delivered in the webinar 06/05/2012

1. Highlights of the Congress
presented by
Dr. Dr. h.c. Monika Lehnhardt
May 6th, 2012

2. Day 1 was dedicated to Basic Research
Biological and Genetic Basis for Hearing Loss
Distinguished speakers from the Laboratory of Molecular Genetics,
National Institute of Deafness and Other Communication Disorders,
National Institutes of Health, Rockville, Maryland, USA (Thomas B.
Friedman, Inna A. Belyantseva, Robert Morell) and from the
Department of Physiology of the University in Kentucky, USA
(Gregory I. Frolenko) talked about
Overview of the genetics of early onset human deafness
Shaping stereocilia from top to bottom
Using massively parallel sequencing to identify the genetic cause
of hearing loss in a new patient
TRPA1 – mediated cell signaling pathways in cochlear protection
and damage
What will the physician do with this information and
will the patient want to know?
Next Gene sequencing and genetic studies are needed.

3. Day 1 was dedicated to Basic Research
Auditory Research
Chaired by the world-renowned scientist Jos J. Eggermont from the Department of Psychology at
the University of Calgary, Canada, who also had an invited lecture on
“Effects of long-term moderate level noise exposure on the cortical
representation of sound: implication for speech perception”.
One key statement in this lecture, which is relevant for parents to remember, was:
The audiogram does not tell us about the problem!
Topics covered were:
Investigation of the neural link between the two ears – Contra-lateral
modulation of ABR before and after unilateral cochlear ablation in a mouse
model
D-methionine administration protects ABR thresholds and hair cells from
kanamycin induced ototoxicity in pigmented guinea pigs
Auditory processing disorder and imaging of corpus callosum fibers using
diffusion tensor imaging
An application of ERP-fMRI technique for assessment of auditory attention
The speakers were R.V. Harrison from the Department of ORL at the University of Toronto,
Kathleen Campbell from the Southern Illinois University School of Medicine, Springfields, USA,
D. L. McPherson from the Brigham Young University, Provo, Utah, USA and
M. Rusiniak from the Institute of Physiology and Pathology of Hearing, Warszawa.

4. Day 1 was dedicated to Basic Research
Electrophysiology and Psychoacoustics
Topics covered were:
An adaptive signal detection paradigm for use with sensory
evoked potentials (McPherson)
Analysis of otoacoustic emissions fine temporal structure
(O. Belov, Moscow)
Auditory nerve neuropathy and brain-stem auditory
neuropathy due to infantile thiamine deficiency: long-term
auditory sequelae (J. Attias, Haifa, Israel)
Spectrum resolving power of hearing as measured by rippled-
noise probes (A. Supin, Moscow)
Nonlinear effects in the auditory masking of the high-
frequency pulsed sounds by noise with a rippled structure
of the amplitude spectrum
(L. (Rimskaya-Korsakova, Moscow)
Fo For parents it may be relevant to know that:
“Thiamine is crucial for normal auditory development and function,
and its deficiency may be considered an acquired metabolic cause
of neuropathy of the auditory system in infants”.

5. Day 2 started with a Symposium
Implantable Technologies in Rehabilitation
of Patients with Hearing Loss
Moderator - Robert Cowan, Melbourne
Panelists - Roland Laszig, Freiburg, Germany, Th. Nikolopoulos, Athens,
P. Skarzynski, Warszawa and George Tavartkiladze, Moscow
Some key facts and statements:
R. Laszig states that there is good reason for treatment in case of monaural
hearing:
70–93 % of patients have a difference in the hearing level between the two
ears, 54–84 % suffer from Tinnitus
53 adults were enrolled in a study to look at the results of CI for SSD in FR
Better hearing as compared to CROS and BAHA was achieved in all patients
(this refers to speech understanding, spatial hearing and quality of speech
as well as localization of sound / speech).
Suppression of Tinnitus was achieved in 95% of the group.
“Soft surgery” to preserve residual hearing is desirable!
P. Skarzynski talks about “Partial Deafness Treatment” and claims 3756 CI
patients in the course of 20 years, out of which 1512 were treated for
“partial deafness”.
The most common objective measurement method is Neural Response
Telemetry
50% of patients with SS HL do not want any solution because they do not
want to wear anything on their head. Many patients do not even realize
they have a problem.
School screening has shown that 10% of children have a hearing problem.
Roland Laszig expresses his conviction that we have no other choice than
providing a CI to children as early as possible. We do not know enough
about neuroplasticity that would allow us to wait

