreement on positioning-choice is still missing.

Aim: Middle-ear reconstructive surgery needs to guarantee satisfac-tory long term functional results. The aim of this presentation is to describe the audiological results obtained for round and oval win-dow positioning of the Vibrant Soundbridge’s (VSB) Floating Mass Transducer (FMT) and to discuss the device’s eff ectiveness on the bases of results obtained.

Subjects and Methods: Of the 43 cases treated with Vibrant Soun-dbridge (VSB) during the last 4 years, the results obtained in 28 cases suff ering from mixed hearing loss of diff erent etiologies who received a VSB either on the round window (15 patients) or on the oval one (13 patients) will be described. The surgical approach was adapted case by case for all subjects and was alternatively: revision of radical cavities (CWU and CWD), transmastoid with posterior tympa-notomy, transmeatal, or combined transmeatal-transmastoid.For the round window placement, the niche was adapted for the FMT and positioning was in contact to the round window membrane, with or without interposition of autologues fascia.For the oval window placement, the FMT was positioned in direct contact with the stapes footplate in 9 cases, on stapes supra-struc-ture in 3 cases, and directly on oval window after stapedectomy in 1 case.

Results: No major surgical complications occurred and no signifi cant worsening of bone conduction was observed post-operatively for all patients. Improvement of speech understanding at VSB activation when comparing aided with unaided condition was observed in all subjects.

The results obtained after a minimum of six months post-surgery were evaluated in terms of aided threshold improvement and functional gain.

For round window placement, data from 9 cases showed unaided mean pure tone average PTA4 at 78 dB HL (s.d.=17.38) with mean speech recognition threshold (SRT) of 85 dB HL. At 6 months from VSB activation mean PTA4 was 38.75 dB HL (s.d.=11.26) with mean SRT of 53 dB.

For oval window placement, data from 8 cases showed unaided mean pure tone average PTA4 at 76.94 dB HL (s.d.=18.08) with mean SRT of 84 dB HL. At 6 months from VSB activation mean PTA4 was 36.88 dB HL (s.d.=10.05) with mean SRT of 53 dB.

Results were maintained with a slight improvement over time in sub-jects with a longer period of observation.

Indications and results of all cases will be discussed for the two diff e-rent placements.

Conclusions: In our opinion, the cochlear windows’ placement of the VSB has shown satisfactory functional results and the choice to direct drive the inner ear through the oval or the round window should be done on the base of imaging and intra-operative fi ndings, aiming the best possible transfer of vibratory energy to the inner ear.


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SS605

OTOLOGICS FULLY IMPLANTABLE HEARING DEVICE PHASE II

CLINICAL TRIALS

Jenkins HA, Lupo V, Claycomb S.University of Colorado Denver School of Medicine, USA.

Abstract: Objectives: In this pivotal FDA clinical trial effi cacy of the Otologics Fully-Implantable MET Hearing Device was asses-sed in adult patients with bilateral moderate to severe sensorineural hearing loss.

Methods: The totally implanted electromechanical transducer tip was coupled to the incus, via insertion into a laser-drilled hole, fo-llowed by post auricular implantation of the microphone/battery/electronics capsule. A repeated-measures within-subjects design assessed aided sound fi eld thresholds, speech performances and subjective benefi t with the subject’s own, appropriately fi t, walk-in hearing aid(s) and the Otologics Fully-Implantable Hearing Device.

Results: Twenty of the fi fty patients necessary for regulatory submis-sion have been implanted. Two and three month data will be presen-ted and compared to the patient’s walk-in hearing aid. No signifi -cant diff erences between preoperative (AC = 57 dB, BC = 53 dB) and postoperative (AC = 62 dB, BC = 56 dB) unaided pure tone averages were noted (p > 0.05). Pure tone average implant aided thresholds (43 dB) were equivalent to that of walk-in-aided (38 dB) condition with no signifi cant diff erenced (p < 0.05) between patients’ walk-in-aided individual frequency thresholds and implant-aided thresholds. Word recognition scores and hearing in noise scores were similar bet-ween the walk-in-aided and for the implant-aided condition. Patient benefi t scales, assessed with the APHAB, showed a preference for the implanted device in all situations, except for similar ratings in aversi-veness. Incremental improvements occurred with time postoperati-vely as the wound sites matured.

Conclusions: Preliminary results of the Otologics MET Fully-Implan-table Hearing Device Pivotal trial provide evidence that this fully im-plantable is equivalent to currently available hearing aids in patients with moderate to severe sensorineural hearing loss.


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7SS07PSYCHOACOUSTICS, SPEECH PERCEPTION AND AUDITORY SIGNAL PROCESSING

Wenesady 24th / 08:00 am / Room Islas Canarias

In order to develop audiology to a full interdisciplinary science with an interplay between experi-mental fi ndings and theoretical concepts, the development and application of adequate models of hearing impairment is necessary. Recent fi ndings from auditory physiology and psychoacoustics are used to characterize the normal and pathological auditory signal processing that takes place du-ring speech perception by normal and hearing-impaired listeners. By comparing the actual perfor-mance of subjects with model predictions, adequate processing models can be tested and impro-ved. Hence our understanding of the impact of sensorineural hearing impairment on human sound perception can be enhanced. The scientifi c basis of such an approach is reviewed in the structured session. Also, the consequences for auditory diagnostics and fi tting of hearing aids are discussed.

Moderator:B. Kollmeier (Germany)

Speakers:W.Dreschler (The Netherlands)

SUPRATHRESHOLD PROCESSING DEFICITS IN HEARING-IMPAIRED LISTENERS AS REVEALED IN THE “AUDITORY PROFILE”

Christian Lorenzi (France)

PROCESSING OF TEMPORAL FINE STRUCTURE INFORMATION BY HEARING-IMPAIRED LISTENERS

Brian Moore (Great Britain)

USE OF A LOUDNESS MODEL TO DERIVE A METHOD FOR FITTING HEARING AIDS WITH EXTENDED HIGH-FREQUENCY BANDWIDTH

Thomas Brand (Germany)

MODELLING SPEECH INTELLIGIBILITY IN STEADY AND FLUCTUATING NOISE FOR NORMAL AND HEARING IMPAIRED LISTENERS

Torsten Dau ( Denmark)

MODELLING SENSORINEURAL HEARING LOSS WITH A NONLINEAR AUDITORY FRONT-END.

Rainer Beutelmann (Germany)

MODELLING BINAURAL SPEECH INTELLIGIBILITY OF HEARING-IMPAIRED LISTENERS IN ADVERSE CONDITIONS.


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SS701

SUPRATHRESHOLD PROCESSING DEFICITS IN HEARING-

IMPAIRED LISTENERS AS REVEALED IN THE “AUDITORY

PROFILE”

Dreschler WA (1), Van Esch T (1), Larsby B (2), Hällgren M (2), Lutman M (3), Lyzenga J (4), Vorman M (5), Kollmeier B (5).(1) Academic Medical Center, Amsterdam, The Netherlands, (2) Linköping

University, Linköping, Sweden, (3) Institute for Sound and Vibration Research,

Southampton, United Kingdom(4) VU University Hospital, Amsterdam, The

Netherland, (5)HörTech GmbH, Oldenburg, Germany.

In the structured session Hearing and Communication, the develo-pment and application of the Auditory Profi le with the EU project HEARCOM (Hearing in the Communication Society) was described. This auditory profi le is designed to become a diagnostic tool that can be assessed for each individual listener, using a standardised battery of audiological tests, in addition to the pure-tone audiogram.

In this presentation we will focus on the outcomes of two multi-cen-ter studies, in which the Auditory Profi le has been measured in about 150 subjects with a sensorineural hearing loss and in 50 normal hea-ring subjects that served as controls. The results will be analysed with respect to the frequency of occurrence of supra-threshold defi cits, the underlying associations between diff erent auditory functions, and the role that supra-threshold processing defi cits play in speech perception and in auditory functioning in daily life.

SS702

PROCESSING OF TEMPORAL FINE STRUCTURE

INFORMATION BY HEARING-IMPAIRED LISTENERS

Christian LorenziEquipe Audition (LPP CNRS-Paris 5 #8158). Dept d’Etudes Cognitives. Ecole

Normale Supérieure 29 rue d’Ulm. 75005 Paris, France

Recent studies suggest that, for normal-hearing listeners, temporal fi ne structure (TFS) cues play a crucial role in speech identifi cation in complex backgrounds, especially for “glimpsing” speech in the tem-poral dips of fl uctuating backgrounds. Additional studies suggest that cochlear damage associated with mild to moderate hearing loss may severely degrade the ability to use TFS cues in speech sounds. This is consistent with the relatively preserved ability of hearing-impaired listeners to identify speech in quiet when audibility is con-trolled for, and the important defi cits observed for these listeners when speech is masked by fl uctuating background sounds. We will review this literature and present the results of recent studies aiming to quantify and predict the reception of TFS cues for normal-hearing and hearing-impaired listeners in various listening conditions.


SS703

USE OF A LOUDNESS MODEL TO DERIVE A METHOD FOR

FITTING HEARING AIDS WITH EXTENDED HIGH-FREQUENCY

BANDWIDTH

Brian MooreDepartment of Experimental Psychology, University of Cambridge, Downing

Street, Cambridge, CB2 3EB, UK

A loudness model applicable to impaired hearing (Moore and Glas-berg, 1997) was used previously to develop two methods for fi tting multi-channel compression hearing aids, CAMEQ, and CAMREST. These two methods give recommended gains for frequencies up to 6000 Hz, which is close to the highest frequency at which most hearing aids provide useful gain. However, several manufacturers now market hearing aids that are claimed to provide useful gain at frequencies above 6000 Hz. To derive recommended gains at high frequencies, we measured the typical spectro-temporal characteris-tics of speech at high frequencies (Moore et al., 2008), and used a revised loudness model (Moore and Glasberg, 2004) to derive gains as a function of frequency and level that would: (1) lead to at least 50% of the dynamic range of speech being above absolute threshold for frequencies from 5000 to 10000 Hz, for speech with an overall le-vel of 65 dB SPL; (2) avoid a specifi c loudness that was greater than normal at high frequencies; (3) lead to a similar overall loudness to normal. The modelling outcomes show that, for the great majority of hearing-impaired people, it is not practical to aim to restore the au-dibility of frequency components of speech above about 10000 Hz.

Moore, B. C. J., Glasberg, B. R., 1997. A model of loudness perception applied to cochlear hearing loss. Auditory Neurosci. 3, 289-311.

Moore, B. C. J., Glasberg, B. R., 2004. A revised model of loudness per-ception applied to cochlear hearing loss. Hear. Res. 188, 70-88.

Moore, B. C. J., Stone, M. A., Füllgrabe, C., Glasberg, B. R., Puria, S., 2008. Spectro-temporal characteristics of speech at high frequencies, and the potential for restoration of audibility to people with mild-to-mo-derate hearing loss. Ear Hear. 29, 907-922.

SS704

MODELLING SPEECH INTELLIGIBILITY IN STEADY AND

FLUCTUATING NOISE FOR NORMAL AND HEARING

IMPAIRED LISTENERS

Thomas BrandCarl von Ossietzky Universität Oldenburg, Germany

One possibility for modelling the infl uence of fl uctuating noises on speech intelligibility is the use of short-term extensions of the Speech-Intelligibility-Index (SII). Diff erent short-term extensions are compared that comprise an increasing deviation from the original SII. Even though these approaches diff er considerably in complexity, their results are very close to each other.

An important factor is speech context that is used by listeners to re-plenish dropouts due to peeks of the fl uctuating noise. This can be done much more effi ciently for highly predictable speech than for speech with low predictability. This can be described using a two-sta-ge context model. In the fi rst stage, the intelligibility of a single word is modelled based on the intelligibility of statistically independent sub-word units. The second stage combines the intelligibilities of the single words in order to calculate the intelligibility of the sentence. The model is based on SRT measurements in quiet and in steady-state noise in order to calculate the SRT in fl uctuating noise.


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SS705

MODELLING SENSORINEURAL HEARING LOSS WITH A

NONLINEAR AUDITORY FRONT-END

Torsten DauCentre for Applied Hearing Research, Department of Electrical Engineering,

Technical University of Denmark, DK-2800 Lyngby,Denmark

Recently, an auditory signal processing model was developed, which could simulate psychoacoustic data from a large variety of condi-tions related to spectral and temporal masking in normal-hearing listeners (Jepsen et al., 2008). The model includes the dual-resonance non-linear (DRNL) fi lterbank suggested by Lopez-Poveda and Meddis (2001) to simulate the non-linear cochlear signal processing, and is otherwise similar to the modulation fi lterbank model by Dau et al. (1997). In the present study, the model parameters were modifi ed to simulate cochlear hearing impairment. The modifi cations of the model were based on individual data from notched-noise masking and forward masking and were associated with changes of the pa-rameters of the DRNL stage of the model. Data from a pure-tone audiogram were used to further reduce the listeners’ sensitivity in connection with an assumed loss of inner hair cells. In addition, in-tensity discrimination and modulation-depth discrimination experi-ments were performed in order to estimate potential retro-cochlear (central) limitations in the processing of supra-threshold stimuli. The model helps understanding the perceptual consequences of hearing impairment in individual listeners and can be useful for the evalua-tion of hearing-aid processing.

Jepsen, M.L., Ewert, S.D., and Dau, T. (2008). A computational model of auditory signal processing and perception, J. Acoust. Soc. Am.124, 422-438.

Meddis, R., O’Mard, L. P., and Lopez-Poveda, E. A. (2001). A computatio-nal algorithm for computing nonlinear auditory frequency selectivi-ty, J. Acoust. Soc. Am. 109, 2852–2861.

SS706

MODELING BINAURAL SPEECH INTELLIGIBILITY OF

HEARING-IMPAIRED LISTENERS IN ADVERSE CONDITIONS

Rainer Beutelmann, Brand T, Kollmeier BMedizinische Physik, Universität Oldenburg, Germany

Acoustically unfavourable situations (characterized by several sound sources and reverberation) are especially challenging for , hearing-impaired listeners. One of the essential aids in adverse conditions is binaural hearing, but the binaural processing of hearing-impaired listeners is infl uenced by their hearing loss, due to distorted input from the periphery and/or because of defi ciencies on higher levels of the auditory system. This talk presents binaural speech intelligibility measurements and model simulations with hearing-impaired sub-jects having various degrees of hearing loss. Speech reception thres-holds (SRT) in noise were measured in a number of situations incor-porating a speech-shaped stationary or fl uctuating noise source at various azimuth angles and in diff erent room acoustical conditions. In addition to their overall decreased SRT by up to 10 dB SNR compa-red to a normally-hearing control group, the subjects suff ered from a loss of binaural unmasking in spatially favorable conditions, mostly between 5 and 10 dB SNR, sometimes up to 20 dB SNR, depending on condition and subject. The observed data were compared to pre-dictions of a binaural speech intelligibility model (Beutelmann and Brand 2006, JASA), a multi-channel equalization-cancellation process used as a binaural front-end for the Speech Intelligibility Index. The hearing losses were included in form of interaurally uncorrelated in-ternal masking noises spectrally shaped according to the individual audiograms. The combined eff ect of audibility and of interaural de-correlation on binaural speech intelligibility can be predicted very well (correlation coeffi cients between predictions and observed data above 0.9). Overall, about 70% of the variance due to hearing impair-ment can be predicted based on the audiogram. Suprathreshold and cognitive eff ects, which may be underlying the remaining variance, will require model extensions and further individual measures of the hearing-impairment.


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8SS08HEARING SCREENING IN ADULTS

Wednesday 24th / 08:00 am / Room Tenerife

Hearing loss is one of the most common chronic health conditions in the elderly population with important implications for patient quality of life. The diminished ability to hear and to communicate is frustrating in and of itself, but the strong association of hearing loss with depression and functio-nal decline adds further to the burden on individuals who are hearing impaired.

Despite the prevalence and burden of hearing loss, hearing impairment is largely underdiagnosed in older persons and undertreated. Too often, the public and still too many health care professionals underestimate the dramatic eff ects of deafness. Therefore, it can be of some assistance to accelerate a process of identifi cation and remediation of hearing loss by the implementation of screening pro-grammes. As an example in Europe, UK and a few other European countries are ready to implement nationwide programs/services, but the penetration of early hearing detection and intervention pro-grammes diff ers greatly from country to country.

In this context, the European Commission decided to fi nance a project titled “AHEAD III: Assessment of Hearing in the Elderly: Aging and Degeneration - Integration through Immediate Intervention” (2008-2010). Project AHEAD III involves a network of top-notch laboratories and clinics all around Europe with complementary capacities and expertise, in an area where the multidisciplinarity of the topics so require.

This project is triggering research in an area where this topic is gaining an increasing momentum, but still has remained in stand-by for decades. Project AHEAD III is exploring novel strategies to make screening and early intervention a feasible part of routine care. The session will presented the main objectives and fi rst outcomes of the project.

Moderator:Ferdinando Grandori (Italy)

Speakers:Ferdinando Grandori (Italy)

THE EUROPEAN PROJECT AHEAD III ON ASSESSMENT OF HEARING IN ADULTS AND THE ELDERLY

Martin Walger (Germany)

MAIN EFFECTS OF AGE-RELATED HEARING LOSS

Sophiae Kramer (Netherlands)

STRATEGIES OF INTERVENTION AFTER SCREENING FOR HEARING IN ADULTS/ELDERLY

Adrian Davis (UK)

HEARING SCREENING IN ADULTS: A CONCEPTUAL MODEL


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THE EUROPEAN PROJECT AHEAD III ON ASSESSMENT OF

HEARING IN ADULTS AND THE ELDERLY

Grandori FInstitute of Biomedical Engineering CNR, Milan, Italy

The European project “AHEAD III: Assessment of Hearing in the El-derly: Aging and Degeneration - Integration through Immediate In-tervention (2008-2011)” is a coordination action which aim is to pro-vide new strategies and new solutions for age-related hearing loss. Specifi cally project AHEAD III has been designed to:

* Provide evidence of the eff ects of hearing impairment in adults and in the elderly;

* Increase the awareness among administrators, policy makers, health care professionals and the public opinion about early de-tection and intervention for hearing impairment in adults in the elderly;

* Analyse costs associated with the implementation of integrated large scale, or nationwide, programmes of hearing screening and intervention in the elderly;

* Provide minimum requirements for screening methods and the related diagnostic techniques;

* Develop recommendations and guidelines on how to imple-ment successful screening programmes using the variety of available methods, and began setting new criteria for recently proposed new technologies;

* Analyse protocols and models to be tuned to the local, social, and economical conditions of a country or region.

Project workplan, overall strategy and working group activities will be presented. A big benefi t of the implementation of the this pro-ject is that it will contribute signifi cantly to the implementation of health protocols, programmes and models for a variety of health care systems to be tuned to the local, social, and economical status of a country in the EU area. This project will also contribute to homogeni-se the quality of screening program and the standards of care in the EU. Within a time range of about 3 years from now, European Citizens may profi t of a full set of provisions and likely also the quality back-ground services to cope with this impairment.

SS802

MAIN EFFECTS OF AGE RELATED HEARING LOSS

Walger MENT University Hospital, Department of Audiology and Cochlear Implant

Center, Cologne, Germany

Age related hearing loss refl ects the sum of all genetic and non gene-tic factors like noise or ototoxic drugs on the structures and function of the peripheral hearing organ and the central auditory system du-ring life. The slow degeneration of sensory cells within the organ of Corti and aff erent nerve fi bres result in a sensorineural hearing loss starting in the high frequency range. The reduced speech percep-tion, especially in diffi cult hearing situations, reduced time resolu-tion and problems in spatial hearing point to the central eff ects of age related hearing loss, which is caused by the peripheral pathology accompanied by the general eff ects of biological aging within the central nervous system with problems in short time memory and a reduced speed of information processing. The psychosocial eff ects of age related hearing loss often result in decreased social activities, loneliness, self-isolation and sometimes depressions in older people with a reduction of quality of life. In view of the demographic de-velopment with an increasing population of older people, screening and early intervention of age related hearing loss becomes one of the most important goals of our health system.


SS803

STRATEGIES OF INTERVENTION AFTER SCREENING FOR

HEARING IN ADULTS/ELDERLY

Kramer SE (1), Davis A (2) Parazzini M (3), Thodi C (4), Smith P (2), Stephens D (5), Anteunis L (6), Grandori F (3 ).(1) VU University Medical Center, Department of ENT/Audiology,

Amsterdam, The Netherlands; (2) University of Manchester, MRC Hearing

and Communication Group, United Kingdom; (3) Institute of Biomedical

Engineering, Milan, Italy; (4) CH & M Cyprus Audiology Center Interacoustics

Ltd, Cyprus; (5) Cardiff University, Cardiff , Wales; (6) Maastricht University

Medical Centre, Dept. of ORL, Div. Audiology, The Netherlands.

One of the workpackages within AHEAD III focuses on interventions following screening for hearing in adult or elderly populations. The primary aim is to review and discuss existing data on the availability and eff ectiveness of interventions after screening. In the internatio-nal literature, diff erent types of intervention after screening have been reported, even though the provision of hearing aids is the most common. An alternative intervention is referral to a professional (e.g. GP, ENT doctor, hearing aid dispenser). In this presentation, we will not only provide a review of the literature on interventions following screening, but will also raise a number of questions that ought to be considered, before any screening programme can be implemented. Examples are: “what do we aim to achieve with the intervention? When shall (an intervention after) screening be regarded as suc-cessful? Is there an increase in the number of people showing com-pliance with the advice given? Is there an increase in the uptake of hearing aids? Is the number of people whose disability reduced after screening AND intervention? An additional aim of this presentation is to suggest interventions after screening other than those descri-bed above. Examples are: training in hearing tactics and/or speech-reading, notifi cation of a professional or someone calling back (to facilitate the care plan). Finally, additional issues such as ‘diff erent interventions for diff erent age groups, or diff erent types/degrees of hearing impairment will be discussed.

SS804

HEARING SCREENING IN ADULTS: A CONCEPTUAL MODEL

Davis A, Smith PUniversity of Manchester, MRC Hearing and Communication Group, United

Kingdom

Most people who seek an audiological assessment for a hearing pro-blem in the UK are aged about 72 years and have had a hearing pro-blem that would have benefi ted from intervention for the last 10 - 15 years. There is no reason to expect that the situation is any diff erent in other European countries. In fact there may be poorer take up as some countries do not have a completely free of charge audiology and hearing aid service as is the case in the UK. Our work has shown that screening programmes are eff ective and provide good value for money in the UK, where they are targeted at a specifi c hearing defi cit about ten years earlier than the average person who consults would have done so. However, the same model cannot be easily applied to other countries. The factors that are important in providing good va-lue for money in systematic and ad-hoc screening programmes will be systematically investigated using current data that are available from the UK and elsewhere. It will be shown that important conside-ration of the vision and aims of the programme are vital in providing better outcomes and value for money.

INVITED SPEAKERS


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IS01

BINAURAL WIRELESS SYNCHRONISATION/PROCESSING

AND EXTENDED BANDWIDTH IN HEARING INSTRUMENTS:

EVIDENCE OF BENEFIT IN SPATIAL PERCEPTION AND SOUND

QUALITY

Ravi SockalingamOticon, Denmark

Hearing Health Care professionals are constantly bombarded with new hearing instruments year after year. Obviously, with these new instruments, novel advanced signal processing technologies are introduced. Wireless synchronization and processing between instruments, and extended bandwidth are two such examples of new technologies that currently feature very prominently among manufacturers. These technologies, however, will not be embraced by the savvy dispenser or end user unless there is clinical evidence that demonstrates their benefi t. This presentation aims to walk the audience through some of the evidence via three separate studies; two on the benefi t of wireless synchronization and processing bet-ween instruments on spatial perception and sound quality, and one on the eff ect of extended bandwidth on sound quality preference for speech and music.

INVITED SPEAKERS

IS02

THE MEANING OF LANGUAGE AS EMBODIED

REPRESENTATIONS IN THE BRAIN

Manuel de VegaLa Laguna University

Every time we understand a sentence we activate a complex circuitry in the brain. It is well known that perisylvian areas in the left hemis-phere are activated to encode features of words and sentences (Wer-nicke area) as well as executing speech (Broca area). Recently, psy-chologists and neuroscientist have also reported that other regions in the sensory-motor cortex are selectively activated to represent linguistic meaning. For instance, verbs describing actions of hands (grasping), mouth (blowing), or foot (jumping) activate somatotopic areas in the brain that partially overlap those involved in planning the corresponding actions. Behavioral and neurological data in our own laboratory support and qualify this view. Thus, sentences descri-bing a transfer action away from you (I gave you a book) or towards you (you gave me a book) interact with simultaneous hand motions that match or mismatch the implicit motion of the sentence. This so-called action-sentence compatibility eff ect was observed even with very abstract sentences (If it had been your birthday I would have gi-ven you a book). In an fMRI experiment we gave participants senten-ces in which the “eff ort” was manipulated by combining action verbs with objects diff ering in weight (e.g., pushing the chair vs. pushing the piano). High-eff ort sentences activated premotor and parietal areas implicit in action planning, and related to the mirror-neuron system, to a larger extend than low-eff ort sentences. These experi-ments suggest that the neural bases of meaning consist of activating embodied simulations of experience rather than abstract symbols. In addition, these studies can contribute to better understand the language defi cits observed in Parkinson, Alzheimer, and other brain patients.


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IS03

CONTROVERSIES IN COCHLEAR IMPLANTATION

Manuel SainzGranada University, Spain.

Cochlear implantation is considered one of the main methods for the treatment of profound hearing loss in children and adults. If there is a general consensus in children on the benefi ts of early implan-tation ,it is still a controversial subject when we have to: make the decision to implant some cases of auditory neuropathy,decide the treatment of choice for inner ear malformations or in the cases of hearing losses associated with other defi cits. From the surgical point of view the choice between the diff erents electrode arrays is impor-tant in some pathologies. Failures in the receptor or in the electrode array may be present in diff erents patients and must be considered in relation with the cause of deafness.

IS04

GENETICS OF HEARING LOSS

Enrique SalidoResearch Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

Hearing impairment is the most common sensory disorder, present in almost 1 of every 500 newborns. Deafness is also an extremely he-terogeneous trait, with close to 50 genes implicated in nonsyndro-mic hearing loss. Considerable progress has been made over the past decade identifying the many genes associated with deafness. As a re-sult of the identifi cation of these deafness genes and the functional characterization of the proteins they encode, we have gained unpre-cedented insight into the molecular mechanisms of hearing in the peripheral auditory system. Indeed, the molecules involved in the development and function of the cochlea eluded characterization until recently owing to the scarcity of the principal cell types present. But the “reverse genetic” approach has circumvented this problem and succeeded in identifying proteins and deciphering some of the molecular complexes that operate in these cells. The mechanosen-sory device of the sensory hair cell, the hair bundle, has been the subject of recent advances in cochlea development, its operation as a mechanotransducer and how it processes sound. With the recent explosion of mouse models, the genetic approach is now revealing some of the principles underlying the development and physiology of the cochlea. Many of the key genes that are involved in the deve-lopment and functioning of the auditory system have been elucida-ted with the help of mouse mutants. A combination of genetic and physiological studies of mutant mice, together with the molecular analysis of protein networks of the stereocilia bundle in the inner ear, are identifying crucial elements of auditory function and providing deep insight into the underlying causes of hearing loss.

The most frequent genes implicated in autosomal recessive nonsyn-dromic hearing loss are GJB2, which is responsible for more than half of cases, followed by SLC26A4, MYO15A, OTOF, CDH23 and TMC1. None of the genes associated with autosomal dominant nonsyndro-mic hearing loss accounts for a majority of cases, although mutations are somewhat more frequently reported in WFS1, KCNQ4, COCH and GJB2. Only a minority of these genes is currently included in genetic diagnostics, but the situation is likely to change as sequencing tech-nology becomes more widely spread and aff ordable.

FREE PAPERS


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FP-001

THE USE OF GENETIC INFORMATION AND PSYCHOPHYSICAL

CHARACTERISTICS TO DETERMINE HEARING AID

AMPLIFICATION STRATEGY

Leijendeckers J, Bosman A, Pennings R, de Leenheer E, Plantinga R, Bom S, Snik A, Huygen P, Kunst H, Cremers C.Department of Otorhinolaryngology / Audiology, University Medical Centre St

Radboud, Nijmegen

This study reviews the phenotypes of several types of hereditary hearing loss. By measuring psychophysical performance, cochlear functioning on a subtle scale can be investigated. Audiometric re-sults further add to the phenotype information, which can be used to determine amplifi cation parameters to relieve the hearing loss.

An overview will be given of results obtained from audiometric and psychophysical measurements in USH2a patients and DFNA2, DFNA8/12, DFNA9 and DFNA13 patients. Measurements include pure tone audiometry, speech recognition in quiet and in noise, lo-udness scaling, gap detection, determination of auditory fi lter sha-pes and diff erence limen for frequency.

Speech perception ability appears to be an important factor to dis-tinguish between the consequences of sensorineural hearing loss in these patient groups. Overall results indicate that hearing qualities in USH2a patients closely resemble sensorineural hearing loss like presbyacusis. DFNA types 8/12 and 13 are mainly characterized by a marked performance of speech perception in noise and can be cha-racterized as inner ear conductive hearing impairment. DFNA types 2 and 9, for example, are both characterized by high frequency sensori-neural hearing impairment, but speech perception in DFNA2 is signi-fi cantly better than in DFNA9 and also better than in presbyacusis.

E-mail: [email protected]

FREE PAPERS

FP-002

INTERACTIVE FITTINGS VERSUS PRESCRIPTIVE FITTINGS IN

HEARING AIDS

Boymans M, Dreschler WA.Academic Medical Center, Amsterdam, The Netherlands.

Background: There is no unequivocal way to fi t modern hearing aids. After a “fi rst-fi t” of the hearing aid according to proprietary fi tting ru-les a further fi ne tuning can be conducted either using in-situ measu-rements or using an interactive fi tting procedure.

Aims: In this multicenter study interactive fi ttings (with the Amplifi t® II system) were compared with prescriptive fi ttings (with insertion-gain measurements).

Methods: For the interactive fi ttings the hearing aid dispenser selec-ted new hearing aids and video fragments which simulated daily life situations. After fi tting the hearing aids (according the “fi rst-fi t”) the subject judged the video fragments and answered questions about speech intelligibility, listening comfort, and sound quality, corres-ponding to six acoustical dimensions. Based on the results, the hea-ring aid dispenser could fi ne tune the hearing aids. The results were compared with a hearing aid fi tting based on insertion-gain measu-rements according the NAL-NL1 fi tting rule.

Results: In a blinded cross-over design 73 subjects had a trial period of six weeks for each hearing aid fi tting. The order of fi ttings was randomized. The fi ttings were evaluated objectively (insertion-gain measurements) and subjectively (by means of extensive question-naires: SSQ and AVETA) after each trial period. The performance was evaluated by speech tests in quiet, continuous noise, and time rever-sed speech, both presented at 0 degrees and with spaciously sepa-rated sound sources. On average the prescriptive fi ttings resulted in higher gains and in better speech intelligibility, in quiet and in noise, than the interactive fi ttings.

Conclusions: The results show that the prescriptive method gives better speech intelligibility and can be regarded as an intelligibility driven approach. However, in the domain of subjective results other benefi ts were found for the interactive fi tting. The interactive fi tting can be regarded as a comfort driven approach that complements the prescriptive procedure.



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FP-003

PRESCRIPTIONS FOR MODERN HEARING AIDS -

COMPARISON OF ACOUSTICAL CHARACTERISTICS

Smeds K, Larsson J, Hertzman S, Bergman N.ORCA Europe, Widex A/S, Stockholm, Sweden.

A number of modern hearing aids from various manufacturers were programmed for a sloping and a fl at audiogram, and coupler gain measurements were conducted. The study answers the following questions.

1. How does the measured gain correlate with the NAL-NL1 prescri-bed gain?

2. In particular, how much gain is prescribed for conductive hea-ring losses?

3. How is gain acclimatization handled in the devices?

Similar gain measurements conducted ten years ago indicated huge variations in prescribed gain. At that time, there was no consensus about which prescription to use, which may explain the results. To-day, however, almost every hearing-aid manufacturer off er the NAL-NL1 prescription as one choice, and it was therefore hypothesized that the diff erence in measured gain should be smaller if measure-ments were performed today.

However, the results show that the spread in prescribed gain for a specifi c audiogram is just as large today as it was ten years ago. Des-pite the use of the NAL-NL1 prescription, the gain diff erences, bet-ween highest and lowest measured gain at a particular frequency, are around 20 dB for all measured input levels, and the shape of the gain-frequency response also varies considerably.

When looking at amplifi cation for conductive losses, the data also show a large spread. Some manufactures seem to have implemen-ted a compensation for conductive losses that mirrors that defi ned by the NAL-NL1, whereas others follow other principles.

Also, in devices where gain acclimatization is realized, large variations in the implementation are seen. The diff erence in gain between the ?full prescription? and the gain prescribed for a fi rst-time hearing-aid user varies from 2 to 10 dB. Most manufactures make gain reductions that are independent of input levels, whereas others implement lar-ger gain reductions for low-level inputs than for high-level inputs.

The implications of the results on clinical work will be discussed.


FP-004

OBJECTIVE HEARING AID FITTINGS USING AUDITORY

STEADY-STATE EVOKED RESPONSES

Shemesh R, Attias J, Hassan M, Doa G.Department of Communication Disorders, University of Haifa, Haifa, Israel.

The ultimate goal of universal newborn hearing screening is to ma-nage those born with hearing loss and if needed to rehabilitate them by fi tting hearing aids immediately following auditory diagnosis and within the fi rst few months of age. Unfortunately, infants and young children can not provide reliable behavioral responses to either ai-ded or unaided sounds. In addition, real ear acoustic measurements are not always available in this age. Thus, the fi tting of young children with hearing aids is therefore much uncertain than adults and may last months of repeated fi tting sessions. Electrophysiological tests may provide an objective and reliable tool both in the diagnosis pro-cess and in the hearing aid procedure of infants and small children identifi ed with signifi cant hearing loss and need early auditory inter-vention. The present study, investigated the possible use of auditory steady state response (ASSR) in hearing aid fi tting. Previous studies showed that ASSR predict accurately the behavioral auditory thres-holds both at the high and low frequencies and were found to be re-liable in infants and small children candidates for cochlear implants. Fifteen subjects with mild to moderately severe sensorineural hea-ring loss with age range of 19 to 48 years, participated in this study. The Free-fi led ASSR threshold across most frequencies were highly correlated with the behavioral auditory responses. Real ear measu-rements revealed that the ASSR stimuli were not distorted. The in-tensity-amplitude ASSR growth function of the aided and unaided group diff ered signifi cantly. The objective hearing aid procedure was relatively quick and could be done in a sleeping subject. The results of this study show great promise in hearing aid fi tting for those who can not reliably respond on behavioral testing. This technique should reduce signifi cantly the time between identifi cation and auditory in-tervention in infants suff ering from signifi cant hearing loss. E-mail: [email protected]


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FP-005

THE PRESCRIPTION OF HEARING AIDS FEATURES FROM THE

AUDITORY STEADY STATE RESPONSES

Zenker F (1,2), Fernández Belda R (3,1,2), Mora Espino R (4,1) and Barajas de Prat JJ (4,2,1).(1) Clínica Barajas, S/C de Tenerife, Spain;(2) Fundación Dr. Barajas, S/C de

Tenerife, Spain; (3) Hospital Universitario Nuestra Señora de la Candelaria, S/C

de Tenerife, Spain; (4) Universidad de La Laguna. S/C de Tenerife, Spain.

The advent of universal hearing screening programs has ensured early detection of hearing impairment at birth. This involves the fi tting of hearing-aids at the earliest stage possible. It is important to have hearing aid fi tting protocols specifi cally designed for very young infants. These protocols will be dependent upon electrophy-siologic methods, as behavioural audiometry is not viable until 5-6 months of age and in some cases of infants or young children with developmental delay, not possible at all.

Non-linear circuits found in digital or wide-dynamic range compres-sion (WDRC) hearing-aids have incorporated new fi tting strategies that provide information about the loudness growth function over the range of intensities amplifi ed. The adjustment of non-linear hearing-aids involves the concept of loudness growth normaliza-tion, where hearing-aid features would be adjusted for a particular hearing loss in order to normalize the perception of loudness. From this kind of loudness judgment it is possible to derive electroacous-tic characteristics of hearing-aids such as average gain, maximum output, compression ratio and onset level.

In this presentation we propose a method to estimate the loudness growth function from the amplitude- intensity function of the Au-ditory Steady-State Responses (ASSR). This procedure enables de-termination of some basic properties of hearing aids. A hearing aid evaluation is discussed as an example of a sensorineural impairment. This procedure based directly on the ASSR could deliver an initial ad-justment of the hearing-aid until other behavioural responses can be obtained.


FP-006

NOISE REDUCTION IN MODERN HEARING AIDS – SHORT-

TERM MEASUREMENTS USING SPEECH

Smeds K, Bergman N, Nyman T.ORCA Europe, Stockholm, Sweden.

Modern hearing aids normally incorporate noise reduction algori-thms. The input to the hearing aid is analyzed, and the gain is ad-justed based on estimates of the signal-to-noise ratio in the various compression channels. There are no standard measurements availa-ble that can describe how the noise reduction works, and, as a cli-nician, it is very diffi cult to know if noise reduction algorithms from various manufacturers operate in the same way.

Measurements of long-term average gain reductions have shown that modern hearing aids use noise reduction algorithms that vary substantially. Diff erences are seen in the frequency dependence of the gain reduction, in how the reduction varies with signal-to-noise ratio and presentation level, and in if the gain reduction is dependent on the programmed hearing loss or not. But, do these long-term ave-rage measurements give a fair description of what the hearing aid is doing for a speech signal in the short-term perspective?

The current study aims at showing how the noise reduction algori-thms of contemporary hearing aids function for real speech in noise.

Coupler gain measurements in an acoustic test chamber were per-formed using ten modern hearing aids and a real speech signal in stationary noise. Recordings of the input to and output from the hea-ring aids, with the noise reduction switched on and off , were used to calculate short-term average gain reductions. The measurements show how the gain reductions depend on signal-to-noise ratio and presentation level. The results will be presented both in moving pic-tures and in static graphs.

The results show that the hearing aid manufacturers have chosen to build their noise reduction algorithms based on completely diff erent principles. Hearing aids that seemed to have similar properties when long-term averages were studied proved to have diff erent eff ects in the short-time perspective.

The clinical signifi cance of the results will be discussed.



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FP-007

INNOVATIVE APPROACH TO HEARING DEVICE FITTINGS

Krause L (1), Holmes A E (2), Shrivastav R (3), Siburt H (4).(1)Audigence Inc; (2,3,4)University of Florida.

Advances in hearing aid (HA) and cochlear implant (CI) technology has created millions of possible programming combinations for au-diologists. These advances have drastically increased our capability of conditioning the input signal so as to maximize its benefi t for each individual user, but present clinical practice still relies heavily on subjective judgments. Our research team has developed a me-thod to optimize digital hearing devices for individual patients using speech stimuli. Preliminary results suggest an increase in phoneme responses as well as increased performance on the BKB-Sin while using our optimization procedure as compared to standard fi tting protocols. This programming technique seeks to develop a standar-dized method to optimize hearing aids for individual users, resulting in improved performance, increased user satisfaction, and shorter programming time.


FP-008

NEW TECHNOLOGIES FOR ADULTS WITH PRE-LINGUAL

PROFOUND HEARING LOSS

Smith J.Audiological Consultancy, South Yarra, Australia.

Individuals with profound hearing loss have traditionally been fi tted with hearing aids which provide high gain and high power. The goal has been to provide maximum loudness on the assumption that they need volume to hear and understand speech. Without audibility the-re can be no intelligibility, but it is now appropriate to review our goals when fi tting individuals with severe/profound hearing loss.

Available gain is not achievable gain if the hearing aid whistles. Multi-band active feedback cancellation systems off er an electronic solu-tion to this problem so the desired gain can now be achieved, but high gain may not necessarily improve speech understanding. Fur-ther, hearing aids now include additional features, such as directional microphones and noise reduction, to assist the user when listening in noise. There has been little consideration of the benefi ts of these technologies for individuals with profound hearing loss.

A systematic approach will ensure hearing for conversational speech, but it is high gain for soft sounds that optimises the fi tting for speech understanding. This gain is achieved through a low compression threshold, not through power. Similarly, if the loss is associated with a “dead region of the cochlea” the user cannot access high frequen-cy speech cues, regardless of the power. To ensure access to these sounds, new generation hearing aids now apply frequency lowering technology.

This paper describes an case study for an adult with a pre-lingual severe/profound hearing loss, who transitioned from a super-power device to a lower powered device, the Widex Mind440 -19 +AE, which has the alternative feature set outlined above. It details the response of the client and the lessons learnt when determining how to meet the needs of this particular client group. The relevance of counselling strategies and in situ demonstrations will be discussed.


FP-009

ALMOST A FREE LUNCH: FEEDBACK CONTROL AND HIGH

QUALITY SOUND

Nesgaard J, Mecklenburger J, Hernvig L, Stender T.GN ReSound A/S, Lautrupbjerg 9 PO Box 130, DK-2750 Ballerup, Denmark.

With ever-increasing popularity, hearing aids that promise to dra-matically reduce or eliminate feedback are hitting the market. These hearing aids have new feedback-control algorithms that can attack and cancel out feedback spikes almost instantaneously, even in challenging situations such as when the hand or another object is located near the ear. However, this superior feedback control may sometimes come at the cost of sound quality. Artifacts may be crea-ted if the feedback control system is too aggressive, or with attempts to cancel out input sounds that are not actually feedback. For this reason, a new feedback-control algorithm was developed that would attempt to provide this benefi t while minimizing the cost in terms of decreased sound quality and artifacts.


FP-010

APPLYING FREQUENCY TRANSPOSITION TO IMPROVE

SPEECH PERCEPTION AND PRODUCTION IN SCHOOL-AGE

CHILDREN

Smith J, Dann M, Brown PM.University of Melbourne, Australia.

A key objective when fi tting hearing aids to children is to maximise the audibility of high frequency speech cues which are critical in the understanding of spoken English. Recent advances in digital signal processing have enabled the development of hearing aids which off er linear frequency transposition as a new way of accessing these important speech sounds. This study examined the changes in aided performance observed in children with hearing impairment who trialled the alternative hearing aid technology.

The rationale behind the research was to evaluate the benefi ts of this new technology, as applied in the commercially available Widex In-teo hearing aid, for a group of children with sloping high frequency sensori-neural hearing loss (n=6). The participants were aged bet-ween 9 and 14 years and all attended mainstream schools. Outcome measures were comprised of tests of speech perception and speech production and questionnaires.

Speech perception abilities were measured using CNC word and phoneme tests, with and without frequency transposition in both the audiovisual and visual alone modalities at 6 weekly intervals for 24 weeks. The Goldman-Fristoe 2 Test of Articulation was the chosen measure of speech production and was administered prior to the new aid fi tting and after 24 weeks of frequency transposition use. Results showed statistically signifi cant improvements for the group as a whole on both these measures. These results were supported by positive reporting on the questionnaires completed by key stake-holders.



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FP11

THE INFLUENCE OF MICROPHONE POSITION ON SOUND

LOCALIZATION WITH HEARING AIDS

Van den Bogaert T, Carette E, Wouters J.ExpORL, Dept. Neurosciences, K.U.Leuven, O&N2, Herestraat 49/721, B-3000

Leuven, Belgium.

The question whether hearing aids transmit enough cues for loca-lizing sound sources and whether hearing aid users are able to use these cues to build up a realistic spatial auditory representation of our surrounding environment has recently gained a lot of interest. This is due to the wide application of bilateral hearing aid fi ttings, to the development of wirelessly inter-linked bilateral hearing aids, to the recent hearing aid designs enabling the preservation of binau-ral localization cues and to the fl exible microphone confi gurations which aim at preserving the monaural spectral cues of the hearing aid user.

In this study hearing aid users, as well as normal hearing listeners as a reference, were evaluated in diff erent localization experiments: elevation and front-back discrimination both focusing on the mon-aural spectral cues and left-right localization focusing on the binaural cues. The hearing impaired subjects were tested without and with diff erent types of hearing aids with microphones behind-the-ear, in-the-canal and in-the-pinna.

Most of the hearing impaired subjects are capable of localizing sounds relatively accurate in all three dimensions (left-right / front-back / elevation) if the test procedure included a frequency specifi c audibility compensation for their hearing impairment. Diff erences between the diff erent hearing aid designs were obtained. This diff e-rence was especially prominent in the front-back experiments.

[This research was partly funded by GN ReSound and the FWO - re-search foundation Flanders – project G.0334.06N]


FP12

CAN AN IN-THE-EAR FITTING BE TRULY OPEN?

Jespersen CT, Moeller KN.GN ReSound AS, Lautrupbjerg 9, 2750 Ballerup, Denmark.

As on- and in-the-ear telecommunication devices continue to rise in popularity, translating the futuristic designs to hearing aid techno-logy seems plausible. A new hearing aid intended to combine the benefi ts of open fi tting with design elements of modern telecom-munication devices has been developed. When designing this devi-ce, three main goals were held paramount: to achieve comparable performance to current open hearing devices in terms of occlusion relief and usable gain; to be comfortable for extended wear; and to be cosmetically appealing and innovative to the hearing aid user.

Individuals with mild to moderate high-frequency hearing loss parti-cipated in a series of clinical trials with these devices. The participants included individuals with no prior amplifi cation experience and people that were experienced with open mini-BTE instruments and completely-in-the-canal (CIC) instruments. Extensive data was collec-ted to demonstrate the degree to which the primary objectives for the device were met. Objective testing included speech recognition testing, gain before feedback with and without feedback suppres-sion activated, occlusion measurement utilizing a probe microphone system and real-ear verifi cation of insertion gain. Subjective measu-res included subject surveys of hearing aid benefi t and satisfaction, subjective reports of occlusion, and reports of comfort, cosmetics and hearing aid performance. Results show that the hearing aid suc-ceeded in meeting the three hearing aid goals.

In this presentation the advantages of non-occluding fi ttings will be reviewed, along with the demands these fi ttings place on the hea-ring aid. The results of the clinical trials will be shared, and will inclu-de data illustrating the benefi t aff orded by these particular hearing aids.



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FP13

WIRELESS TECHNOLOGIES TO ENHANCE TELEPHONE USE

WITH HEARING INSTRUMENTS

Chalupper J (1), Ricketts T (2), Picou E (2).(1) Siemens Audiologische Technik, Germany; (2) Vanderbilt University, USA

Background: Recently, hearing aid manufacturers have introduced wireless technologies that enable the right and left hearing instru-ments to be linked and work together in a synchronised system. The input obtained from both hearing aids is shared so that important decisions concerning signal processing are based on this combined processing. In addition, this wireless technology is used to connect to external audio devices such as mobile phones. This is accomplis-hed by using a relay station (e.g. remote control) which transmits and receives Bluetooth signals from external audio devices. Ultra-low power, short range wireless technology is employed to transmit sig-nals between remote control and hearing instruments. Such a sys-tem allows listening to phone signals bilaterally.

Research is presented that investigates perceptual advantages of wi-reless technology in hearing instruments when using the telephone through a wireless audio link.

Methods: Participants were 20 hearing-impaired adults fi tted with RIC devices, using either occluding or non-occluding ear tips. Speech recognition scores and subjective ratings were collected in a noisy environment with six wireless speech transmission conditions and one acoustic telephone condition. In the wireless conditions, speech was transmitted to both ears simultaneously (diotic) or to one ear only (monotic).

Results & Conclusions: Diotic speech transmission allowed for signi-fi cantly better speech recognition than monotic transmission. Dio-tic and monotic wireless conditions resulted in signifi cantly better speech recognition than the acoustic telephone for subjects with oc-cluding domes. In conclusion, wireless technologies can help to im-prove the satisfaction of hearing aid wearers when using telephones.


FP14

MUSIC APPRECIATION OF HEARING AID USERS

Looi V, Rutledge K. The Department of Communication Disorders. The University of Canterbury.

Christchurch, New Zealand.

This study aimed to investigate whether there are any diff erences in the music appreciation levels of hearing aid (HA) users as a function of hearing loss (mild vs. moderate or worse), as well as between HA users that have been assessed for a cochlear implant (CI) (HA-CI group) and those who have not been assessed for a CI (HA-NCI group). It was hypothesised that: i) music enjoyment levels of the HA-CI group would be worse than for the HA-CI group; and ii) that HA users with a moderate or worse hearing loss will have lower music enjoyment levels than those with a mild hearing loss.

An existing questionnaire developed for CI recipients was modifi ed for this study. Participants were asked about: (i) music listening habits and enjoyment; (ii) their ratings of how instrumental families, voices, and musical styles sounded with a HA compared to how they expect them to sound to a person with normal hearing; (iii) self-training stra-tegies adopted to try to improve music listening; (iv) factors aff ecting their music listening enjoyment, and (v) interest in a music training program.

Thirteen HA-CI and 98 HA-NCI participants returned the question-naire. The HA-NCI group was divided into two subgroups: mild (n = 51), and moderate or worse (‘moderate+’; n = 47). It was found that the HA-CI group had signifi cantly lower music listening (p = 0.001) and enjoyment levels than the HA-NCI group (p = 0.021). They also provided lower ratings in terms of ‘pleasantness’ and ‘naturalness’ for instruments and music styles than the HA-NCI group. For the com-parisons between the mild and moderate+ subgroups, results were mixed, although most commonly, there were no signifi cant diff eren-ces between the groups. Overall the results showed that HA users judged instruments to sound signifi cantly diff erent to how they would expect it to sound to a person with normal hearing, with mu-sic enjoyment diff ering for the level of hearing loss for some areas only.



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FP15

EVALUATION OF SUBJECTIVE AND FUNCTIONAL OUTCOME

MEASURES IN HEARING REHABILITATION IN THE

DISPENSER’S PRACTICE

Kaandorp MW (1), Goverts ST (1), Drok T (2), Kramer SE (1), Festen JM (1).(1) ENT-Audiology, VU University Medical Center, Amsterdam, The Netherlands;

(2) Hinkgroep, Amersfoort, the Netherlands.

Next to functional outcomes, subjective outcome measures are considered increasingly important in hearing rehabilitation. Most research in this domain includes patients of audiological centers, whereas in The Netherlands an increasing proportion of hearing aid applicants is seen by a dispenser only. Aiming to ensure adequa-te quality of audiological care, we investigated self reported and functional outcome measures. We included 237 hearing-aid users, clients of six hearing-aid dispensers. Mean age was 67 years (27 – 87 y), mean pure-tone hearing loss (averaged across 1 – 4 kHz) was 50 dB (24 - 85 dB). Main outcome measures were the International Outcome Inventory for Hearing Aids (IOI-HA) that measures two as-pects of hearing aid use (improvement and residual participation li-mitation) and a functional test, measuring spatial speech perception in noise (SRT). Other parameters taken into account were degree of hearing loss, years of hearing aid experience, age and fi ve factors of subjective auditory functioning (Amsterdam Inventory on Auditory Disability and Handicap; AIADH). Hearing aids were divided into four categories, based on hardware price.

Regression analysis showed that both IOI factors are determined by self-rated auditory performance (AIADH), especially the ability to un-derstand speech in noise. For improvement a small positive eff ect of degree of hearing loss was found. Other parameters including SRT showed minor or no relation. Regression analysis showed that SRT scores are determined by age and hearing loss.

In a dispenser’s population, the IOI factors improvement and residual participation limitation are mostly determined by subjective evalua-tion of auditory function. Age and type of hearing aid do not play a role. Functional outcomes do not seem to play a major role in self rated outcome measures. Implications of these fi ndings for hearing rehabilitation practice will be discussed.


FP16

MOTIVATION OF POTENTIAL FIRST TIME HEARING AID

USERS

Nielsen C.Eriksholm Oticon Research Centre. Denmark

Several studies have shown that there are many non adopters of hearing aids and that the proportion of these non-adopters has re-mained unchanged for years. Thus, a remarkable number of hearing-impaired people are hesitant and wait several years before seeking help, despite the recent advances in hearing-aid technology. There-fore it is an attractive idea to apply some sort of ‘preconditioning’ to motivate the hearing-impaired person to take action and to become better prepared for a future hearing-aid fi tting process. In this pre-sentation a process model of motivation of potential hearing-aid users is presented. Coaching concepts have been used as an impor-tant part of the model. Self-refl ection and activation of unconscious knowledge are the key elements in the coaching sessions. An explo-rative study was carried out using the motivation model. Experiences based on 10 people who went through the motivation process will be presented and discussed.


FP17

COGNITIVE DEVELOPMENT AND READING PERFORMANCE

IN HEARING-IMPAIRED CHILDREN WITH HEARING AIDS

Lyxell B(1), Uhlén I (2), Sjödin C (2), Mårtensson I (2), Johansson A (2), Wass M (1).University of Linköping, Swedish Institute for Disability Research HEAD,

Sweden; (2) CLINTEC, Karolinska Institutet, Stockholm, Sweden.

The present study examines cognitive development and reading in hearing-impaired children with hearing aids. Cognitive development is assessed by tests of working memory (WM), phonological skills and lexical access. One basic assumption is that a hearing loss will have a negative impact on the development of these skills, that also will aff ect the development of reading ability. The results were analysed with respect to the number of correct answers as well as the time needed to produce an answer. Hearing-impaired children were com-pared with normal hearing children and deaf children with cochlear implants (CI). Children with hearing-impairment showed signifi -cantly lower scores than normal hearing children and the diff erence between the groups were most pronounced for test with relatively high demands on lexical and phonological processing. Children with hearing-impairment and deaf children with CI displayed a diff erent pattern of results such that children with hearing-impairment per-formed better on phonological tasks, but poorer on tasks measuring reading comprehension.



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FP18

A POSTAL SURVEY OF TINNITUS MANAGEMENT IN GENERAL

PRACTICE- RESULTS OF A PILOT STUDY

Sriskandarajah V, Jayarajan V.Dept of Audiological Medicine, Royal Surrey County Hospital, Guildford, UK.

The UK Department of Health published in January 2009 a document regarding provision of services for adults with tinnitus. This promp-ted us to carry out a survey of tinnitus management in General Prac-tice. We designed a postal survey in two parts: a)a pilot study b)a national survey.

For the pilot study twenty GPs were selected at random across the UK. The purpose of the project was to evaluate current tinnitus ma-nagement methods, and also to modify the questionnaire for the na-tional survey, based on the responses of the GPs.

There were six responses, of which only four were complete. Three of the four said they had little knowledge of tinnitus, but all four felt they had some awareness of treatment measures. All the respon-dents stated that they would take a history and carry out an ENT examination.

There appeared to be a good understanding of tinnitus services such as the British Tinnitus Association (BTA) and Royal National Institute for the Deaf (RNID) as well as the use of behavioural techniques in the treatment of tinnitus. All the respondents indicated that they would like an improvement in the current provision of services for tinnitus patients.

We found this feedback quite valuable. The questionnaire for the national survey was modifi ed based on the responses of the pilot survey, and was distributed to 400 (20%) randomly selected GPs in the UK.


FP-019

COMPARISON OF TINNITUS SEVERITY BETWEEN PATIENTS

WITH NEARLY NORMAL HEARING AND THOSE WITH

HEARING IMPAIRMENT

Geczy BB,Vatovec J, Zargi M.Department of Otorhinolaryngology and Cervicofacial Surgery, University

Medical Center Ljubljana, Slovenia.

Purpose. The aim of our study was to compare the severity of tinnitus in two groups of patients: those with hearing impairment (HI) and those with nearly normal hearing (NH).

Methods. Each group consisted of 100 patients with tinnitus on one or both ears as the main reason for the visit at the Audiologic service. The fi rst group (HI group) consisted of 100 patients with mild and moderate hearing impairment up to 60 dB for speech frequencies on one or both ears. The NH group represented 100 patients with normal hearing up to 3 kHz and notches at 4, 6 or 8 kHz on one or both ears. Tinnitus severity was evaluated by the tinnitus severity questionnaire consisting of 10 questions. The results were statistica-lly analyzed using the t-test for comparing averages of two indepen-dent samples. The possible risk factors for the tinnitus development were obtained from the medical documentation.

Results. The results of the study have shown that tinnitus is perceived as more annoying by patients with nearly normal hearing. They had mostly high pitched tinnitus (at 4, 6 and 8 kHz) and it was perceived as the most annoying. The major risk factors for tinnitus develop-ment were anxious-depressive disorders. More than one third of the patients in both groups were treated for them. The second most pro-minent risk factor in NH group was the noise exposure; the HI group was signifi cantly less often exposed to noise.

Conclusions: Patients from NH group have found the high pitched tinnitus to be the most annoying, probably because of fewer possibi-lities in masking it with tinnitus maskers and environmental sounds. We suppose that their problems in coping with stress also contribu-ted to the severity of their tinnitus.



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FP-020

TINNITUS MATCHING IN FEIGNED TINNITUS

Adelman C (1,2), Priner R (1,2), Fraenkel R (2), Levi H (1,2).(1) Speech and Hearing Center, Hadassah University Hospital, Jerusalem,

Israel; (2) Department of Communication Disorders, Hadassah Academic

College, Jerusalem, Israel.

Tinnitus is a frequent complaint following exposure to noise. As disa-bility damages may be claimed for hearing loss and/or tinnitus, there is a need for methods to evaluate the presence of tinnitus and its severity. This is diffi cult, as tinnitus is usually subjective.

In this study, two groups (normal hearing, sensorineural hearing loss) of volunteers without tinnitus were asked to feign tinnitus du-ring tinnitus-matching tests and while answering questionnaires. Tinnitus-matching for type (steady or warble pure tone, narrow band noise), frequency, and loudness were carried out three times at half-hour intervals in the contralateral ear. The resulting characteristics and consistency of responses were compared to those obtained in individuals with tinnitus following noise-induced hearing loss and acoustic trauma.

Tinnitus matching to narrow-band noise, frequencies under 3000Hz, and high intensities (mean over 35dB SL) were more common in both feigned-tinnitus groups, compared to a predominance of steady pure tone, frequencies 3000Hz and above, and low subjec-tive intensities (mean 12.6dB SL) in those with tinnitus. Consistency of response was signifi cantly diff erent between the groups feigning tinnitus and those with real tinnitus, but many individuals feigning tinnitus were consistent within norms established for the group with tinnitus. In the group of volunteers with sensorineural hearing loss feigning tinnitus, the “tinnitus” was often at a frequency other than the frequency with greatest hearing loss. The questionnaire included scales for the extent the tinnitus disrupted daily life in various situa-tions: scores were signifi cantly lower in feigned tinnitus groups. In the groups feigning tinnitus, there was no correlation between the tinnitus level obtained in the matching procedure and the level re-ported in the questionnaire.

When summarizing tinnitus-matching parameters and questionnaire results, it’s possible to conclude that the results are consistent with those expected in tinnitus, but not to determine if someone is feig-ning.


FP-021

EVALUATION OF THE COCHLEAR AND EFFERENT FUNCTION

IN NORMAL HEARING TINNITUS SUBJECTS: ANALYSIS

OF MULTIPARAMETRIC GLOBAL FEATURES AND TIME-

FREQUENCY FINE STRUCTURE OF OTOACOUSTIC EMISSIONS

Paglialonga P (1), Tognola G (1), Parazzini M (1), del Bo L (2), Ravazzani P (1).(1) CNR Institute of Biomedical Engineering, Milan, Italy; (2) Fondazione

Ascolta e Vivi, Milan, Italy.

Background: A number of questions still remain unanswered as to the origin of subjective tinnitus, especially when tinnitus develops in the absence of hearing loss. Recently, it was postulated that when tinnitus develops in normal-hearing subjects, a minor cochlear da-mage (mainly of OHCs), not necessarily implying decreased hearing thresholds, may act as a trigger of tinnitus. The question whether the phenomena triggering tinnitus occur in the peripheral hearing sys-tem still remains unanswered.

Aims: This study was aimed to assess if minor OHC dysfunction and/or defective cochlear eff erent system functionality in subjects with normal hearing might be considered a necessary condition for the generation of tinnitus.

Methods: Diff erently from previous studies, simultaneous evalua-tion of both multiparametric global features and Wavelet-derived time-frequency (TF) fi ne structure of TEOAEs and DPOAEs in normal-hearing tinnitus subjects (N=28) and control subjects was carried out. The TF approach here applied is a powerful tool to improve OAE sensitivity in detecting possible slight diff erences in cochlear and/or eff erent function between tinnitus and non tinnitus ears that might be too subtle to be detected just by comparing OAE global features. The inhibitory function of the medial olivo-cochlear eff erent system was assessed by measuring OAEs in the presence of contralateral acoustic stimulation (CAS).

Results: No statistically signifi cant diff erences between tinnitus pa-tients and controls could be detected both in DPOAEs and TEOAEs and in CAS. Also, analysis of TF fi ne structure of TEOAEs revealed no statistically diff erences both in the latency of TEOAE frequency com-ponents and in the slope of the latency vs. frequency curve in tinnitus and control subjects. Overall, results seem to reveal that minor OHC dysfunction and/or defective cochlear eff erent system functionality in subjects with normal hearing might not be considered a necessary condition for the generation of tinnitus.



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FP-022

PSYCHOMETRIC PROPERTIES OF A CHINESE (CANTONESE)

VERSION OF THE TINNITUS QUESTIONNAIRE

Kam ACS (1), Cheung APP (2), Cahn PYB (3), Leung EKS (4), Wong TKC (4), Tong MCF (1), Van Hasselt C(1)(1) Department of Otorhinolaryngology, Head & Neck Surgery, Chinese

University of Hong Kong, Hong Kong; (1) 1 Institute of Human Communicative

Research, Chinese University of Hong Kong, Hong Kong; (2) 2 Yan Chai Hospital,

Hong Kong; (3) 3 Pamela Youde Nethersole Eastern Hospital, Hong Kong; (4)

Prince of Wales Hospital, Hong Kong

Background: The most commonly employed tinnitus assessment and monitoring devices for both research and clinical purposes are self-report scales. Tinnitus questionnaires are the primary tools for evaluating and quantifying the disabling and handicapping eff ects of tinnitus, and are useful as outcome measures in determining the eff ectiveness of treatment. Until now, no tinnitus-specifi c question-naire has been available in Chinese (Cantonese).

Aims: To translate the Tinnitus Questionnaire (TQ) into Chinese (Can-tonese) and then determine its reliability and validity.

Methods: The TQ was translated using the translation-back trans-lation method. The Chinese TQ (TQ-CH) was administered to 114 patients who attended the Audiology Clinic in three local hospitals with tinnitus as their primary complaint or secondary to hearing loss. Factor analysis was done to validate the subscales categorized in the TQ. Construct validity, internal consistency reliability and test-retest reliability of the questionnaires were also assessed.

Results: The TQ-CH and its subscales showed good internal consis-tency reliabilities (α = 0.75 to 0.94) comparable to those of the original version. High correlations were observed between TQ-CH and psychological distress, tinnitus-related problem ratings and se-verity ratings. Factor analysis showed high construct validity of the subscales of TQ-CH. High test-retest reliablity was observed.

Conclusion: The results suggest that the TQ-CH is a reliable and valid measure of general tinnitus-related distress that can be used in clini-cal settings to quantify the impact of tinnitus on daily living.


FP-023

EFFECTS OF REPETITIVE TRANSCRANIAL MAGNETIC

STIMULATION ON CHRONIC TINNITUS: AN EGYPTIAN STUDY

El-Nabil LM(1), Khalil LH (2), Amal F (1).(1) Department of Neurology and Psychiatry, Ain Shams University, Cairo,

Egypt (2) Department of Audiology, Ain Shams University, Cairo, Egypt.

OBJECTIVES: Focal brain activation in the auditory cortex has been demonstrated in chronic tinnitus. Low-frequency repetitive transcra-nial magnetic stimulation (rTMS) of the temporal cortex was found to reduce tinnitus associated cortical hyper excitability. This study tested the long term eff ect of two weeks low-frequency rTMS, over left auditory cortex,compared with the sham stimulation. Also the potential prognostic factors in tinnitus patients that allow benefi t of rTMS treatment were examined.

SUBJECTS AND METHODS: thirty patients with chronic tinnitus ran-domly divided into two groups; group (1) fi fteen patients received six real rTMS over the left temproparietal cortex every other day for two weeks, group (2) fi fteen patients received six sham rTMS with the coil 90 degrees tilted behind the left ear every other day for two weeks. The treatment outcome was assessed with a tinnitus questionnaire immediately after the six sessions and monthly for three months. Therapeutic success was related to the patients’ clinical characteris-tics.

RESULTS: there were no signifi cant diff erences in base line as-sessment between the two groups of patients. Repeated measures analysis by ANOVA revealed a signifi cant “rTMS” ×”time” interaction for tinnitus complaints as shown by tinnitus questionnaire. This was because real rTMS produced greater improvement than sham rTMS. There were negative correlations between the percentages of im-provement in tinnitus questionnaire and tinnitus duration as well as hearing threshold.

CONCLUSION: Six sessions of rTMS for two weeks over the left tem-proparietal cortex showed continuous and progressive inhibition of tinnitus up to three months period. Patients with normal hearing and a short history of complaints benefi ted more from rTMS treatment. Tinnitus related maladaptive plastic changes due to longer duration and higher degree of hearing loss might explain treatment outcome.



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FP-024

MECHANISMS OF NOISE INDUCED HEARING LOSS AND ITS

ALLEVIATION

Adelman C (1,2), Tamir S (3), Perez S (3), Weinberger J (4), Sohmer H (2)(1) Speech and Hearing Center, Hadassah University Hospital; (2) Dept.

of Physiology, Hebrew University-Hadassah Medical School; (3) Dept. of

Otolaryngology and Head & Neck Surgery, Shaare Zedek Medical Center;

(4) Dept. of Otolaryngology and Head & Neck Surgery, Hadassah University

Hospital; Jerusalem, Israel.

Exposure to noise can cause a noise induced hearing loss (NIHL), the severity of which is a function of the magnitude and duration of the noise. In this study, pharmacological methods were used to gain in-sight into the mechanisms of NIHL and to suggest drugs which could alleviate the loss.

In order to enable comparison between drugs, all experiments were conducted on the same species (mice), exposed to the same noise (continuous broadband for 3.5 hours, which causes permanent hea-ring loss - PTS), with auditory threshold assessed in the same way (click auditory nerve and brainstem evoked response (ABR) thres-holds) before and two to three weeks after the noise exposure. The drugs administered in the diff erent groups before or after noise ex-posure included salicylic acid and furosemide, which depress the co-chlear amplifi er and hence the active displacements in the cochlea, the anti-oxidant NAC (N-acetyl-L-cysteine), and saline (control). The degree of PTS was calculated as the diff erence between the ABR threshold two weeks after the exposure and that before exposure. The degree of protection provided by each of the drugs was calcula-ted as the diff erence between the PTS in the saline control group and that in each drug group.

Salicylic acid and furosemide, administered just before the noise, each provided more protection than NAC, showing that reduction of active mechanics is most eff ective. This can be due either to a reduction in excessive active vibrations (which can cause direct me-chanical structural damage) or to the resulting decrease in metabolic demand (with reduced release of free radicals and indirect metabolic structural damage). The fi nding that the anti-oxidant NAC also provi-ded some protection is evidence for oxidative damage. Preliminary experiments have shown that it is not likely that the PTS is due to excessive passive displacements, even following exposure to impul-se noise.


FP-025

LOW DPOAES WITH NORMAL AUDIOGRAMS AND THE RISK

OF EARLY HEARING LOSS AT NOISE EXPOSURE: PREDICTIVE

VALUE OF AN OTOACOUSTIC VULNERABILITY INDEX

Job A (1), Raynal M (2), Kossowski M (2).(1) CRSSA centre de recherches du service de santé des armées, France; (2)


Background : It is unknown whether low distortion product otoacous-tic emissions (DPOAEs) are risk markers for subsequent early hearing loss in normal hearing ears exposed to noise.

Objective: To identify at risk subjects for early hearing loss in a normal hearing population using an index of abnormal DPOAEs (IaDPOAE) to estimate ear vulnerability to noise

Study Design : A longitudinal study.

Methods: The study population consisted of pilots 20-40 years old. Data collection consisted of tonal audiograms, DPOAEs measure-ments completed by the IaDPOAE calculation and a clinical ques-tionnaire. The cut-off value of 15% for the IaDPOAE gave the best sensitivity and specifi city to part normal hearing ears from impaired hearing ears (n=550). We could re-tested 219 of 340 normal ears (all frequencies = 10dB HL) after 3 years and we observed the occurrence of impaired ears (at least one frequency > 25 dB HL), depending if IaDPOAE was initially low (<15%) or high (>15%).

Results : In initially normal hearing ears, occurrence of impaired hea-ring, 3 years later was, in the high IaDPOAE group compared to low IaDPOAE group, 21% and 8%, respectively (p<0.012). Early hearing loss in normal ears with IaDPOAE > 15% were associated with a rela-tive risk of 2.9 (95% CI, 1.24 to 6.58)

Conclusion: Low DPOAEs espacially IaDPOAE >15% is a risk marker for early hearing loss. It predicts a vulnerability before the alteration of audiograms. This study emphasised the high interest of DPOAE measurements in noise exposure prevention policies.



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FP-026

PREVALENCE OF 6 KHZ “NOTCH” IN POPULATIONS OF

ADOLESCENTS AND YOUNG ADULTS

Le Prell CG (1), Guire K (2), Hall JW (1), Holmes AE (1).(1) University of Florida; (2) University of Michigan, USA.

The classic evidence for noise-induced hearing loss (NIHL) in indus-trial workers is a “notched” audiogram, with discrete hearing loss largely confi ned to 4 kHz test frequencies. In contrast, a number of studies suggest that musicians largely experience hearing loss at 6 kHz. Such data suggest the eff ects of industrial noise may diff er from those of exposure to loud music. We screened various adolescent and young adult populations, including juvenile residents housed at a detention facility, incoming college students, and adolescents par-ticipating in the NHANES study. We detected a discrete 6 kHz hearing loss consistent with NIHL in a subset of the members of each of the-se adolescent and young adult multiple populations. More recently, we have been screening college students at the University of Florida for normal hearing. To date we have screened 45 students who use digital music players. A general elevation in threshold sensitivity, as well as a notched hearing loss at 6 kHz, was detected in 12 students (27%). Taken together, these data indicate that certain adolescent and young adult populations may experience NIHL at a higher rate than that reported for the age-matched general population and the primary eff ect may be at a higher frequency (6kHz) than the traditio-nal industrial-noise-induced 4 kHz notch. The potential that factors such as gender and/or ear canal resonance may contribute to a 6 kHz notched audiogram will be discussed. The prevalence of NIHL in younger populations, and the potential that digital music player use may contribute to an increased incidence of NIHL, is of signifi cant interest but remains a controversial topic.

Funded by NIH/NIDCD U01 DC008423.

E-mail: [email protected] .edu

FP-027

DEVELOPING HEARING CONSERVATION PROGRAM FOR

ROLLING STOCK PLANT WORKERS

Sliwinska-Kowalska M (1,2), Zamojska M (1), Dudarewicz A (1), Kotylo P (1), Pawelczyk M (1), Pawlaczyk-Luszczynska M (1).(1) Nofer Institute of Occupational Medicine, Lodz, Poland; (2) Medical

University of Lodz, Poland.

Background: The use of exposure limits and the integration of wor-kers in health surveillance program are nowadays the most effi cient international tools in controlling and assessing workplace exposures and preventing their consequences. According to the EC Noise Di-rective, hearing conservation programs must involve estimation of individual risk for hearing threshold shift as an outcome of complex interaction of external and intrinsic factors.

Aims: The aim of the study was to estimate the individual risk of hea-ring loss in rolling stock plant workers and to evaluate the need for implementing hearing conservation programs in this industry.

Methods: Noise measurements, questionnaire inquiries, pure-tone audiometry and distortion product otoacoustic emissions were ca-rried out in 123 employees of a rolling stock plant. A questionnaire was aimed at self-assessment of hearing status and identifi cation of occupational and non-occupational risk factors for the noise-indu-ced hearing loss (NIHL).

Results: Based on the results from noise measurements and ques-tionnaire data, the assessment of risk of hearing impairment was performed according to the ISO 1999:1990 standard. Workers under study were exposed to noise at equivalent-continuous A-weighted sound pressure levels from 78 to 97 dB during the period of 1-40 years. Such exposures were associated with increased risk of NIHL. Most respondents (82 %) were aware of exposure to excessive noi-se and declared usage of hearing protectors (89 %). However, nearly every third worker noticed hearing impairment. Predicted hearing threshold shifts based on the ISO standard were compared to actua-lly measured ones.

Conclusions: Obtained results confi rmed the need to implement the hearing conservation program in the rolling stock industry. The de-tails of the program will be presented.



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FP-028

DPOAEs AND SUSCEPTIBILITY TO TINNITUS IN NORMAL

HEARING SUBJECTS EXPOSED TO NOISE

Job A (1), Raynal M (2), Kossowski M (2).(1) CRSSA centre de recherches du service de santé des armées, France; (2)


We investigated potential markers of susceptibility to tinnitus in a population of normal hearing young pilots aged 25-35 years and with 8 ± 5 years of aircraft noise exposure. A sample of 316 pilots were interviewed about their tinnitus status and were tested for hea-ring thresholds (audiograms) and distortion products otoacoustic emissions (DPOAE-grams). There was no subject with permanent tinnitus. 23 % reported to perceive occasionally tinnitus after fl ight missions and 77 % reported never having experienced tinnitus after fl ight missions. General discomfort in the ears to noise was higher in the occasional tinnitus group (15 % vs 6%). The major fi nding was that diff erence of susceptibility to tinnitus in normal hearing sub-jects exposed to noise on a daily basis seemed to be clearly related to lower DPOAEs, bilaterally, in the 1500-2800 kHz range. However, no diff erence could be observed between groups, on audiograms at the 2 kHz frequency range. This study provided evidence of outer hair cell dysfunctions in normal hearing subjects exposed to noise, sus-ceptible to tinnitus. Hypersensitivity to noise and DPOAEs decreases in a non noise-specifi c frequency range supported the idea of ano-ther alteration mechanism than noise itself. This point was discussed in the light of recent publications.


FP-029

MODELING NOISE INDUCED HEARING LOSS

Tronstad TV, Kvaloy O.SINTEF ICT, Norway.

It is well known that the Outer Hair Cells (OHCs) are the fi rst structu-res to be damaged during excessive noise exposure. The work of the OHCs during noise exposure consumes energy. This energy is pro-duced by chemical reactions within the cell and relies on an infl ux of substances to the cell. There will also be waste products from the processes that must be removed. If cells are stressed above a certain level they will suff er from metabolic fatigue. This fatigue will damage the cells, either temporary or permanent, and will eventually lead to cell death.

A model is presented where the mass transport to and fro the OHC is a diff usion process. The model has the shape of an electric circuit where the voltage and currents are analogs to the concentration and transport of substances. The electrical analog modeling is well established and enables us to predict concentrations and therefore damage and potential cell death.

In the assumptions mentioned above it is not important what com-pounds that need to be transported to and fro the OHC, but literature show that Reactive Oxygen Species (ROS) are central and involved in cell death. If ROS is assumed to be the damaging compounds, anti-oxidants are needed to protect from damage.

The model has been compared with the known standards for hearing damage. One of the most obvious advantages of our model is that it will take into account recovery between periods of noise exposure. It is known that the ear benefi ts from such resting periods but they are not taken into account by the models underlying today´s legislation. Furthermore, if there is a correlation between temporary threshold shift and concentration of damaging compounds (e.g. ROS), this can be used to calibrate the model to each person, eliminating individual diff erences.



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FP-030

HIGH FREQUENCY AUDIOMETRIC NOTCH: AN OUTPATIENT

SURVEY

Yeoh LH, Osei-Lah V.St Helier University Hospital, UK.

The aim of this study was to identify the prevalence of high frequen-cy notch (HFN) in a tertiary audiovestibular medicine outpatient cli-nic population at a district general hospital. One hundred and forty nine consecutive adult patients were assessed. According to stan-dard practice at the audiovestibular clinic, a full clinical history with particular emphasis on neuro-otological symptoms, noise exposure and medical risk factors for sensorineural hearing loss was taken. After standard 8-frequency pure tone audiometry, subjects were di-vided into those with HFN and those without. Subjects with conduc-tive hearing loss were excluded. There were 84 (56%) females and 65 (44%) males with a mean age of 45 years (range: 19 to 91 years). 39.6% had notches not attributable to noise (occupational or recrea-tional) or any other known risk factor. In 28 (49.2%) and 15 (25.4%) the HFN was present in the left and right ear respectively whereas 15 (25.4%) were bilateral. The frequency least aff ected was 3 kHz while 4 kHz and 6 kHz were aff ected in almost equal proportions. In 53 ears (71.6%), the notch depth was less than 20 dBHL (10-19 dB) compared to 21 ears (28.4%) with a depth of 20 dBHL or more. This study con-cludes that high frequency notch without excessive noise exposure or any other known factor is common. It is neither diagnostic of, nor invariable with NIHL unless a convincing history of Noise exposure.


FP-031

OCCUPATIONAL NOISE-INDUCED HEARING LOSS IN

POLAND: EPIDEMIOLOGY AND STATISTICS THROUGHOUT

1999 - 2008

Sulkowski WJ (1), Szymczak W (2).(1) Clinic of Occupational Diseases and Toxicology; (2) Department of

Environmental Epidemiology. Nofer Institute of Occupational Medicine, Lodz,

Poland.

Background. It is commonly known that a long-term and everyday repeated exposure to noise levels exceeding 85 dB-A may result in hearing impairment traditionally called the chronic acoustic trauma,recognized in the all EU countries as the compensable occu-pational disease. Accordingly to the latest estimations about 500 000 workers employed in noisy plants are put at risk in Poland. The aim of this study was to present the most recent data on the incidence of occupational noise-induced hearing loss (ONIHL) which could be used for implementing the suitable prophylactic undertakings.

Methods. The data were derived from the state register of the all prescribed occupational diseases and individual fi les of subjects with diagnosed ONIHL were statistically analysed concerning the worker’s age, duration of exposure,industrial branch and geographic location of workplace.

Results and conclusions. The highest indices of the ONIHL were found in employees of coal mining,iron and steel,metallurgical and transport equipment industries,mainly in the southern and western provinces,known for a large concentration of noisy enterprises. The most aff ected have appeared the workers aged 50-59 years and the-se exposed to noise for over 20 years.Since the beginning of 1999 the rate of ONIHL amounting earlier to about 36 new cases annually per 100 000 employees has signifi cantly decreased to 19 cases per year.

One may presume that introduction of the obligatory pre-employ-ment and follow up audiometric examinations in 1999 has infl uen-ced the change for the better.

Acknowledgement. This work was supported in part by research grant No 1631/B/PO1/2008/34 from the Ministry of Science and Hig-her Education



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FP-032

DYNAMIC HEARING PROTECTION FOR PEOPLE WITH

HEARING LOSS

Mülder HE, Goldbeck F.Phonak Communications AG, Switzerland.

Wearing time during noise determines to a large extent the eff ec-tiveness of hearing protection devices. No matter how high the instantaneous damping may be, the maximum protection is just 10 dB if wearing time is 90% instead of 100%. As a consequence, ideal hearing protection is extremely comfortable, and in fl uctuating or intermittent noise ideal hearing protection allows for communica-tion, even in the presence of a hearing loss. To investigate the latter, a group of hearing impaired subjects was equipped with diff erent custom made hearing protection devices, and speech understanding in diff erent noise levels was measured with the OLSA (Oldenburger Satz) test. The hearing protection devices were both passive devices and dynamic devices. The hypothesis was tested whether hearing impaired subjects have better speech understanding in noise when using dynamic hearing protection than passive hearing protection. This may have a direct impact on what persons with hearing loss, of-ten a consequence of noise and non-compliance with unsatisfactory hearing protection, should get as preferred hearing protection type of device.


FP-033

ORAL D-METHIONINE (MRX-1024) SIGNIFICANTLY

PROTECTS AGAINST CISPLATIN-INDUCED HEARING LOSS: A

PHASE II STUDY IN HUMANS

Campbell KCM (1), Nayar R (2), Borgonha S (2), Hughes L (1), Rehemtulla A (3), Ross B (3), Sunkara P (3).(1) Southern Illinois University School of Medicine, Springfi eld, IL, USA; (2)

St. John’s National Academy of Sciences, Bangalore, India; (3) Molecular

Therapeutics, Ann Arbor, Michigan, USA.

Background: D-methionine (D-met) protects against cisplatin-, ami-noglycoside- and noise-induced hearing loss in multiple animal stu-dies. Further, D-met protects against radiation induced oral mucosi-tis. We are currently preparing for clinical trials for D- met protection against noise-induced and aminoglycoside-induced hearing loss. Phase II clinical trials results for D-met protection from radiation-induced oral mucositis are currently being prepared for publication.

Aims: This study represents the fi rst clinical trials results for D-met protection from cisplatin-induced ototoxicity in humans. The pur-pose is to determine if hearing thresholds can be protected without antitumor interference or signifi cant side eff ects.

Methods: In this double blind randomized pilot study, 14 adult pa-tients received 100mg/kg dose of an oral orange fl avored suspen-sion of D-met (MRX-1024) and 13 subjects received fl avor matched placebo in equivalent volume prior to each dose of cisplatin. Mean cumulative cisplatin dosing was 263.57 (SD 74.79) in the experimen-tal group and 253.85 (SD 56.94) in the control group. Primary tumor sites ranged from genitourinary tract to head and neck cancers. Six patients in the experimental group and four patients in the place-bo group also received radiation to the head and/or neck area for primary tumors in that region. Auditory thresholds were tested bi-laterally at 8, 10, 11.2 and 12.5 kHz with a GSI 61 audiometer using a modifi ed Hughson-Westlake technique.

Results: Signifi cant hearing threshold protection was obtained for the frequencies of 10 kHz and above. No diff erence in tumor regres-sion was noted between groups.

Conclusions: We are encouraged that signifi cant otoprotection was observed even with a small group of patients receiving fairly low cu-mulative cisplatin dosing. Larger scale clinical trials are being plan-ned.



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FP-034

RECOGNITION OF DICHOTIC DOUBLE DIGITS IN YOUNG AND

ELDERLY CANTONESE-SPEAKING LISTENERS

Kam ACS (1), Keith RW (2).(1) Department of Otorhinolaryngology, Head & Neck Surgery, Chinese

University of Hong Kong, Hong Kong and Institute of Human Communicative

Research, Chinese University of Hong Kong, Hong Kong; (2) Department of

Otolaryngology, University of Cincinnati, USA.

Background: Dichotic listening tests are commonly used in assessing children and adults suspected of auditory processing problems, es-pecially in search of interaural asymmetry. In general, the eff ects of aging on dichotic speech recognition result in poorer performance and larger REAs for older adults relative to fi ndings for young adults. As Chinese and English diff er completely in phonology, morphology and syntax, it seems reasonable to suspect if their cerebral represen-tations would be diff erent.

Aim: The primary purpose of the present research study was to deter-mine if diff erences in dichotic listening performance exist between young adults with normal hearing and older adults with minimal sensorineural hearing loss in the Cantonese-speaking population.

Methods: Cantonese dichotic digits recognition was evaluated in free-recall, directed-attention right, and directed-attention left res-ponse conditions. All participants were right-handed and included a group of young adults (n = 30, age range = 20-35) with normal hea-ring and a group of older adults (n = 30, age range = 65-80) with minimal sensorineural hearing loss.

Results: In all conditions, performance by the young adults was bet-ter than performance by the older adults. A right-ear advantage (REA) was observed for both groups. Due to a greater defi cit in dichotic digits recognition performance for digits presented to the left ear of older subjects their REAs were larger than those for the young adults.

Conclusions: The results support an age-related disadvantage in recognition performance for dichotic stimuli presented to the left ear not entirely accounted for by diff erences in hearing sensitivity between subject groups but may be related to a primary cognitive defi cit.

E-mail:[email protected]

FP-035

NORMATIVE VALUES FOR POLISH DICHOTIC DIGIT TEST

Senderski A (1), McPherson D (2), Kochanek K (1), Piotrowska A (1), Skarzynski H. (1)(1) Institute of |Physiology and Pathology of Hearing Warsaw, Poland; (2)


Dichotic listening tests are among the most powerful of the beha-vioral auditory processing test battery. They are used as a measure of interhemispheric transfer of information and development and maturation of the auditory nervous system. The aim of the study was to develop the normative data for polish dichotic digits test in children. Material consisted of 6355 7 y.o. and 5910 12 y.o. children with normal hearing sensitivity (threshold better than 15 dB HL for frequencies from 500 to 8000 Hz) without learning and language problems. The test was conducted in free recall mode (divided atten-tion). Age-specifi c normal cutoff s were developed using the criterion of two standard deviations below the means. The results: Mean – 2SD values were as follow: 45% for right ear and 10 % for the left ear for 7 y.o. children and 70% for the right ear and 50% for the left ear in 12 y.o. children. We observed statistically signifi cant right ear advantage (REA) in both groups of children. The REA was signifi cantly greater in 7 y.o. children comparing to 12 y. o. children. The REA refl ects left hemisphere dominance for language and it was present in our mate-rial regardless of handedness. The reduction of REA with age can be treated as an eff ect of the maturation of the auditory system. Further research on the Polish DDT is recommended to investigate its validity and reliability, and to study its performance on children with known auditory processing defi cits.


FP-036

DICHOTIC DIGITS TEST – WHAT IT CAN TELLS US ABOUT

LEARNING AND COMMUNICATION ABILITIES OF SCHOOL

AGE CHILDREN

Senderski A (1), McPherson D (2), Kochanek K (1), A.Pilka A.(1), Skarzynski H.(1)(1) Institute of Physiology and Pathology of Hearing Warsaw, Poland; (2)


Dichotic listening tests are among the most powerful of the beha-vioral auditory processing test battery. They are used as a measure of interhemispheric transfer of information and development and ma-turation of the auditory nervous system. We have developed polish dichotic digits test (DDT) based on English dichotic digits (Musiek, 1983) Based on the material of more than 50000 school children tes-ted in hearing screening programs in Poland in the years 2007 and 2008 we developed the normative values for 7 and 12 y old children and gathered data from audiological questionnaires. The aim of the study was to assess the correlation between clinical information about learning and communication abilities from the questionnai-re and the results of dichotic digit test in school age children. Based on DDT and pure tone audiometry results subjects were separated on three groups (C) - central auditory processing disorder group, (P) - peripheral hearing impairment group and (N) - children with nor-mal hearing sensitivity and normal results of the dichotic digit test. Results: children from group C had more often delayed or disturbed speech development, and lower school achievements in comparison with those from group (N) and (P). More than 40 % of children from group (C) had dyslexia and more than 35% of children from group (C) had problems with learning of foreign languages. The results of this analysis have shown that in substantial number of children with lear-ning and language problems there are abnormal results of dichotic digits test. We discuss the issue of the contribution on non-auditory-specifi c factors on the results of dichotic digits test and its usefulness as a screening test for central auditory processing disorder.



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FP-037

PLASTICITY OF THE AUDITORY SYSTEM IN THE ELDERLY

Lavie L, Attias J, Karni A.University of Haifa, Israel.

Hearing loss is the third chronic most common condition reported by the elderly. Many elderly people face greater diffi culties understan-ding speech than would be expected from their audiograms, particu-larly in degraded listening situations. At least a part of these percep-tual diffi culties is attributed to Auditory Processing Disorders (APD). One common phenomenon in APD is a reduced overall performance in dichotic listening tests and an enlarged right ear advantage (REA) for speech, due to enlarged defi cit in the left ear (LED). These fi ndings are linked to poor ability to use binaural cues.

Hypothesis: It is possible to diminish the gap between the dominant ear and the non-dominant ear (as measured with dichotic listening tasks) in the elderly, by means of sequential hearing aids fi tting and monaural practice. Training will diminish the LED through plastic changes in the auditory system.

Method: 36 elderly hearing impaired subjects (ages 64-89) divided into 3 groups were fi tted with binaural hearing aids as followed:

Two groups (A and B) were fi tted sequentially, such that the subjects used one hearing aid monaurally for one month, either in the non-dominant ear (group A) or in the dominant ear (group B) (according to dichotic listening tests). On the second month, these subjects used hearing aids binaurally. In the third group (group C) subjects received binaural hearing aids since day one.

Aural auditory training was applied (7 training sessions, 40 minutes each) during the fi rst month, while the subjects wear their personal hearing aid/s. Thus, when monaural hearing aid mode was applied, the aided ear received a higher intensity input, due to the hearing aid’s amplifi cation.

Dichotic listening tests were conducted in the beginning of the stu-dy, and several times through the study period.

Results: Fast and signifi cant changes in dichotic listening scores fo-llowing training and hearing aid/s usage were observed. The chan-ges diff ered according to the trained (fi tted) ear and between mon-aural and binaural fi tting.


FP-038

ON THE SURPRISINGLY PROLONGED DEVELOPMENTAL

TRAJECTORY OF (CENTRAL) AUDITORY PROCESSING

Banai K.University of Haifa, Israel.

Developmental gains in the ability to detect and discriminate fi ne acoustic diff erences between sounds are usually attributed to either sensory factors or to the ability to attend to the relevant auditory cue for the duration of the assessment. Here we show that depending on the task listeners are required to perform, frequency discrimination thresholds are either adult- like by 8 years of age (when measured with an oddball procedure in which listeners are asked to select the ‘odd-one-out’ among three alternatives) or still not adult- like by 14 years of age (when measured with a 2-interval-2-alternative-forced-choice identifi cation procedure in which listeners are asked to deter-mine which of 2 tones is higher). Because the stimuli used in both assessments were similar, sensory maturation seems an unlikely account for these fi ndings. On the other hand, task related cogniti-ve factors cannot account for the entire developmental diff erence between the oddball and identifi cation procedures either, because in contrast to frequency discrimination, the ability to detect ampli-tude modulations (AM detection) is not adult like by 12 years of age even when assessed with an oddball procedure. To derive a measure of auditory attention during task performance, within listener per-formance consistency, determined as the standard deviation around the mean discrimination or detection threshold was analyzed. Con-trary to expectation, this measure could not account for the deve-lopmental trajectory of either frequency discrimination as assessed with the identifi cation procedure or of AM detection measured with the oddball procedure. These data imply that attentional factors alo-ne are also not likely responsible to the prolonged development on these tasks. Therefore cognitive functions other than sensation and attention and which continue to develop during adolescence may be responsible for the development of auditory discrimination and should be taken into account in both research on and diagnosis of Auditory Processing Disorders.



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FP-039

EFFECT OF AGE ON UNILATERAL AND BILATERAL EDULINK

FITTING IN NORMAL HEARING SUBJECTS

Mukari SZ, Umat C, Abdul Razak UA, Mannan NH, Mohamad S.Department of Audiology & Speech Sciences, Universiti Kebangsaan Malaysia,

Malaysia.

This study examined the age eff ect on the benefi t obtained from unilateral and bilateral Edulink usage. Measurements were conduc-ted on 66 normal hearing subjects consisted of 22 children (8 to 9 years old), 22 young adults (aged 20-30 years old), and 22 older adults (50 to 60 years old). Reception threshold for sentences (RTS) was measured using the Malay Hearing in Noise Test (HINT) in three listening conditions: no-Edulink, unilateral and in bilateral Edulink fi ttings. Edulink benefi t was defi ned as the improvement in RTS with the Edulink usage as compared to without the Edulink. A mixed re-peated measure ANOVA revealed that for all age groups, there was a signifi cant main eff ect of listening conditions F(1.76, 108.98) = 14.72, p<0.001, in which the mean RTS without Edulink was signi-fi cantly poorer than those obtained in unilateral (p<0.001) and in bilateral Edulink fi tting (p<0.001). However, there was no signifi cant diff erence between the mean RTS values in unilateral and bilateral groups (p>0.05). A signifi cant interaction between listening condi-tion and age group was also present signifying diff erential eff ects of age group on the RTS values in diff erent listening conditions. A one way ANOVA was conducted to examine the eff ect of age groups on Edulink benefi ts. There were signifi cant main eff ects of age groups in unilateral benefi t (F (2, 63)=12.14, p<0.001) and in bilateral fi tting (F(2,63)=15.40, p<0.001). Unilateral fi tting revealed that children and older adults received signifi cantly greater benefi t than did young adults (p<0.01), while for bilateral fi tting, children received a signifi -cantly higher benefi t than both adult groups (p<0.05). This study has demonstrated that age has a signifi cant eff ect on the magnitude of benefi t from edulink usage. Bilateral fi tting did not provide a signifi -cantly better RTS than unilateral fi tting for all age groups.


FP-040

PRESBYACUSIS – WHAT IS A REASON FOR DECREASING

SPEECH INTELLIGIBILITY?

Marn B.Children’s University Hospital Zagreb, Croatia.

Changes due to presbyacusis are described at all levels of the audi-tory system. Nevertheless it is still a matter of discussion where these changes are most often, does the localization change by aging and where impairment responsible for poor speech intelligibility (SI) is lo-calized. Tinnitus is also connected with presbyacusis in many articles.

109 examinees older than 60 were divided into four groups and tested by pure tone audiometry, frequency selectivity and tempo-ral resolution tests, brainstem evoked response audiometry (BERA), intelligibility of phonetically balanced words in silence and noise as well as sentences of normal speed, distorted by time-compression technique and by rapid alternate test.

Comparison of test results and statistical analysis indicated that:

impairment at the peripheral level is due to the impairment of recep-tors and not the fi rst neuron;

BERA test showed that changes at that level are rare (4% of exami-nees);

standard speech audiometry was quite insensitive to detect central disorders – much more sensitive were testing of SI for words in noise, time-distorted sentences and rapid alternating sentences.

Tinnitus was present at only 9% of examinees, so, it seems not to be a characteristic sign of presbyacusis.

According to this investigation, changes due to cortical impairment seem to be the main reason of decreasing SI.


FP-041

TYPES OF HEARING IMPAIRMENT - DEFINITIONS CHANGING

OVER TIME

Neumann K (1), Stephens D (2).(1) Department of Phoniatrics and Pediatric Audiology, University of Frankfurt,

Frankfurt am Main, Germany; (2) School of Medicine, Cardiff University,

Cardiff , Wales.

Objective: Over the years a range of defi nitions of diff erent types of hearing impairment has been proposed, starting with a separation of conductive and sensorineural impairment. Such defi nitions have changed and been elaborated on with time, with increasing subdi-visions. However, overlapping, unclear or absent defi nitions have resulted in some confusion in the past. In particular, the division bet-ween retrocochlear hearing disorders, central hearing disorders, cen-tral auditory processing disorders, and auditory neuropathy is not always clear and often confuses students of acoustics and audiology or physicians who specialize in hearing problems and related fi elds.

Method: A critical analysis was made of previous defi nitions together with a consideration of current knowledge of functions and dys-functions of the auditory system.

Results and Conclusions: A coherent set of defi nitions compatible with the contemporary understanding of auditory disorders and their perceptual eff ects is proposed.



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FP-042

COMPARISON OF CONVENTIONAL AUDITORY PROCESSING

EVALUATION WITH A NEWLY DEVELOPED NON VERBAL

AUDITORY PROCESSING BATTERY IN A PEDIATRIC

POPULATION

Iliadou V (1), Ferguson MA (2), Kaprinis St (1), Moore DR (2).(1) Clinical Psychoacoustics Laboratory, Medical School Aristotle University of

Thessaloniki, Greece; (2) MRC Institute of Hearing Research, Nottingham, UK.

Background: Controversies in auditory processing disorder (APD) diagnosis exist as to the infl uence of top-down cognitive eff ects as a by-product during evaluation using the conventional tests.

Aim: The aim of this study is to evaluate the auditory processing re-sults of a conventional battery (CB) and one newly developed adapti-ve computer-based test battery (IMAP) in a group of children suspec-ted of learning disabilities.

Material and Methods: 32 children between the ages of 8-13 years suspected of having learning disabilities were fi rst tested with a con-ventional APD test battery. After being diagnosed with APD on the basis of the CB they were evaluated with the IMAP battery, which provides apart from individual auditory processing task results, two derived measures of temporal and frequency resolution that spe-cifi cally test sensory processing. The control group consisted of 15 children between the ages of 8-13 years with normal IQ referred for learning disabilities and having normal auditory processing abilities as measured by the same CB used for the APD group.

Results: Analyzing data with the Mann Whitney test for the two inde-pendent sample groups, the APD group (diagnosed with the CB) had poorer results in the following IMAP auditory processing tests com-pared with the control group. The two groups diff ered signifi cantly in both backward masking conditions with BM0 z=-2.198, p=0.028; BM50 z=-2.717, p=0.007; in simultaneous masking with notch z=-2.098, p=0.036 and in frequency resolution z=-2.828, p=0.005 and frequency discrimination with z=-2.054, p=0.04.

Conclusion: This research indicates that in an overall test battery approach, the two batteries show statistically signifi cant similarities in categorizing children according to their auditory processing abili-ties. Their diff erences may be attributed to both bottom-up proces-ses (sensory defi cits, as evidenced by poor frequency resolution on IMAP), and top-down cognitive eff ects, evidenced by IMAP individual auditory processing tasks.


FP-043

BINAURAL HEARING WITH BAHAS. RE-EVALUATION OF

NIJMEGEN DATA.

Snik A, Mylanus E, Bosman A, Cremers C.ENT department, University Medical Centre St Radboud, Nijmegen, The

Netherlands.

During the last years, we studied binaural hearing in patients with bilateral conductive or mixed hearing loss, fi tted bilaterally with Ba-has and patients with unilateral conductive hearing loss, fi tted with one Baha. These results were reanalysed with respect to directional hearing and head shadow eff ects. For reference purposes, normal hearing subjects were included, listening with two ears, or with one ear blocked. Lifting of the acoustical head shadow was measured with sentences in noise; directional hearing with narrow-band noise bursts.

In normal hearing subjects, de-blocking of a temporary occluded ear eliminated head shadow completely. However, no evidence was found for the presence of a squelch eff ects (central demasking).

For patients with bilateral Baha or one Baha in case of acquired uni-lateral conductive hearing loss, head shadow was (just) eliminated. A squelch eff ect was not found either. For unilateral congenital con-ductive hearing loss, mean results were poor. Patients only partly compensated for head shadow.

In the latter group, directional hearing with Baha was poor or even absent. In contrast, on the average, the other patient groups showed acceptable improvements in directional hearing when listening with two ears. However, directional hearing was better in normal hearing subjects listening with two ears.

To understand the results, two factors will be discussed, viz. plasticity of the auditory neural pathways and the inevitable cross hearing du-ring bone-conduction stimulation.



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FP-044

PRIVILEGES AND LIMITATIONS OF IMPLANTABLE HEARING

AIDS IN AN AUDIOLOGICAL LONG TERM SURVEILLANCE

Mojallal H, Hinze A, Stöver T, Schwab B, Lenarz T.Department of Otorhinolaryngology, Medical University of Hannover, Germany

Introduction: After more than a decade of using various implantable hearing aids, the long term results and indications of these devices should be demonstrated.

Patients and Methods: Prä- and post operative (average time 6.3 years postop.) audiological measurements consisted of Pure Tone Audiometry (PTA) and Speech Audiometry (SRT and SDS via ear phone and free fi eld audiometry), speech in noise (OLSA), Tympano-metry and Multi Frequency Tympanometry (MFT) were performed with patients (n=69) wearing implantable hearing devices as Vibrant Soundbridge® (VSB), Otologics SIMOS® and CARINA® and DACS®

Results: The determined results till now show the following functio-nal gain by various systems: VSB with incus-coupling for SNHL: 27 dB (n=38); VSB with round window coupling for MHL: 58 dB (n=12); SI-MOS : 35 dB (n=13); CARINA: 20 dB (n=2) and DACS: 52 dB (n=4). In a period of 1997 till today one patient of a total of 89 VSB patients was implanted with a CI due to progression of the hearing loss. One case of the SIMOS patients (n=20) was reimplanted and three patients were provided with CIs.

Conclusion: To demonstrate the benefi ts of implantable hearing aids, the analysis of long term results by the performing clinics is very im-portant. On the basis of such data a realistic estimation of the therapy success with implantable hearing devices can be predicted.


FP-045

A NEW SIGNAL ENHANCEMENT ALGORITHM FOR COCHLEAR

IMPLANT USERS WITH HIRES120: RESULTS OF A PILOT

STUDY

Saalfeld H (1), Brendel M (1,2), Litvak L (3), Frohne-Buechner C (1,2), Lenarz T (1), Buechner A (1).(1) Medical University of Hannover, Department of Otolaryngology, Hannover,

Germany; (2) Advanced Bionics GmbH, Hannover, Germany; (3) Advanced

Bionics LLC, Valencia, USA.

Background: To date, little work has been carried out with sound en-hancement pre-processing algorithms in cochlear implant systems. Even though several studies showed only minor improvements with monaural real time algorithms in hearing aids, those algorithms may still have potential for cochlear implant systems. Cochlear implant users have less independent auditory channels (estimation: 6 to 8), struggle when listening in noise and do not have the comparison to natural sound quality to the same degree as hearing aid users.

Method: The algorithm under investigation used a single micro-phone and was implemented on a research version of the Harmony behind-the-ear processor. The basic principle was to reduce statio-nary signals using a multi-channel analysis, leaving more dynamic (speech containing) channels unaff ected. The gain on channels with modulation frequencies below 2 Hz was reduced.

Eight study participants were fi tted with the research algorithm, fur-ther participants currently being enrolled. The HSM sentence test in speech shaped noise was administered for the clinical program as well as the research program. During the fi rst two weeks of the take home period, participants gave a rating of sound quality and speech perception via a questionnaire (APHAB).

Results: No fi tting diffi culties were encountered and only global ad-justment of the M-levels was required to compensate for the reduced loudness provided by the research condition. All eight participants achieved better results with the research algorithm in the HSM sen-tence test in noise. The group average of the questionnaire result was signifi cantly better for the research algorithm compared to the clinical program.

Conclusions: Even though this pilot study did not allow individual optimization of research condition parameters, a signifi cant impro-vement could be achieved. Optimal parameters and fi tting guideli-nes need further investigation.



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FP-046

PREFERENCE AND PERFORMANCE WITH HIRES AND HIRES

120 DURING THE FIRST THREE MONTHS AFTER FIRST

FITTING

Saalfeld H (1), Lenarz T (1), Lesinski-Schiedat A (1), Frohne-Buechner C (1,2), Buechner A (1).(1) Medical University of Hannover, Department of Otolaryngology, Hannover,

Germany; (2) Advanced Bionics GmbH, Hannover, Germany.

Background: Since April 2007, users of the Advanced Bionics HiRes Cochlear Implant system can choose between two strategies: HiRes, based on a maximum of 16 physical channels and HiRes 120, which creates intermediate pitch percepts using current steering and is therefore analyzing the input signal via 120 channels. A survey was implemented to investigate whether a) one of the two strategies was preferred and b) any subject specifi c data correlated with the prefe-rred strategy.

Method: 77 adult HiRes90K users participated in the survey with a mean age at implantation of 56 years (19 to 83 years) and mean dura-tion of deafness of 6 years (0 to 53 years). Half of the subjects started with HiRes and received HiRes 120 at the end of the fi rst fi tting week. The other half received the strategies in the reversed order. Speech perception tests in quiet and noise were conducted with both stra-tegies at the end of the fi rst fi tting phase as well as three months afterwards.

Results: 40% of the participants preferred HiRes while 54% preferred HiRes 120. Three months after fi rst fi tting, the group performance in the HSM sentence test in quiet as well as in noise was signifi cantly better with HiRes 120 compared to HiRes (mean in quiet: 59% vs. 51%; mean in noise: 18% vs. 13%). Giving all subjects HiRes 120 only would lead to a similar performance as leaving them the option to use their preferred program. However, fi tting all subjects with HiRes only would decrease the performance signifi cantly. No indicators for the preferred strategy were found.

Conclusions: In the group evaluated slightly more users prefer HiRes 120 compared to HiRes while the objective data indicate better per-formance with HiRes 120 compared to HiRes. Therefore, we recom-mend to use HiRes 120 in case only one strategy can be fi tted.


FP-047

CROSS-OVER STUDY FOR EVALUATION OF THE STRATEGY

HIRES 120 IN NEW USERS

Brendel M (1,2), Buechner A (1), Saalfeld H (1), Frohne-Buechner C (1,2), Lenarz T (1).(1) Medical University of Hannover, Department of Otolaryngology, Hannover,


Background: Advanced Bionics introduced the novel sound proces-sing strategy called HiRes Fidelity 120 (commonly known as HiRes 120) to the European market. HiRes 120 processes the signal in 120 virtual channels to improve the frequency resolution and is now su-pported by the behind-the-ear processor Harmony.

Aims: This cross-over study investigated the subject’s performance with HiRes and HiRes 120 strategy on the Harmony sound processor from the fi rst fi tting onwards.

Method: 23 subjects with a HiRes90K implant system were enrolled in the study. The participants were divided into two subgroups: Group I started with HiRes and Group II with HiRes 120. Every three months, subjects were converted to the other strategy, respectively. Evalua-tions were performed prior to each strategy change via speech per-ception tests, psychophysical tests and questionnaires.

Results: Fourteen subjects have already passed their 6-months appo-intment. Subjects in Group I showed an average improvement of 16% in their speech understanding using the HSM sentence test in noise (10dB SNR) between their 3-month appointment with HiRes and 6-months appointment with HiRes 120. Group II improved by only 8% on the same test between the 3-months appointment with HiRes120 and 6-months appointment with HiRes.

Conclusions: When switched from HiRes to HiRes 120, Group I showed results which were better than expected due to the learning eff ect only. Group II showed results less than the expected learning eff ect, after being switched from HiRes 120 to HiRes. These results indicate a benefi t for speech understanding in noise with HiRes 120 compared to the standard Hires. HiRes 120 did not reveal any specifi c diffi culties when used from fi rst fi tting onwards.



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FP-048

THE NEW BTE PROCESSOR FOR ADVANCED BIONICS’ FIRST

GENERATION COCHLEAR IMPLANT: THE C1 HARMONY

Brendel M (1,2), Rottmann T (1), Buechner A (1), Frohne-Buechner C (1,2) Lenarz T (1)(1) Medical University of Hannover, Department of Otolaryngology, Hannover,


Background: The Medical University of Hannover has more than 450 users of the fi rst generation implant system “C1” (Clarion 1.0 and 1.2 devices from Advanced Bionics). Until now, these users have access to a bodyworn Platinum Sound Processor (PSP) and the Platinum behind-the-ear (BTE) Processor, while users of CII and HiRes90K im-plant systems have access to the much more advanced Harmony BTE system.

Aims: The combination of the Harmony sound processor and an appropriate software which is able to drive the C1 implants has now been made available for C1 subjects within this trial. The fi rst acute stage of the study was to confi rm the safety and effi ciency of the C1 Harmony prior to commercial distribution.

Method: 23 C1 implant users participated in the acute stage. They had a mean duration of implant use of 12.5 years (9.1 to 15.3 years) with the speech coding strategies CIS, SAS or PPS. In an acute session, the clinical processor, as well as the Harmony processor, were tested using the HSM sentence test in quiet and if possible in noise. The stability of communication between implant and processor was eva-luated and the subjective reports concerning speech understanding and sound quality were collected. Only minor programming changes were required to address sound quality issues.

Results: The HSM sentence test in quiet showed an equal result for the clinical processor and the Harmony processor (both 86.1%). For the HSM in noise, there was a signifi cant improvement with the new processor (clinical processor: 17.0%, Harmony: 21.8%).

The majority of participants reported better sound quality and sub-jectively better speech understanding.

Conclusion: Sound quality and subjective speech perception for the C1 Harmony were comparable to the subjects’ current clinical proces-sors. The HSM test showed signifi cantly better results in noise with the C1 Harmony compared to their clinical processor.


FP-049

A 3D FORCE MEASUREMENT SYSTEM: APPLICATION IN THE

DEVELOPMENT OF A MINIMALLY TRAUMATIC ELECTRODE

ARRAY

Lenarz TMedical University of Hannover, Department of Otolaryngology, Hannover,

Germany

While the locations likely to show cochlear trauma during electrode array insertion have been well reported, the actual forces imposed onto the cochlea are still quite poorly understood.

The goal was to correlate human temporal bone insertion measure-ments performed on the force measurement system (FMS) with his-tology and microCT analysis.

The state-of-the-art FMS used was able to resolve milli-Newton for-ces in three dimensions. A video camera was synchronized such that movement of the electrode array could be reviewed with the corres-ponding FMS values. Additionally, a real-time audio feedback signal was used with pitch modulated by insertion force.

Multiple fi xed human temporal bones were implanted using full-turn prototype electrode array designs, along with HiFocus1j as controls. Variables studied included: stiff ness, lateral wall and mid-scala loca-tions, and length. Insertions were made via a cochleostomy or via the round window; both free hand and using prototype insertion tools.

For prototype lateral wall electrodes with the same length as the Hi-Focus1j, forces could be low for most of the insertion, with normal and lateral forces on the order of 10mN. However, to complete the last few millimetres of the insertion, forces would appreciably rise, and the three-axis force profi le would refl ect the more aggressi-ve eff orts to complete the insertion. The mid-scala electrode array generally felt smooth during insertion, and with 1-2mm remaining to the insertion, normal forces were below 20mN, and lateral forces were below 15mN. However, to complete the insertion, both normal and lateral forces could rise much higher. Audio feedback was found to be very useful and could play a valuable role in development and training on minimally traumatic surgical approaches.

Even in these initial experiments, the FMS has shown itself to be an invaluable tool for understanding the complex forces associated with cochlear implantation, and an aid to electrode array development.



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FP-050

RESISTANCE CHANGES IN THE CI ELECTRODE ARRAY

CHANNELS DURING THE FIRST YEAR OF REHABILITATION

Tavartkiladze GA, Kruglov AV.National Research Centre for Audiology and Hearing Rehabilitation. Moscow,

Russia.

Background: Electrode resistance in the CI electrode array has the limiting eff ect on stimulation current level as well as on the current spread in cochlea. In addition, changes in resistance could refl ect the processes in the cochlea after implantation.

Material and Methods: The data obtained in the course of one year of rehabilitation of 100 patients using Nucleus CI24 Freedom sys-tem were included in the study. Resistance was measured on each inserted electrode both during the surgery and through one year of rehabilitation.

Results: Most frequently the decrease in resistance during the reha-bilitation was obtained. The resistance was increased after the sur-gery and remained high before the switch-on of the processor and followed by approximately double decrease. This fact is usually inter-preted as a recovery from trauma and infl ammatory processes.

In our investigation we demonstrated that the resistance on the elec-trodes excluded from the map was signifi cantly higher than on acti-ve electrodes and was practically unchanged when measured during the switch-on and in the course of a year of rehabilitation.

Discussion: The results obtained could be interpreted as an eff ect of electric stimulation on tissues surrounding active electrodes possi-bly changing their permeability. Diff erent explanations will be also discussed.


FP-051

DIGITAL IMPLEMENTATION OF A FAST RESPONSE

ACOUSTIC IMPEDANCE METER FOR THE FITTING OF SPEECH

PROCESSORS IN PATIENTS SUPPLIED WITH CI

Stephan K, Lanziner-Furtenbach R.Department for Hearing, Speech and Voice Disorders. Innsbruck Medical

University. Innsbruck, Austria

Background: Numerous studies showed that an early implantation of children (at an age less than 2 years) is essential for the benefi t of a cochlear implant (CI). As children of that age are not able to per-form loudness scaling, the fi tting of the speech processor often has to be based on objective measures like testing of electrically evoked compound action potentials or electrical stapedius refl ex thresholds (ESRT). For the latter, a high correlation with psychoacoustic comfort levels is known. However the clinical applicability of ESRT-testing is often limited, because specifi c instrumentation is not generally avai-lable to perform this task.

Aims: The present concept of digital implementation of an impedan-ce meter with fast response should provide an easy to use testing device of the electrical stapedius refl ex with a minimum of hardware eff ort. As a routine test it should run in parallel to the common fi tting procedure of CI speech processors.

Methods: According to our good experience with the application of a hardware-based fast response impedance meter, a PC software so-lution was realized for real-time application based on synchronous demodulation of the probe tone signal. As hardware, a commercial acoustic impedance probe was used connected to a high quality sound card in a PC.

Results: First tests with the implementation showed that real stape-dius refl exes can be easily distinguished from artefacts due to the fast response of the system. This feature is particularly important when measuring accurate ESRT in children supplied with cochlear implants. Due to the high effi ciency of the algorithm, a direct imple-mentation in real-time is possible, which can serve as a parallel soft-ware task during the routine CI fi tting procedure.

Conclusions: With the present implementation it is expected that fi t-ting of CI speech processors based on ESRT measurements will be facilitated.



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FP-052

INTRACORPOREAL CORTICAL TELEMETRY: THE COCHLEAR

IMPLANT AS EEG DEVICE?

Beynon AJ, Luijten BL, Snik AFM. Auditory Evoked Potential Lab.Radboud University Nijmegen Medical Centre.

Donders Institute for Brain, Cognition and Behaviour. The Netherlands.

Background: Until now, the only EP directly recorded by a cochlear implant is the electrically-evoked compound action potential (ECAP). However, the predictive value of ECAPs on electrical thresholds (T/C-levels) seems to be limited. Several groups focus on electrically-evoked auditory cortical responses (EACRs).

Although longer latency responses are usually obtained with con-ventional EEG systems, it would be more convenient for CI patient and clinician when EPs are directly recorded and averaged by the im-plant itself without the discomfort and disadvantages of (extracor-poreal) EEG setup, e.g. fi xed scalp wirings, environmental noise. The development of an implant that could stimulate, obtain, ánd average longer latency EPs might enhance the development of automatic ob-jective fi tting procedures.

Aims: A feasibility study was carried out to develope a recording pa-radigm based on neural response telemetry (NRT) functionality of a CI system to (intracorporeally) record EACRs.

Materials and methods: A Nucleus Freedom CI system was used for recording and averaging. A new recording paradigm that concate-nates multiple NRT windows was used to enlarge recording time window up to 240 ms. Subcutaneous reference electrodes were used to record EEG, while intracochlear electrodes were used for bipolar stimulation. First, the feasibility of a CI as an EP recording system was investigated by using a second (extracorporeal) implant system to measure EPs of normal hearing subjects, ‘in vitro’. Secondly, ‘in vivo’, data intracorporeally-obtained from CI users were compared to data that was simultaneously extracorporeally-obtained from conventio-nal EEG recordings in same subjects.

Results and Conclusions: Data show that it is feasible to record cor-tical potentials with a cochlear implant. In contrast to ‘in vivo’ data, ‘in vitro’ recordings were more sensitive for external noise. All data showed reproducible responses. Based on the present fi ndings, role of location of subcutaneous recording electrodes, response morpho-logy, clinical application, e.g. automatic processor fi tting, and future implant design are addressed.


FP-053

ELECTROPHYSIOLOGICAL MEASUREMENT OF THE

PERCEPTUAL DISTANCE OF NEIGHBOURING ELECTRODES IN

COCHLEAR IMPLANT SYSTEMS

Hoppe U (1), Wohlberedt T (1), Danilkina G (1), Lerahn J (1), Hessel H (2).(1) University of Erlangen, Dept. of Audiology, Waldstr. 1, D-91054 Erlangen,

Germany; (2) Cochlear GmbH, Hannover, Germany.

The Acoustic Change Complex (ACC) is an auditory evoked potential in response to acoustic changes. It can be interpreted as an electro-physiological measure of the neural processes that underlie the de-tection of a change in an ongoing acoustic signal. Recently, it was shown that the ACC can be measured in cochlear implant subjects with electrical stimulation of the auditory nerve. The aim of our study was to investigate the ACC in response to subsequent stimulation of neighbouring intracochlear electrodes and to compare the ACC with psychophysical discrimination abilities.

Ten adult subjects provided with a nucleus freedom cochlear implant (CI) and with at least 6 months of CI experience took part in the study. Electrophysiological measurements were recorded on eight electro-des placed on the scalp. Stimuli consisted of 1.5s stimulation on one electrode immediately followed by stimulation for 1.5s on the next neighbouring electrode in apical direction. Stimulation levels were adjusted to achieve identical loudness perception (adjusted on ‘loud’ via categorical loudness scaling). For each subject, ACC recordings were performed on three electrode pairs: 3/4 (basal), 10/11 (mid), and 18/19 (apical). Additionally, the psychophysical diff erentiability (D’-measurements) for each electrode pair was measured by a 3-AFC paradigm.

Due to electrical artefacts caused by the CI usually some electrodes were disturbed. An ACC was identifi ed as detected when on three electrodes a response was observable. Using this criterion, the ACC was detectable in 72% of the measurements. Detectability of the ACC varied more across subjects than across intracochlear electrode location. ACC amplitudes correlated with psychophysical D’ measure-ments signifi cantly (r=0,65, p<0,01).

The measurements support the hypothesis that the ACC provides an electrophysiological measure of discrimination abilities. It may be also used for evaluation of cochlear implant performance.

The study was supported by a grant from Cochlear Ltd., London, UK.



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FP-054

FACTOR ANALYSIS OF HEARING PRESERVATION AFTER

COCHLEAR IMPLANTATION

Piotrowska A, Lorens A, Jedrzejczak WW, Skarzynski H.Institute of Physiology and Pathology of Hearing, Warsaw, Poland.

Background: Recent studies showed diff erent range of a residual hea-ring preservation after cochlear implantation.

Aim: The objectives of this study were to identify factors that explain a variety of hearing preservation.

Method: This was a retrospective study. Data of 500 CI patients, im-planted in the Institute of Physiology and Pathology of Hearing, was analysed. Variables such as gender, age and duration of deafness, etiology, degree of hearing loss, surgical technique (cochleostomy/round window), type of electrode were identifi ed and factor analysis was used.

Results: Two factors: a surgical technique and a age infl uenced the hearing preservation to the large extent.

Conclusion: It is possible to preserve hearing in the majority of cases using the appropriate surgical approach and electrode design.


FP-055

LONG TERM AND SHORT TERM RESULTS OF PARTIAL

DEAFNESS COCHLEAR IMPLANTATION (PDCI)

Skarzynski H, Lorens A, Podskarbi-Fayette R, Piotrowska A.Institute of Physiology and Pathology of Hearing, Warsaw, Poland

Background: The International Centre of Hearing and Speech repor-ted their fi rst case of Partial Deafness Cochlear Implantation (PDCI) in 2002. In the case of PDCI, there is essentially signifi cant hearing in the low frequencies. After cochlear implantation this would allow for electrical stimulation of the high frequencies via the cochlear im-plant and acoustic stimulation of the low frequencies hearing

Aim: Objective: To evaluate long term and short term benefi t from the combined electric acoustic stimulation after partial deafness co-chlear implantation) using various electrode designs.

Methods:40 adults and 25 children with partial deafness received Combi 40+, Pulsar and 15 adults received Nucleus CI24 cochlear implant with various electrodes designs, using the round window technique for hearing preservation. Pure tone audiometry, monos-yllable testing in quiet and noise were conducted pre-operatively, at implant fi tting and then at 1, 3, 6,12, 24, 36 and 48 months after initial device fi tting.

Results: Improvements in speech scores over time in both quiet and noise were signifi cant.

Conclusion: With developed surgical procedure hearing can be pre-served in the majority of patients with partial deafness. The combi-nation of electric and acoustic stimulation provides a more complete representation of sounds than it would be possible with either mo-dality alone.


FP-056

DESIGN CONSIDERATIONS AND INITIAL CLINICAL

EXPERIENCE WITH A PROTOTYPE TOTALLY IMPLANTABLE

COCHLEAR IMPLANT RESEARCH DEVICE

Cowan RSC (1, 3), Briggs R (1, 3), Plant KL (1, 2), Eder HC (1, 2), Seligman PM (1, 2), Dalton J (1, 2), Money DK (1, 2), Patrick JF (1, 2).(1) The HEARing CRC, Melbourne, Australia; (2) Cochlear Limited, Melbourne,

Australia; (3) The Department of Otolaryngology, University of Melbourne,

Australia.

Objectives: This study aimed to evaluate the design considerations and eff ectiveness associated with the development and fi rst-time-in-human (FTIH) trials of a prototype totally implantable cochlear im-plant research implant (TIKI).

Materials and Method: Signifi cant biosafety and microphone bio-performance assessments were completed on a prototype totally implantable TIKI design. Following the completion of these studies, a limited FTIH study was conducted with three adult subjects, all of whom had severe-to-profound hearing loss. The TIKI research device incorporated a lithium ion rechargeable battery, a package-mounted internal microphone, and sound-processing electronics that enabled the use of “invisible hearing” (ie. without the use of an external devi-ce), in addition to standard functionality with an external ESPrit 3G sound processor as a conventional cochlear implant. Postoperati-vely, patients used both the TIKI and conventional ESPrit 3G modes. Assessments of speech perception were measured at 1, 3, 6 and 12 months, and performance of the internal battery and microphone were also made.

Results: No surgical or postoperative complications were found. As expected, audiometric thresholds while using invisible hearing were higher than for ESPrit 3G, due to the subcutaneous positioning of the microphone. However, all three subjects were able to employ invi-sible hearing and conventional ESPrit 3G modes. Subjects reported some body noise interference that limited use of invisible hearing to a varying extent. All continue to use invisible hearing on a limited daily cycle. To date, the rechargeable battery has functioned well.

Discussion & Conclusion: The study clearly identifi ed the many cha-llenges to be overcome in developing a safe and eff ective totally im-plantable device.



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FP-057

SPARSE PROCESSING FOR COCHLEAR IMPLANTS

Lutman ME, Li GInstitute of Sound and Vibration Research, University of Southampton, UK

Background: Processing strategies in cochlear implants (CI) have changed from crude feature extraction and re-synthesis, to whole signal representation using continuous interleaved sampling (“more is better”). The most common signal processing strategies nowadays select frequency bands with the most energy within short time fra-mes and reject other bands.

Aims: An alternative approach is evaluated here, in which the proces-sing attempts to extract salient information from the incoming signal and throw away redundant parts of the signal (“less can be better”). It relies on the fact that speech and most other environmental sig-nals are highly redundant, and that hearing impairment represents a bottleneck restricting information transmission.

Method: Mathematical principles of information theory have been used to develop a signal processing algorithm for CI named SPAR-SE. The term sparse is understood here, in a mathematical sense, to be a signal with the minimal underlying components necessary to represent the incoming signal across the electrode array. SPARSE is compared with the commercial ACE algorithm in 10 normal hearing listeners under simulated CI listening, and also in 10 CI users with pre-processed speech in continuous and modulated noise stimuli.

Results: SPARSE appears to have advantages over ACE for speech re-cognition in noise, especially for poorer performing CI users. There are incidental advantages of lower power consumption and conse-quently longer battery life.

Conclusions: New approaches to speech processing, based on the statistical properties of the incoming signal and principles of infor-mation theory, may off er improved performance to users of CI and other devices such as auditory brainstem implants. This knowledge may also help to explain how the auditory system deploys its resour-ces to convey acoustic information to the brain in the most effi cient manner in everyday listening.


FP-058

SIMULATED INTERAURAL PLACE MISMATCH OF COCHLEAR

IMPLANT ELECTRODES LEADS TO BREAKDOWN OF THE

ABILITY TO SUPPRESS REFLECTIONS

Seeber BU.MRC Institute of Hearing Research, Nottingham, UK.

Background: Cochlear implants (CIs) often restore speech understan-ding in quiet, but most patients complain that the presence of rever-beration or noise makes understanding of speech more diffi cult or even impossible. The precedence eff ect is thought to help in those si-tuations as it shows the perceptual suppression of sound refl ections while localization is maintained at the leading, the direct sound. In our previous study of the precedence eff ect about half of the tested bilateral CI-patients showed no precedence eff ect; instead a single sound source was localised in-between the leading and the lagging source while a few patients showed the precedence eff ect even for temporally overlapping stimuli. Simulations of the precedence eff ect with a noise-band vocoder instead showed a breakdown such that the refl ection was always audible.

Aims: (1) To test if the precedence eff ect can be evoked with CI-simu-lations based on a sinusoidal vocoder. (2) To test if a place mismatch of CI-electrodes between the ears aff ects the ability to suppress re-fl ections.

Methods: The precedence eff ect was tested in a localization domi-nance paradigm with a sinusoidal vocoder for brief noise bursts and a word. The interaural match of the carrier frequencies was varied.

Results: The precedence eff ect broke down, i.e. the lag was audible, if carrier sinusoids were not matched in frequency. However, for zero or small frequency off sets some subjects showed the precedence eff ect and heard one sound at the lead location regardless of the interaural time diff erence (ITD) conveyed in the carrier.

Conclusions: It is possible to evoke the precedence eff ect with on-going sounds without encoding ITDs in the carrier. The precedence eff ect can solely be based on interaural level and time diff erences conveyed in the envelope if carrier frequencies have a similar fre-quency. This suggests that accurate place matching of CI-electrodes would help the analysis of concurrent sounds.



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FP-059

RESULTS OF THE EUROPEAN ADULT MULTI-CENTRE HIRES®

120 STUDY

Buechner A (1), Lenarz T (1), Boermans PP (2), Frijns J (2), Mancini P (3), Filipo R (3), Fielden C (4), Cooper H (4), Eklof M (5), Freijd A (5), Lombaard S (6), Meerton L (6), Pickerill M (7), Vanat Z (7), Wesarg T (8), Aschendorff A (8), Kienast B (9), Arnold L (9), Boyle P (9), Meyer B (10), Sterkers O (11), Mueller-Deile J (12), Ambrosch P (12), Helbig S (13), Frachet B (14), Gallego S (15), Truy E (15), Jeff s E (16), Morant A (17), Marco J (17).(1) Medical University of Hannover, Germany; (2) Leids Universitair Medisch

Centrum. The Netherlands; (3) University of Rome “La Sapienza”, Italy; (4)

Birmingham Adult Cochlear Implant Programme, UK; (5) Karolinska University

Hospital, Huddinge, Sweden; (6)RNTNE Cochlear Implant Programme London,

UK; (7) The Emmeline Centre, UK; (8) Albert-Ludwigs-Universität Freiburg,

Germany; (9) Advanced Bionics, France; (10) St Antoine, France; (11) Beaujon

Clichy, France; (12) Christian-Albrechts-Universität zu Kiel, Germany; (13)

Klinikum d J W Goethe Universität, Frankfurt, Germany; (14) Avicenne, France;

(15) Hopital Edouard Herriot, France; (16) Nottingham Cochlear Implant

Program, UK; (17) Hospital Clinico Universitario, Spain.

Background: A new sound coding strategy called HiRes® 120 was commercially released by Advanced Bionics® in 2006. This sound co-ding strategy gives cochlear implant users access to virtual channels by steering current between two adjacent electrodes.

Aims: The goals of this study were to: 1) Investigate the effi cacy of HiRes 120 vs. the previous generation HiRes coding strategy; 2) De-termine the benefi t of the Harmony® sound processor compared to earlier processor models; 3) Identify variables to predict users who might benefi t from HiRes 120.

Methods: The multi-centre study consisted of several diff erent pro-tocol options evaluating the benefi t of HiRes 120 with the Harmony or PlatinumTM sound processors. Experienced users, as well as users with no previous cochlear implant experience, were evaluated.

Results: Results from 65 users will be reported. Performance results are signifi cantly better with HiRes 120 (p=0.0204) compared to Hi-Res. Subjective sound quality questionnaire data show a signifi cant improvement in the categories ‘immunity to noise’ (p=0.037) with HiRes 120. A signifi cant benefi t for HiRes 120 in music was reported for sound quality (p=0.048) and sound pleasantness (p=0.0196) com-pared to HiRes. The Harmony processor was rated highly, especially with respect to increased battery life. 86.4% of subjects preferred Hi-Res 120 when using the Harmony (N=22).

Conclusions: The HiRes 120 strategy has proven to off er benefi t in challenging, real life situations such as noisy environments or with music. The behind-the-ear Harmony processor is reliable, comforta-ble and has a substantial battery life improvement compared to the previous Auria® processor.


FP-060

SPEECH PERCEPTION SCORES AND SELF-ASSESSMENT OF

SOUND PERCEPTION AFTER COCHLEAR IMPLANTATION

Hast A, Wohlberedt T, Digeser F, Hoppe U.Department of Audiology, ENT clinic, University Hospital Erlangen, Medical

School, Waldstraße 1, 91054 Erlangen, Germany.

Speech perception scores in quiet and in noise are an important tool to monitor the progress in speech recognition after cochlear implan-tation. Speech perception results are documented during the whole rehabilitation process. They assist to identify various diffi culties in processor programming.

The aim of this study was to compare diff erent speech perception tests after cochlear implantation with self-assessment concerning the auditory perception in everyday life.

Forty-one adult subjects with a minimum of 6 months experience with a Nucleus Freedom cochlear implant were investigated. Four diff erent speech perception tests were performed: Freiburger mo-nosyllable test in quiet (65 dB SPL), Göttinger sentence test in quiet (65 dB SPL), Göttinger sentence test in noise (65 dB SPL, S/N = 5 dB) and Oldenburger sentences (adaptive determination of the speech perception threshold).

These results were compared with the self-assessment for basic sound perception and advanced sound perception by use of 20 questions of the Nijmegen Cochlear Implant questionnaire (NCIQ, german version) [1,2].

The largest correlation has been found between the monosyllable test in quiet and the self assessment of the advanced sound percep-tion (r=0,38, p=0,01) and overall sound perception (r=0,36, p=0,02). The sentence tests in quiet and noise showed lower correlations.

As the correlations between speech perception scores and self as-sessment of speech perception in everyday life are moderate to weak, subjective and objective measures of speech perception should be included in an evaluation of the outcome of the cochlear implantation.

[1] Hinderink J, Krabbe P, van den Broek P: Development and appli-cation of a health-related quality-of-life instrument for adults with cochlear implants: The Nijmegen Cochlear Implant Questionnaire. Otolaryngol Head Neck Surg. 2000 Dec; 123(6):756-765.

[2] Hirschfelder A, Gräbel S, Olze H: The impact of cochlear implanta-tion on quality of life: The role of audiologic performance and varia-bles. Otolaryngol Head Neck Surg. 2008 Mar; 138(3):357-62.



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FP-061

LANGUAGE PERCEPTION OF INFANTS WITH COCHLEAR

IMPLANTS

Gerrits E.Maastricht University Medical Centre, The Netherlands.

This study investigated early language outcomes after cochlear im-plantation in infancy. An important early linguistic skill is word lear-ning. In order to learn words, infants must develop perceptual skills that allow them to recognize words in the continuous speech stream. These perceptual skills were tested in 25 deaf infants with cochlear implants (CI). They were one and two years of age. Their age at initial stimulation was 13 months.

The procedure used was the head-turn preference paradigm. In a familiarization phase infants listened to isolated target words. Subse-quently, they were presented with passages that did or did not con-tain the target words. Their visual attention for these auditory stimuli was measured.

The results revealed that, after 6 months of CI use, deaf infants liste-ned longer to sentences with familiarized target words. This means that they were able to detect words in fl uent speech even after only a brief period of exposure. However, not all children showed the ex-pected listening preference. This suggests that individual diff erences like those reported in speech perception outcomes of older children with CI were also present in this very young group of CI-users. Sur-prisingly, almost all infants demonstrated a strong preference for the classical music that was presented in a pre- and post test trial.

The fi ndings demonstrate that deaf infants with CI are able to detect words in fl uent speech, just like hearing infants are. Their early word segmentation skills are expected to have a positive impact on other aspects of spoken language development, such as learning of novel words. It is concluded that cochlear implantation in children youn-ger than 12 months will lead to signifi cant gains in spoken language development.


FP-062

WHAT CAN WE EXPECT OF SPOKEN LANGUAGE

DEVELOPMENT AFTER INFANT COCHLEAR IMPLANTATION?

Gerrits E.Maastricht University Medical Centre, The Netherlands.

This study evaluated auditory and language development of the youngest cochlear implant users in the Netherlands, infants of one and two years old. Their general reactions to auditory stimuli were measured as well as their understanding and use of early symbolic gestures and words. Participants were 25 infants of one and two years old. Their average age at initial stimulation was 13 months. Two norm-based parent questionnaires were used: LittlEARS and the McArthur-Bates Communicative Development Inventories (CDI). The LittlEARS Auditory Questionnaire is a parent questionnaire that evaluates all types of auditory behaviour which are observable as a reaction to acoustic stimuli. The MCDI (Dutch version by Zink & Le-jaegere, 2002) consists of forms at which parents can mark the child’s understanding or use of hundreds of early vocabulary items.

The results showed that the level of auditory and language of the majority of the children in this young CI-group was lower than that of hearing typically developing children, but showed very rapid rates of development. In addition, 20% of these children with CI demonstra-ted excellent perceptual and vocabulary skills, performing within the normal range of hearing children. Importantly, early auditory percep-tion and word production was always much better than expected on the basis of children’s eff ective hearing age, except for the children who became deaf after meningitis.

The fi ndings demonstrate that early implantation promotes the de-velopment of auditory and language skills such that profoundly deaf toddlers achieve skills comparable to hearing age-matched peers. The norm-based tests mentioned here can be used eff ectively to stu-dy outcomes of very early cochlear implantation. The results provide objective and realistic expectations about auditory and language de-velopment of deaf infants following cochlear implantation.



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FP-063

ADULT COCHLEAR IMPLANT USERS’ VOWEL CONFUSIONS

DURING FOUR YEARS OF CI USE

Välimaa T (1),Sorri M (2), Laitakari J (2), Sivonen V (2,3).(1) Faculty of Humanities/Logopedics;(2) Department of Clinical Medicine/Otorhinolaryngology, University of Oulu, Finland;(3) Department of

A&S Psychology, University of Louisville, USA.

Background: It is well established that cochlear implants (CIs) are successful in facilitating vowel perception in adults with severe or profound hearing impairment. However, it is not known, whether CI users fi nd it diffi cult to discriminate formant frequencies or whether they fi nd it diffi cult to adapt to the basalward shift, i.e., the mismatch between the original acoustic frequency and the characteristic fre-quency of the neurons stimulated electrically.

Aims: This study examined how adults relearn to recognize vowels and what patterns of misperception they have during the fi rst four years of cochlear implant use.

Methods: Finnish-speaking adult CI users (N=40) listened to a non-sense-syllable test in an open-set condition before implantation with and/or without a hearing aid (if used), and during four years after the switch-on of the device in a prospective repeated-measure design. The responses were coded for phoneme errors and modeled by using the Glimmix procedure with the help of SAS Proprietary Software 9.2.

Results: The estimated vowel recognition was 73.2% (95% confi den-ce interval 67.2-78.4) 12 months after switch-on, and 80.2% (95% confi dence interval 75.1-84.4) 4 years after switch-on. Most of the improvement in the vowels that were easier to recognize was seen during 12 months after switch-on. The Finnish front vowels were the most diffi cult to recognize and clear improvement was seen in the re-cognition of these vowels during the whole period. Moreover, during the four-year period the most prevailing vowel confusion patterns were towards the next closest vowel with higher F1 and in some ca-ses higher F2.

Conclusion: The recognition of the diffi cult vowels continued to im-prove throughout the whole period of four years. Furthermore, vowel confusions were drawn more towards the closest vowel with the next highest F1 (and in some cases even higher F2) indicating a basalward shift in the confusions.


FP-064

SPEECH BASED OPTIMIZATION OF COCHLEAR IMPLANTS

Krause L (1), Holmes AE (2), Shrivastav R (3), Siburt H (4).(1) Audigence Inc; (2,3,4) University of Florida, USA.

Cochlear implants (CI) are devices that can restore hearing for a large number of hearing impaired patients. Modern CI devices are highly sophisticated and capable of advanced signal processing to enhance listener performance. These advances in signal processing have dra-matically increased our capability of conditioning the input signal so as to maximize its benefi t for each individual CI user. Although such extended capabilities have given audiologists the capability to select one out of several million possible combinations, there is no stan-dard procedure to identify the settings that would give the optimum fi t for individual CI users. Instead, current clinical practice relies on subjective judgments from the patient to achieve a limited degree of device optimization. Our research team has developed an innova-tive method to optimize the CI devices for individual patients using speech stimuli. Twenty experienced cochlear implant users were re-programmed using this procedure. Signifi cant improvements were found with the optimized maps compared to maps programmed using standard methods. This procedure shows promise to improve patient performance and increase patient satisfaction in a shorter clinical test time.



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FP-066

TRANSIENT DEAFNESS IN YOUNG CANDIDATES FOR

COCHLEAR IMPLANTS

Attias J (1,2), Raveh E (3)(1) Department of Communication Disorders, University of Haifa, Haifa;

(2) Institute for Audiology and Clinical Neurophysiology; (3) Department of

Otorhinolaryngology, Schneider Children’s Medical Center of Israel and Rabin

Medical Center, Petah Tiqwa, affi liated with Sackler Faculty of Medicine, Tel

Aviv University, Tel Aviv, Israel.

This study describes 8 infants who were diagnosed with auditory neuropathy (AN) associated with severe to profound neural hearing loss shortly after birth. Unexpectedly, on repetition of the tests 7-12 months later, all infants showed full or partial recovery. The follow-up electrophysiological patterns in 7 of the patients were characterized by the appearance of wave I, followed by wave III and V, refl ecting synchronization of auditory pathways and improvement in auditory nerve function. In the 7th case the recovery started from wave V to III and I. Fluctuations in behavioral and electrophysiological measu-res were found. While 5 infants had risk factors to congenital hearing loss, the other two infants had no risk factors. Suspected causative or contributory factors were neonatal hyperbilirubinemia, hypoxia, ischemia, and central nervous system immaturity, alone or in com-bination. These fi ndings indicates that lack of an ABR does not ne-cessarily mean no hearing AND that situation when AN exists can improve. Thus, although cochlear implants may yield better auditory performance if applied early, they should be considered a thera-peutic option only after repeated measures prove persistent auditory neuropathy and no child should be considered for an implant until a behavioral measure of hearing is reliably obtained.


FP-065

METHODOLOGICAL ASPECTS OF EVALUATION OF

FREQUENCY DISCRIMINATION IN COCHLEAR IMPLANT

LISTENERS

Digeser FM (1), Pogorzelski J (1), Hast A (1), Hessel H (2), Hoppe U (1).(1) Department of Audiology, ENT Clinic, University Hospital Erlangen,

Germany; (2) Cochlear GmbH, Hannover, Germany

Frequency discrimination is an important prerequisite for the com-prehension of speech and the appreciation of music. Compared to normal hearing listeners, CI-Listeners have a restricted frequency resolution. The determination of frequency discrimination in CI-lis-teners is important for both, programming of CI sound processors as well as evaluation during the rehabilitation process. Adaptive 2-AFC tests were conducted in order to determine the infl uence of harmonics upon frequency discrimination in CI-listeners. However, some of the CI-listeners either had large test-retest variability or a non-converging progress of the experiment. Since an adequate ps-ychometric function (logistic function) is a premise for adaptive AFC tests, a subsequent study was concerned with the determination oft the psychometric function in CI-listeners. The aim of the study was to compare both testing procedures and their appropriateness.

Twelve CI-listeners (Nucleus Freedom, ACE) performed adaptive 2-AFC tests for frequency discrimination at diff erent frequencies (196Hz, 494Hz, 988Hz, 1976Hz, 3951Hz), with both, sinusoidal bursts and harmonic bursts. A 2-AFC frequency discrimination task was per-formed at 494 Hz with sinusoidal bursts in order to obtain the psy-chometric functions. Interval sizes ranged from one ¼-tone interval up to 15 quartertones.

Besides the typical individual variation in performance of CI-listeners, they have better frequency discrimination for sinusoidal bursts (6 to 3 quartertones) compared to harmonic bursts (11 to 3 quartertones). The majority of the CI-listeners show regular psychometric functions that may be fi tted by a logistic function. In this case, the usage of adaptive procedures is appropriate. However some of the CI-liste-ners’ psychometric functions are irregular. For these subjects, adapti-ve tests should not be conducted since they would result in incorrect frequency discrimination thresholds. As a summary, the adequate method as well as the applied type of the stimuli has to be selected carefully in order to maintain comparable results in frequency discri-mination thresholds.



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FP-067

QUALITY OF LIFE OUTCOMES FOR ADULT COCHLEAR

IMPLANT RECIPIENTS AND THEIR SIGNIFICANT OTHER

Looi V, Mackenzie M, Bird P.The Department of Communication Disorders. The University of Canterbury.

Christchurch, New Zealand.

This study aimed to investigate whether cochlear implantation im-pacts on the Quality of Life (QOL) of postlingually deafened adult CI recipients from New Zealand, and their signifi cant other (SO), and if so, which areas of daily life are impacted on the most. Questionnaires were developed for this study to obtain QOL ratings. A total of 94 adult CI recipients and 70 adults on the waiting list (WL) for a CI retur-ned the questionnaires. There were also 83 SO for the CI respondents and 58 SO for the WL respondents.

Responses returned showed that cochlear implantation has a sig-nifi cant positive impact on QOL. CI recipients had higher ratings in all areas of QOL and satisfaction, compared to adults on the WL. The greatest subdomain diff erences were seen in basic sound perception (37.81), social interaction (36.21), and activity limitations (32.27). QOL ratings were also signifi cantly higher when the pre-to-post rating for the subgroup of participants implanted during the course of this stu-dy (n = 7). The results also suggested that CIs have a positive eff ect on the QOL of the SO; the CI-SO had higher QOL ratings compared to the WL-SO. Comparisons between the CI user and their SO showed that the SO had similar ratings to the recipient on the impact of im-plantation. This suggests that improvements seen for the CI users’ lives are also evident in the lives of the SO. There were also signifi cant diff erences between the SO of the CI and WL respondents, with the CI-SO scoring higher overall.

Overall, this study shows positive changes in QOL as a result of im-plantation, and suggests that these changes extend to beyond the recipient. This is an important fi nding as it not only shows how that the eff ects of implantation are far-reaching, but also that examining non-audiological factors, such as QOL should be included in the as-sessment of benefi t from a CI.


FP-068

SPATIAL HEARING AND MUSIC PERCEPTION ABILITIES

IN SUBJECTS USING A COMBINATION OF ELECTRIC AND

ACOUSTIC STIMULATION

Cowan RSC (1, 4), Plant KL (1, 2), Briggs R (1, 4), Whitford LA (1, 2), Law M (1, 2), Incerti P (1, 2), Gorrie J (1, 2), Skinner L (1, 2, 3 ).(1) The HEARing CRC, Melbourne, Australia; (2) Cochlear Limited, Melbourne,

Australia; (3) The Sydney Cochlear Implant Clinic, Sydney, Australia; (4) The

Department of Otolaryngology, University of Melbourne, Australia.

Objectives: A number of recent studies have reported preservation of acoustic low-to-mid frequency hearing in cochlear implant reci-pients following careful surgical insertion techniques and using new electrode technology. Such recipients have the potential to make use of both acoustic hearing and electrical stimulation delivered to the same ear. The aim of this clinical study was to assess the potential benefi t of use of the residual hearing in the implanted ear.

Materials and Method: The benefi ts of ipsilateral acoustic hearing was assessed in twelve adult cochlear implant recipients. All sub-jects were implanted with either the Nucleus Contour Advance or a specialised Hybrid-L24 electrode array. Benefi ts were assessed through comparing test outcomes for a ‘combined’ condition - using the cochlear implant together with an both an ipsilateral and con-tralateral hearing aid, with a ‘bimodal’ condition - using the cochlear implant with only a contralateral hearing aid. All subjects received a minimum of months experience after initial activation prior to assessments. Localisation ability was measured using an 8-speaker array with a 180-degree span. Speech perception was evaluated in a range of speaker confi gurations to measure spatial hearing abilities. Musical tests included pitch ranking of sung vowels, identifi cation of stretched or compressed melodies and sound quality ratings.

Results: For most subjects, performance in the combined condition was superior to that for the bimodal condition for tests of speech perception in noise, sound localisation, musical sound quality ra-tings and functional performance in real-world listening situations. No measurable improvement was observed on objective music tests.

Discussion & Conclusion: The potential benefi ts of use of an ipsilate-ral hearing aid fi tted with a cochlear implant should be communica-ted to cochlear implant candidates, and considered for all patients who show preservation of residual hearing postimplantation.



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FP-071

READING ABILITY AND ACADEMIC PERFORMANCE IN

MALAY LANGUAGE IN CHILDREN WITH A COCHLEAR

IMPLANT

Stephen AA, Umat C, Zamratol-Mai S, Mukari S.Department of Audiology & Speech Sciences, Faculty of Allied Health Sciences,

Universiti Kebangsaan Malaysia 50300 Kuala Lumpur, Malaysia.

The study aimed to describe reading ability and academic perfor-mance in Malay language among school-age children with a co-chlear implant. A total of 54 children aged 7 to14 years with implant experience ranged from 1 year 7 months to 10 years 1 month par-ticipated in the reading test. The reading test was conducted using reading materials based on the Integrated Curriculum for Malaysian Primary Schools, assessing their pronunciation, comprehension, and fl uency. Academic results in Malay Language for comprehension and writing were obtained from their schools for 26 and 20 children, res-pectively. Results were grouped into fail (0-40%), pass (41-79%) and excellent (80-100%). Results from grade-matched normally-hearing peers were also obtained from 7 mainstream schools and they were classifi ed as below average (< 25th percentile), average (25th – 75th percentile) and above average (> 75th percentile). In the reading test, 46.3% of the subjects were unable to read while 59.3% of the subjects were unable to comprehend the texts with the majority of them from Grade 1. After controlling the eff ect of duration of im-plantation, age at testing signifi cantly correlated with pronouncia-tion (r=0.23, p<0.001), comprehension (r=0.23, p<0.001) and fl uency (r=0.42, p<0.001) while age at implantation signifi cantly associated with comprehension (r=0.08, p<0.001) and fl uency scores (r=0.23, p<0.001). School placement, communication mode, and race were all insignifi cant factors (p>0.05). For the academic performance, most of the implanted children (61.5%) passed the Malay comprehension while 7.7% (2 subjects) obtained excellent result and 60% of the children failed writing. Comparing results for 7 implanted children to their normally hearing grade-matched peers, 42.9% had below average performance for Malay comprehension. For Malay writing, those at average and below average performances were equally dis-tributed (50% each). The above fi ndings suggest that although these children had sucessfully being implanted, the majority of them had relatively poor literacy skills.


FP-069

RESULTS OF APPLICATION OF FSP CODING STRATEGY IN

CHILDREN – SATISFACTION AND PREFERENCE STUDY

Lorens A, Zgoda M, Skarzynski H.Institute of Physiology and Pathology of Hearing, Warsaw, Poland.

Background: This study aimed to assess objective and subjective performance of children with long-term experience with the C40+ cochlear implant system utilising the CIS+ coding strategy, who have now received an upgrade to the OPUS 2 using FSP.

Method: 60 children, who had more than 3.5 years device experience with the TEMPO+ speech processor using CIS+ coding, were upgra-ded to the OPUS 2 audio processor and were fi t and tested with the FSP, HDCIS, CIS+ strategies. The children completed visual analogue scales questioning satisfaction, and coding strategy preference, when listening to speech and to a pop song.

Results : Satisfaction when listening to speech and music was higher with FSP than with CIS+. Similarly, FSP showed preference when di-rectly compared to CIS+ using speech and music.

Conclusions :The FSP strategy can provide signifi cant objective and subjective advantages to paediatric users of the C40+ cochlear im-plant.


FP-070

TEACHERS’ PERSPECTIVE ON READING AND WRITING

ABILITIES OF CHILDREN WITH A COCHLEAR IMPLANT

Stephen AA, Umat C, Zamratol-Mai S, Mukari S.Department of Audiology & Speech Sciences, Faculty of Allied Health Sciences,

Universiti Kebangsaan Malaysia 50300 Kuala Lumpur, Malaysia.

The study aimed to examine the reading and writing abilities of chil-dren with a cochlear implants from their teachers’ perspective. A to-tal of 30 language teachers at the schools attended by the cochlear implant children throughout Malaysia (21 from the mainstream schools and 9 from special schools) responded to the questionnaires distributed through their schools. The questionnaires utilized in the study were the standard and validated Malay version of Dyslexic Ins-trument Checklist and Diagnostic Checklist of Writing Disability used in the Ministry of Education Malaysia. There are 7 questions in the dyslexic instrument checklist which covers on reading diffi culties (4 questions), common mistakes in reading (5 sections in 1 question) and comprehension (2 questions). As for the diagnostic checklist of writing ability, there are 15 questions which cover various aspects of writing elements. For reading ability, teachers at the normal schools rated 76% of the implanted children had diffi culties to read long sentences, 71% had problem to read words with combined vowels and diphtongs, 62% neglected punctuation marks, 71% had com-prehension diffi culties and 62% had diffi culties in story-retelling. For implanted children at the special schools, the majority of them neglected punctuation marks (89%) during reading and diffi culties in reading comprehension (almost 80%). The major problems faced by the implanted children in writing skills as noted by teachers at both normal and special schools were diffi culties in building phrases, sentences and paragraphs, using conjunctions and following proper essay format. However, the majority of the teachers (85.7% at normal schools, 88.9% at special schools) agreed that these children had tidy and neat handwriting. The results suggest that many of school-going children with cochlear implants have problems in reading and wri-ting as reported by teachers. Thus, the need for support teachers to help them in acquiring these literacy skills is of paramount impor-tance.



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FP-072

PERCEPTION AND TRAINING OF EMOTIONAL AFFECTATION

IN SPEECH BY CI USERS

James CJ, Laborde ML, Orreteguy L, Riviere A, Fraysse B.Hôpital Purpan, CHU Toulouse, France

CI recipients rely essentially on intensity cues to identify emotional aff ectation in speech. We hypothesised that a self-training program where intensity cues are removed would improve the use of frequen-cy cues for the recognition of emotions in speech.

Five neutral sentences spoken with the emotions “anger”, “joy”, “sad-ness” and “fear” and in a neutral tone were recorded with four voice actors. Semantically congruous sentences were also recorded for the self-training material. In all presentations the RMS amplitudes of the sentences were equalized.

18 adult cochlear implant users and 18 normally hearing adults were evaluated. CI subjects were tested twice in two sessions, with a trai-ning period of approximately one month between. Normally hearing subjects were tested twice in one single session.

For the fi rst session CI subjects scored on average 35% correct com-pared to 72% for the NH subjects. There were no signifi cant diff eren-ces between the fi rst and second tests for both groups. The neutral tone and “anger” were best identifi ed followed respectively by “joy”, “sadness” and “fear”. The mean score for CI subjects increased signifi -cantly to 41% after the self-training: Most improvement was seen for the identifi cation of “fear”.

Self-training can improve the perception of emotional aff ection in speech, particularly to enlarge the use of frequency cues. Focused training on specifi c listening tasks could give a benefi t for cochlear implanted children.


FP-073

DEVELOPMENT OF AUDITORY MEMORY IN COCHLEAR

IMPLANTED CHILDREN OVER TIME

Mikic B, Miric D, Ostojic S, Asanovic M, Mikic M.Clinical Center of Serbia, Insitute of ENT. Belgrade, Serbia.

Short term auditory memory is extremely important for speech de-velopment in hearing or hearing impaired children.

Objective of this study was to assess development of auditory me-mory in a group of cochlear implanted children and to discover the factors that aff ect it.

A group of 30 CI children aged 3 to 12 has been tested using a Test of immediate verbal memory developed by Spasenija Vladisavl-jević.The test consists of four subtests of increasing complexity.

Children were divided in three subgroups accoridng to duration of postoperative rehabilitation: A. With less than 1 year of postop reha-bilitation, B. 1- 2 years and C. More than 2 years. Two subgroups were compared regarding age at implantation: those imnplanted before the age of 3 and those implanted later than 3 years of age.

Results have shown that short-term auditory memory is constantly improving over time in all of the cochlear implantees. Scores are in-creasing after a year or two of rehabilitation,especially for the most complex subtest of short sentences.

Children that were implanted before the age of 3, have show consi-derably better scores in all four subtests, which implies that develo-pment of auditory memory is dependent on central nervous system plasticity.

Improvement of short-term auditory memory is consistently seen over time in postoperative rehabilitation of cochlear implanted chil-dren. Early implantation, before the age of 3, enables maximal achie-vement in hearing, speech and auditory memory.

E-mail:[email protected]


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FP-075

DISTORSION PRODUCT OTOACOUSTIC EMISSION (DPOAE)

EXAMINATIONS IN PATIENTS WITH TYPE-1 DIABETES

MELLITUS

Tóth F, Várkonyi TT, Sevacsek Zs, Rovó L, Lengyel Cs, Légrády P, Jóri J, Kiss JG.Department of Otolaryngology, Head and Neck Surgery; (1) 1st Department of

Medicine, University of Szeged, Szeged, Hungary.

Introduction: Our previous results showed that diabetic neuropathy may be manifested in certain dysfunctions of the central auditory pa-thways. BAEP parameters of patients with long-standing (>20 years) type-1 diabetes mellitus diff ered signifi cantly compared with healthy controls. A signifi cant correlation was observed between the overall autonomic score (AN) and the latencies (wave III and V) and IPL-s (I-III, I-V).

Methods: We performed DPOAE examinations in patients with type-1 diabetes mellitus (DM). 27 insulin-treated patients duration were included. Cardiovascular refl ex tests were applied for assessment of autonomic neuropathy. Peripheral sensory nerve function was stu-died with a Neurometer (Neurotron Inc., Baltimore), using constant current sine wave transcutaneous stimulation. Our aim was to com-pare the DPOAE results of this patient group with controls and to look for the possible correlation between the alteration of the inner ear function and the cardiovascular autonomic and the peripheral sensory neuropathy.

Results: Analysing of absolute and relative amplitudes of DPOAE we revealed a signifi cant diff erence between diabetics and healthy con-trols. A positive correlation was observed between the cardiovascu-lar refl ex tests and the DPOAE intensities. Evaluation of the periphe-ral sensory nerve function revealed negative association the current perception thresholds (CPT at 2 kHz and 250 Hz) and the DPOAE amplitudes.

Conclusions: Several parameters of autonomic and sensory neuro-pathy consequently worsen together with abnormalities of cochlear function. Our data support the hypothesis that diabetic neuropathy might be manifested in certain dysfunctions of the hair cell activity.


FP-074

EVALUATION OF LOW FREQUENCY OTOACOUSTIC

EMISSIONS IN SUBJECTS WITH NORMAL AND IMPAIRED

HEARING

Jedrzejczak WW, Lorens A, Piotrowska A, Kochanek K, Sliwa L, Skarzynski H.Institute of Physiology and Pathology of Hearing, Warsaw, Poland

Background: The aim of this study was to investigate if transiently evoked otoacoustic emissions (TEOAEs) could be used in evaluation of hearing in as low frequencies as 0.5 kHz, and to check if tone burst stimuli can give any improvement in comparison with standard click stimuli.

Material and Methods: TEOAEs evoked by clicks and 0.5 kHz tone bursts were measured from two groups of subjects using ILO96 sys-tem by Otodynamics. The fi rst was a group with partial deafness (10 subjects) and the second was a control group with normal hearing (20 subjects). Partial deafness is characterized by steep audiograms with normal thresholds up to 0.5 kHz and almost total deafness abo-ve. Additionally, each subject was tested for the presence of spon-taneous OAEs (SOAEs) using synchronized SOAE (SSOAE) technique provided by ILO96 equipment.

Results: The presence of OAE was evaluated by reproducibility para-meter. It is defi ned as the correlation between two buff ers of sub-averages of single responses. The reproducibility of responses to clicks for partial deafness was very low, meaning that these stimuli did not produced OAEs. On the other hand reproducibility for res-ponses to 0.5 kHz bursts was only slightly lower than that of normal subjects.

Conclusions: The 0.5 kHz tone burst OAE is more reliable than click evoked OAE in case of activity in low frequencies. However the repro-ducibility values for low frequency responses are signifi cantly lower than for standard wideband click stimuli. Therefore the prolongation of measurement and/or lowering detection criteria should be consi-dered. Nevertheless the 0.5 kHz tone burst OAE could be promising tool for detection of emissions in patients with deep high frequency hearing loss when click stimuli did not produced OAE.



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FP-076

APPLICATION OF AUTOMATED OAE AND ASSR ALGORITHMS

TO EVALUATION OF HEARING SENSITIVITY IN NORMAL-

HEARING AND HEARING IMPAIRED SUBJECTS

Sliwa L (1), Jedrzejczak WW (1), Hatzopoulos S (2), Kochanek K (1), Pilka E (1), Skarzynski H (1).(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland; (2)

University of Ferrara, Italy.

The objectives of this study were (i) to evaluate the eff ectiveness of hearing threshold estimation by the use of automated acousti-cal protocols (Cochlea-Scan) and auditory steady-state responses (ASSR), (ii) to assess the applicability of these methods to hearing screening programs of pre-school and school age children, and (iii) to examine the possibility of improving threshold estimation accuracy by combining two objective hearing testing methods.

A group of normal-hearing and hearing-impaired subjects with mild-to-moderate hearing losses were used in the study. The group inclu-ded adults and school-age children Hearing threshold levels were assessed by pure tone audiometry (PTA), the Cochlea-Scan (Fischer-Zoth/Natus) DPOAE protocols, and ASSR threshold measurement. The BioLogic Master and GSI Audera electrophysiological systems were used in ASSR tests. An optimized PTA threshold prediction al-gorithm was used, based on previous investigations by the authors.

The results made it possible to compare advantages and shortco-mings of both methods. The data also indicate that concurrent application of acoustic and electrophysiological tests may lead to an improvement in assessment of hearing sensitivity in both normal-hearing and in hearing-impaired subjects. The margin of assessment in the hearing impaired group was found to be closer to a PTA va-lue then in normal hearing group. Assessment error can be further reduced by applying further refi nements in OAE measurements and better estimations of ASSR thresholds. Implementation of combined electrophysiological and acoustic test protocol is proposed for a new device being developed.


FP-077

EFFECT OF PEER REVIEW ON ACCURACY OF REPORTED ABR

HEARING THRESHOLDS IN NEWBORN HEARING SCREENING

PROGRAMME REFERRALS

Raglan E, Radomskij P, Sudhagar K.St George’s Healthcare NHS Trust. London, UK.

Aims: Peer-review is the process in which colleagues’ work is evalua-ted. This process benefi ts both the reviewed (who obtains feedback) but also the reviewer, who improves their own skills.

A formal peer-review system to evaluate accuracy of ABR threshold estimation was implemented at St George’s Hospital, London in April 2008.

The aim of this project is to establish the impact of this peer-review.

Methods: All subjects were referred from NHSP and tested within 3-months of age. ABR data recorded using NHSP click-ABR protocol.

Group-A: threshold estimated by audiologist carrying out test (Thres-hold-A)

Group-B: threshold estimated by audiologist carrying out test with peer-reviewer (Threshold-B)

All ABR tests in group A&B were independently analysed retrospec-tively and collective judgement made on estimated threshold (two senior audiologists). This threshold estimation is deemed the ‘expert threshold’ (Threshold-E).

The diff erences between A&E thresholds and B&E thresholds were analysed.

Results: Non-peer-reviewed traces – mean diff erence in thresholds (E-A) is 6dB (SD 5dB). The expert threshold is higher than the thres-hold estimated on the day of testing.

Peer-reviewed traces – mean diff erence in thresholds (E-B) is 1dB (SD 6 dB).

Good correlation found between the expert and audiologist thres-holds (0.94 without and 0.97 with peer-review)

No signifi cant diff erence between the two populations (E-A and E-B) P<0.005

However, two results need to be considered where peer review in-creased the estimated threshold by 25dBnHL.

Discussion: It may appear that peer-review has minimal impact on threshold estimation (<=5dB), which would have little clinical signi-fi cance. In fact peer-review provides opportunities for peer support and continuing professional development, as well as a safety net for those cases, which are diffi cult to analyse, and in which signifi cant hearing losses may be missed.

Conclusions: A system of formal review is strongly advocated.



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FP-078

AUDITORY STEADY-STATE RESPONSES IN DYSLEXIC

READERS: A DEFICIT IN AUDITORY TEMPORAL PROCESSING?

Poelmans H (1), Luts H (1), Boets B (2), Vandermosten M (2), Ghesquiére P (2), Wouters J (1).(1) ExpORL, Dept. Neurosciences, K.U.Leuven, Belgium; (2) Center for

Parenting, Child Welfare and Disabilities, K.U.Leuven, Belgium.

Developmental dyslexia refers to a defi ciency in reading and writing skills, caused by a defi cit in the development of phonological skills. It is hypothesized that the phonological problems in dyslexia result from a fundamental defi cit in low-level auditory temporal proces-sing, in turn causing a subtle defi cit in speech perception.

In the present study, temporal envelope processing was investigated in a group of normally reading and dyslexic adults by means of au-ditory steady-state responses (ASSRs), in combination with cognitive and psychophysical measures. Multichannel ASSRs were evoked by speech-weighted noise stimuli that were 100% amplitude-modula-ted at 4, 20 and 80 Hz. Listening conditions were degraded by adding masking noise or lowering modulation depth. Furthermore, reading tests and a psychophysical AM-detection task were conducted.

The aim of this study is to try to trace at what level of the auditory system (brainstem or cortex) possible neurophysiological diff erences between normally reading and dyslectic subjects occur. Furthermo-re, we want to investigate whether dyslectic subjects have a defi cit in temporal envelope processing, in optimal listening conditions or only in degraded conditions. Finally, we examine the relation bet-ween neurophysiological and psychophysical indicators of auditory temporal processing and speech perception.

Preliminary analyses suggest comparable neurophysiological tem-poral envelope processing for both groups at 80 Hz. In contrast, dyslexic subjects tend towards defi cient processing at 20 Hz when masking noise is added. Correlations between psychophysical and ASSR measures indicate that both are related mechanisms. Results will be discussed at the conference.


FP-079

UNCOMFORTABLE LOUDNESS LEVELS IN NORMAL HEARING

ADULTS DERIVED FROM THE AUDITORY STEADY STATE

RESPONSES

Mora Espino R (1,2), Zenker F (1,2), Fernández Belda R (3,1,2), and Barajas de Prat JJ (4,2,1).(1) Fundación Dr. Barajas, S/C de Tenerife, Spain;(2) Clínica Barajas, S/C de



Determination of the frequency-specifi c uncomfortable loudness level (ULL) is an important requirement for hearing aid fi tting. Sub-jective ULL assessment procedures are of limited value in neonates, infants, babies, toddlers and uncooperative children and adults. Al-ternative objective techniques such as physiological measures have been used in order to predict subjective ULLs.

In this study is established whether the Auditory Steady State Res-ponses (ASSR) can be used to predict uncomfortable loudness levels (ULLs) in a group of normal hearing adults. Subjective ULLs were obtained using standard procedures. Objective ULL were obtained from parameter-intensity functions using amplitude and phase of the ASSR.

Preliminary result shows that the best predictions of the subjective ULL were using individual phase-intensity functions. Poor predic-tions were obtained from the amplitude-intensity functions due to high inter-subject variability. The best predictions were considered suffi ciently accurate to warrant further investigation in patients with varying degrees of hearing loss.



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FP-080

AUDITORY STEADY-STATE RESPONSES IN YOUNG INFANTS:

THRESHOLDS AND LATENCIES

Alaerts J (1), Luts H (1), Van Dun B (1,2), Desloovere C (3), Wouters J (1).(1) ExpORL, Dept. Neurosciences, K.U.Leuven, Belgium;(2) SCD-SISTA, Dept.

of Electrical Engineering (ESAT), K.U.Leuven, Belgium;(3) Dept. Oto-Rhino-

Laryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium.

The current study describes thresholds and latencies of multiple-stimulus auditory steady-state responses (ASSRs) in high-risk in-fants, tested in early infancy. The fi rst objective was to evaluate the diagnostic value of ASSRs for estimating hearing thresholds in very young infants. Therefore, ASSR thresholds were compared between infants and adults with normal hearing, and infant ASSR thresholds were assessed in relation to behavioral hearing thresholds (BHTs). The second and main objective of this study was to gain insight into the mechanisms underlying ASSRs and possible maturational issues involved. To this end, phase delays and latency estimates in both in-fants and adults with normal hearing were assessed and age-related changes in latency within the infant group were evaluated.

Normal ASSR thresholds were on average 12 dB higher in infants compared with adults. Correlations between ASSR thresholds and BHTs were 0.75, 0.87, 0.87 and 0.79 for 0.5, 1, 2 and 4 kHz, respec-tively. There was a signifi cant eff ect of carrier frequency on ASSR latency, with higher carrier frequencies evoking shorter latencies in both infants and adults. Mean latencies in adults were 24.3 ± 1.5, 22.3 ± 1.1, 19.4 ± 1.0 and 18.0 ± 1.1 ms for 0.5, 1, 2 and 4 kHz, respecti-vely. Depending on the data fi t of the infant latency estimates, mean latencies were 1.0 ms shorter or 9.5 ms longer in infants compared with adults. In infants, latencies were on average 2.0 ms longer in the youngest infant group (≤0 weeks) relative to the oldest infant group (3-8 weeks). These age-related trends, together with other ar-guments, point to longer latencies in infants compared with adults.

The results of this study are valuable as a clinical reference for inter-preting ASSR results obtained in high-risk infants within their fi rst months of life, and indicate developmental changes occur regarding ASSR latency.


FP-081

CORTICAL AUDITORY STEADY-STATE RESPONSES AND

SPEECH UNDERSTANDING

Alaerts J, Luts H, Hofmann M, Wouters J.ExpORL, Dept. Neurosciences, K.U.Leuven, O&N 2, Herestraat 49/721, B-3000

Leuven, Belgium

Beyond hearing threshold estimation, there has been a growing in-terest in the application of auditory steady-state responses (ASSRs) to evaluate suprathreshold auditory abilities. The aim of this research was to evaluate suprathreshold ASSRs in relation to behavioral speech understanding skills. Since modulation frequencies below 20 Hz are the most prominent in the speech envelope and appear crucial for speech understanding, ASSRs to low frequencies may have the potential of being strongely related to the process of speech un-derstanding.

In a fi rst step, the reliability of low-frequency ASSR recording was evaluated, and the eff ect of modulation frequency on ASSR ampli-tude and latency was explored in a group of normal-hearing adults. In a second step, low-frequency ASSR measures were linked to the perceptual outcomes of speech intelligibility for phonemes and sen-tences in noise in normal-hearing and hearing-impaired listeners.

Large variability in response amplitude was observed between in-dividuals. Within certain frequency ranges, the mean phase delay increased linearly with modulation frequency, indicating a constant latency. Apparent latencies for frequency regions of 8-12 Hz, 18-22 Hz and 26-30 Hz were 117, 102 and 31 ms, respectively. These results point to primarily cortical sources underlying the response genera-tion. Furthermore, signifi cant diff erences between normal-hearing and hearing-impaired adults were found for ASSR measures that in-tegrated low modulation frequencies of 4, 10, and 20 Hz. Comparing these responses with phoneme identifi cation scores over diff erent stimulus levels showed both measures increased with stimulus level in a similar way (ρ=0.82). At a fi xed stimulus level, ASSRs were signifi cantly correlated with speech reception thresholds for phone-mes and sentences in noise (ρ -0.45 to -0.53). These results indi-cate the objective low-frequency ASSRs can be related to behavioral speech understanding independently of level.

The results of this research may provide promising prospects for the application of suprathreshold cortical ASSRs in objective speech au-diometry.



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FP-082

AUDIOVESTIBULAR MANIFESTATIONS IN HYPERLIPIDAEMIA

Jayarajan V, Prasher D, Topass N, Vangapalli S.Royal Surrey County Hospital, Guildford, England

There is some evidence that vascular insuffi ciency can cause abnor-malities in the central pathways of hearing and balance. However, it is less well known that these problems may be due to hyperlipidaemia. We present the cases of two patients with hyperlipidaemia who were found to have disorders of the auditory and vestibular pathways.

Case 1: A 35 year old man noticed a hearing loss after a minor head injury. He was found to have a left sided sensorineural hearing loss on Pure Tone Audiometry. ABR testing showed abnormalities on the left side, and an MRI brain scan demonstrated a focus of high signal in the pons. Blood tests showed signifi cant elevations of serum cho-lesterol and triglycerides.

Case 2: A fi fty year old man had dizziness, altered consciousness and tinnitus for two weeks. There was a family history of ischaemic heart disease. Pure Tone Audiometry showed bilateral high frequency hea-ring losses, while abnormalities were seen on ABR testing (left side) and videonystagmography (saccades and smooth pursuit). An MRI brain scan was found to be normal, and a carotid ultrasound scan showed evidence of atherosclerosis.Blood tests demonstrated mar-kedly elevated levels of cholesterol and triglycerides.

Discussion: In both these patients we found abnormalities in the cen-tral auditory pathways, while in Case 2 there were additional lesions in the vestibular pathways. Blood tests showed evidence of hyperli-pidaemia in both patients. The lesion seen on the MRI brain scan in Case 1 was thought to be a pontine infarct, while the second patient was diagnosed as having Familial Hypercholesterolaemia. Both pa-tients have commenced treatment with cholesterol lowering agents (statins).


FP-083

A PROPORTIONAL META ANALYSIS STUDY OF HEARING

LOSS IN TURNER’S SYNDROME

Dasgupta S (1), Das VK (2).(1) Manchester Royal Infi rmary, UK; (2) University of Manchester, UK.

Discovered in 1934, Turner’s syndrome is a condition characterised by an absent or abnormal X chromosome in the female with mono-somy XO as the predominant genotype. Multiple organs may be in-volved that include neurological system. Of this, hearing loss is a well recognised feature.

The incidence of hearing loss, its type, intensity and characteristics have been reported in the literature. However, this evidence is extre-mely heterogeneous with wide variations in their fi ndings. A syste-matic review along with meta analysis of the data is thus needed to draw meaningful inferences from all studies combined.

In the present study, a prospective cohort comprising of 13 patients with Turner’s syndrome were audiometrically and clinically analysed. This series was then included for statistical analysis along with the existing published evidence comprising of 21 articles exploring the relationship of hearing loss to Turner’s syndrome. A total of 1816 pa-tients were considered.

Proportional meta analysis with StatsDirect 2009 was performed to obtain a statistically robust incidence rate of normal hearing, otitis media with eff usion, conductive hearing loss, mixed hearing loss and sensorineural hearing loss in the study population. Publication bias was not signifi cant (Begg Mazumdar Kendal’s tau p>0.05); heteroge-neity was signifi cant ( Cochran’s Q p<0.00001) and inconsistencies I2. were marked (88% - 94%). Due to this, a random eff ects pooled proportion (DerSimonian Laird) yielded values of 31% incidence of normal hearing, 61% incidence of otitis media with eff usion, 26.4% incidence of conductive or mixed hearing loss and 40% incidence of sensorineural hearing loss in patients with Turner’s syndrome.

This study is the fi rst of its kind to present results from all studies combined together statistically. The results were diff erent from tho-se reported before. The observations reinforced the philosophy that hearing loss in Turner’s syndrome needs to be managed aggressively, especially given the high incidence of conductive and sensorineural hearing loss.



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FP-084

A SUGGESTED MECHANISM FOR THE AIR-BONE-GAP IN

SUPERIOR CANAL DEHISCENCE SYNDROME

Sichel J Y (1), Perez R (1), Sohmer H (2).(1) Dept. of Otolaryngology, Head & Neck Surgery, Shaare Zedek Medical

Center, Jerusalem, Israel; (2) Dept. of Physiology, Hebrew University-Hadassah

Medical School, Jerusalem, Israel.

Introduction: Superior canal dehiscence syndrome (SCDS) is a relati-vely new entity. In 2000, the presence of increased sensitivity of bone conduction hearing (conductive hyperacusis), together with and an Air-Bone-Gap (ABG), in the absence of a true conductive lesion in the middle ear was described in several SCDS patients. The aim of this report is to propose a physiological explanation (mechanism) for this phenomenon.

1- Improvement of Bone-conduction (BC) threshold: Our research team published in the past a series of experiments in animals and humans which demonstrated that BC is mainly based on a fl uid pa-thway from intra-cranial fl uid (cerebrospinal fl uid) to intra-cochlear fl uid. The pathological “opening” in SCDS patients provides a lower impedance fl uid pathway from the intra-cranial fl uid contents to the inner ear, enhancing its excitation, and improving BC threshold.

2- Worsening of air conduction (AC) threshold: Deterioration of AC threshold may be explained by the same lower impedance pathway in SCDS patients, shunting part of the sound pressure energy toward the intracranial fl uid contents and away from the inner ear, so that less sound energy is available to the cochlea.

Conclusion: The improvement of the BC along with the worsening of the AC leads to an apparent ABG and conductive hearing loss while there is no real middle ear conductive lesion.


FP-085

MAJOR AND MINOR HEAD INJURIES – A CLINICAL STUDY ON

THE EFFECTS ON THE HUMAN TEMPORAL BONE

Fenech AJ (1), Camilleri MT (2).(1) Audiology unit, Department of Otolaryngology Mater Dei Hospital Malta;

(2) Department of Anatomy, University of Malta.

Objectives: To study the clinical eff ects of head injury on the tempo-ral bone.

Design: 24 patients with major head injury and 50 patients with mi-nor head injury admitted to hospital investigated audiologically on admission and followed up over a number of years.

Settings: Major head injury cases admitted to intensive therapy unit and minor head injury cases admitted to general surgical wards

Partecipants: All the work involved was entirely conducted by myself

Main outcome measure: Severity of head injury must be high for co-chlear concussion to occur. Permanent sensori-neural hearing loss was the major symptom while tinnitus, vertigo and facial palsy di-sappeared or decreased in severity during the fi rst year post head injury. None of these were observed in cases of minor head injury either on admission or during follow up.

Results: Major head injury study: permanent sensori-neural hearing loss was the most common symptom especially when there was fracture of the temporal bone. Tinnitus and vertigo were observed in 20% to 25% of cases while facial palsy was less observed.

Minor head injury study: none of the cases suff ered any hearing loss, tinnitus, vertigo or facial palsy after investigating them with pure tone audiograms, middle ear pressures and otoacoustic emissions.

Conclusion: Severity of head injury must be high for cochlear concus-sion to occur as confi rmed in the study of major head injuries resul-ting in mainly permanent sensori-neural hearing loss and to a much lesser extent in tinnitus, vertigo and facial palsy. Minor head injury does not constitute any of such signs and symptoms.



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FP-086

FRACTURES OF THE HUMAN TEMPORAL BONE - A NEW

PLANE OF SECTIONING

Fenech AJ (1), Camilleri MT (2), Michaels L (3).(1) Anatomy Department, University of Malta and Department of

Otolaryngology, Mater Dei Hospital, Malta; (2) Anatomy Department,

University of Malta; (3) University of London, United Kingdom.

Objectives: To study the eff ects of fatal head injury on the temporal bone: both the cochlear and vestibular structures

Design: 41 human temporal bones involved in fatal trauma to the head due to motor vehicle accidents or falls from height were stu-died by microslicing them in the coronal plane.

Settings: Temporal bones were harvested soon after dead.

Participants: All the work involved was entirely conducted by myself

Main outcome measure: Most fractures were found to be of the obli-que and mixed types and not just true longitudinal or transverse frac-tures. CT scans by themselves will only detect gross fractures: further dissecting microscope examination often revealed microfractures not detected by routine X-rays.

Results: Oblique and mixed fractures together constituted almost same percentage involvement as in longitudinal fractures. Involve-ment of middle ear structures were mainly found in longitudinal and oblique fractures while inner ear involvement was mainly noticed in transverse fractures. Oblique fractures and to a lesser degree mixed fractures exhibited involvement in all three parts of the ears. Facial nerve involvement was found in almost all types of fractures. Hae-morrhage was observed in all types of fractures but almost none in transverse. Bone density studies showed that the otic capsule had a high Hounsfi eld value.

Conclusion: CT scans of whole temporal bones did not show all frac-tures ? they underestimated the presence and extent of fractures. There was a gradation of eff ects on the temporal bone with increa-singly violent trauma. Bone densitometry study showed that the otic capsule has a fairly constant amount of calcium, was the same irrespective of age and gender and no statistical signifi cant diff eren-ce was observed when diff erent types of fractures were compared. The greater the trauma to the head, the more likely was the tempo-ral bone to fracture and in turn cause symptoms due to damage of important structures if there was survival. Bone studies showed that fractures were more common than clinically suspected.


FP-087

THE IMPORTANCE OF THE AUDIOLOGICAL ASSESSMENT

COMBINED WITH THE PAEDIATRIC ENT ASSESSMENT

Willis-Lorrier RMS, Vinck S, Homans NC, Verschuure J.Audiological Centre, ENT Department, Erasmus Medical Centre. Rotterdam,

The Netherlands.

In the Netherlands neonatal hearing screening and the diagnostic hearing assessment has been fully in place since the beginning of 2006. In our region all failed children are referred to our tertiary hos-pital.

The ideal assessment situation would be ABR, OAE, Tympanogram and ENT assessment carried out in one visit. Due to practical circums-tances this is not always possible.

If a hearing loss is found, or in case of doubt ( neurological matu-ration, conductive losses, inconclusive or contradictory results), the assessment is usually repeated after 3 month.

We found that the hearing thresholds of some infants changed dra-matically and we investigated the cause of this change. The supposi-tion was that normal neural maturation could be the cause. To avoid cases with a complicated history, we limited ourselves to children that were referred to us by well-baby clinics indicating near-normal development. Further criteria were no conductive or mixed loss, and more than one assessment before their fi rst birthday.

We included 80 ears in the analysis and found that 49 ears (61.25%) showed an improvement in the ABR threshold of 10dB or more. Clea-ring up of middle ear problems is accountable for a number of these improvements, while the ABR assessment had been interpreted as a sensorineural loss. Suspicion based on tympanometry and otoscopic inspection was more reliable in these cases.

We concluded that ABR is not reliable in itself showing small con-ductive hearing losses. Tympanometry and otoscopic inspection by a well-trained paediatric ENT specialist should always be done. Our initial hypothesis that threshold changes were caused by neural ma-turation was proven incorrect.



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FP-088

AUTOIMMUNE INNER EAR DISEASES AND

CHANNELOPATHIES AS POSSIBLE AETIOLOGIES FOR

TINNITUS AND MENIERE’S DISEASE; A REVIEW

Refaie AE.Bristol University; UK.

Ion channels are macromolecular proteins embedded in the cellu-lar membrane. Their main function is to guide the directional fl ow of ions from inside and outside the cell, through concentration or elec-trical gradients (Kole et al, 2003). A growing number of diseases are now recognized to be the direct cause of dysfunctional ionic chan-nels, usually through genetic mutation “channelopathies” (Waxman, 2007). Other implicated aetiologies are autoimmunity or drug toxici-ty. Transmission of sound and sharp tuning in the cochlea is largely dependant on ionic concentration of primarily potassium, sodium and calcium ions inside the endolymph. Inner and outer hair cells have distinct K+ channels and express calcium channels too

Some kinds of non-syndromic autosomal dominant progressive hea-ring loss were found to be related to mutations aff ecting K+ channels expressed in the outer hair cells as well as some syndromic hereditary conditions (Gates, 2005). Other conditions were channelopathies are implicated, like familial ataxia and migraine, have common characte-ristics with Meniere’s disease

Studies looking at the therapeutic eff ects of some calcium channel blockers in cases of clinical tinnitus (Nimodipine) (Davies et al, 1994) and other neuroprotective drugs (Shulman, 1997) are reviewed. The aim of this presentation is to explore the evidence in literature about possible correlations between the pathological processes implicated in Channelopathies, autoimmune inner ear diseases, Meniere’s disea-se and tinnitus in the literature.


FP-089

DPOAES IN PATIENTS WITH DEFINITE MÉNIÈRE’S DISEASE

Al-Saif S (1), AbdelTawwab MM (2).Consultant of ORL, KFMMC Hospital, Dhahran, KSA, Egypt (1); Lecturer of

Audiology, ENT Department, Faculty of Medicine, Mansoura University, now

Audiological Physician in KFMMC Hospital, Egypt (2).

Objectives: The purpose of this study was to investigate the distor-tion product otoacoustic emission (DPOAEs) across selected fre-quencies in patients with defi nite Ménière’s disease (DMD) and to compare them with that of the contra-lateral ears as well as the nor-mal control group.

Materials and methods: This prospective study consisted of 35 con-senting patients with DMD, their age ranged from 19 to 58 years, 16 males and 19 females as a study group and 31 subjects 15 females and 16 males, their age ranged from 21 to 56 years with normal hearing and no previous history of vestibular system aff ection as a control group. They were subjected to pure tone audiometry and DPOAEs measurements.

Results: In this study, female to male preponderance was 1.18: 1 for DMD. Bilateral DMD was observed in 34.28 % of the study group. The incidence and mean emission amplitude across the DPOAEs measu-red frequencies in the aff ected ears was signifi cantly lowers than that of both the non-aff ected ears in unilateral DMD and control group. Also it was noticed that as the hearing loss increases in patients with DMD the DPOAEs amplitude decreases.

Discussion and Conclusion: DPOAEs in patients with DMD diff er from those in the contra-lateral ears as well as from that of the control group. Reduction in the emission amplitude of DPOAEs in the aff ec-ted ears was signifi cant in comparison with that of the non-aff ected ears in unilateral DMD and that of the control group. This diff erences could be attributed to the patho-physiologic mechanism and hea-ring loss encountered in patients with DMD.



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FP-090

AETIOLOGY OF BENIGN PAROXYSMAL POSITIONAL

VERTIGO

Pace Balzan E, Borg C, Farrugia E.Audiology Unit, Department of Otolaryngology and Head and Neck Surgery,

Mater Dei Hospital, Msida, Malta.

In spite of the high prevalence of Benign Paroxysmal Positional Ver-tigo (BPPV) and the therapeutic effi cacy of repositioning and libera-tory manoeuvres, there is only limited knowledge regarding the ae-tiology of this condition and the cause of its recurrences. Our study was conducted in an attempt to improve the current understanding of factors that can cause BPPV or predispose to the condition.

The subjects included in this study were diagnosed with BPPV after a positive provocative positioning test. These patients were asked about events which preceded the onset of their symptoms and the-refore could potentially be directly responsible for the occurrence of BPPV. They were also questioned about diverse risk factors and conditions, many of which had somehow been linked to BPPV in the literature.

Among the 128 patients studied, the most common factor that pre-ceded the onset of BPPV was a signifi cant stressful event (25.0%). The second most common preceding its occurrence was a head or whi-plash injury (19.5%). The third most common preceding event was a viral illness (10.2%). When we investigated the risk factors for BPPV we found that several co-morbid conditions that have been classica-lly associated with this form of vertigo were indeed more common in our sample of patients than in the general population. These inclu-ded migraine, cerebrovascular disease, hypertension and diabetes. We also found that gout and hypothyroidism had a higher prevalen-ce in our patient cohort than expected from their prevalence in the general population.

In this study we investigated not only factors that have been linked to BPPV in previous clinical analyses and surveys, but also factors that had been suggested as possible precipitating and aggravating fac-tors in the form of ‘plausible hypothesis’. Indeed we have reproduced several previous fi ndings; yet, other patterns which emerge warrant further investigation.


FP-091

BILATERAL VESTIBULAR FAILURE

Cvjetko T, Aras I, Vlahovic S, Celap M.Polyclinic for speech and hearing rehabilitation,Zagreb Croatia,Department of

Otorhinolaryngology. Zagreb, Croatia.

AIM: To present a case series of four patients with bilateral vestibular failure (BVF) of no known cause, including their clinical and labora-tory features.

BACKGROUND: Bilateral vestibular failure is not a rarity, but neither the average neurologist nor the average ENT surgeon is terribly fami-liar with this condition. The most common causes of the disease are gentamicin otoxicity, post-meningitic, idiopathic and miscellaneous causes.

METHODS: In the offi ce, screening for this condition was made by ta-king very thorough history,examination for refi xation saccades after brisk head movements while attempting visual fi xation, and heel-to-toe Romberg and the one–foot Romberg test.

Diagnosis was confi rmed with electronystagmography by bilatera-lly reduced or absent caloric response and abnormally low gain of vestibulo-ocular refl ex on rotational chair testing.

RESULTS: Three patients had symptoms of progressive disequilibrium with episode of acute vertigo in one patient, and oscillopsia. In one patient the onset was acute with unsteadiness and oscillopsia.

Pure tone audiometry and auditory brainstem response were perfor-med in all patients, and stabilometry in patient with acute onset of the symptoms.

CONCLUSION: Bilateral vestibular failure may aff ect patients of all ages and the symptoms arise as a result of loss of vestibulospinal and vestibulo-ocular refl exes.

The mainstay of the tretment is vestibular rehabilitation.



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FP-092

EFFECTS OF HEARING IMPAIRMENT ON PSYCHOSOCIAL

HEALTH AND NEED FOR RECOVERY AFTER WORK IN ADULTS

AGED BETWEEN 18-70 YEARS: RESULTS FROM AN INTERNET-

BASED NATIONAL SURVEY ON HEARING

Nachtegaal J (1,5), Smit JH (2,5), Smits C (1,5), Goverts ST (1,5), Anema JR (3,4,5), Festen JM (1,5), Kramer SE (1,5).(1) Department of ENT/Audiology, VU University Medical Center, Amsterdam,

The Netherlands. (2) Department of Psychiatry, VU University Medical Center,

Amsterdam, The Netherlands. (3) Department of Public and Occupational

Health, VU University Medical Center, Amsterdam, The Netherlands. (4)

Research Centre for Insurance Medicine, AMC – UWV – VU University Medical

Center, Amsterdam, The Netherlands. (5) EMGO Institute for Health and Care

Research, VU University Medical Center, Amsterdam, The Netherlands.

Although the majority of people with hearing impairments are older than 65 years, a considerable number of younger people are expe-riencing hearing problems as well. For these younger people little is known about the eff ects of hearing impairment on various aspects of life, such as psychosocial health and work situation. To gain more insight in the eff ects of hearing impairment on these aspects of life, the National Longitudinal Study on Hearing was set up. In this study, both normally hearing and hearing impaired adults aged 18-70 years participate. Hearing status is measured using an Internet speech-in-noise test, launched a few years ago. Questionnaires administered via the Internet are used to examine psychosocial health (distress, de-pression, anxiety, somatisation, loneliness & self-effi cacy) and work characteristics (job demands, job control, need for recovery). With the cross-sectional data, the relationship between hearing status and psychosocial health could be examined for 1511 subjects. Regression models showed signifi cant adverse associations between hearing status and distress, somatisation, depression and loneliness. Diff e-rent age groups exhibited diff erent associations. For working parti-cipants (n=926) the relationship between hearing status and need for recovery after work is currently being investigated. These results will be presented as well. The fi ndings underline the need to address the adverse eff ects of limited hearing among adults younger than 70 years. Implications for clinical practice will be discussed.


FP-093

COMPUTER-AIDED 3D VISUALIZATION IN PATIENTS WITH

ACOUSTIC NEURINOMA

Kiss JG, Nagy AL, Tanács A, Czesznak A (1), Smehák G (2), Tóth F, Rovó L, Jóri J.University of Szeged, Department of Otolaryngology and Head and Neck

Surgery; (1) University of Szeged, Department of Image Processing and

Computer Graphics; (2) Sun Microsystems Hungary Ltd.

Objectives: We are looking for a method to routinely evaluate CT and MR scans obtained for patients who will undergo surgery. As all these data are presented to us on digital media, further possibilities open up on image processing, 3D reconstruction, and surgical planning. We were looking for free software to complete this task.

Methods: We evaluated the 3D Slicer software (www.slicer.org), as this tool is free to use, free to modify – if needed – has a very solid and active developer community, and it exists on multiple platforms. We used a Sun Java Workstation (2*2,8GHz AMD Opteron 250 CPUs, 4GB RAM, Nvidia Quadro FX 3000 VGA) with Solaris Express Develo-per Edition to port, compile, and run Slicer.

Results: We present 3D reconstructed and combined CT/MR images of 14 patients with acoustic neurinoma. We also present audiologic fi ndings of the latter patients. Were actually used these results in the preoperative evaluation of the surgical intervention.

Conclusion: Nowadays, as computers get faster, and become much more aff ordable, 3D image reconstruction, computer-aided plan-ning of surgical interventions, or even image guided therapy (IGT) may become a tool for everyday use. Software developers quickly following the rapid evolution of hardware, make us possible to use these tools to the benefi t of our patients.



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FP-094

DEVELOPMENT AND EVALUATION OF TWO SPEECH

INTELLIGIBILITY TESTS FOR FRANCOPHONE LISTENERS

Jansen S (1), Luts H (1), Wagener K (2), Kollmeier B (3), Frachet B (4), Wouters J (1).(1) ExpORL, Department of Neurosciences, KULeuven, Herestraat 49 bus 721,

B-3000 Leuven, Belgium; (2) Hörzentrum Oldenburg, Germany; (3) Carl von

Ossietzky University of Oldenburg, Germany; (4) Hôpital Avicenne, Université

Paris XIII, FrancePresbyacousie, France.

Objectives: One of the aims of the European HearCom project was to develop speech-in-noise tests that are comparable across several languages. This study involves the development and evaluation of a digit triplet screening test and a closed-set sentence test (matrix test) for Francophone listeners.

Methods: Speech material consisted of triplets containing digits 1 to 9 and sentences with a fi xed syntactic structure and composed of a closed set of words. Stationary speech-weighted noises were gene-rated. The digit triplet test was presented in two versions: through te-lephone (limited bandwidth) and through headphones (broadband). First, the speech materials were optimized on the level of individual digits/words. Then, norms for normal hearing subjects were esta-blished for both versions of the digit triplet test, and the matrix test. The telephone digit triplet test was further validated in both normal hearing and hearing impaired listeners using an adaptive procedure. Finally, the screening test by telephone was launched in France.

Results: SRTs of -6.4 (SD=0.4) and -10.5 (SD=0.3) dB SNR and slopes of 17 and 27 %/dB were found for the telephone and broadband digit triplet test, respectively. Validation showed an SRT-PTA0.5,1,2,4 corre-lation of 0.77 and a sensitivity and specifi city of 0.71 and 1.00. Test-retest reliability was 0.7 dB. In the fi rst month after public release, already 20 000 calls were registered. For the matrix test, a reference SRT of -6.0 dB SNR (SD=0.6) and slope of 14 %/dB were obtained. As expected, adaptive training measurements revealed a learning eff ect of 1.2 dB between a fi rst and second list.

Conclusions: Both newly developed tests have steep slopes and small SRT diff erences across normal hearing listeners. The telephone digit triplet test has a high reliability and proves to fulfi ll the need for an easy accessible hearing screening.

[This work was supported by grants from the European Union FP6 Project 004171 HearCom.]

E-mail: sofi [email protected]

FP-095

SPEECH DISCRIMINATION IN SPATIALLY SEPARATED NOISE

IN THE GROUP OF UNILATERAL DEAF CHILDREN FITTED

WITH BAHA AND CONVENTIONAL CROS SYSTEMS

Piotrowska A, Lorens A, Mrowka M, Olszewski L, Charukiewicz A, Skarzynski H.Institute of Physiology and Pathology of Hearing, Warsaw, Poland.

Background: One of possible therapeutic solutions for patients with single sided deafness is application of conventional Cros or BAHA system on the deaf side.

Aim: The aim of this study is to compare the benefi ts of Baha and Cross in children with single sided deafness (SSD).

Method: 15 children, not younger than 5 years of age, with SSD were included to the study. SSD was defi ned as a hearing threshold bet-ter than or equal to 20 dB HL (measured at 0.5, 1, 2, 3 kHz) on the good ear and worse than 90 dB BC (bone conduction) on the bad ear. Speech discrimination in noise was evaluated for three signal/noise level confi gurations: signal level 50 dB, SNR 0 and signal level 65 dB, SNR 0 dB and SNR+5 dB in two spatial orientations – signal to the deaf ear/noise to the good ear and signal to good ear/noise to the deaf ear. Testing was performed in three conditions: unaided and two aided - with conventional Cros and Baha system.

Results: Results for speech in noise show signifi cant diff erences for condition (BAHA or Cross) (p<10-3), signal/noise level confi guration (p<10-6) and spatial orientation (p<10-6)

Conclusion: Achieved results indicate the potential benefi t for BAHA in single-sided deafness.


FP-096

SOUND LOCALIZATION AND SPEECH PERCEPTION IN

BILATERAL USERS OF VIBRANT SOUNDBRIDGE (VSB)

Koci V, Sprinzl G, Zorowka P.Innsbruck Medical University, Austria.

Background and Aims: The objective of the study was to investigate binaural hearing abilities of patients supplied with two active middle ear implants - Vibrant Soundbridge (VSB).

Materials and Methods: Sound localization tests were performed on 5 bilaterally implanted adult VSB users. Sound localization was tested in the frontal horizontal plane by means of sound source identifi ca-tion. 11 equally spaced loudspeakers were mounted from -60° to 60° on a steel ring of 2 m diameter. Speech-shaped noise bursts at rando-mized levels in the range of 70 dB ±6 dB were used as stimuli.

In a second experiment, speech reception thresholds were measured using the Oldenburg sentence test. Speech was always presented from the front. Noise at a level of 65 dB was either presented from the front, from the left side, or from the right side. Each condition was measured for unilateral and bilateral VSB use.

Results and Discussion: Sound localization is more accurate when both VSB’s are used compared to the monaural test condition. Binau-ral summation and squelch eff ect were derived from the speech test results by comparing the scores for diff erent directions of the noise and monaural or binaural implant use. First results regarding benefi t in speech reception in noise will be discussed.



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FP-097

THE EFFECT OF A CARRIER PHRASE AND RESPONSE

ALTERNATIVES ON SPEECH INTELLIGIBILITY IN QUIET FOR

TWO MONOSYLLABIC TESTS

Sukowski H (1), Brand T (1), Wagener KC (2), Kollmeier B (1,2).(1) Medizinische Physik, Universität Oldenburg, Germany; (2) Hörzentrum

Oldenburg, Germany

In the current study we compared two german monosyllabic speech intelligibility tests. One test is the Freiburg monosyllabic test (Hahl-brock, 1953, “FBMo”). The FBMo is normally carried out in an open paradigm (participants repeat what they understood) and all items are presented without a carrier phrase. The other test is the monosy-llabic rhyme test by von Wallenberg and Kollmeier (1989, “WaKo”). In this test the items are announced by a carrier phrase and the partici-pants can choose their response from fi ve alternatives displayed on a computer screen (closed paradigm).

When both tests are presented in silence at the same presentation level, the WaKo test results in higher speech intelligibility than the FBMo test. We investigated to what extent the carrier phrase and the response format (open versus closed paradigm) contribute to this di-ff erence. Therefore we modifi ed the original procedures as follows: FBMo with/without carrier phrase; WaKo with/without carrier phra-se and with/without response alternatives. Three groups of listeners with diff erent hearing status participated in this study. Each of the six test versions was conducted at fi ve or six diff erent presentation levels in silence.

For all groups similar results were found: analyses including all test versions did not show a signifi cant eff ect of the carrier phrase. Analy-ses with respect to the four rhyme test versions revealed a signifi cant eff ect of the response format, with higher speech intelligibility in the conditions in the closed than in the open paradigm.

By means of this result a part of the diff erence between both original test versions could be explained, but there is still some diff erence left. Thus the infl uence of further factors, e.g. the speaker or recording quality, need to be discussed. However, because results in all groups are similar, the remaining diff erence does not constrain the usability of both tests as interchangeable test procedures.


FP-098

CLINICAL APPLICABILITY OF ADAPTIVE SPEECH TESTING: A

COMPARISON OF THE ADMINISTRATION TIME, ACCURACY,

EFFICIENCY AND RELIABILITY OF ADAPTIVE SPEECH TESTS

WITH CONVENTIONAL SPEECH AUDIOMETRY

O’Beirne GA, Sincock BP, Starfi nger C.University of Canterbury, New Zealand.

Adaptive procedures are a common method of investigating sensory abilities in research settings; however, their use in clinical settings is more limited. We have investigated the advantages of using both closed-set and open-set adaptive speech tests in the clinical audio-logy setting, with respect to administration time, accuracy, effi ciency and reliability. Preliminary testing of two major adaptive procedures (staircase and maximum-likelihood procedures) was conducted to determine the optimal procedures and parameters for use in clini-cal speech tests. The maximum-likelihood QUEST procedure showed advantages over the staircase procedures in terms of administra-tion time; however, the reliability of both this test and conventional speech audiometry was poor, indicating that these tests were not as suitable as staircase tests for the clinical setting. Subsequent clinical testing of the optimal adaptive speech tests using participants with varying degrees of hearing loss found that administration time was similar between conventional speech audiometry and the adaptive closed-set staircase tests when optimised termination criteria were employed. Adaptive open-set staircase tests with larger step sizes at the beginning showed the best accuracy of any of the tests when using the pure-tone average as a reference, while the effi ciency of all the adaptive staircase tests was similar. Overall, the results highlight some of the potential advantages of adaptive speech testing in the clinical Audiology setting; however, further studies are required to determine the specifi c parameters that achieve the best results.



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FP-099

THE COCHLEAR DISCRIMINATION TEST IN VERY YOUNG

CHILDREN

Cuda D, Murri A, Guerzoni L, Briccola E, Frontera P.Department of Otolaryngology, “Guglielmo da Saliceto” Hospital, Piacenza,

Italy.

Object: to generate further normative data on discrimination capabi-lity of normal-hearing infants at 6th months old.

Materials and methods: the Auditory Speech and sound evaluation Test (Eargroup of Antwerp- Belgium) was carried out in 30 Italian nor-mal hearing children of 6 months of life. All babies, without audiolo-gical risks factors, passed local universal newborn hearing screening (TEOAE-based) at our Institution. All of them had a mean hearing threshold of 20 dB HL at 500-4000 Hz. Two experienced clinicians in paediatric audiology evaluated them for 10 speech sound pairs in three diff erent sessions. The speech sounds were presented in free fi eld at 70 dB HL with loudspeaker at 1 meter from child on the left or right side, using visual reinforcement.

Results: A signifi cative percentage of 6th months children is able to discriminate in a clear and reproducible way some consonant-conso-nant contransts and vocal-consonant pairs.

In a low percentage of this group we found some diffi culty to eva-luate the discrimination of vowel-vowel pairs for unclear reasons: methodological reasons like small number of babies, room acoustics, physiological ones like maturation of auditory pathways (arousal res-ponses, attention, etc.)

Conclusions: it is very feasible in babies as young as 6 months of life. It is very useable to assess the cochlear discrimination capability in normal infants and also in which babies that use hearing aids or co-chlear implants. Further data are necessary to validate the routinely test application in the common audiological practice as part of au-diological tests battery.


FP-100

GREEK SPEECH AUDIOMETRY TEST-PHASE 2

Iliadou V (1), Eleftheriadis N (2)(1) Medical School, Aristotle University of Thessaloniki; (2) Audiological Center

Agias Sofi as 23 Thessaloniki. Greece.

Introduction: Speech audiometry indicates assessment of auditory function with the use of speech materials. The most commonly used speech materials in the current clinical audiological practice are ba-sed on the principal of assessing word recognition with minimal re-liance on language knowledge. Following work on development and control in normal hearing adults of 3 lists of 50 bi-syllabic words each (Iliadou et al 2006) we present in this study the fi rst adults with sen-sorineural hearing loss tested with the developed lists of words that are frequently used, phonetically balanced, balanced as to syllable stress and refl ect the distribution of vowels in the stressed syllable.

Material & Methods: Adults with sensorineural hearing loss were as-sessed with the presentation of one list of words in each ear, which was tested separately. The subjects listened to each word preceded by a carrier phrase, over headphones as it was played by a CD player through an audiometer. Each ear was tested in a random order and its list presented in a random order, as all three are equivalent. The words were played at a comfortable hearing level of 30dB above the pure tone average (at 0.5, 1, 2 & 4KHz) threshold which was estimated for each subject. Each adult was tested (prior to the suprathreshold speech audiometry) with pure tone audiometry air and bone con-duction, tympanometry and acoustic refl exes both contra and ipsi. The subjects tested were between 30 to 90 years old with 11 of them being female and 7 male. All of them had sensorineural hearing loss. 7 of them had no gap between air and bone conduction and 11 had a gap between air and bone conduction threshold denoting the pre-sence of an additional conductive component.

Results: A statistical analysis for comparison between pure sensori-neural and sensorineural with a conductive component with the percent correct score of the speech audiometry was conducted. The non parametric Mann-Whitney test that was preferred (as this test permits minimum assumption about data distribution) revealed that the sensorineural component was prevailing in the speech recogni-tion test administered as there was no statistical diff erence between the two sub-groups. Graphical representation of right and left ear percent correct results of the speech audiometry used illustrates the great diversity from the normative data that we have acquired with the same methodology in normal hearing adults.

Conclusion: Speech audiometry with the newly developed test materials for Greek language denotes clear defi cits in subjects with sensorineural hearing loss in speech perception at suprathreshold levels,that is infl uencing their everyday communication and quality of life.



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FP-101

DEVELOPMENT OF A PAEDIATRIC AUDIO-VISUAL SPEECH

TEST IN NOISE

Arnold L (1), Canning D (2), Dykmans P (1), Vanpoucke F (1).(1) Advanced Bionics Europe; (2) Hear2Learn Ltd.

Background: The importance of audio-visual speech integration in the communication of children with cochlear implants may someti-mes be underestimated. Not many tools are available to assess lip-reading abilities.

Aims: To develop a paediatric audio-visual speech test to evaluate the benefi t obtained from adding lip-reading information to audi-tory signal.

Methods: Materials from the existing McCormick and English as a Second Language tests were selected. The words available were re-corded from male and female children. Editing was performed to add competing noise to the speech signal. A system capable of driving two screens simultaneously (“subject” screen allowing lip-reading and “clinician” control screen) was created and software prepared to drive it. Pilot testing was performed on twelve paediatric cochlear implant users, fi rst with lip-reading, then with auditory signal only.

Results: The video recordings provided acceptable quality. The preli-minary version (PAVT 1.0) of the software platform was tested: words were randomly presented to the subjects whose task was to indica-te the corresponding picture or toy, or to repeat the word. Testing may be conducted in quiet or noise, with adaptive signal to noise ratio. The clinician may select audio only or lip-reading with audio. Controls were available for scoring and automatic report generation. The results showed diff erences in scores obtained in the audio-visual condition compared to the auditory only condition, highlighting the benefi ts that might be obtained from adding lip-reading information to auditory signal. Feedback was collected on how to improve the interface and a new version was released (PAVT 2.0), which will be introduced, together with some supporting results.

Conclusions: The feasibility of using recorded audio-visual material to assess lip-reading abilities was confi rmed. The option to test in noi-se allows for a better representation of real-life conditions. The next steps will involve validation of PAVT 2.0 on a larger group of subjects.


FP-102

MUSIC LISTENING SOFTWARE FOR ADULT COCHLEAR

IMPLANT USERS

Geff riaud G (1), Rocca C (2).(1) Institut Saint-Pierre, Service d’Audiophonologie, 34250 Palavas les fl ots,

France. Hospital Gui de Chauliac, Service ORL, 34000 montpellier, France. (2)

Mary Hare School, United Kingdom. Advanced Bionics Europe, France.

Music is a universal language that gives emotion. In contrast with our prejudice, it is reachable by any cochlear implant user. Nevertheless, it sometimes needs a little training.

“Atmosphère musicale” is an interactive music discovery software, set out as a game, for hearing-impaired adults. Instead of testing, the main goal is listening to music samples of carefully graded diffi cul-ty with playing pleasure. The structure of the software is divided in fi ve themes (mood in fi lm soundtracks, instrument recognition, voice recognition, mother language recognition, and lyrics identifi cation), each of them including numerous levels of complexity. The software user just needs to follow the questions that are not only made to help his understanding but also to entertain. (For instance, in the level one of the voice recognition section: “Try to imagine the way the singer looks, his age, his gender…”) Answers can be glanced before liste-ning, guessed or checked out at any time. All the uses are appropria-te. Many bonuses are given to show the clips. Links to go further in music listening on the web are also provided.

Very quickly users will fi nd out that music can be reached and that they can recognize by themselves instruments, singers, lyrics… They will discover standards, classical music but also “trendy” music and will astonish their friends and family.

The CD (software) can be taken home and used for an individual ex-ploration of all aspects of music.

Auditory rehabilitation thus appears not to be only synonymous of eff orts and stress: it may also be a source of entertainment.

Email: geraldinegeff [email protected]


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FP-103

SUBJECTIVE RATING OF MUSIC PERCEPTION WITH TWO

GENERATIONS OF THE ADVANCED BIONICS COCHLEAR

IMPLANT SYSTEM

Kreibohm K (1), Adams D (1), Brendel M (1,2), Ruehl S (1), Lesinski-Schiedat S (1), Buechner A (1), Lenarz T (1). (1) Medical University of Hannover, Department of Otolaryngology, Hannover,

Germany; (2) Advanced Bionics GmbH, Hannover, Germany

Background: In the past years, an increasing number of research studies are focusing on music perception in the fi eld of cochlear im-plants. It could be shown that today’s cochlear implant (CI) techno-logy convey certain musical elements better than previous genera-tions. However, only little research has been carried out to compare the behavioural music perception through today’s cochlear implant technology with the impression of users implanted with earlier ge-neration systems.

Aim: Two surveys were initiated to gain insight into factors infl uen-cing the rating of music perception, like speech processor type (Clarion 1.2, S-Series, Platinum Series, Platinum BTE, CII BTE, Auria, Harmony), speech coding strategy (CIS, SAS, PPS, HiRes, HiRes 120), speech perception, habits and demographics.

Method: In a fi rst survey, 100 users of any Advanced Bionics implant system were interviewed regarding fi ve topics of everyday listening situations, one of them being music. More than 15 users shall partici-pate in a second survey which addresses the sound quality of various types of music, ability to identify musical instruments and to follow the melody, as well as hearing habits in further details.

Results: The subjective music appreciation correlated with the sub-jective speech perception, but not to the speech perception measu-red by speech tests. Demographical factors such as duration of im-plant use, age at implantation and duration of deafness infl uenced the rating of the music’s sound quality. Certain aspects such as ins-trument identifi cation were rated better by users of newer technolo-gy. The evaluation of the second survey will give further insight how hearing habits prior implantation infl uence the habits, the apprecia-tion, and the subjective performance after implantation.

Conclusion: Preliminary data indicate that not only demographical data but to some degree also implant technology infl uence musical enjoyment. Further evaluation of the second questionnaire is nee-ded to draw further conclusions.


FP-104

EVALUATION OF MUSIC PERCEPTION IN ADULT USERS OF

HIRES® 120 AND PREVIOUS GENERATIONS OF ADVANCED

BIONICS® SOUND CODING STRATEGIES

Gazibegovic D (1), Arnold L (1), Rocca C (1,2), Boyle P (1).(1) Advanced Bionics Europe, France; (2) Mary Hare, London, UK.

Objectives: In 2007 Advanced Bionics has launched the novel sound coding strategy HiRes 120.The strategy incorporates the concept of current steering and off ers up to 120 stimulation sites using only 16 electrodes.

Early clinical results showed improved speech understanding in noisy environments. Also the naturalness of speech and music and the sound quality overall were improved.

Objective of the evaluation is to observe if there is a diff erence in music perception, listening frequency, enjoyment and ability to di-ff erentiate special musical features, between the three main group of subjects using diff erent generations of strategies:

- CIS/MPS/SAS

- HiRes

- HiRes 120

Methods: The evaluation is based on a questionnaire. Forty questions are divided into several sections:

Individual sections will help collecting information on etiology, equi-pment used for listening to music, sound coding strategy, frequency of listening to music, musical activity, and enjoyment of music before becoming deaf and with the cochlear implant. Last section is asses-sing subject’s ability to follow melodic and harmonic structure of mu-sic and to investigate its impact on emotions.

Results: In the pilot phase of the evaluation a group of twenty fi ve normal hearing subjects were tested as control group. Preliminary re-sults suggest that the normal hearing subjects are performing quite well (Average 8 on a scale 1-10) in majority of the tasks. There are few tasks as “identifying how many instruments are playing together” or “understanding words in new music”, which appear to be more diffi -cult for some subjects (4-6 on a scale 1-10).

Discussion: Based on the data obtained from normal hearing sub-jects, the evaluation seems to be appropriate to collect a large num-ber of data within a short time frame. The results may help unders-tanding how much cochlear implanted subjects do listen and enjoy music and if the advances in sound coding strategies are improving these abilities.

Email:[email protected]


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FP-105

CUSTOM PROGRAM FOR IMPROVING THE MUSIC

PERCEPTION WITH ADVANCED BIONICS’ SYSTEM

Boyle P (1), Wansbury V (3), Gazibegovic D (1), Rocca C (1,2).(1)Advanced Bionics Europe; (2) Mary Hare, London, UK; (3) Portland, London,

UK.

Objectives: A reasonable understanding of speech in quiet, and in some noise, is common for the large majority of cochlear implant re-cipients. The perception of music for many however, is still disappoin-ting. This work investigates programs created specifi cally to enhance music perception.

Methods: A range of program parameters was selected which might impact music perception. Changes to parameters were made iterati-vely, one at a time, while listening to familiar pieces of music played from CD. Electrode contacts showing no pitch diff erentiation from their neighbours were removed. Diff erent settings of input dynamic range (IDR) were evaluated, along with linear amplifi cation or input Automatic Gain Control (AGC). Stimulation rate was manipulated based on the electrical dynamic range being measured for a series of stimulation rates. Frequency response was modifi ed through the channel gain settings. These changes were systematically made for two musically trained participants. Both were bilaterally implanted, used the Harmony processor and attended several programming sessions. A questionnaire was used to capture responses.

Results: For music a larger IDR than the 60 dB default was found be-nefi cial. However, increases beyond 70 dB were deleterious. Remo-ving the front-end AGC was useful where the participant controlled the music’s presentation level. A lower stimulation rate than the cli-nical default (highest sequential rate) was preferred, indicated by a maximization of electrical dynamic range. Emphasis of both high and low parts of the spectrum was preferred, bringing out previously in-audible parts. Both participants used their music programs for music listening, but standard clinical programs for speech.

Conclusion: It appears that the default program settings for music perception are not the same as those required for optimal speech understanding. Changes were required on an individual ear basis for these bilateral users. A set of music defaults may be suggested, but should be evaluated on a larger group before being formally recom-mended.


FP-106

THE NEURO-COMPENSATOR: A HEARING COMPENSATION

ALGORITHM BASED ON COCHLEAR MODELING AND

MACHINE LEARNING

Becker S (1), Pango P (2), De Laat JAPM (3).(1) McMaster University of Toronto, Canada; (2) VitaSound Audio, Ontario,

Canada; (3) Leiden University Medical Center, Netherlands.

In this presentation, we will describe the design and testing results of a novel hearing aid based on the Neuro-Compensator algorithm. The Neuro-Compensator employs neurocomputational models of the pathophysiology of hearing loss to optimize the gain calculation in a hearing aid so as to generate a more normal pattern of neuronal fi ring in the auditory nerve of the hearing impaired listener.

The Neuro-Compensator employs sophisticated computer models of the cochlea to determine the optimal gain calculation for a given hearing impaired listener. The auditory models are used to simulate how the auditory nerve of a hearing impaired person would respond to a given level of amplifi cation across all frequency channels. The resultant auditory neuronal fi ring pattern for the impaired ear model is compared to that of a healthy ear model. Machine learning me-thods are used to iteratively adjust the gain calculation performed by the Neuro-Compensator, until a normal pattern of neuronal activity is restored. Once this training procedure is completed, the Neuro-Compensator no longer requires the complex auditory model, and the fi nal gain calculation can then be incorporated into a conventio-nal hearing aid microprocessor. In the resulting hearing aid, rather than calculating the gain separately within each frequency channel, the gain of each channel is dynamically calculated as a function of the entire spectral content of the signal. The Neuro-Compensator thereby has the ability to restore the non-linearities and cross-chan-nel modulatory functions normally achieved by the outer hair cells. Computer simulations indicate that compared to the widely used WDRC gain calculation, the Neuro-Compensator is better able to res-tore intelligibility of higher frequency components of speech signals. Preliminary subjective reports from hearing-impaired individuals in-dicate that compared to conventional hearing aids the Neuro-Com-pensator-based hearing aid restores a much more natural sound for both speech and music, while sound perception in noise and sound localization are greatly enhanced.



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FP-107

LONGITUDINAL OUTCOMES OF CHILDREN WITH HEARING

IMPAIRMENT (LOCHI): INTERIM RESEARCH FINDINGS ON

LANGUAGE DEVELOPMENT

Mahler N,Ching T, Brower A, Cook C, Cornick S, Crowe K, Day J, Flynn C, Hou S, Krynda G, Law C, McGhie K, Mahler N, Martin V, Street L, van Buynder P, Youn S, Zhang V.National Acoustic Laboratories. Brisbane, Australia.

A prospective study investigating the outcomes of children with hearing impairment (N=470) who fi rst received intervention prior to their third birthday was commenced in 2005 by National Acoustic Laboratories (NAL). The study aims to measure the eff ect of a ran-ge of factors on the speech, language, functional, educational and psycho-social development of this cohort over the initial fi ve years of intervention. Standardised speech and language assessments, custom-designed tests and a range of parent and teacher report forms are administered to participants at set intervals. The current paper reports interim fi ndings of language development as measu-red globally by the Preschool Language Scale (PLS-4), and more spe-cifi cally of receptive vocabulary by the Peabody Picture Vocabulary Test (PPVT). The impact of several factors on language development in the presence of a hearing impairment is evaluated with reference to these data, including age of audiological intervention, mode of amplifi cation, degree of hearing impairment, and hearing aid pres-cription. Although the age of intervention had a signifi cant eff ect on children’s language scores when measured 12 months after the initial hearing aid fi tting, at three years of age, the severity of hearing loss, rather than the age of intervention, had a signifi cant eff ect. The language scores from standardised tests were signifi cantly correla-ted with parents’ and teachers’ evaluations of children’s functional performance in everyday life. Furthermore, age of cochlear implan-tation had a signifi cant eff ect on children’s language development. Children who received a cochlear implant prior to 12 months of age achieved language scores within the normal range, whereas children who received later implantation performed at or below 1 SD of the normative mean. General developmental trends as indicated by the-se preliminary data will be discussed briefl y.


FP-108

CLINICAL OUTCOMES OF THE EUROPEAN MP3000™

OPTIMIZATION STUDY IN FREEDOM™ RECIPIENTS

Beynon A (1),Szyfter W (2),Allum J (3),Brokx J (4),Burdo S (5), Cuda D (6), Dhooge I (7), Dillier N (8), Estrada Leypón E (9), Eyles J (10), Falcón González JC (11), Festen J (12), Frachet B (13), Fürstenberg D (14), Gentine A (15), Gräbel S (16), Grolman W (17), Hey M (18), Hoppe U (19), Huarte Irujo A (20), Leone C.A (21),Mazzoli M (22), Meyer B (23), Morera Pérez C (24), Müller-Deile J (25), Müller-Mazzotta J (26), Niemczyk K (27), Off eciers E (28), Paludetti G (29), Quaranta A (30), Roux-Vaillard S (31), Steff ens T (32), Triglia J (33), Uziel A (34), VandeHeyning P (35), Wesarg T (36), Pesch J (37), Rypkema G (37), Killian M (37), Büchner A (38).(1) Nijmegen-NL; (2) Poznan-PL; (3) Basel-CH; (4) Maastricht-BE; (5)

Varese-IT; (6) Piacenza-IT; (7) Gent-BE; (8) Zurich-CH; (9) Barcelona-ES; (10)

Southampton-UK; (11) Las Palmas-ES; (12) VU Amsterdam-NL; (13) Bobigny-

FR; (14) Köln-GE, (15) Strasbourg-FR; (16) Berlin-GE; (17) AMC Amsterdam-

NL; (18) Halberstadt-GE; (19) Erlangen-GE; (20) Pamploma-ES; (21) Naples-IT;

(22) Padua-IT; (23) Paris-FR; (24) Valencia-ES; (25) Kiel-GE; (26) Marburg-GE;

(27) Warsaw-PL; (28) Wilrijk/Antwerp-BE; (29) Rome-IT; (30) Bari-IT; (31)

Angers-FR; (32) Regensburg-GE; (33) Marseille-FR; (34) Montpellier-FR; (35)

Antwerp-BE; (36) Freiburg-GE; (37) Cochlear-EU; (38) MHH Hannover-GE.

Introduction: MP3000 is a new sound coding concept making use of a compression algorithm based on psycho-acoustical masking and has been implemented on the Nucleus® Freedom cochlear implant system. The primary objectives of this study are to investigate the preference for, and the performance with MP3000 in comparison to the ACE™ coding strategy. The secondary objectives include optimi-zation of MP3000 fi tting parameters and comparison of battery life.

Materials and method: A prospective, multi-centre study was con-ducted in 9 diff erent European countries including a total of 37 cochlear implant centres recruiting 247 Freedom users with open set speech recognition of 12 years and older. At study entry MAP-T/C levels were optimized and then a range of maxima (NofM) and masking function slopes were tested to optimize the MP3000 MAP. Speech tests in Dutch, English, French, German, Polish, Italian and Spanish were performed for MP3000 and ACE according to an ABABA design to compensate for learning eff ects. Diaries were used to log battery life and at the end of the study recipients had to complete comparative questionnaires and indicate preferred MAP.

Results: In the total study population and in the populations of the diff erent language areas no signifi cant diff erences in performance between MP3000 and ACE were observed. The number of recipients preferring MP3000 was not signifi cantly diff erent from the number preferring ACE. Median MAP T and C profi les increase is 6 and 7 CLs when converting an ACE into an MP3000 MAP. Most recipients prefe-rred MP3000 with high NofM and narrow masking functions. A signi-fi cant average battery life improvement of up 24% was found.

Discussion and conclusions: MP3000 coding delivers speech percep-tion performance equivalent to ACE coding strategy and is equally preferred as the ACE strategy by Freedom users used to the ACE strategy. Most recipients benefi t from MP3000 by an improvement in battery life.

Comments: Study sponsored by Cochlear AG, Basel



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FP-109

EVALUATION OF EVERYDAY LISTENING SITUATIONS

OF CHILDREN AND ADOLESCENTS AND THEIR USE OF

ACCESSORIES TO IMPROVE HEARING WITH COCHLEAR

IMPLANTS

Kreibohm K (1), Adams D (1), Brendel M (1,2), Ruehl S (1), Lesinski-Schiedat A (1), Buechner A (1), Frohne-Buechner C (1,2), Lenarz T (1).(1) Medical University of Hannover, Department of Otolaryngology, Hannover,

Germany; (2) Advanced Bionics GmbH, Hannover, Germany

Background: There is an increasing number of teenagers with co-chlear implants (CI) today, as children implanted early reach se-condary level. This raises the interest in better understanding the everyday hearing habits, accessory use and subjective performance of children and adolescents, with the focus on school days.

Method: 23 children and adolescents participated in this survey to date all with more than six months experience with any generation of an Advanced Bionics CI system. The mean age was 15.3 years (7.5 to 21.8 yrs) and mean duration of deafness 4.5 years (0 to 11.7 yrs). The questionnaire is addressing their profi le, telephone use, hearing music, communication at school/university and hearing in social en-vironments. The HSM sentence test was used to evaluate performan-ce objectively.

Results: The score in the HSM sentence test in quiet correlated with the subjective rating of speech perception in quiet while the HSM sentence test in noise correlated with the subjective speech percep-tion of a distant speaker. The type of school (main stream or school for hearing impaired) was independent of the overall subjective and objective speech perception. Pupils of a school for hearing impaired had signifi cantly more diffi culties to understand an unknown teacher compared to a known teacher, whereas there was no diff erence for pupils of a mainstream school. Similar to adult CI users, accessories were only rarely used with the exception of wireless FM systems at school and the TMic for behind-the-ear processor users.

Conclusion: CI users at schools for hearing impaired seem to have more diffi culties with unknown teachers compared to mainstream CI users. The majority are not using accessories to improve speech per-ception. Further investigation on the diff erences between CI users at diff erent school types seems sensible.


FP-110

HEARING DIAGNOSTICS IN CHILDREN USING DPOAE AND

PURE-TONE THRESHOLDS

Janssen T (1),Bohnert A (2) ,Heller O (3) , Schirkonyer V (1), Oswald H (4), Zoth P (4), Keilmann A (2).(1) Technische Universität München, Germany; (2) Universität Mainz, Germany;

(3) Universität Würzburg, Germany; (4) Path medical GmbH, Germany.

The objective of hearing screening in childhood is to identify hearing impairment which is not obvious or apparent but will cause signifi -cant handicap for the child concerned. Late identifi cation may com-pound problems in communication, language acquisition and aff ect other areas of development. Contrary to newborn hearing screening, for hearing screening in children more frequency-specifi c and quan-titative information on the hearing loss is needed.

The purpose of the present study was to investigate the test-perfor-mance and the effi cacy of a novel hand-held device (Path Medical GmbH, Germany) that off ers test procedures on both a psycho-acoustical and a physiological base.

The psycho-acoustical test based on a ‘multiple-choice auditory gra-phic interactive check’ (MAGIC). Pure-tone thresholds were determi-ned by selecting icons (animals) from a touch-screen that “produces” sounds with diff erent frequencies and sound pressure levels. The test run was controlled by the child itself. After each test-sound, the child had to indicate if the sound was heard or not by touching the appro-priate icon on the screen. From the “responses” (heard, not heard) the threshold was determined. There was a close correlation between the pure-tone behavioural threshold (gold standard) and the thres-hold obtained by the new method. By using appropriate images (ani-mals) as visual amplifi ers the child’s attentiveness was signifi cantly enhanced.

In the physiological test DPOAE I/O-functions were measured bet-ween 1.5 and 6 kHz. DPOAE-audiograms (derived from extrapolated DPOAE I/O-functions) were obtained in children aged between 0.5 to 15 years. The diff erence between DPOAE-audiogram thresholds and behavioural pure-tone thresholds decreased with increasing age from 40 to 5 dB proving the known discrepancy between be-havioural und physiological measures in young children. Both tests are easy to handle and provide frequency-specifi c and quantitative information on both cochlear and central sound processing within a couple of minutes.



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FP-111

ASSESSMENT OF USEFULNESS OF OBJECTIVE AND

AUDIOMETRIC METHODS IN HEARING SCREENING OF

SCHOOLCHILDREN

Sliwa L (1), Kochanek K (1), Pilka A (1), Senderski A (1), Sulkowski W (2), Skarzynski PH (1).(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland; (2)

Nofer Institute of Occupational Medicine, Lodz, Poland.

In newborn hearing screening, one exclusively applies objective hea-ring testing methods – based on ABR and/or OAE. However, when testing schoolchildren, one can consider both audiometric and electrophysiological methods. The choice of methods is determi-ned by the aims of the program. If one wants to detect conductive hearing losses, impedance audiometry seems to be the method of choice. In the case of central processing disorders, one should use psychoacoustic tests, such as Gap Detection Test (GDT), Dichotic Digit Test (DDT), etc. However, if the screening program is aimed at detecting both conductive and sensorineural impairments, one can alternatively consider application of tone and/or speech audiometry.

The aim of the work was to compare the eff ectiveness of audiometric and objective methods - OAE and impedance audiometry, in applica-tion to hearing screening of schoolchildren. The examinations were carried out in a group of 190 children of 12 years of age (6th grade of primary school). The results obtained with the use of specifi c me-thods were compared. Practical aspects of application of particular methods in school conditions were discussed.


FP-112

DIAGNOSIS AFTER A UNIVERSAL NEONATAL SCREEN

Verschuure J, Willis-Lorrier RMS, Homans N, Brocaar MP, de Gier HHW, Hoeve LJ.Hearing and Speech Center, ENT department, Erasmus MC, Netherlands.

Goal: The universal neonatal screen has been implemented in the Netherlands in a three-tier testing procedure. All fails are referred to Audiological Centers. In the South-western region all fails are refe-rred to our Childrens’ Hospital. In this presentation we present the diagnostic procedure of the refers.

Materials and methods: Diagnostic tests in our Children’ Hospital are clinical ABR, OAE and 1000-Hz tympanometry. They are seen by an ENT specialist and an audiologist in a combined session. ABR results are identifi ed according to the found I-V interval as neurally mature or not; conductive losses by the horizontal shift of the level-latency curves and the threshold by the lowest level at which a response was found. If no peak I could be identifi ed the distinction between neural maturation and conductive loss is uncertain. Therefore the fi rst visit may be inconclusive and subsequent visits are necessary. We present data on the fi rst and the last visit.

Results: Over the years about 350 children were assessed. We inclu-ded the children born up to 1st April 2008. We found no pathology initially in about 8% of the cases; in the end this was so in about 20% of the cases.

Conductive losses were found in about 25%. Sensorineural losses were found in about 50% of the cases. About 15% showed no ABR responses and these children are considered candidates for cochlear implantation if the eff ect of hearing aid fi tting is negative. The initial group inconclusive ended up in all categories. Causes of the hearing losses will be presented. They include genetic causes, syndromes, maternal infections, ome, etc.

Conclusion: The diagnostic analysis is complicated requiring audio-logical, ent and genetic skills. In our setting this requires the close cooperation of a pediatric ent specialist and a pediatric audiological specialist.



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FP-113

A DECADE OF UNIVERSAL HEARING SCREENING IN

FLANDERS, ROUTINE AND COBBLE-STONES

Van Kerschaver E.Kind en Gezin, Brussels, Belgium.

Objective: Since 1998 an integrated universal newborn hearing scree-ning programme (UNHSP) based on automated auditory brainstem response (AABR) has been implemented in Flanders. The protocol of the UNHSP is based on guidelines defi ned by the American Academy of Paediatrics (AAP). The aim of this presentation is to report on the screening protocol and to assess its feasibility.

Methodology: Descriptive study based upon an analysis of the scree-ning results in the neonatal non-NICU population of Flanders bet-ween 1999 and 2007. The UNHSP, organized by Kind en Gezin (K&G), uses a 2-stage protocol: children with a refer at the fi rst screening test are retested, and those with a refer at the retest are referred to a certifi ed centre. Screening and referral centres communicate their data to a central database at K&G.

Results: From the beginning of 1999 until the end of 2007 a screening was off ered to 97.91% of all eligible babies in Flanders; 91.5% of the-se babies were screened by K&G using the Algo® Portable Newborn Screener and the Algo3i®. Three-quarters of the referred babies had a confi rmed hearing loss. In 57.6% of these babies, hearing loss was bilateral. Some babies had a temporary hearing problem. The false positive rate after two tests was 0.53‰. All ascertained babies star-ted early intervention, most of them before the age of 4 months.

Conclusions: K&G has succeeded in organizing a new, well-structured community-based UNHSP according to the guidelines of the AAP on Neonatal Hearing Screening. Permanent awareness is needed in or-der to adjust unexpected developments.


FP-114

EXPECTED ADVANTAGE OF COMBINED AUDIOLOGICAL AND

GENETIC SCREENING OF NEWBORNS

Tavartkiladze GA (1), Polyakov AV (2) , Markova TG (1).(1) National Research Centre for Audiology and Hearing Rehabilitation,

Moscow, Russia, (2) Moscow Medical Genetic Research Centre, Moscow, Russia.

The only eff ective method of revealing hearing loss in newborns and infants is audiological screening which has been performed in Russia since 1996. Despite obvious achievements, there are also certain pro-blems. Deaf children with unknown reason of hearing impairment fall out the risk group and miss existing audiological screening sys-tem. Moreover, the screening can not reveal children with mild to moderate hearing impairment.

According to our previous data children with unknown etiology make up to 50% of congenital deafness cases and half of these cases are connected to 35delG mutation in GJB2 gene. Тhe age of primary detection and clinical diagnoses of a hearing disorder in 87% of 35delG mutation homozygotes comprised the period of fi rst two years of life. It is also known, that in rare instances homozygote chil-dren have mild to moderate hearing impairment. Considering these data, we can assume that genetic screening will raise the effi ciency of early revealing of children with 35delG mutation in GJB2 gene. Such children should be sent to audiological centre for precise diagnostics and early intervention.


FP-115

STRATEGIC ISSUES IN NEWBORN HEARING SCREENING

PROGRAMS PLANNING AND IMPLEMENTATION

Tognola G (1), Tavartkiladze G (2), Grandori F(1).(1) CNR Institute of Biomedical Engineering,Milan, Italy; (2) National Research

Centre for Audiology and Hearing Rehabilitation, Moscow, Russia.

This work will present the main strategic issues related to Newborn Hearing Screening (NHS) planning and implementation. The princi-ples of all programs are based on their justifi cation, assessment of screening performance and the prevalence and impact of newborn diseases and disorders. Recommendations for national NHS pro-grams have to consider the information on screening systems cu-rrently used in each country, current screening methods, result inter-pretation, personnel/equipment requirements for newborn hearing screening, system performance and future technological options. Special attention must be given to NHS programs for the developing countries and the development of protocols for rural/community ba-sed screening. Screening from an economic viewpoint is infl uenced by measures of benefi t (age and life expectancy, needs of the society, direct, indirect, value of quality of life), necessity of effi cacy, econo-mic parameters (value added, sinking fund, depreciation, discount rate, etc.), global eff ect on local family unit, local community, region, nation, world. The ethics of screening and communicating with pa-rents is very important component of the program. It includes parent perspectives, their empathetic understanding, involvements into the screening and diagnostic process: NHS programs have to be followed by paediatrician’s assessment and preferably by newborn metabolic and genetic screening. Integrated health care and data systems have valuable impact on screening success. The follow-up strategies must be considered as an integral part of each NHS program. To improve the eff ectiveness of the follow-up the development of standardized algorithms for follow-up testing and monitoring of follow up results is recommended. The fi nal stage of screening is early intervention.



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FP-116

UNIVERSAL NEW BORN HEARING SCREENING PROGRAM IN

KFMMC HOSPITAL

Al-Saif S (1), AbdelTawwab MM (2).Consultant of ORL, KFMMC Hospital, Dhahran, KSA, Egypt (1); Lecturer of

Audiology, ENT Department, Faculty of Medicine, Mansoura University, now

Audiological Physician in KFMMC Hospital, Egypt (2).

Objectives: The purpose of this study was to establish universal new-born hearing screening (UNHS) program in KFMMC hospital and to study the prevalence of hearing loss in neonates delivered in this hospital.

Subjects and methods: All neonates delivered normally or by cesa-rean section in KFMMC hospital from 15 April 2003 to 1st August 2006 were screened for hearing impairment by OAEs then ABR.

Results: A total of (2592) neonates were screened for hearing loss. The prevalence of hearing loss was 0.98% in both ears, 51 out of 5184 ears have hearing loss. 29 (1.1 %) newborn had hearing loss of va-rious degrees, 22 of them were bilateral and 7 newborn had unilate-ral hearing loss.

Discussion and conclusion: The prevalence of hearing loss in our me-dical facility is 11 out of 1000 newborn suff er from hearing loss of various degrees. From this study we concluded that it is important to make the public aware of the value and importance of hearing scree-ning at the earliest possible opportunity also UNHS should be made mandatory in order to allow for early detection and management of hearing loss. Keywords: Universal Newborn Hearing Screening, UNHS, Transient Evoked Otoacoustic Emissions, TEOAEs, Auditory Brain Stem Response, ABR, Hearing loss


FP-117

STRATEGIC ISSUES IN NEWBORN HEARING SCREENING

PROGRAMS PLANNING AND IMPLEMENTATION

Tognola G (1), Tavartkiladze G (2), Grandori F(1).(1) CNR Institute of Biomedical Engineering,Milan, Italy; (2) National Research

Centre for Audiology and Hearing Rehabilitation, Moscow, Russia.

This work will present the main strategic issues related to Newborn Hearing Screening (NHS) planning and implementation. The princi-ples of all programs are based on their justifi cation, assessment of screening performance and the prevalence and impact of newborn diseases and disorders. Recommendations for national NHS programs have to consider the information on screening systems currently used in each country, current screening methods, result interpretation, personnel/equipment requirements for newborn hearing screening, system performance and future technological options. Special attention must be given to NHS programs for the developing countries and the development of protocols for rural/community based screening. Screening from an economic viewpo-int is infl uenced by measures of benefi t (age and life expectancy, needs of the society, direct, indirect, value of quality of life), neces-sity of effi cacy, economic parameters (value added, sinking fund, depreciation, discount rate, etc.), global eff ect on local family unit, local community, region, nation, world. The ethics of screening and communicating with parents is very important component of the program. It includes parent perspectives, their empathetic unders-tanding, involvements into the screening and diagnostic process: NHS programs have to be followed by paediatrician’s assessment and preferably by newborn metabolic and genetic screening. Integrated health care and data systems have valuable impact on screening success. The follow-up strategies must be considered as an integral part of each NHS program. To improve the eff ectiveness of the follow-up the development of standardized algorithms for follow-up testing and monitoring of follow up results is recommen-ded. The fi nal stage of screening is early intervention.



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FP-118

AUDIOMETRIC SCREENING OF 8-14 YEAR OLD CHILDREN -

RESULTS OF THE GERMAN ENVIRONMENTAL SURVEY FOR

CHILDREN (GERES IV)

Babisch W, Schulz C, Seiwert M, Becker K, Conrad A, Zigelski C, Kolossa-Gehring M.Federal Environment Agency, Dessau/Berlin, Germany

The German Environment Agency (UBA) carried out its fourth envi-ronmental survey from 2003 to 2006, which was especially for chil-dren (GerES IV). 959 children, 8-14 years of age, who were randomly selected from all over Germany underwent an audiometric screening test (representative sample). The survey aimed to provide reference values for a variety of environmental and individual (bio-monitoring) factors, which may be relevant to children’s health and well-being. Furthermore, the emphasis was on associations between environ-mental and habitual factors on potential health outcomes – in this case, associations between leisure activities and hearing.

All children were asked about leisure activities, housing conditions and environmental factors. The hearing tests were performed during home visits, using an automatic audiometer with improved sound in-sulation earphones (AURITEC type AT409, Sennheiser Type HDA 200 earphones). The background noise during the hearing tests was con-trolled with a sound level meter. Pure tone air conduction screening thresholds of the children’s hearing (5 dB increments) were assessed in the conventional frequency range from 1 to 6 kHz. No further au-diometric tests were carried out. The children constitute an unscree-ned population sample (ISO 1999), in this respect.

12.8 / 2.4 % of the children had a hearing loss of more than 20 / 30 dB HL at one of the test frequencies on one ear. When only the high fre-quency range was considered (3-6 kHz), the prevalences were 10.6 / 2.1 %. Boys (13.1 / 3.1 %) were more often aff ected than girls (8.0 / 1.0 %). Diff erent criteria were used to defi ne potentially noise induced sensorineural hearing impairment. No associations were found with the use of personal audio equipment. The average daily exposure was 0.5 hours per day. The lifetime exposure may well have been too short for the detection of a respective association due to the young age of the children.


ROUND TABLE


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EDUCATION IN AUDIOLOGY

Chair: Kajsa-Mia HolgersPanellists: Birger Kollmeier, Linda Luxon,Tiago Ferrão

Already from the foundation of European Federation of Audiology Societies (EFAS) in 1992, it was concluded that an important step for the organisation was to identify the status of the audiological training in Europe. The over-view of the situation during the 90:ties led to the General audiologist model, presented in 1999, where almost all EFAS member countries were represented in the working group. There were other initiatives taking place to promote audiological education. To respond to the needs for higher education reform in Central and Eastern European countries, following the fall of the Berlin Wall in 1989, EFAS was involved in the process to reform the audiological education together with the local EFAS representatives and local universities.

Even though EFAS has presented a model for general audiologist, this model needs to be discussed further and updated based on new knowledge that emerges.

There are diff erences in how the various areas in Audiology training are emphasised in the national curriculum between countries. This is a challenge for the exchange of students between countries but it may also be seen as an opportunity.

We also need to establish guidelines and a consensus on the levels of knowledge and skills needed to practice audiology at specialist levels. In the UEMS ORL section, which is the link to the European Commission for the education of physicians, a work is on-going to construct a common curriculum for the Otorhinolaryngologists’ training in Audiology to establish a subspecialisation in Audiology. Another training pathway exists in the UK for the speciality of Audiovestibular Medicine and in some countries a combination between Audiology and Phoniatrics exist. Engineering and physics are also basic areas which play an important role as the technical de-velopment has been evident both with regard to equipment for diagnostic procedures and to signal processing and outcome assessment in the fi eld of hearing aids, cochlear implants and other means of technical rehabili-tation. Psychology is another area of importance, both with regard to the interplay between auditory function and cognitive abilities and in terms of providing a basic understanding of the handicap experienced by hearing loss and how this can be ameliorated.

A meeting was held in 2008, in Bad Zwischenahn, Germany in order to further analyse and revise the concept of the “general audiologist” and the “audiological specialist” as defi ned by EFAS, and another follow-up meeting is planned to take place in 2010.

At this session we will discuss the continuing development of a curriculum and the pros and cons for adopting a general audiologist program as well as a specialist program will discussed. All delegates are welcome to take part in the discussion and to present examples on how the General audiologist programme has been used. We will also discuss possibilities to formalise continuous professional development (CPD).

ROUND TABLE

POSTER SESSION


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P101

DISTORTION PRODUCT OTOACOUSTIC EMISSIONS AND

EXTENDED HIGH-FREQUENCY (EHF) AUDIOMETRY IN

NORMAL-HEARING PATIENTS WITH UNILATERAL TINNITUS

Fabijanska A (1), Smurzynski J (2), Kochanek K (1), Skarzynski H (1).(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland; (2)


Johnson City, TN, U.S.A.

It has been suggested that the presence of a limited area of dama-ged outer hair cells (OHCs) with intact inner hair cells, which may not be detected on the conventional audiogram, results in unbalanced neural activity between Type I and Type II fi bers leading to tinnitus. In normal-hearing tinnitus patients, DPOAEs provided ambiguous data of OHC function when compared to non-tinnitus controls. Hearing loss in the EHF region may decrease DPOAEs evoked at lower fre-quencies. Results of EHF audiometry in tinnitus patients are limited. The aim of the study was to evaluate DPOAEs and EHF thresholds in normal-hearing patients reporting unilateral tinnitus in left ear. Thus, each subject acted as their own control.

Data were obtained for 31 subjects with bilateral hearing thresholds <25 dB HL from 0.25 to 8 kHz and <70 dB HL at 10, 12.5, 14, and 16 kHz. The DP-grams were measured in the 0.5-8 kHz range using 65/55-dB SPL primaries and f2/f1=1.2. The data analyses included DPOAEs with S/N>3 dB.

The signed rank test showed that audiometric thresholds in the left ears were signifi cantly higher than those in the right ears at all four EHFs. Mean DPOAE levels of the left ears were lower than those of the right ears for all primaries, except for the 500-Hz frequency region. A paired-comparison test of DPOAE levels of each patient’s right and left ear revealed signifi cant diff erences at 6 and 8 kHz.

The results indicate that: 1. OHC impairment in the most basal region reduces contribution to more apically generated DPOAEs; 2. OHC im-pairment in a limited area, which may be revealed by DPOAEs but not by conventional audiometry, can contribute to tinnitus generation; and 3. patients with unilateral tinnitus and normal hearing on the conventional audiogram are likely to demonstrate hearing loss in the EHF region.


POSTER SESSION

P102

APPLICATION OF THE AUDITORY BRAINSTEM RESPONSE

FOR SCALING IMPULSIVE AND CONTINUOUS NOISE

Kochanek K (1), Zera J (2,3), Pilka A (1), Mlynski R (2), Skarzynski P (1).(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland; (2)

Central Institute of Labour Protection – National Research Institute, Warsaw,

Poland; (3) Faculty of Electronics and Information Technology, Warsaw, Poland.

The aim of the work was to test whether it is possible to scale the impulsive noise and continuous noise by equivalent wave V latency or thresholds in the auditory brainstem responses (ABRs). A forward masking paradigm was applied in which a 4-kHz tone pip was used to evoke the ABR. The tone pip was masked by the preceding 201-ms or 501-ms interval of click trains or band-pass noise. Eff ect of mas-king was measured for click/noise SPL varied in 10-dB steps. Masking click trains diff ered in number of clicks presented in a range from 50 clicks/s (Δt = 20ms) to 10 clicks/s (Δt = 100ms). Bands of continuous noise ranged in their center frequency from 250 Hz up to 4000 Hz. Results allowed for a comparison of masking eff ect of impulsive noise and that of continuous noise.



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P103

LONG-TERM CLINICAL OUTCOMES OF TINNITUS TREATMENT

BASED ON ACOUSTIC STIMULATION

Tavora-Vieira D, Bellekom S, Miller S.Medical Audiology Services

Background and aims: This study intends to determine the long-term tinnitus relief for patients treated with a particular tinnitus rehabilita-tion program, which includes counselling and a customized acoustic signal that provides relief and relaxation to the patient. This study involves fi fteen fee-paying patients who concluded a sound-based tinnitus treatment over the last twelve months in a private practice in Western Australia. Previous studies reported 12 month clinical outco-mes of the treatment during its clinical trial. However, there are no studies reporting full fee paying patients’ experiences twelve months after commencing the treatment. Therefore, the scope of this study is to ensure that the benefi ts experienced during the fi rst six month program are still sustained in the longer term, with the measurement of outcomes at twelve months.

Method: Fifteen patients, who concluded the tinnitus rehabilitation program, at least six months prior to the commencement of this stu-dy, are asked to report on their tinnitus disturbance. They are being requested to complete the Tinnitus Reaction Questionnaire (TRQ) based on their tinnitus’ characteristics for the previous week. The TRQ scores post-therapy is compared to their TRQ scores at the beginning of the treatment.

Results and Conclusion: Data on the fi rst ten patients suggest that a high proportion of patients retain the benefi ts of the treatment in the long term, with a signifi cant lower level of tinnitus disturbance (as measured by TRQ). The complete dataset for this study will be ready and analyzed for the conference.


P104

IMPACT OF TINNITUS ON QUALITY OF LIFE AMONG

TINNITUS COUNSELLING CLINIC PATIENTS

Joyce Lim JBH (1), Peter Lu KS (1), David Koh SQ (2), Eng SP (1).(1) Changi General Hospital, Singapore; (2) National University of Singapore, Singapore.Aims: To describe impact of tinnitus on patients’ quality of life

Methods: Patients attending a tinnitus counselling clinic in CGH were given the Tinnitus Handicap Inventory (THI) to complete during their initial consultation from November 2006 to August 2008. THI is a self-administered 25-item questionnaire measuring the patient’s emotional state, functional state and catastrophic impact of tinnitus. Emotional state was assessed by their response to questions relating to anger, frustration, irritability, anxiety, depression and insecurity. Functional state was related to questions on stress, loss of concentra-tion and sleep, interference with job, household responsibilities and social activities. A catastrophic response was assessed by questions on sense of desperation, perception of having a terrible disease, lack of control, and inability to escape and cope. Total THI score was clas-sifi ed into categories denoting handicap severity: no (scores 0-16), mild (scores 18-36), moderate (scores 38-56), severe (scores 58-100).

Results: 327 patients (193 males, 134 females), age range 15-91 years (mean 48.9, SD13.4years), completed the THI. Of these, 33% had no handicap from tinnitus, 31% had mild handicap, 18% had mode-rate handicap and 19% had severe handicap. Mean for emotional state was slightly higher in females (12.3 SD9.7) than in males (11.9 SD10.3). Mean for functional state was scored higher in males (13.2 SD 11.3) than in females (12.2 SD10.3). Both males and females had similar catastrophic response scores (mean±SD= 8.7±5.7 vs 8.6± 5.6).

There was no statistically signifi cant diff erence in overall THI scores (mean±SD 33.7±25.1 for males, 33.3±23.3 for females) as well as in all the 3 domains (emotional, functional and catastrophic) between the sexes.

Conclusion: This study shows that tinnitus has a signifi cant impact on quality of life among tinnitus counselling patients. The THI values can potentially be used as a baseline to monitor patient’s progress during counselling.



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P105

SCREENING WITH AAST IN 6-7 YEAR OLD CHILDREN IN

ELEMENTARY SCHOOLS IN POLAND

Coninx F (1), Senderski A (2), Kochanek K (2), Lorens A (2) Skarzynski H.(2)(1) Institut für Audiopädagogik, at the Univ. of Cologne, Germany; (2)

International Center for Hearing and Speech, Kajetany/Warsaw, Poland.

Research question: When children are entering primary school a screening procedure for hearing is extremely important. Hearing plays an essential role in communication and instruction in the clas-sroom and particularly in developing phonological and phonemic awareness as a basis for the development of reading and writing.

The question was raised whether the traditional golden standard of “pure tone audiometry” might be (partly) replaced and/or extended with a speech based hearing screening procedure.

In the present study, the use of AAST (Adaptive Auditory Speech Test) is tested and evaluated.

One special point of interest was the possibility to identify not only children with a peripheral hearing loss but also those with disorders at the level of auditory processing (APD).

Method: The auditory speech test AAST (Coninx 2006) – measures the Speech Recognition Threshold (SRT) in quiet and in noise. By that, it includes relevant conditions refl ecting daily life situations of the child, particularly also for the noisy school environment.

AAST is constructed to be a global speech test, i.e. including not only analytical (bottom-up) but also global (top-down) processes. The AAST has been constructed with special focus on young children: an interactive PC-task, automatized adaptive procedure, using a closed set of only 6 spondee words. Standard testing time is 2 minutes; in the screening version this has been reduced to 1 minute per ear.

Results: In a screening program in eastern Poland N=120.000 chil-dren were screened with pure tone audiometry. In a subgroup of about 14.000 children also AAST-Screening was implemented. For these children AAST and pure tone audiometry data were compared, showing high correlation. The results of AAST and pure tone audio-metry were also compared with the data from audiological question-naire.


P106

CHANGES IN SHORT-TERM AUDITORY MEMORY FOLLOWING

THE USE OF EDULINK IN CHILDREN WITH AUDITORY

PROCESSING DISORDERS

Umat C (1), Zamratol-Mai Sarah Mukari S (1), Farhana Badrul Ezan N (1), Normah Che’ Din C (2).(1) Department of Audiology & Speech Sciences, Faculty of Allied Health

Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; (2) Health

Psychology Unit, Faculty of Allied Health Sciences, Universiti Kebangsaan

Malaysia, Kuala Lumpur, Malaysia.

The study examined the changes in auditory memory following the use of Edulink system in children with auditory processing disorders (APD). Fifty three children between seven to nine years old partici-pated in the study with 15 as control group (not fi tted with Edulink), and 19 in the unilateral and bilateral-Edulink groups, respectively. Subjects wore the Edulink during school time (4-5 hours per day) for 12 weeks. Subjects were measured on their working memory (WM), best learning (BL) and retention of information (ROI) using the Rey Auditory Verbal Learning Test (RAVLT) at pre-, post- (after 12 weeks Edulink usage) and at long-term (after not using Edulink for 1 year). Between-group scores for the WM, BL and ROI were not signifi cantly diff erent at baseline (p>0.05). Subjects in the fi tting groups showed consistent improvement in the mean scores for BL and ROI at post- and long-term, however, only the mean scores at long-term were signifi cantly higher than at pre-fi tting (p<0.01). For the WM, there was randomness in scoring pattern between subject groups. There was no signifi cant diff erence in performance between unilateral and bilateral groups. The fi ndings suggest the use of Edulink might give a long-term eff ect on improving selected short-term auditory memo-ries of some APD children.



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P107

RESULTS OF HEARING SCREENING IN SCHOOL AGE

CHILDREN IN EASTERN POLAND

Skarżyński H (1), Kochanek K (1), Senderski A (1) , Sułkowski W (2). 1) Institute of Physiology and Pathology of Hearing Warsaw Poland

2) The Nofer Institute of Occupational Medicine (NIOM), Lodz, Poland

It is recommended to conduct hearing screening in school age chil-dren especially in areas with non well developed health care system however there is still debate concerning methods and organization of such a screening. The hearing screening program conducted last year in seven eastern provinces of Poland was aimed to detect chil-dren with conductive or sensory hearing loss in children from fi rst grade of elementary schools and to raise the awareness of the pa-rents and teachers about the consequences of delayed detection of hearing disorders and about the possibilities of early therapeutic intervention.

The hearing screening was conducted by means of the device “Au-diometer S” using air conduction pure tone audiometry for frequen-cies ranging from 250 to 8 kHz. Additionally to assess higher auditory functions adaptive speech inteligibility test and dichotic digits test were used. Parents fi lled out audiological questionnaire and additio-nally during the testing children were asked few questions.

In the period of three months 146 testers has tested 95320 children from 50541 elementary schools in rural areas of eastern Poland. 13, 1 % of children did not pass the pure tone audiometry screening test, 15 % of children did not pass the speech in noise test and dichotic digits test. After careful analysis of the results of individual tests for further diagnostic evaluation we referred 8432 children. We will pre-sent results of the detailed analysis of all audiometric tests and au-diological questionnaire.


P108

SSW: RIGHT-HANDED VERSUS LEFT-HANDED

Araújo S, Conceição T, Ferreira S, Marques D, Mateus T, Pedrosa S, Serrano MEscola Superior de Tecnlogia da Saúde de Coimbra. Viseu, Portugal.

The purpose of this scientifi c article is to verify the inter-hemispheric diff erences in oral and dichotic language between right-handed and left-handed people. The sample was made up of 15 right-handed and 15 left-handed people. History of otological, neurogical and psychic pathology was considered an exclusion factor. Other exclu-sion factors include otoscopy with obliterating wax; Timpanogram C2 or uni or bilateral B; absence of ipsi and/or contra lateral refl exes to 500Hz, 1000Hz and 2000Hz; absence of acoustic otoemissions by distortion products in frequencies between 1257Hz and 6348Hz. We used an inclusion and a specifi c selection of the sample survey and a SSW dichotic audition test. In the study, we concluded that a dichotic hearing between right-handed and left-handed people in the noncompetitive left variable represents signifi cant statistical di-ff erences, were right-handed people have less number of errors; in the other variables it was not observed signifi cant statistical diff eren-ces between right-handed and left-handed people. However, in the noncompetitive right variable and competitive left, we observed a less number of errors in left-handed people and in the other varia-bles in study (competitive right, noncompetitive left, right error, left error, percentage of errors in the right ear, percentage of errors in the left ear and total percentage of errors) in right-handed people. Even though the left hemisphere appears to be dominant for the langua-ge process in right-handed people and the right hemisphere domi-nant for the left-handed people, with this study we can affi rm that it was not observed diff erences between them in dichotic hearing (studied by SSW).

E-mail: xofi [email protected]


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P109

DEVELOPMENT OF A MONOSYLLABIC ADAPTIVE SPEECH

TEST FOR THE IDENTIFICATION OF CENTRAL AUDITORY

PROCESSING DISORDER

O’Beirne GA, McGaffi n AJ.University of Canterbury, New Zealand.

One category of tests that examine auditory processing disorders (APD) are the various versions of the “fi ltered words test” (FWT), whereby a monaural, low-redundancy speech sample is distorted by using fi ltering to modify its frequency content.

Due to the richness of the neural pathways in the auditory system and the redundancy of acoustic information in spoken language, a normal listener is able to recognize speech even when parts of the signal are missing, whereas this ability is often impaired in listeners with APD. One limitation of the various versions of the FWT is that they are carried out using a constant level of low-pass fi ltering (e.g. a fi xed 1 kHz corner frequency) which makes them prone to ceiling and fl oor eff ects. The purpose of this study was to counter these eff ects by modifying the FWT to use a computer-based adaptive procedure, to improve the sensitivity of the test over its constant-level counter-parts.

In this preliminary study, 23 normal adults and 32 normal children (aged 7 to 11 years) were tested using the University of Canterbury Monosyllabic Adaptive Speech Test (UC MAST), a four-alternative for-ced-choice adaptive test that altered the low-pass fi lter (LPF) level to track the corner frequency at which participants correctly identifi ed a certain percentage of the words.

Findings indicated a signifi cant maturational eff ect on the UC MAST results. Adult participants performed signifi cantly better on the UC MAST in comparison to the child participants (50% correct scores at 419 ± 108 Hz LPF for adults compared to 688 ± 193 Hz LPF in chil-dren). The UC MAST test was reliable over repeated administrations. The development of the UC MAST is discussed and the clinical impli-cations of the fi ndings are explored. Further testing using a popu-lation of participants with auditory processing disorders is planned.


P110

STUDENTS AT THE UNIVERSITY OF SANTIAGO DE

COMPOSTELA AND PERSONAL MUSIC PLAYERS LISTENING

Vazquez C, del Oro Saez CP, Gigirey LM.Audilogy Unit. University of Santiago de Compostela.

Introduction: Last studies show that young people exposed to social noise had increased to around 19% since 80 decade. It is estimated that between 5-10% of personal music players users in the EU (2.5-10 million people) risk permanent hearing loss due to an “inappropriate use” of this technology (long-time exposure at high volume)

Objetives: The main purpose of our study is assessed the eff ect of personal media players use on the students hearing of the University of Santiago the Compostela. We also have investigated if our univer-sity students know the harmful eff ects of loud sounds exposure on auditory health.

Method: A total of 225 younger students (aged 18-23) of the Univer-sity of Santiago participated in this study during a two-year period (2004-2006). A questionnaire was given to the students in order to know their listening habits and their knowledge of noise exposure outcomes on hearing . Pure tone audiometry was performed to de-termine the hearing thresholds in the 250-6000 Hz range.

Results: Statistical analysis shows that 99.56% of people under stu-dy, heard music and a high percent of them (75%) reported being concerned about the harmful eff ect of loud sounds exposure on hea-ring. With regard listening hours, 26.62% of the students heard music 1-2hours per week, 28.06% between 3-4hours and 45.32% between 5-7hours per week.

Otherwise, 46.30% of the students that were worried about the risk of noise exposure on hearing, listened music 5-7hours per week.

Conclusion: Results suggest a wide use of personal media players for the students at the University of Santiago de Compostela although their knowledge about the hazardous eff ects of loud sounds expo-sure on hearing.



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P111

USE OF SELF-ASSESSED QUESTIONNAIRES AS DUAL

SENSORY SCREENING TOOLS IN GALICIAN GOVERNMENT

NURSERY HOMES

Vazquez C, del Oro CP, Gigirey LM.University of Santiago de Compostela, Spain.

Evidence exists that up to 30% of persons over the age 65 years have undiagnosed hearing loss, and that up to 18% have undiagnosed some visual disfuntion. In Galician (Spain) there are 21,3% over 65 and 9.2% with hearing problems and 10% with visual problems.

Purpose: we wanted validate the Hearing-dependent Daily Activities (HDDA Scale) and Functional Vision Screening questionnaire as a means of identifying the impact of hearing loss and visual impair-ment in older persons on Galician Government Nursery Homes. On the project Doctoral Thesis (pilot study)

Methods: we realized a observational study to validate a question-naires administered during personal interview (108 persons) aged 65 years and older. Also used auditory and visual test to identify patient with hearing and visual impairment.

Tonal audiometry were use to determine hearing capacity o the el-derly using Ventry and Weinstein criteria and use Visual acuity(VA) to determine visual function with WHO criteria and over we pass the Whispered Voice Test .

Results: Of the 108 potencial participants selected in the pilot stu-dy, we had average age of interview was 77,14 ; 30 were man and 78 were woman. The 67% of participants did not complete primary school.

According to the criterion standard, 41.66 % participants had hearing impairment and 22.22% had visual impairment. The scale HDDA showed 68:57% must have gone to Audiology or ORL specia-list and Functional Vision screening questionnaire showed 34.28% must have gone to Optometrist.

Due to psychosocial and linguistic characteristic to Galician nursery homes older people, fi rst results show discrepancies signifi catives between self-assessed questionnaires and result in auditory and vi-sual test.

Conclusion: We need adapt self-assessed questionnaires to the cultu-ral patterns, education and linguistic older people reality in Galician Community.


P112

EFFECT OF OCCLUDING THE ROUND WINDOW ON NOISE

INDUCED HEARING LOSS

Sichel J Y (1), Perez R (1), Freeman S (2), Sohmer H (2).(1) Dept. of Otolaryngology and Head and Neck Surgery, Shaare Zedek Medical

Center; (2) Dept. of Physiology, Hebrew University-Hadassah Medical School,

Jerusalem, Israel.

Objective/Hypothesis: It has been suggested that at high stimulus intensities, the passive basilar membrane traveling wave may pro-vide overload protection of the delicate and fragile hair cells from excessive vibrations. In a previous study conducted by our group, we have shown that introduction of a hole in the vestibule of the sand rat, which was then exposed to noise, lead to an increased auditory nerve and brainstem response (ABR) threshold elevation in response, supporting the protection theory. In the present experiment, in order to further substantiate this theory, we occluded the sand rats’ round window (RW) before exposure to loud noise. Occluding the RW could possibly compromise the generation of the passive basilar membra-ne traveling wave in these animals.

Methods: Ten sand-rats underwent baseline ABR measurements fo-llowed by bilateral opening of the bulla and occluding the RW with glue in one ear. Subsequently, the animals were exposed to broad-band noise (113 dB SPL) for 12 hours and on the following day (24 hours after the round window was occluded) ABR measurements were repeated. Four additional animals not exposed to noise served as control.

Results: Occluding the RW did not induce signifi cant change in ABR threshold. ABR thresholds were elevated by 54±9 dB in the ears with the occluded RW and by 40±9 in the contralateral ears (p<0.004). In the 4 control ears, there was no change in ABR threshold 24 hours after the round window was occluded.

Conclusion: These results show that occluding the RW had a clear eff ect on the responses of the inner ear to high intensity noise expo-sure. This further validates the theory that the passive basilar mem-brane traveling wave may serve to protect the inner ear from high intensity noise.



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P113

COMPARISON OF THE SPEECH AND PITCH PERCEPTION

SKILLS OF CHILDREN USING A COCHLEAR IMPLANT,

HEARING AIDS, OR BIMODAL STIMULATION

Looi V (1), Radford C (1), Peryman P (2,1).(1) Department of Communication Disorders, University of Canterbury,

Christchurch, New Zealand; (2) Van Asch Deaf Education Centre, Christchurch,

New Zealand.

Improved speech perception in noise, and melody recognition using binaural bimodal stimulation (BBS) compared to a cochlear implant (CI) only has been widely documented in adults, but less so in chil-dren. For this study BBS was defi ned as the simultaneous use of a CI in one ear, and a hearing aid (HA) in the contralateral ear. The purpose of this study was to determine the extent of any benefi ts provided by BBS on tasks of speech and pitch perception in children.

Four groups of children were recruited: CI-only users (n=8); bilate-ral HA-only users with bilateral severe to profound losses (n=6); ex-perienced BBS users (n=9); and children with normal hearing (NH; n=16). All children were assessed using HINT sentences in quiet and noise (10dB SNR), and a pitch-ranking task.

Preliminary results suggest that there were signifi cant diff erences (p < 0.05; 2-way RM ANOVA) between the groups for the HINT test, with the NH group scoring signifi cantly better than the CI group, but no diff erent to the HA or BBS group. Scores were also signifi cantly higher in quiet than noise. For the pitch test there were signifi cant diff eren-ces between the groups for each subtest (p < 0.05; 1-way ANOVA), with the main diff erences appearing to be between the NH & CI, NH & BBS, HA & CI, and HA & BBS groups. There was no signifi cant diff e-rence between the NH & HA groups.

Overall the fi ndings suggest that diff erent modes of stimulation can provide diff erent outcomes for children with a CI and/or HAs for speech and pitch perception.


P114

THE INFLUENCE OF ADDITIVE NOISE AND REVERBERATION

ON LISTENING DIFFICULTY: REACTION TIME STUDY

Blaszak MA (1), Majewska N (2), Rydzewski B (3).(1) Adam Mickiewicz University, Poznan, Poland; (2) Karol Marcinkowski

Medical University, Poznan, Poland; (3) ENT Department, Franciszek Raszeja

Municipal Hospital, Poznan, Poland.

Background: in common situations, word recognition scores do not discriminate well among various acoustic conditions. Listening diffi -culty, measured by the reaction time, is proposed as a new subjective measure for the evaluation of speech transmission in enclosures.

Aims: the main purpose of the present study was to investigate the process of speech perception in diffi cult noisy and reverberated con-ditions and examine the validity of “listening diffi culty” measured by the delay in listeners’ responses.

Method: traffi c and multitalker babble noises have been added to the phonetically balanced 100-element CVC lists and generated in three enclosures (RT = 2, 1.3 and 0.9 s) and in the anechoic chamber. The experiment has been performed under various conditions of sig-nal to noise-ratio (SNR = -5, +5, +15 dB and no noise). The analysis were made on the basis of: (a) nonsense words’ recognition scores, and (b) reaction time for correctly repeated signals.

Results: the obtained results were consistent with the expectation that the longest duration of signal recognition in mental process is needed in enclosures with the highest reverberation and level of noise. Even if no diff erences were noticed in speech comprehension for various acoustic conditions, signifi cant diff erences were found in listening diffi culty. Therefore, reaction time can evaluate speech transmission performance more accurately and sensitively than inte-lligibility scores and seems to be an alternative to classic measures of speech perception in enclosures.

Conclusions: it seems important to use unconventional tests and to obtain, in addition to correctness of response, other measures of speech perception that are correlated with the ease of communica-tion.



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P115

ADULT-LIST EQUIVALENCY TESTING AND COMPARISON OF

SPEECH RECOGNITION BETWEEN MALE AND FEMALE VOICE

Trimmis N (1), Markatos N (1), Malaperdas K (1), Papadas T (2)(1) Department of Speech Pathology. Technological Educational Institute of

Patras; (2) Department of Otolaryngology. University Hospital of Patras, Greece

Background: Word recognition score tests should contain a number of equivalent word-lists. Male and female voices are suffi ciently diff e-rent to cause diff erences in word recognition scores.

Aims: The objective of this study was: fi rstly, to examine the list equi-valency of the four phonemically balanced 50-bisyllabic-word lists, developed by Trimmis et al (2006), for speech recognition score tes-ting, and secondly, to compare the performance-intensity function of each list between male and female voice.

Methods: One hundred adults (average age, 26.50 years; SD, 3.90) with normal hearing, divided in 2 groups (25 males and 25 females in each group) served as subjects. The lists with the male and the fema-le voice were presented to group A and B, respectively at 11 intensity levels ranging from 0 to 50 dBHL in 5 dB increments.

Results: Statistical analysis of the results revealed no statistical sig-nifi cant diff erences among the four lists, either with male or female voice. In contrast, statistical signifi cant diff erences were emerged on all four lists between male and female voice. In addition, steeper per-formance-intensity functions were obtained for the male recordings (M=6.1%/dBHL) than the female ones (M=5.8%/dBHL).

Conclusions: These fi ndings suggest that all four lists were found to be equivalent for listeners with normal hearing whose native langua-ge is Modern Greek. Further research with hearing impaired subjects is required.


P116

DEVELOPMENT OF A NONSENSE SPEECH RECOGNITION

TEST IN MODERN GREEK

Trimmis N (1), Makri V (1), Markatos N (1), Gouma P (2).(1) Department of Speech Pathology. Technological Educational Institute of

Patras; (2) 251 General Air Force Hospital, Greece. Background: Although several speech audiometry tests are presently available in Modern Greek, there is still a defi cit in nonsense mate-rials. Nonsense materials are the least redundant type of item and as a result their recognition is not dependent upon the vocabulary of the listener. In addition, nonsense materials permit a detailed analy-sis of the phonemic errors made by the listener. Aims: The purpose of the present study was to develop material for the construction of a nonsense test for suprathreshold speech re-cognition testing for native speakers of Modern Greek language. The specifi c aims of the present study were to construct phonemically balanced lists of nonsense material, and to perform a preliminary in-vestigation of list equivalence. Methods: Nonsense bisyllables with possible phonemic combina-tions in Greek were chosen as stimuli. Two syllable combinations were chosen as stimuli in order to satisfy the criterion of phonemic balance. To examine list equivalency, the 5 lists were administered monaurally in 5 dB increments to 10 subjects whose hearing was wi-thin normal limits. Results: A nonsense test for speakers of Modern Greek has been de-veloped. The test material consists of fi ve lists, each of which contains 50 open-set bisyllabic combinations. Statistical analysis of the results revealed no statistical signifi cant diff erences among the fi ve lists. Conclusions: These fi ndings suggest that all four lists were found to be equivalent for clinical purposes. Further investigations with larger numbers of subjects are required to determine the validity and relia-bility of those lists.



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P117

CORTICAL AUDITORY EVOKED POTENTIALS (CAEPS) IN

CHILDREN WITH COCHLEAR IMPLANT AND CHILDREN WITH

NORMAL HEARING

Mukari SZ (1), Umat C (1), Chan SC (1), Zakaria MN (2), Mohd Yusoff N (1), Ali A (1).(1) Dept of Audiology and Speech Sciences, Universiti Kebangsaan Malaysia,

Kuala Lumpur, Malaysia; (2) Dept of Audiology & Speech Pathology, Universiti

Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

This study compared the CAEPs in children with cochlear implant and normal hearing children. Subjects consisted of 41 children with cochlear implant aged between 4 to 12 years old (26 with good speech perception performance and 15 with poor performance) and 26 age-matched normal hearing children. CAEPs were measured using oddball paradigm with 1000 Hz pure tone and /ba/ as frequent stimuli and 2000 Hz tone and /bu/ as target stimuli. The morpholo-gy, latency and amplitude of P1, N1, P2, N2 and P300 were recorded using ipsilateral stimulation for children with cochlear implant and using right monaural stimulation for normal hearing children. In pure tone stimulation, the three subject groups did not show any signi-fi cant diff erences in waveform morphology, latency and amplitude of the measured waves. CAEPs measured using speech stimuli re-vealed that cochlear implanted children with poor performance had signifi cantly lower frequency of occurrences of P1 and N1 compared to the other two groups (p<0.05). Cochlear implant subjects with good performance showed a signifi cantly larger P1 amplitude but a signifi cantly smaller N1 than the other two groups (p<0.05). There was no signifi cant diff erence in latencies of all the waves between the three subject groups (p>0.05). Within-group comparisons for type of stimuli demonstrated that cochlear implanted children with poor performance had signifi cantly larger amplitude of P300 when stimulated using pure tone compared to when using speech stimuli (p<0.05). These fi ndings suggest that CAEPs measured using speech stimuli are more sensitive in diff erentiating between cochlear im-plant subjects with good and poor speech perception performance.


P118

TIME-FREQUENCY ANALYSIS OF CLICK-EVOKED

OTOACOUSTIC EMISSIONS RECORDED WITH LINEAR AND

NONLINEAR PROTOCOLS

Jedrzejczak WW (1), Smurzynski J (2) , Kochanek K (1), Skarzynski H (1).(1) Institute of Physiology and Pathology of Hearing, Warsaw, Poland; (2)


Johnson City, USA.

Background:The purpose of the study was to process CEOAEs re-corded using linear and non-linear presentation modes by applying time-frequency (t-f ) analysis by the Matching Pursuit (MP) method of adaptive approximation.

Material and Methods: The data were recorded in 26 normal-hearing subjects using the ILO96 system with clicks presented at 78-82 dB pSPL. In the non-linear mode, a series of four clicks was delivered with three at the same level and polarity and the fourth three times greater in amplitude and inverted in polarity, whereas in the linear mode all stimuli were presented at the same level and polarity. The responses consisting of 512 data points were stored in two buff ers. For each subject, 520 responses were recorded separately for off -line MP analyses. The MP method allowed decomposition of signals into waveforms of defi ned frequency, latency, time span, and amplitude and also identifi ed patterns of resonance modes that were characte-ristic for CEOAEs recorded in each individual ear.

Results: The overall CEOAE levels were higher by 4 dB for the linear mode than those for the nonlinear method, in agreement with stu-dies reported previously. In general, t-f properties of CEOAEs recor-ded with linear and non-linear protocols were similar with the ex-ception of the 0-6-ms post-stimulus time window and the frequency range below 2.2 kHz. This part of the signal was contaminated by a stimulus artifact in the linear mode. The reproducibility factor grew faster with an increase of the number of averaged responses for the linear protocol than for the non-linear method.

Conclusions:The results suggest that main diff erences between CEOAEs measured with the two methods are related to stimulus ar-tifacts occurring at the beginning of the recording time-window in the linear mode.



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P119

TECHNICAL ASPECTS OF STIMULUS PRESENTATION

THROUGH THE HEARING AID FOR ASSR RECORDING

Bronyakin SA, Belov OA, Tavartkiladze GA.National Research Centre for Audiology and Hearing Rehabilitation,

Moscow,Russia.

Recently objective methods are widely used for hearing threshold determination as well as for the evaluation of the results of hearing aid fi tting and speech processor programming in CI users.

The main goal of our study was to evaluate the usefulness of ASSR registration for the objective verifi cation of the gain parameters in patients using hearing aids (HA).

The ASSR registration was performed in patients with HA based on the Gennum platform with the use of AUDERA device. The automa-tic algorithm based on phase coherence technique for the response detection was applied at frequencies of 500, 1000, 2000 and 4000 Hz.

The amplitude-modulated stimulus was presented (i) to the HA mi-crophone located in the soundproof room and (ii) through the audio input of the HA. For the second condition the appropriate calibration was performed. Stimulation level was precisely adjasted to produce equal HA output level for both conditions. The second approach was developed due to multiple problems existing with free-fi eld quality in conventional (not soundproof) rooms.

In both stimulus presentation conditions the amplitude characteris-tics as well as modulated tone spectrum were analysed at each fre-quency at the input and the output of HA.

The results obtained suggest that the described approach could be used for objective measures of HA amplifi cation parameters in pa-tients with hearing loss.


P120

INTERACTION EFFECTS IN AUDITORY STEADY STATE

RESPONSES (ASSR)

Papakonstantinou A, Riedel H, Kollmeier B.Carl von Ossietzky University of Oldenburg, Germany.

Background: Auditory steady-state responses (ASSR) are evoked res-ponses generated by stimuli with periodic envelope fl uctuations. Multiple ASSRs (MASSR) have been suggested as an audiological te-chnique to record thresholds for diff erent frequencies and ears simul-taneously reducing measurement time. However, at least at high sti-mulation levels, strong interaction reduce the response amplitudes.

Aim: The present study investigates ASSR interaction at a moderate stimulus level of 60 dB SPL.

Methods: A stimulus with two carriers (fc1 = 1 kHz, fc2 = 2 kHz) and modulation rates near 40 Hz (fm1 = 38 Hz, fm2 = 42 Hz) was used. ASSRs were measured for 20 normal-hearing subjects and characte-rized by the averaged amplitude and SNR of the Fourier components at the two modulation frequencies.

Results: ASSR amplitudes were generally larger for fc1 compared to fc2. Unmodulated interferers had no infl uence on ASSR amplitudes. Modulated interferers, presented ipsi- or contralaterally to the pro-be ear, both signifi cantly reduced the ASSR amplitude at the probe-frequency, on average by 8.7%. The ASSR at the beating frequency (fm2 – fm1= 4 Hz) was signifi cant in the grand average amplitude spectrum for ipsi- and contralateral interferers.

Conclusions: Since ASSR amplitude reduction is similar for ipsi- and contralateral interferers, modulation interaction appears to be domi-nated by central rather than peripheral processes. Spectral energy at the beating frequency indicate a central nonlinearity. A level of 60 dB SPL can easily be reached during an ASSR hearing screening of an adult with mild sensorineural hearing-impairment. Therefore, in-teractions should be taken into account when estimating thresholds from MASSR.



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P121

HOW WELL DO ABR THRESHOLDS IN NEWBORNS PREDICT

BEHAVIORAL THRESHOLDS AT 6-18 MONTHS?

Uhlén I, Geng R.Karolinska University Hospital, Stockholm, Sweden.

The aim of this study was to compare ABR thresholds early in the screening process with diff erent Behavioral Hearing Tests (BHTs) per-formed at follow up, to know what the correlations are.

Neonatal hearing screening was implemented in the whole Stoc-kholm region in 2005. The maternity wards are responsible for pri-mary testing with TOAE. After a second OAE with no pass result the child is referred to the Department of Audiology for further investi-gation. There the investigation starts with a third TOAE and if negati-ve ABR thresholds are established in natural sleep. All OAE and ABR test results are saved in a data base. During the period from october 2005 to may 2008, 120 children with ABR thresholds of 40 dB on both ears or worse were diagnosed. Intervention took place in children with thresholds of 50 dB or above who received hearing aids within 3-6 months. Otoscopy is diffi cult in these tiny ears and OME could be suspected in many of these children. Hearing thresholds of less tha 50 dB and suspected OME were scheduled for follow up. Hearing threshold from 1-4 KHz at 6-18 months have been compared to ABR thresholds. There is a positive correlation but with a considerable va-riability. Medical conditions e.g. cleft palate and Mb Down are com-mon explanations but true progress is also seen.


P122

BENEFIT OF THE BONE-ANCHORED HEARING AID WITH

DIFFERENT AUDITORY PROFILES

van Wieringen A (1), Bosman AJ (2), De Voecht K (3), Wouters J (1).(1) ExpORL, Department of Neurosciences, KULeuven, Herestraat 49 bus 721,

B-3000 Leuven, Belgium; (2)Department of Otorhinolaryngology, University

Medical Centre St. Radboud, Nijmegen, The Netherlands;(3) ENT-dept,

UZLeuven, Kapucijnenvoer 33, B-3000 Leuven, Belgium.

Objectives: Assessment of audiological and self-report outcomes of the bone-anchored hearing aid (BAHA) in patients with diff erent au-ditory profi les.

Study Design: Prospective audiometric evaluation on 16 patients at Experimental ORL (University Hospital Leuven)

Methods: 18 diff erent experimental conditions: unaided and aided sound-fi eld thresholds, speech intelligibility in quiet and in noise (presented from diff erent angles). In addition, the Speech, Spatial and Qualities of hearing scale (SSQ), the APHAB questionnaires, and several other questions were administered as self-report measures. Data were collected of 16 unilaterally fi tted patients, of whom 5 with Single Sided Deafness (SSD), 6 with an asymmetry in bone conduc-tion hearing loss on either side limited to 20-25 dB (BIL), and 5 with an asymmetry in bone conduction hearing loss greater than 25 dB (MON).

Results: SSD patients benefi t from lifting the head shadow with the BAHA. BIL patients, who listen with both ears, perform signifi cantly diff erent in aided and unaided conditions. The latter is also true for the MON patients. However, their hearing loss at the non-BAHA side is too great to contribute to hearing. The diff erences between unai-ded and aided conditions result from listening predominantly with their BAHA. Self-report outcomes show that all subjects were satis-fi ed with the intervention, thus corroborating the audiometric data.

Conclusions: The BAHA enhances performance in all three hearing confi gurations, albeit to diff erent extents. The subjective data co-rroborate the speech data and the BAHA is considered an eff ective intervention by all subjects



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P123

THE SPEECH-TEST CHANGES IN PATIENTS WITH BINAURAL

HEARING AID

Golubok-Abizova T(1), Deyeva Y (2). (1) Kiev Regional Hospital, Ukraine;(2) Bogomolet`s Natiomal

MedicalUniversity, Ukraine.

Background: Speech recognition is plays most important role in the hearing aids tecknik. That’s why the investigations of speech test be-fore and after binaural hearing aids is very actual.

Aim: The aim of our investigation was to recognize the results of speech-test before and after binaural hearing aid.

Methods:The 29 patients (experimental group) with symmetries sen-sorineural hearing impairment were undergone the pure-tone and speech audiometry before and 1 year aften performing the binaural hearing aid. And 21 monaurally aided patients (control group) were andegone the same investigation.

Results:The results revealed signifi cant increasing of speech intelligi-bility in 86,2% patients with binaural fi ttings after 1 year of hearing aids using camparing with monaurally aided patients.

Conclusion:The fi ndings are consistent with the presence of an au-ditory deprivation eff ect on word-recognition in speech test. Our re-sults indicate the preference of binaural hearing aid comparing with monaural. In patients with symmetric sensorineural hearing loss.


P124

UNIVERSAL NEONATAL HEARING SCREENING PROGRAMM:

5 YEARS RESULTS

Díaz FJ , García-Alvarez G, García-Dueñas J, Seguí P , Jiménez M, Masegosa P.ENT Department, Complejo Hospitalario Universitario de Albacete, Spain.

Introduction: Review of the universal hearing screening programme in our community from 2003.

Methods: Retrospective study of the general newborn population in the Health Area of Albacete from July 2003 to June 2008. This is a four stage protocol programme and patients are studied a week after hospital discharge. Otoacoustic emissions (OAE) are used in First and Second stages and Brainstem Evoked response Auditory (BERA) in the Third stage or in high risk patients. At the fourth stage diagnosis is achieved and treatment is started between 6 and 12 months old.

Results: From July 2003 to June 2008 a total of 16321 babies were born in our Health Area.

• Stage 1. 16003 babies (98,05%) of total newborn were tested with OAE, and 186 (1,13%) referred to the third stage had high risk of de-afness.

• Stage 2. 1092 babies of fi rst stage (6,82% of newborn) failed OAE and were referred. 14 patients (2%) did not attend.

• Stage 3. 274 babies were tested with BERA (2,87% of fi rst stage) and some degree of hearing loss was found in 69 cases.

• Stage 4: Mild hearing loss (less than 50 dB): 38 cases (16 with high risk). Moderate hearing loss (50-60 dB): 21 cases (12 with high risk). Severe hearing loss (more than 60 dB): 10 cases (8 with high risk).

Discussion: 98,5% of neonates were screened. Referral rate for diag-nosis: 2,87%. The programme detected 69 cases with some degree of hearing loss (0,42 % of newborn) in fi ve years. Only 2,87 % of babies needed to perform BERA. There was high risk in 48 cases and no risk in 33 cases.



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P125

UNIVERSAL NEONATAL HEARING SCREENING IN THE

INSTITUTE OF CHILD AND ADOLESCENT HEALTH

Sargsyan A (1), Movsesova N (2), Gevorkyan A (2), Shukuryan A (1), Babayan L (2), Manukyan T (2).(1) State Medical University of Armenia; (2) Institute of child and adolescent

health. Yerevan, Armenia.

We have about 40.000 newborns in Armenia every year. According to international data, among every 1000 newborns there are one or two deaf children. Consequently, every year in Armenia the number of deaf children is from 40 to 80 newborns. In Armenia there is only one children audiologi-cal centre, which observe all children in Armenia. In the centre only 2 deaf children until one year old and 10 children in age group from one to three years old have been detected in 2008. Such situation wouldn’t allow us to begin early rehabilitation of deaf children, to provide them with hearing aids and speech therapy in time.

Since June 2008, a pilot- program of neonatal hearing screening have been begun in two maternity hospitals. The pilot-program was established on the governmental level. There is an intention to wi-despread it over the whole Republic.

Here are the screening results in one of these maternity hospitals.

Methods of examination: OAE, ABR.

There were observed 1497 newborns. During following examination the diagnose was submitted in 5 cases: tree children had profound hearing loss and 2 children- middle hearing loss.

All revealed children have been provided with hearing aids. They are under our permanent observation in the centre. The special rehabi-litation multidisciplinary group works with them and their parents.

Conclusion: Despite our work is just the beginning and there is a lot to do yet, but results which we have already got shows us the neces-sity of it.

Keywords: UNHS, Transient Evoked Otoacoustic Emissions, ABR, Hearing loss


P126

SCREENING NEONATES WITH MSSR TO SIMULTANEOUSLY

PRESENTED BONE- AND AIR- CONDUCTED STIMULI

Pérez Abalo MC, Hernández MC, Santos E, Rodríguez E, Hernández O, Torres A.Cuban Neuroscience Center, La Habana, Cuba.

Background: With the rapid growth of universal neonatal hearing screening, the methods and technology for early detection of hea-ring impairments need to be continuously perfected. An important goal is to reduce the false positive rate in the initial screen due to transient conductive impairments.

Objectives: To evaluate the diagnostic effi ciency and overall perfor-mance of an automatic MSSR screening device using simultaneous bone- and air- conducted stimulation.

Methods: A sample of 24 infants (46 ears) with and without high risk factors was screened within 3 days of birth. Each infant (ear) was tes-ted twice (in random order) with MSSR to simultaneous bone- and air-conducted stimuli and with automatic EOA (Accuscreen, Mad-sen). All babies (pass/fail) were followed up and re-evaluated within 1 month of age with: 1) standard MSSR and EOA; 2) Otoscopy and Im-pedance testing. The MSSR stimuli were two amplitude modulated (95% depth) carrier tones (500 & 2000 Hz) presented simultaneously through bone- (B71) and air- conducted (Eartone 5A) transducers. The intensities were fi xed at 30 and 40 dB HL for BC and AC stimuli respectively. The pass/fail intensity criterion was previously establis-hed (100% response detectability) in control groups of 15 healthy infants.

Results: Both automatic screening devices performed adequately in the maternity ward, showing similar pass/fail results in most (77%) tested ears. The diagnostic sensitivity and specifi city rates were much better though for the MSSR (100% and 95%) than for the AOAE (50% and 83%) screening test. This was due to the MSSR correct iden-tifi cation of 9 of the 11 screen failures classifi ed as ¨transient conduc-tive impairments¨ and the detection of a sensorineural hearing loss than passed the OEA screen.

Conclusions: The automatic MSSR screening device performed ade-quately in the maternity ward identifying more effi ciently transient and permanent impairments missed by an AOAE.



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P201

SENSITIVITY TO INTERAURAL CUES IN CHILDREN WITH

BILATERAL COCHLEAR IMPLANTS

Van Deun L (1), Van Wieringen A (1), Scherf F (2), Off eciers FE (3), Desloovere C (4), Van de Heyning PH (2), Dhooge I (5), Deggouj N (6), Wouters J (1).(1) ExpORL, Dept.Neurosciences, K.U.Leuven, Belgium ; (2) Univ.Dept.ORL,

Antwerp University Hospital, University of Antwerp, Belgium; (3) Dept.ORL,

AZ St Augustinus, Wilrijk, Belgium; (4) Dept.ORL, UZLeuven, Belgium; (5)

Dept.ORL, UGent, Belgium; (6) Service ORL, Clinique St-Luc-UCL Bruxelles,

Belgium.

Background: Bilateral cochlear implants may off er deaf children a range of advantages compared to unilateral cochlear implants. It is unclear, however, to which extent bilateral implantation restores true binaural hearing, or the processing of interaural cues (time and inten-sity diff erences). In Belgium, a group of 42 children received a second cochlear implant at ages from 1,5 to 12 years.

Aims: Bilateral and binaural benefi ts were investigated in a selection of these children.

Methods: In a fi rst experiment, sound localization was tested in the sound fi eld, with a broadband bell-ring presented from nine louds-peakers in the frontal horizontal plane. Children listened with their own, clinical speech processors and fi ttings. In a second experiment, electrical stimuli were presented directly to the internal part of the implant, to control interaural parameters. Binaural Masking Level Di-ff erences (BMLDs) were measured for a 180° phase shift in a 125-Hz sinusoid, presented in a 50-Hz wide noise band and modulating a 1000-pps carrier pulse train. Stimuli were presented to a single elec-trode in the middle of the electrode array at both ears.

Results: Most children were able to localize the bell-ring better than chance level, with better scores for children who received their im-plants at a younger age. Results were correlated with parent ratings of sound localization ability (SSQ). Children who did not perform above chance level were retested after one year. Positive BMLDs were measured in seven children with good localization scores. One child showed no diff erence in detection performance for the dichotic (interaurally out of phase) versus diotic (interaurally in phase) signal.

Conclusions: The present results show that most but not all children benefi t from bilateral implantation for sound localization, and that controlled bilateral electrical stimulation might improve binaural hearing skills.


P202

SENTENCE COMPREHENSION IN ADULT COCHLEAR-

IMPLANT USERS AS REVEALED BY LATE ERPS

Hahne A (1), Wolf A (1), Müller J (2), Friederici AD (1).(1) Max-Planck-Institute of Human Cognitive and Brain Sciences, Germany;

(2) Julius-Maximilian-Universität Würzburg, Germany.

Within the framework of cognitive neuroscience detailed models of language comprehension in normally hearing adults have been de-veloped. However, hearing with a cochlear implant (CI) diff ers signifi -cantly from normal hearing, and the cognitive processes underlying language comprehension with CI are yet to be determined. We inves-tigated auditory sentence comprehension in 11 postlingually deaf adult CI-users using event-related brain potentials (ERPs).

Sentences were either correct or contained a semantic or a syntactic violation. In age-matched normally hearing controls these two viola-tion types correlated with diff erent ERP eff ects: semantic violations elicited a N400 eff ect, whereas syntactic phrase structure violations evoked a late positivity, thereby replicating previous results. If pre-sented visually, the same sentences elicited a similar result pattern also in the group of CI-users. By contrast, when sentences were pre-sented auditorily, CI-users showed a N400-like negativity, i.e. a corre-late of semantic integration processes for both types of violation.

These results suggest that CI-users focus on semantic information during auditory comprehension at the expense of structural analysis. However, as diff erences between unimpaired listeners and CI-users were restricted to the auditory modality, they do not seem to refl ect general cognitive processing diff erences but rather a specifi c feature of auditory processing with a CI device.



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P203

FM SYSTEMS IN COCHLEAR IMPLANTS USERS. BENEFIT

OVER SPEECH RECOGNITION IN NOISE.

Mora Espino R (1,2), Zenker F (1,2), Fernández Belda R (3,1,2), and Barajas de Prat JJ (4,2,1).(1) Fundación Dr. Barajas, S/C de Tenerife, Spain;(2) Clínica Barajas, S/C de



The use of frequency-modulated (FM) systems with cochlear im-plants has steadily increased as the FM technology has become more integrated with the cochlear implant speech processor. Although noise-reduction technology is incorporated into cochlear implants, this technology cannot compensate for the reduction in the speech signal that occurs as the distance from the speaker is increased. The use of FM systems with cochlear implants is most often addressed in educational environments in which the noise level may interfere with learning new information.


P204

PERCEPTION OF SPEECH IN REVERBERANT CONDITIONS

USING AM-FM COCHLEAR IMPLANT SIMULATION

Drgas, S, Blaszak, M.A.Adam Mickiewicz University, Faculty of Physics, Institute of Acoustics, Poznan,

Poland.

Purpose: This study assessed the eff ects of stimulus misidentifi cation and cognitive processing errors in normal-hearing adults exposed to degraded auditory input simulating signals provided by cochlear im-plants in reverberation conditions.

Method: Under control were three variables: number of vocoder bands (6 and 12), instantaneous frequency change rate (none, 50, 400 Hz), and enclosures (diff erent reverberation conditions). The analyses were made on the basis of: (a) nonsense words’ recognition scores for eight young normal-hearing listeners, (b) ease of listening based on the time of response (response delay), and (c) the subjecti-ve measure of diffi culty (ten-degree scale).

Results: The maximum value of speech intelligibility in cochlear im-plant simulation for considered parameters was 70% and was obtai-ned for non-reverberant conditions with 12-channel vocoder and changes of instantaneous frequency limited to 400 Hz. In the presen-ce of refl ections stimulus misidentifi cation was about 10–20 percen-tage points higher. There was little diff erence between the 50 and 400 frequency modulation cutoff for 12-channel vocoder; however, in the case of 6 channels this diff erence was more signifi cant.

Conclusions: Speech perception of cochlear implant users is extre-mely aff ected by the reverberation, especially in terms of subjective measures of listening diffi culty. The 12-channel processing systems were shown to be more largely resistant to the tested levels of rever-beration than 6-channel vocoder.



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P206

APPLICATION OF THE DIARY OF EARLY LANGUAGE (DI-EL®)

IN MONITORING LANGUAGE DEVELOPMENT IN INFANTS

USING COCHLEAR IMPLANTS AND HEARING AIDS

Cowan RSC (1, 5), Nott P (1, 2), Brown M (3), Wigglesworth G (4).(1) The HEARing CRC, Melbourne, Australia; (2) Advisory Council for

Children with Impaired Hearing, Melbourne, Australia; (3) The Department

of Early Learning, University of Melbourne, Australia; (4) The Department

of Linguistics, University of Melbourne, Australia; (5) The Department of


Objectives: The advent of universal newborn screening has resulted in signifi cant number of infants receiving cochlear implants during the fi rst six to twelve months of life. The evaluation of implant per-formance, as well as pre-implant speech benefi ts from use of hearing aid, is challenging in such young children who have not as yet de-veloped language. Analysis of pre-verbal behaviours can be eff ecti-ve, but is time-consuming and requires skilled clinicians. The aim of this study was to evaluate the eff ectiveness of a novel technique for assessing emerging language in children using cochlear implants or hearing aids.

Materials and Method: The eff ectiveness and validity of the Diary of Early Language (Di-EL), a technique in which parents collected data about their child’s fi rst 100 single words was measured by determi-ning whether it could be implemented by parents and whether it provided information about early implant use that was not availa-ble from other tests. Validity of the Di-EL was determined from two perspectives. First, the level of agreement between the lexical data obtained from each participant’s 100-word Di-EL and the lexical data obtained from the MacArthur-Bates Communicative Development inventory (CDI) was determined. Second, the correlation between raw scores obtained on the Di-EL, the CDI and the Rossetti Infant Toddler Language Scale was computed. Results indicated the Di-EL to be an eff ective and valid tool for collecting lexical data in young children using cochlear implants. It provided “on-line” information about lexical acquisition not available from other tools and parents reported it to be a valuable educational tool. Further support for the Di-EL technique was found in a subsequent study which evaluated the language of two groups, one including normally hearing chil-dren, and a second group of children with hearing loss.

Results: The Diary of Early Language was easily completed by all pa-rents of all children in the study. Results showed that the time period for acquisition of all lexical targets was longer for the children with hearing loss as compared to their normal hearing peers. The patterns of acquisition were found to be similar, although specifi c diff erences in lexical content were noted between the two groups.

Discussion & Conclusion: The Diary of Early Language is an eff ective tool for monitoring the early language performance of children using cochlear implants or hearing aids.


P205

COMPARISON OF IMAGING PLATES & HIGH-RESOLUTION

CCD FOR X-RAY MICRO-FOCUS IMAGING OF COCHLEAR

IMPLANTS

Xu J (1, 3), Stevenson AW (2), Cowan RSC (1, 4).(1) The HEARing CRC, Melbourne, Australia; (2) CSIRO Materials Science and

Engineering, Australia; (3) The Bionic Ear Institute, Melbourne, Australia; (4)

The Department of Otolaryngology, University of Melbourne, Australia

Introduction: Recording high-resolution X-ray images of inner-ear structures and inserted implants is a challenging issue at the fo-refront of current radiography techniques. Previous studies have shown that micro-focus radiography, using the new concept of phase contrast combined with traditional absorption contrast, can greatly improve in vitro temporal bone imaging. In this study we will compare the performance of two imaging detectors, Imaging Plates (IPs) and high-resolution charge-coupled devices (CCD).

Methods: Formalin-fi xed cadaver temporal bone was implanted with Nucleus 24 Contourä electrode array. A Feinfocus micro-focus X-ray source with a minimum spot size of 4μm was used. The tempo-ral bones were imaged in projections of Cochlear View and Side View by using both Imaging plates and a high-resolution CCD detector.

Results: Both of the imaging detectors provide good visualisation of anatomical details of inner ear and micro-electrode structures. IP has very good sensitivity and large dynamic range. The CCD detector has higher spatial resolution, but over a smaller fi eld-of-view.

Conclusions and future prospects: IP and CCD detectors are valuable and complementary imaging devices for capturing high-resolution X-ray images. The CCD detector has the advantage of being very use-ful for recording multiple images as required for X-ray micro-tomo-graphy studies.



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P207

ISSUES IN TRANSLATING NEW MATERIALS AND

TECHNOLOGIES TO CLINICAL APPLICATIONS

Cowan RSC (1, 2). (1) The HEARing CRC, Melbourne, Australia; (2) The Department of


Abstract: The intersection of such diverse fi elds as polymer chemis-try, micro and nanotechnology, microsurgery, bioengineering and biomaterials heralds the potential for signifi cant advances in cell-based therapies and re-engineering of damaged neural systems for locomotion, hearing and sight.

Enthusiasm for the application of new knowledge from such diver-se fi elds must be tempered with recognition of the diffi cult path for drug or device development from the basic underpinning research to full application in humans.

In particular, the issue of the biosafety of chronic use or presence of new materials and therapies in biomedical applications, and the po-tential for unexpected side eff ects is one that has to date received insuffi cient attention and research.

A second concern is the manufacturability of new applications, which may demonstrate effi cacy in the laboratory or small-scale trial, but encounter problems in scale-up to large volume manufacturing, or scale-down to microminiature applications. Such problems may be restricted to eff ects on effi cacy, but may also render applications too costly for large scale use in health therapies.

A third potential problem is that of intellectual property and com-mercialisation, in particular for developments arising from consor-tiums, where aligning the interests of partners from diff erent sectors with varying strategic aims and objectives is a major challenge to successful translation.

These issues will be discussed in more detail with examples.


P208

A MUSICAL JOURNEY THROUGH THE RAINFOREST: A

RESOURCE TO DEVELOP MUSICAL PITCH IN CHILDREN WITH

COCHLEAR IMPLANTS

Rocca C (1,2), Driver S (3), Stark E, Gazibegovic D, Arnold L(2).(1) Mary Hare Schools, UK; (2) Advanced Bionics Europe; (3) Guy’s and St.

Thomas’ Hospital, UK.

Background: Children with cochlear implants (CI) have the ability to develop musical skills through natural experiences of singing and playing music. They are able to respond well to rhythmic, dynamic and tempo changes. More challenging is to develop a greater accu-racy in the singing voice in relation to pitch production. A paediatric (re)habilitation resource was created, to develop early literacy, musi-cal and speech and language skills. The stages of developing singing are mapped out in the sequence of songs, from the earliest stages of perception and production of rhythmic features, to the fi nal stages of training the ability to control pitched notes and intervals in the voice. The resource is called ‘A Musical Journey through the Rainforest’. It provides a structured series of voice training exercises, set in a natural musical context, aiming to motivate and engage the child.

Aims: To demonstrate the pitch related musical development of pre-lingually deaf, CI children participating in an (re)habilitation progra-mme based on the Rainforest resource.

Methods: CI children aged 2-6 years were included. They undertook a set of exercises from the Rainforest resource, that encompassed listening, singing, playing and recognition of melodic lines. Video recordings were made of all sessions and the recorded material was analysed by accuracy of pitch production.

Results: The Rainforest resource will be presented, together with the analysis of the video recordings, demonstrating increasing acquisi-tion of musical pitch in the singing voice. The subjects were begin-ning to have a greater sense of pitch accuracy, which demonstrated the eff ect of the programme.

Conclusions: Although psycho-acoustic tests of CI hearing have tended to show disappointingly poor performance on pitch related tasks, structured (re)habilitation training programmes based within a musical context can lead to the development of the ability to sing in tune in CI children with latest generation devices.



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P210

POSTMENINGITIC OSSIFIED COCHLEAS. IMPLICATIONS FOR

COCHLEAR IMPLANTATION.

Seguí Moya P (1),Blanco Cabañero AG (2), Diaz Fernández J (1), Villar García M (2).(1) Servicio de ORL del Complejo Hospitalario Universitario de Albacete; (2)

Servicio de Radiología del Complejo Hospitalario Universitario de Albacete.

We report a case of severe labyrinthitis ossifi cans, in a young patient with bilateral hypoacusia after episode of meningitis pneumococci-ca.

The labyrinthine ossifi cation can be found in a high percentage of patients with deep hypoacusia as result of a bacterial meningitis.

We described the radiographic evident signs of the initial labyrinthi-tis and the following images of TC and RM, very signifi cant of labyrin-thine ossifi cation in our patient.

The radiographic evidence of the labyrinthine ossifi cation can be found two months later to acute infection, indicating probably the process intracoclear begins before.

We praise the obligatiry nature to fullfi l RMN in all cases, especially with precedents of meningitis, because TAC can provide false nega-tives.

Also we indicated impossibility, most of the times, to place a classic Choclear implant devices in ossifi ed cochleas, being necessary to rely on compressed model or forked one. In our case was impossible to performe choclear implant. So, it’s very important to indicate the pro-ceed in the window period after labyrinthitis.


P209

STAR2 VALIDATION WORKING GROUP: TESTING COCHLEAR

IMPLANT USERS IN REAL-LIFE LISTENING CONDITIONS

Arnold L, Joff o LM, Boyle P.Advanced Bionics, Clinical Research Department

The STAR2 (Sentence Test with Adaptive Randomised Roving levels) aims to assess speech perception that more closely relates to real life listening situations than the fi xed level tests traditionally conducted. Sentences are each delivered by either a male or a female speaker, at one of three diff erent presentation levels, with adaptively varying background noise. The presentation order is randomized, for both the level and the speaker, such that subjects cannot optimize their processor controls as for fi xed level tests. This aspect of the STAR2 design better mimics group conversations and more fully challenges sound processor functionality, such as the Automatic Gain Control (AGC) system which is not usually exercised in conventional tests.

The objective is to conduct a validation process for STAR2 by gathe-ring data from a number of European centres using STAR2 in their clinical routine.

STAR2 data are collected from adult CI users. Lists of 30 sentences are delivered from a loudspeaker placed one metre in front of the participant. Global analysis will investigate: normative data, list equi-valence, learning eff ects, test-retest variation. STAR2 scores will also be compared with other routine clinical tests as well as with other measures of everyday-life performance.

Pilot data on 18 normal hearing individuals found low inter-subject variability with mean Speech Reception Thresholds (SRTs) of -7.9 dB and -9.24 dB for the male and female speakers respectively (Nunn, 2008). Preliminary results obtained in the same study from hearing impaired subjects and CI users showed a reverse pattern with better SRTs for the male speaker, most likely due to the faster delivery rate of the female voice.

These observations as well as those from other studies using STAR2 to investigate front end processing are very encouraging on the use-fulness of the methodology behind STAR2 for experimental designs as well as for clinical application.



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P211

PRELIMINARY RESULTS USING THE “FITTING TO OUTCOMES

EXPERT” (FOX®)

Govaerts PJ (1), Buechner A (2), Nunn T (3), Brendel M (2,4), Vaerenberg B (1), Ceulaer GD (1), Daemers K (1), Jiang D (3), Lenarz T (2), O’Connor AF (3).(1) The Eargroup, Antwerp, Belgium; (2) Medical University of Hannover,

Department of Otolaryngology, Hannover, Germany; (3) Guy’s and St. Thomas’

Hospitals; (4) Advanced Bionics GmbH, Hannover, Germany.

Background: Cochlear implant programming requires specifi c skills and competences. Routine fi tting procedures may sometimes be so laborious that no time is left for in depth performance assessment, let alone for feedback on such an assessment to modify the fi tting. To overcome this issue, a software program FOX® was developed at the Eargroup, to automate the fi tting and turn it into a simple, rapid, expert driven and outcome based procedure. The core is a feed-back engine to which both audiological results and existing program pa-rameters are fed and which delivers modifi cations to the program.

Aims: To pilot the use of FOX outside of the Eargroup and to get fee-dback both on system and on practical use.

Methods: Ten adult subjects using the HiResolution® Bionic Ear® sys-tem were included at Guy’s and St. Thomas’ hospitals as well as the Medical University of Hannover (MHH). A baseline test was conduc-ted with the subjects’ clinical programme, using a sentence test pre-sented in noise. The FOX system was driven and used to create a new programme. After ensuring that the new programme supported de-tection of a practical range of sound intensities, the participants were encouraged to acclimatize for about 15 minutes. The speech test was then applied again. The subjects were allowed to choose between clinical programme and FOX programme, taking both home for a more extensive trial.

Results: The outcomes of the tests at both clinics will be presented, including subjective feedback obtained through Sound Quality Questionnaires. Clinician comments on the practical use of FOX will also be reported.

Conclusions: The introduction of fully automatic and outcome driven expert software has the potential to substantially reduce fi tting time and to provide good fi tting quality. Such an approach will allow au-diologists to allocate more time to the more diffi cult subjects and to further develop expertise.


P212

EVALUATION OF SPEECH PERCEPTION AND SPEECH

DEVELOPMENT IN CHILDREN USING HIRES 120

Akhmetshin (1), Attias J (2) , Cervera J (3), Della Volpe A (4) , Driver S (5), Ernst A (6) , Hanvey K (7) , Jones J (8) , Kameswaran M (9) , Manoj MP (10) , Marco J (11), Neumann K (12), Niemczyk S (13) , Sainz M (14) , Vadhera M (15), Vaid N (16), Gazibegovic D (17).(1) Rep. Children Hospital, Ufa, Russia.

(2) Schneider Children’s Medical Center, Tel-Aviv, Israel.

(3) Hospital del Nino Jesus, Madrid, Spain.

(4) Ospedale Santobono, Neaples, Italy.

(5) St. Thomas’ Hospital, London, UK.

(6) Unfallkrankenhaus Berlin, Berlin, Germany.

(7) Aston University Day Hospital, Birmingham, UK.

(8) Oxford Cochlear Implant Program, Oxford, UK.

(9) Madras ENT Research Foundation, Chennai, India.

(10) Dr.Manoj’s Superspeciality Institute and Research Centre, Calicut, India.

(11) Hospital Clinico Universitario de Valencia, Valencia, Spain.

(12) Klinikum der J.W. Goethe Universität, Frankfurt, Germany.

(13) University Clinic, Warsaw, Poland.

(14) Hospital Clinico San Cecilio, Granada, Spain.

(15) Meenakshi Speech and Hearing Clinics, Delhi, India.

(16) KEM Hospital and Research Center, Pune, India.

(17) Advanced Bionics, Clinical Research Department.

Objective: The new sound coding strategy from Advanced Bionics is called HiRes 120 and it implements virtual channels by steering cu-rrent between two adjacent electrodes.

The aim of the project is to:1) Verify the ability to fi t HiRes 120 easily in children at the fi rst fi tting; 2) Defi ne the benefi t of HiRes 120 for pro-duction, perception and music development 3) Monitor the outcome over a 24 month period 4) document psycho-physical fi tting para-meters .

Method: Children between 12 months and 4 years of age are included in the survey. All subjects are fi rst fi tted with HiRes 120 using either their Harmony or Platinum Sound Processor. Pre-implantation, ba-seline is evaluated using the Children’s Implant Profi le (Nottingham Version) and a free fi eld audiogram if it is under clinical routine. The children are evaluated with a series of questionnaires: MUSS, (IT) MAIS, SIR, CAP, PRISE and the Music Stage Profi le questionnaire at approximately the 3,6,9,12,18 and 24 month visit. Performance data using the clinics clinically routine tests are collected.

Results: To date 6 subjects have started the survey. 15 centres in Euro-pe, Russia, India and Israel are taking part in the survey. The survey design will be presented as well as the preliminary data.

Discussion: The adult HiRes 120 Study has showed a signifi cant be-nefi t for adults, both subjectively and objectively using HiRes 120, compared to HiRes. Based on these fi ndings, a pilot paediatric stu-dy was performed in which children were upgraded from the Auria sound processor/HiRes to the Harmony and HiRes 120 sound coding strategy. It was seen that fi tting and managing HiRes 120 in children was easy and immediately accepted by the children. This study will validate these fi ndings in a large group of children.



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P214

MULTIDIMENSIONAL ACOUSTIC ANALYSIS OF PATIENTS

BEFORE AND AFTER TRAINING IN SELF-PERCEIVING VOICE

BY HEARING

Petrovic-Lazic M , Babac S, Vukovic M, Dobrota N.Faculty for Special Education and Rehabilitation, University of Belgrade, Serbia

We showed multidimensional acoustic analysis of /e/ vowel sound of patients before and after training in self-perceiving voice by hearing.

Training in self-perceiving voice by hearing, that is carefully planned auditive preception training is key to accomplishing almost every goal in voice therapy. Not until the patient has become aware of his voice disorder and established good contact with the vocal therapist, can the creation of voice model or voice example begin.

Vocal therapist together with the patient fi nds the best voice altering the pitch and intensity of patient’s voice, trying to acchieve his opti-mal colour. Thus, the phase of development of auditive perception represents an introduction to the vocal therapy, which integrates a number of vocal techniques.

We examined 43 patients, 29, 8±4,56years old. In all patients vowel /e/ was recorded and analyzed before and one month after vocal treatment. Success of vocal therapy was followed-up through the computed acoustic analysis of vowel /e/. We analyzed parameters of the voice signal, noise, and tremor.


P213

COCHLEAR IMPLANT IN PATIENT WITH WAARDENBURG

SYNDROME

Kosanovic R, Stojanovic S, Petrovic-Lazic M, Babac S.ORL Clinic City Hospital, Belgrade, Serbia

Profound congenital hearing loss is found per average in 1:1000 new-born children. Environmental elements are considered important in 50% of cases, whereas another 50% are beeing geneticaly caused. Approximately 70% of congenital profound deafnesses connected with genetic factors are nonsyndromic, where deafness is not related to other clinical entities which would defi ne recognizable syndrome. Remaining 30% of cases can be defi ned in some of more than 400 types of syndromic deafnesses, related to other clinical entities. The-se clinical fi ndings vary from clear ones to subtile and hardly recog-nizable. Waardenburg syndrome is represented by white hair near forehead, dystopia canthorum, heterochromia iridis, early gray hair, vitiligo and wide nose root. Autosomal dominant type of inheritance is described. Waardenburg syndrome type I is more common and is classical form as described. Type 2 is rare and hearing loss is more of-tenly found (up to 77%). Progressive, bilateral, moderate to profound hearing loss is diagnosed. This article describes case of a 5 years old girl with Waardenburg syndrome, diagnostical procedures and habi-litation results after cochlear implantation.



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P215

THE ELECTRICALLY-EVOKED ACOUSTIC CHANGE COMPLEX

IN COCHLEAR IMPLANT USERS

Beynon A, Keck TN, Snik AFM.Auditory Evoked Potential Lab, Radboud University Nijmegen Medical Centre

Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience,

Dept of Otorhinolaryngology. Nijmegen, The Netherlands.

Background: The Slow Vertex Potential (SVP) or N1-P2 complex is an electrophysiological stimulus detection response elicited after an abrupt change in an acoustical environment. Although SVP measure-ments are applied for objective determination of auditory thresholds in clinical settings, a second N1-P2 complex (referred to as the acous-tic change complex or ACC) can be evoked by changing an acoustic parameter within one stimulus (Ostroff et al, 1998; Martin et al, 2000). Apparently, this complex refl ects change detection within a stimulus at the cortical level.

Aims: Investigating the feasibility to obtain ACCs using diff erent sti-mulation parameter via electrical stimulation (EACCs) in the sound fi eld and via direct intracochlear electrode stimulation.

Method: Two experiments were carried out, i.e. Experiment 1 in 9 normal hearing subjects and Experiment 2 in 22 adult CI-users. The purposes of the fi rst experiment were to test the practical applica-bility of the setup and to optimize the stimulation/recording para-meters. The second experiment investigated the electrical variant in the soundfi eld (indirect) and via direct stimulation of intracochlear electrodes. Three stimulation parameters were changed, i.e. frequen-cy (electrode allocation), stimulation level (loudness) and stimula-tion rate. Additionally, the infl uence of the magnitude of the acoustic change within the stimulus on the EACC was evaluated.

Results: It was possible to elicit (E)ACCs in either soundfi eld and via direct stimulation by stimulus changes in frequency, stimulation le-vel or stimulation rate. Comparisons of EACC after direct and indirect stimulation showed diff erent morphologies of the EACC, showing more robust responses via direct stimulation due to limited impact of electrical artefact.

Conclusion: ACCs can be elicited electrically by (in)direct stimulation in cochlear implant users and might be a tool for objective evaluation of (electrical) stimulus change detection.


P216

THE COCHLEAR® HYBRID™ SOUND PROCESSOR FOR

COCHLEAR IMPLANT RECIPIENTS WITH RESIDUAL

LOW-FREQUENCY HEARING

Incerti P, Parkinson A, James C, Gorrie J, Pesch J, Plant K, Bouchataoui I.Cochlear Ltd, Sydney, Denver, Toulouse, Melbourne, Hannover and Mechelen.

Conservation of varying degrees of residual low- frequency hearing following cochlear implantation has been achieved by several re-search groups using either standard cochlear implants, such as the Nucleus®24 Contour Advance (CI24R) and Nucleus® Freedom™ co-chlear implant with Contour Advance™ electrode (CI24RE) or using shorter investigational electrode arrays such as the Hybrid™L24, Hybrid™S8 and Hybrid™ S12 (Fraysse et al., 2006, Gantz & Turner, 2003; Gantz & Turner, 2004; Gantz et al., 2005; Gstoettner et al., 2004; James et al., 2005; Turner et al., 2003; von Ilberg et al., 1999). An inves-tigational device, the Hybrid sound processor, has been developed to deliver both acoustic and electrical stimulation to cochlear im-plant recipients with residual low frequency hearing in the implanted ear, thereby eliminating the need to use a separate hearing aid in the implanted ear. A two-phase clinical study was conducted with adult recipients of the Hybrid cochlear implants. Performance with the Hybrid SP device was compared to Nucleus Freedom sound proces-sor used with a conventional Phonak ITE hearing aid. Recognition of words in quiet and sentences in babble noise was tested. Qualitative measures were also made through completion of usability, comfort and comparative questionnaires. Results will be discussed with a par-ticular focus on the implications of this new technology being made available to cochlear implant recipients with residual low frequency hearing in the implanted ear.



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P218

LONG-TERM FOLLOW UP OF PSYCHOPHYSICAL

PARAMETERS IN COCHLEAR IMPLANT USERS

Kiss JG , Tóth F, Szamosközi A, Torkos A, Jarabin J, Rovó L, Jóri J.University of Szeged, Department of Otolaryngology and Head and Neck

Surgery, Szeged, Hungary.

During the fi tting process it is the most important to determine the exact electrical threshold and comfort levels, which assumes a series of psychophysical measurements to be taken. The intensity at which just a hearing sensation is evoked (threshold level) and the intensity that causes a bearable loudness (the comfort level) must carefully be determined on each electrode. The speech processor will then trans-form the external sound stimuli – with the use of the appropriate speech coding strategy - to this dynamical range.

Psychophysical parameters show a temporal change which can be traced back to numerous reasons. The electrodes implanted into the inner ear will be covered with connective tissue which changes the electrodes’ impedance. This way to reach the same stimulation one must set diff erent amplitudes for the stimuli. During an adaptation period the central nervous system gets used to the louder sounds (especially in the case of praelingual and long lasting post lingual hearing loss). The comfort level rises, the hearing threshold drops, the dynamical range widens. As the result of continuous stimulation some regeneration processes occur at the periphery of the hearing nerve. This causes the change of thresholds (sometimes drastically). Numerous reasons can cause the electrodes to dislocate inside the cochlea. Because of the small sizes a sub-millimeter dislocation can cause a signifi cant change in the threshold levels. Having the above in mind we must say that the regular programming of the device is very important.


P217

NEWBORN HEARING SCREENING

Falcón González JC, Borkoski Barreiro S, Rodríguez Jiménez MC, Lopez Cano Z, Chicarro Soria I, Ramos Macías AUnidad de Hipoacusia. Servicio de Otorrinolaringología y Cabeza y Cuello.

Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria,

Spain.

The precocious detection of the infantile hipoacusia performs great importance to be able to initiate the early, and like that rehabilita-tion obtain a normal development of the language and of all the cognitive capacities that from it stem. The incident of the hipoacu-sia is coded in fi ve of every thousand newborn children according to information of the World Organization of the Health. If we refer to hipoacusias moderated to deep, the numbers range between 1 and 3 for thousand, and if we speak of hipoacusias severe to deep, we place in approximately 1 of every thousand newborn children.

In Spain the incident of the hipoacusia is 7,69 % in the population of risk, which 2,8 % supposes for thousand newborn children in the general population. The hipoacusias of severe degree to deep take place in 2,13 % of the population of risk, that is to say 0,77 % for thousand newborn children in the general population.

It is considered suitable that the diagnosis of the hipoacusia should realize in the fi rst six months of life, to be able to initiate in this age the rehabilitation and be able to include the candidates in the Pro-gram of Implants Cocleares, of what it is a Reference of the Autono-mous Community, Hipoacusia´s Unit of the Complejo Hospitalario Universitario Insular Materno Infantil. This aim achieves with more frequency every day, thanks to Screening Auditivo’s Program that at present it is Universal.

In the present work there are analyzed the results obtained with the Program of Precocious Detection of the Deafness of our Complejo Hospitario, in the period understood between January, 2007 and De-cember, 2008.

Newborn children studied a whole of 14199, being in use the Tran-sitory and Clinical Otoemisiones Evocadas as test of cribaje and the Evoked Auditory Potentials of Cerebral Trunk and of Stable State as diagnostic method for those that did not overcome the sifted one. The whole of newborn children with negative results was of 758 children, the number of newborn children with factors of risk was of 2708 children, and the whole of children included in the program of Implants Cocleares was of 8 children.

The percentage of coverage of the universal screening was 97 % the existing relation being considered to be very positive between effi -ciency and effi ciency.



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P220

ACOUSTIC VOICE MEASUREMENT IN PATIENTS WITH

BROCA’ S APHASIA

Vukovic M, Petrovic Lazic M.Faculty of Special Education and Rehabilitation, University of Belgrade, Serbia.

The aim of this paper was to analyze acoustic characteristics of voi-ce in patients with Broca’s aphasia and compared them to the voice of normal adult subjects. The acoustic tests were carried about on ten male patients with Broca’s aphasia and ten male control subjects without speech and language disorders. Each subject was asked to perform maximal vowel ‘a’ phonation. The acoustic parameters were jitter and shimmer. The computerized voice analysis laboratory „Kay Elemetrics“ (Multi-dimensional Voice Program) is used. The results showed that analyzed acoustic parameters in the Broca’s aphasics are signifi cantly diff er from the acoustic characteristics of voice in control group of subjects. It was pointed out that acoustic analysis of voice could have signifi cance in the evaluation of speech and language de-fi cits in Broca’s aphasia.


P219

GENETIC FINDINGS OF SELECTED PATIENTS WITH NON-

SYNDROMIC HEARING LOSS, AND THEIR RELATIVES

Nagy AL (1), Csáki R (3), Tóth F (1), Klem J (2), Tálosi G (4), Rovó L (1), Kovács K (2), Jóri J (1), Kiss JG (1).(1) University of Szeged, Department of Otolaryngology, Head and Neck

Surgery, Szeged, Hungary; (2) University of Szeged, Department of

Biotechnology, Szeged, Hungary; (3) Alfa-Biosoft Ltd., Szeged, Hungary; (4)

University of Szeged, Department of Pediatrics, Szeged, Hungary.

Introduction: Non-syndromic hearing loss (NSHL) is one of the most abundant human sensory disorders, and can be found in 1 out of 1000 newborns. In 60-70 percent of the cases this disorder is here-ditary, and in 70-80 percent of the cases has autosomal recessive ge-notype. The phenotype varies from moderate hearing loss to almost complete deafness, and, sometimes its expression occurs only in late childhood.

Methods: We evaluated 51 patients with cochlear implants (CI), who have hearing loss of unknown origin, their relatives, and a few other patients from our Department, who have hearing problems of unk-nown etiology. They total a number of 318. 20 control person’s GJB2 gene was sequenced as well, all their audiograms were all above -5dB. We have analysed our samples looking for mutations in the GJB2 (Cx26) gene with direct sequencing. We drew peripheral blood into EDTA-anticoagulated tubes, purifi ed DNA with Gentra’s kit, and stored the samples at 4 Celsius until use.

Results: We found 51 35delG heterozygotes, 23 35delG homozygo-tes, and 23 other patients with various other mutations in the GJB2 gene. None of these mutations are new, but some are very rare to fi nd in Caucasian population. 4 of the 35delG heterozygotes, and 8 35delG homozygotes are CI users, and 5 more CI users have other mutation than 35delG in the GJB2 gene. One CI user has two mu-tations in the GJB2 gene. We have analyzed 576 randomly selected blood samples from the Dept. of Paediatrics with AS-PCR, looking for 35delG mutation (being the most frequent cause of NSHL amongst Caucasians) to serve as control group. We did not fi nd any 35delG ho-mozygous patients, but we found 13 heterozygotes to this mutation

Conclusions: Evaluating these results, it seems obvious that gene-tic screening should be a routine task when we meet patients with hearing loss of unknown etiology, because almost one third of our selected patients has some mutation in the GJB2 gene, regarding the 35delG mutation, whereas only 2,25% has this in the randomly selected population. This screening could be extended to infants, or newborns, so if we know their genetic background, we can prepare for audiological care in time.

This work has been supported by the grant GVOP-3.1.1-2004-05-0498/3.0



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P222

GENETIC VARIANTS OF GJB2-RELATED DEAFNESS IN NORTH

CAUCASUS

Bozhkova V (1), Khashaev ZK (1), Umanskaya TM (2).(1) Institute for Information Transmission Problems of RAS, Russia; (2) Faculty

of Defectology of Moscow State Pedagogical University, Russia.

Aim and Background: Our aim was to study the etiology of hearing loss among the children living in one of a region of Russian Federa-tion - North Caucasus (a South-East part of Europe). First, it has been confi rmed that the c.35delG mutation in the GJB2 gene is the most common cause of sensorineural inherited non syndromic hearing impairment among children living in majority of European part of Russia. Among 9 young students aff ected by autosomal recessive non syndromic hearing loss (ARNSHL), mutations in the coding re-gion of the GJB2 gene have been revealed for 100 percent of deaf students. The allele frequency of the c.35delG mutation appeared to be 94% of all the mutations detected in the GJB2 gene. Another mu-tation we have revealed was 167delT the allele frequency being 6%.

Method and Results: On the other hand, when the entire coding region of the GJB2 gene was sequenced for 12 children from Nor-th Caucasus, aff ected by profound prelingual ARNSHL, mutations has been detected only in 4 deaf children (33% of cases). The total number of revealed mutations was three: 35delG (two children, non-relatives, the allele frequency of 40%), delE120 – formerly known as scarce one (two children, non-relatives, the allele frequency of 40%), and a novel mutation delE187 (one child, the allele frequency of 20%). In one case, the mutations were in a compound heterozygous state (35delG/ delE120 genotype), in three others – in a heterozygous state.

Conclusion: Since the pathogenicity of the delE120 mutation is con-sidered proven (Gabriel et al., 2001; Bruzzone et al., 2003; Baysal et al., 2008), its relatively high frequency in the North Caucasian region along with a relatively low frequency of the 35delG mutation should be taken into account when developing DNA diagnostics strategies for revealing inherited hearing loss.


P221

HELP APHERESIS IN SUDDEN HEARING LOSS TREATMENT

Bianchin G, Renna L, Guastamacchia P.Otolaringology Department. Santa Maria Nuova. Hospital of Reggio Emilia.

Italy.

Sudden Sensorineural Hearing Loss (SSHL) represents an acute mostly unilateral inner ear disorder of unknown etiology. In a selec-ted group of subjects suff ering from SSHL,we evaluated

- The results of an apheresis session versus 10 days of standard treatment

- The results of a selective apheresis session followed by 10 days of standard treatment versus 10 days of standard treatment

It was possible to compare a single apheretic treatment and the standard treatment considering that apheresis was conducted in the 24 hours following hospitalization with the patient not having star-ted with any kind of treatment.

“Standard” Treatment : infusion of 500 cc of glycerol, once a day, for 10 days, and intramuscular administration of Desametazone 8 mg once a day, for 10 days.

“HELP”(extracorporeal low-density lipoprotein fi brinogen precipita-tion) Treatment :a single H.E.L.P.-apheresis session, followed by Stan-dard treatment for 10 days.

The inclusion criterion for the patients was the presence of an acute,one-sided, sudden sensorineural hearing loss with a diff eren-ce of at least 30 dB as compared to the unaff ected ear in at least 3 connected frequencies. At diagnosis, the patients showed a value of LDL – cholesterol > 120 mg/dl and/or fi brinogen > 320 mg/dl A total of 131 patients were enrolled in the trial;61 were given “stan-dard” treatment and 70 were given plasmapheresis plus “standard” treatment

Recovery percentage:apheresis group 70 patients 50 (71,4%) with improvement and 20 (28,5%) without change

standard therapy group 61 patients 24 (39,3%) with improvement and 37 (60,6%) without change

The comparison between the two treatment methods (HELP and standard) evaluated on a number of patients with recovery shows a higher effi cacy of the HELP treatment as compared to “standard” treatment. This element shows that the HELP treatment cannot be considered as an alternative to “standard” treatment but is found to be an integration of the latter with the aim of improving the effi cacy.



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P224

DIAGNOSING DEAD REGIONS IN CHILDREN

Malicka AThe University of Manchester, UK

A dead region (DR) is a region in the cochlea where inner hair cells and/or neurons are functioning so poorly that a tone producing peak vibration in this region is detected by off -frequency listening. The presence of a DR can have signifi cant impact on the perception of speech. People with and without DRs may diff er in the benefi t obtained from amplifi cation and require diff erent hearing aids set-tings. The Threshold Equalizing Noise (TEN) test and psychophysical tuning curves (PTCs) are two masking procedures used to identify DRs in adults. The aims of this study were to: i) examine the feasibi-lity of using Fast-PTC and TENHL test with normal-hearing children ii) investigate the agreement of these two procedures with hearing impaired children. Participants were comprised of two groups: 21 normal-hearing children (30 ears) and 12 hearing-impaired children (21 ears), aged 7 to 13 years.

All normal-hearing children were able to perform the Fast-PTC task; however it was only possible to defi ne the tip in 87% of the fast-PTCs. The mean shift in the tip measured with ascending masker sweep was 11.4% and 8.2% of the 1 kHz and 4 kHz signal respectively. The TENHL test results, showed that masked thresholds in TEN measu-red in normal-hearing children are usually below TEN level/ ERBN. This suggests that adult TEN test criteria should be applicable when testing children as no age related eff ect on masked threshold was observed.

All hearing-impaired children were able to perform the TENHL test and fast-PTCs (as a gold standard). Nine out of 21 ears did not meet the criteria for a DR on both tests. 12 ears meet the criteria for a DR on TENHL test (using adult criteria); however fast-PTC confi rmed DR in only eight ears. Nevertheless the adult criteria for the TENHL are still the most appropriate in terms of specifi city and sensitivity when diagnosing DR in children.


P223

VESTIBULAR REHABILITATION – AN EFFECTIVE

MANAGEMENT FOR ACUTE UNILATERAL VESTIBULAR

DYSFUNCTION

Zupan L.ENT Department, General Hospital Celje, Oblakova ulica 5, 3000 Celje,

Slovenija. Background: A peripheral defi cit of the labyrinth or an unilateral le-sion of the vestibular nerve cause a threefold syndrome involving posture, ocular motion and perception. Vestibular defi cits require a considerable period for compensation to occur. Adaptive mecha-nisms can be facilitated by using vestibular rehabilitation (VR). We formed our own VR programme and used it in clinical practice. Re-habilitation favoured new sensory inputs and new motor strategies substituting for the lack of patient’s static and dynamic vestibular function by an early and active training including all available sen-sory cues. We modifi ed the VR according to patient’s ability (age, per-ceptive style). The patients were off ered a psychological support and pharmacotherapy to stimulate vestibular compensation.

Aims: The aim of this study was to evaluate the effi cacy of such thera-py in acute unilateral vestibular dysfunction (AUVD).

Methods: 16 patients with AUVD were recruited to the study after obtaining informed consent. 6 of them were treated with betahistine and 10 patients received medication combined with balance retrai-ning exercises. We compared the treatment effi cacy in both groups. The eff ects were evaluated using a validated self-assement question-naire called the Dizziness Handicap Inventory (DHI).

Results: Both treatments were eff ective in decreasing DHI score. Main change of DHI score after 3 months of treatment was for the fi rst group 31 and for the second 50,1. Exercise-based VR had a signifi -cantly higher effi cacy (p<0,05).

Conclusions: The recovery of vestibular dysfunction is greater when early active retraining and adequate pharmacological treatments are used in combination. This is a safe and eff ective management for AUVD.


AUTHOR INDEX


AU

TH

OR

IN

DE

X

A AbdelTawwab MM FP-89, FP-116Abdul Razak UA FP-39Adams D FP-103, FP-109Adelman C FP-20, FP-24Akhmetshin P212Alaerts J FP-80, FP-81Ali A P117Allum J FP-108Al-Saif S FP-89, FP-116Amal F FP-23Ambrosch P FP-59Anema JR FP-92Anteunis L SS803Aras I FP-91Araújo S P108Arnold L FP-59, FP-101, FP-104, P208, P209 Asanovic M FP-73Aschendorff A FP-59Attias J FP-04, FP-37, FP-66, P212

B Babac S P213, P214Babayan L P125Babisch W FP-118Banai K FP-38Barajas de Prat JJ FP-05, FP-79, P203Bauer C SS203Becker K FP-118Becker S FP-106Bellekom S P103Belov OA P119Bergman N FP-03, FP-06Bernhard H SS601Beutelmann R SS706Beynon AJ FP-108, FP-52, P215Bianchin G P221Bird P FP-67Bisgaard N SS302Blanco Cabañero AG P210Blaszak MA P114, P204Boermans PP FP-59Boets B FP-78Bohnert A FP-110Bom S FP-01Borg C FP-90Borgonha S FP-33Borkoski Barreiro S P217Bosman AJ FP-01, FP-43, P122Bouchataoui I P216Boyle P FP-59, FP-104, FP-105, P209Boymans M FP-02Bozhkova V P222Brand T SS704, SS706, FP-97Branda E SS102Brendel M FP-45, FP-47, FP-48, FP-103, FP-

109, P211Briccola E FP-99

Author IndexBriggs R FP-56, FP-68Brocaar MP FP-112Brokx J FP-108Bronyakin SA P119Brower A FP-107Brown PM FP-10, P206Büchler M SS504Büchner A FP-108, FP-45, FP-46, FP-47, FP-48,

FP-59, FP-103, FP-109, P211Burdo S FP-108Buschermöhle M SS501, SS503

C Cahn PYB FP-22Camilleri MT FP-85, FP-86Campbell KCM FP-33Canning D FP-101Carette E FP-11Celap M FP-91Cervera J P212Ceulaer GD P211Chalupper J FP-13Chan SC P117Charukiewicz A FP-95Che’ Din C N P105Cheung APP FP-22Chicarro Soria I P217Ching T FP-107Claycomb S SS605Colletti V SS602Conceição T P108Coninx F P106Conrad A FP-118Cook C FP-107Cooper H FP-59Cornick S FP-107Costanzo S SS604Cowan RSC FP-56, FP-68, P207, P205, P206Cremers C FP-01, FP-43Crowe K FP-107Csáki R P219Cuda D FP-99, FP-108Cvjetko T FP-91Czesznak A FP-93

D Daemers K P211Dalton J FP-56Danilkina G FP-53Dann M FP-10Das VK FP-83Dasgupta S FP-83Dau T SS705Dauman R SS204Davis A SS803, SS804Day J FP-107de Gier HHW FP-112De Laat JAPM FP-106de Leenheer E FP-01


AU

TH

OR

IN

DE

X de Vega M IS-02De Voecht K P122Deggouj N P201del Bo L FP-21del Oro CP P111del Oro Saez CP P110Della Volpe A P212Desloovere C FP-80, P201Deyeva Y P123Dhooge I FP-108, P201Diaz Fernández J P210, P124Digeser FM FP-60, FP-65Dillier N SS401, SS504, FP-108Doa G FP-04Dobrota N P214Downs M SS501Dreschler WA SS502, SS503, SS504, SS701, FP-02Drgas S P204Driver S P208, P212Drok T FP-15Dudarewicz A FP-27Dykmans P FP-101

E Eder HC FP-56Eklof M FP-59Eleftheriadis N FP-100Ellingsen E SS104El-Nabil LM FP-23Eneman K SS504Eng SP P104Ernst A P212Estrada Leypón E FP-108Eyles J FP-108

F Fabijanska P101Falcón González JC FP-108, P217Farhana Badrul Ezan N P105Farrugia E FP-90Fenech AJ FP-85, FP-86Ferguson MA FP-42Fernández Belda R FP-05, FP-79, P203Ferreira S P108Festen JM FP-15, FP-92, FP-108Fielden C FP-59Filipo R FP-59Flynn C FP-107Fortune T SS303Frachet B FP-59, FP-94, FP-108Fraenkel R FP-20Fraysse B FP-72Freeman S P112Freijd A FP-59Friederici AD P202Frijns J FP-59Froehlich M SS504Frohne-Buechner C FP-45, FP-46, FP-47, FP-48, FP-109Frontera P FP-99Fürstenberg D FP-108

G Gallego S FP-59García-Alvarez G P124García-Dueñas J P124Gazibegovic D FP-104, FP-105, P208, P212Geczy BB FP-19Geff riaud G FP-102Geng R P121Gentine A FP-108Gerrits E FP-61, FP-62Gevorkyan A P125Ghesquiére P FP-78Giarbini N SS604Gigirey LM P110, P111Goldbeck F FP-32Golubok-Abizova T P123Gorrie J FP-68, P216Gouma P P116Govaerts PJ P211Goverts ST FP-15, FP-92Gräbel S FP-108Grandori F SS801, SS803, FP-115, FP-117Grimm G SS504Grolman W FP-108Grover B SS505Guastamacchia P P221Guerzoni L FP-99Guire K FP-26

H Haeusler R SS601Hahne A P202Hall JW FP-26Hällgren M SS501, SS502Hanvey K P212Harlander N SS504Hassan M FP-04Hast A FP-60, FP-65Hatzopoulos S FP-76Helbig S FP-59Heller O FP-110Henning Puder SS504Hernández MC P126Hernández O P126Hernvig L FP-09Hertzman S FP-03Hessel H FP-53, FP-65Hey M FP-108Hinze A FP-44Hoeve LJ FP-112Hofmann M FP-81Hohmann V SS504Holmes AE FP-07, FP-26, FP-64Homans NC FP-87, FP-112Hoppe U FP-53, FP-60, FP-65, FP-108Hou S FP-107Houben R SS504Huarte Irujo A FP-108Hughes L FP-33Huygen P FP-01


AU

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OR

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DE

XI Iliadou V FP-42, FP-100Incerti P FP-68, P216

J James CJ FP-72, P216Jansen S SS504, FP-94Janssen T FP-110Jayarajan V FP-18, FP-82Jedrzejczak WW FP-54, FP-74, FP-76, P118Jeff s E FP-59Jenkins HA SS605Jespersen CT FP-12Jiang D P211Jiménez M P124Job A FP-25, FP-28Joff o LM P209Johansson A FP-17Jones J P212Jóri J FP-75, FP-93, P218, P219Joyce Lim JBH P104

K Kaandorp MW FP-15Kam ACS FP-22, FP-34Kameswaran M P212Kaprinis St FP-42Karni A FP-37Keck TN P215Keilmann A FP-110Keith RW FP-34Khalil LH FP-23Khashaev ZK P222Kienast B FP-59Kiessling J SS105Killian M FP-108Kiss JG FP-75, FP-93, P218, P219, Kleinjung T SS205Klem J P219Kochanek K FP-35, FP-36, FP-74, FP-76,FP-111,

P101, P102, P106, P107, P118Koci V FP-96Koh SQ D P104Kollmeier B SS502, SS501, S503, SS706, FP-94,

FP-97, P120Kolossa-Gehring M FP-118Kompis M SS601Kosanovic R P213Kossowski M FP-25, FP-28Kotylo P FP-27Kovács K P219Kramer SE SS803, FP-15, FP-92Krause L FP-07, FP-64Kreibohm K FP-103, FP-109Kruglov AV FP-50Krynda G FP-107Kunst H FP-01Kvaloy O FP-29

L Laborde ML FP-72Laitakari J FP-63

Lanziner-Furtenbach R FP-51Larsby B SS502, SS501, SS503,Larsson J FP-03Lavie L FP-37Law C FP-107Law M FP-68Le Prell CG FP-26Légrády P FP-75Leijendeckers J FP-01Leijon A SS504Lenarz T SS404, SS603, FP-44, FP-45, FP-46,

FP-47, FP-48, FP-49, FP-59, FP-103, FP-109, P211

Lengyel Cs FP-75Leone CA FP-108Lerahn J FP-53Lesinski-Schiedat A FP-46, FP-103, FP-109Leung EKS FP-22Levi H FP-20Li G FP-57Litvak L FP-45Lombaard S FP-59Lombard A SS504Looi V FP-14, FP-67, P113Lopez Cano Z P217Lorens A FP-54, FP-55, FP-69, FP-74, FP-95,

P106 Lorenzi C SS702Luijten BL FP-52Lupo V SS605Lutman ME SS501, SS502, SS503, FP-57Luts H SS504, FP-78, FP-80, FP-81, FP-94Lyxell B FP-17Lyzenga J SS501, SS502, SS503

M Mackenzie M FP-67Mahler N FP-107Majewska N P114Makri V P116Malaperdas K P115Malicka A P224Mancini P FP-59Mannan NH FP-39Manoj MP P212Manukyan T P125Marco J FP-59, P212Markatos N P115, P116Markova TG FP-114Marn B FP-40Marques D P108Mårtensson I FP-17Martin V FP-107Masegosa P P124Mateus T P108Mauler D SS504Mazzoli M FP-108McGaffi n AJ P109McGhie K FP-107McPherson D FP-35, FP-36Mecklenburger J FP-09Meerton L FP-59


AU

TH

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X Meyer B FP-59,FP-108Michaels L FP-86Mikic B FP-73Mikic M FP-73Miller S P103Miric D FP-73Mlynski R P102Moeller KN FP-12Mohamad S FP-39Mojallal H FP-44Money DK FP-56Moonen M SS504Moore B SS703Moore DR FP-42Mora Espino R FP-05, FP-79, P203Morant A FP-59Morera Pérez C FP-108Movsesova N P125Mrowka M FP-95Mülder H SS103, FP-32, Müller-Deile J SS402, FP-59, FP-108, P202Müller-Mazzotta J FP-108Mukari S FP-39, FP-70, FP-71, P117Murri A FP-99Mylanus E FP-43

N Nachtegaal J FP-92Nagy AL FP-93, P219Nayar R FP-33Nesgaard J FP-09Neumann K FP-41, P212Nielsen C FP-16Niemczyk K FP-108Niemczyk S P212Nott P P206Nunn T P211Nyman T FP-06

O O’Connor A P211O’Beirne GA FP-98, P109O’Donoghue G SS405Off eciers E FP-108, P201Olszewski L FP-95Orreteguy L FP-72Osei-Lah V FP-30Ostojic S FP-73Oswald H FP-110Ozimek E SS501

P Pace Balzan E FP-90Paglialonga P FP-21Paludetti G FP-108Pango P FP-106Papadas T P115Papakonstantinou A P120Parazzini M SS803, FP-21Parkinson A P216Patrick JF FP-56Pawelczyk M FP-27

Pawlaczyk-Luszczynska M FP-27Pedrosa S P108Pennings R FP-01Pérez Abalo MC P126Perez R FP-84, P112Perez S FP-24Peryman P P113Pesch J FP-108, P216Peter Lu KS P104Petrovic-Lazic M P213, P214, P220 Pickerill M FP-59Picou E FP-13Pilka A FP-36, FP-111. P102Pilka E FP-76Piotrowska A FP-35, FP-54, FP-55, FP-74, FP-95Plant KL FP-56, FP-68, P216Plantinga R FP-01Podskarbi-Fayette R FP-55Poelmans H FP-78Pogorzelski J FP-65Polyakov AV FP-114Prasher D FP-82Priner R FP-20

Q Quaranta A FP-108

R Radford C P113Radomskij P FP-77Raglan E FP-77Ramos Macias A SS403, P217Ravazzani P FP-21Raveh E FP-66Raynal M FP-25, FP-28Refaie AE FP-88Rehemtulla A FP-33Renna L P221Ricketts T FP-13Riedel H P120Riviere A FP-72Roberts L SS201Rocca C FP-102, FP-104, FP-105, P208Rodríguez E P126Rodríguez Jiménez MC P217Rønningen M SS104Ross B FP-33Rottmann T FP-48Roux-Vaillard S FP-108Rovó L FP-75, FP-93, P218, P219Ruehl S FP-103, FP-109Rutledge K FP-14Rydzewski B P114Rypkema G FP-108

S Saalfeld H FP-45, FP-46, FP-47Sainz J SS505Sainz M IS-03, P212Salido E IS-04Sanchez T SS202Santos E P126Sargsyan A P125


AU

TH

OR

IN

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XScherf F P201Schirkonyer V FP-110Schulte M SS504Schulz C FP-118Schwab B FP-44Seeber BU FP-58Seguí Moya P P124, P210Seiwert M FP-118Seligman PM FP-56Senderski A FP-35, FP-36, FP-111, P106, P107,

P108Serrano M P108Sevacsek Zs FP-75Shemesh R FP-04Shrivastav R FP-07, FP-64Shukuryan A P125Siburt H FP-07, FP-64Sichel JY FP-84, P112Sincock BP FP-98Sivonen V FP-63Sjödin C FP-17Skarzynski H FP-35, FP-36, FP-54, FP-55, FP-69,

FP-74, FP-76, FP-95, FP-111, P101, P102, P106, P107, P118

Skinner L FP-68Skjersli Lønseth T SS104Sliwa L FP-74, FP-76, FP-111Sliwinska-Kowalska M FP-27Smeds K SS101, FP-03, FP-06Smehák G FP-93Smit JH FP-92Smith J FP-08, FP-10Smith P SS803, SS804Smits C FP-92Smurzynski J P101, P118Snik A FP-01, FP-43, FP-52, P125Sockalingam R IS-01Sohmer H FP-24, FP-84, P112Sorri M FP-63Spriet A SS504Sprinzl G FP-96Sriskandarajah V FP-18Starfi nger C FP-98Stark E P208Steff ens T FP-108Stender T FP-09Stephan K FP-51Stephen AA FP-70, FP-71Stephens D SS803, FP-41Sterkers O FP-59Stevenson AW P205Stieger C SS601Stojanovic S P213Stöver T FP-44Street L FP-107Streitberger C SS604Sudhagar K FP-77Sukowski H FP-97Sulkowski WJ FP-31, FP-111, P107Sunkara P FP-33Szamosközi A P218Szyfter W FP-108

Szymczak W FP-31

T Tálosi G P219Tamir S FP-24Tanács A FP-93Tavartkiladze GA FP-50, FP-114, FP-115, FP-117,

P119Tavora-Vieira D P103Thamar van Esch SS502Thodi C SS803Tognola G FP-, FP-115, FP-117Tong MCF FP-22Topass N FP-82Torkos A P218Torres A P126Tóth F FP-75, FP-93, P218, P219Triglia J FP-108Trimmis N P115, P116Tronstad TV FP-29Truy E FP-59

U Uhlén I FP-17, P121Umanskaya TM P222Umat C FP-39, FP-70, FP-71, P105, P117Uziel A FP-108

V Vadhera M P212Vaerenberg B P211Vaid N P212Välimaa T FP-63Van Buynder P FP-107Van de Heyning PH P201, FP-108Van den Bogaert T FP-11Van Deun L P201Van Dun B FP-80Van Esch T SS503Van Hasselt C FP-22Van Kerschaver E FP-113Van Wieringen A P122, P201Vanat Z FP-59Vandermosten M FP-78Vangapalli S FP-82Vanpoucke F FP-101Várkonyi TT FP-75Vatovec J FP-19Vazquez C P110, P111Verschuure J FP-87, FP-112Villar García M P210Vinck S FP-87Vlahovic S FP-91Vlaming M SS301, SS505Vorman M SS502, SS504Vormann M SS503Vukovic M P214, P220

W Wagener KC SS501, SS503, FP-94, FP-97Walger M SS802Wansbury V FP-105Wass M FP-17


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X Weinberger J FP-24Wesarg T FP-59, FP-108Whitford LA FP-68Wigglesworth G P206Willis-Lorrier RMS FP-87, FP-112Wohlberedt T FP-53, FP-60Wolf A P202Wong TKC FP-22Wouters J SS501, SS504, FP-11. FP-78, FP-80,

FP-81, FP-94, P122, P201X Xu J P205

Y Yeoh LH FP-30Youn S FP-107Yusoff NM P117

Z Zakaria MN P117Zamojska M FP-27Zamratol-Mai S FP-70, FP-71, P105Zargi M FP-19Zenker F FP-05, FP-79, P203Zera J P102Zgoda M FP-69Zhang V FP-107Zigelski C FP-118Zokoll M SS503Zorowka P FP-96Zoth P FP-110Zupan L P223

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