6. Day 2 continued with a Round Table
Cochlear Implantation –
Criteria continuously changing
Moderator: T. Nikolopoulos, Greece
Panelists: S.Burdo (Varese, Italy), R. Gray (UK), R. Filipo
(Rome, Italy) G. Kyrafinis (Greece), R. Laszig
(Germany).
• Is it advisable to provide a CI under the age of 6
months?
All panelists agreed that this is not the case, unless the
child had meningitis.
• Which tests are useful for a 6 months old child to
base the decision on?
EABR, cortical responses, emissions with and without HA,
compare clinical results with behavioral, electro-
cochleography (FR)
• At which age are children too old for a CI?
Sandro Burdo: at around 5 years, the key is whether a
child has oral communication
Roland Laszig: There is no sharp edge! Important is the
training background, is there any residual hearing?
What is the level of expectation from the parents?
Roger Gray: the cochlear nucleus is important. By the age
of 13 years the degeneration is complete
Bilateral CI is supported by all panelists, however in the UK
funding is only available in case the HL is > 90dB.

7. Cochlear Implantation –
Criteria continuously changing
• Would you implant a child at the age of 2 years, suffering from 70dB HL
across the range, diagnosed at 18 months?
R. Laszig would, R. Gray no because of lack of funding, Filipo in Italy would be
careful and S. Burdo in Italy would implant one CI and continue with HA on the
other side.
• What about HA trials?
S. Burdo minimum 3 months, not only HA but also vibrator, R. Laszig advocates HA
for training and adapt the children to wear the outer components of the CI.
R. Gray is also for trials for 3 months except for in case of meningitis.
• Which communication mode is best?
S. Burdo: My centre is an oral centre, candidates who use sign language go to
another centre
R. Laszig: We offer a chance
R. Gray: A signing environment may hinder the development of spoken language
• What about a deaf child from a deaf family?
In case another family member, e.g. the grandmother will talk to the child a CI is
indicated.
These children do very well and use bimodal communication.
• What is an absolute contraindication?
R. Laszig: the absence of the auditory nerve, the absence of the cochlear,
in case the patient or the parents are not able to mechanically use the device,
fatally sick persons who have a life expectancy of only a couple of months

8. Day 2 parallel sessions on
Newborn Hearing Screening and
Speech Perception
The Newborn Hearing Screening comprised four
presentations about the situation in the UK, Mexico and Latin
America, Belarus and Russia and was chaired by Adrian Davis
from the UK.
The Speech Perception comprised five presentations, mainly
about various tests (e.g. multi-frequency Animal Sound Test,
HEARD, Matrix) and was chaired by Frans Coninx from the
Netherlands and Inna Koroleva from St. Petersburg.
Another invited lecture was by Giancarlo Cianfrone on
“Strategies for early detection of psychological comorbidity in tinnitus patients”

9. Day 2 with 4 sessions on CI
Cochlear Implantation I
Chaired by Roland Laszig
Robert Cowan (Melbourne) had three presentations
Six years experience with a totally implantable cochlear implant
The microphone is embedded in the titanium case. The “invisible hearing” can also be used with
an external processor. At 55dB all patients get recognition but all lower as compared to using
the external device. Some use the 3G during the day and the invisible hearing during the
night. The external also charges the internal device.
The battery autonomy is dropping over time, it will have to be replaced after 16 years when
using it 10 hours a day.
The microphone is the key issue, because we need to avoid body noise.
The other question is whether we will have a long-term-rechargeable battery.
Surface modifications to improve performance of cochlear implant electrode arrays
A drug eluting electrode is a feasible vehicle for delivery of therapeutic agents into the cochlea.
The goal is to modulate the tissue response.
Clinical experience with the Nucleus slim straight electrode array
This is a new electrode, specifically designed to preserve the residual hearing. First results are
very promising.
Predictions of success with cochlear implants using neural networks (S.Haumann, MHH)
• There were parallel sessions on Rehabilitation and Genetics, both comprised four lecture.
• The session on rehabilitation was chaired by R. Harris from Canada,
• the session on genetics by T. Friedman

10. Day 2 Lunch
The Cochlear Satellite Symposium
Performance. And more
Moderator - Roland Laszig
An International Faculty shared their latest insights and covered the following
topics:
Asymmetric hearing loss
Partial deafness
Conductive and mixed hearing loss
Single sided deafness (SSD)
Most of these topics were covered in previous lectures.
We can provide written information upon request.
The afternoon was dedicated to parallel sessions on
Cochlear Implantation
Screening Programs
Speech Audiometry
Humanitarian Audiology

11. Day 2
Cochlear Implantation II
Chaired by Monika Lehnhardt and Sandro Burdo
Scalability of post-operative care for CI-recipients (Monika Lehnhardt)
The full text and slides will be uploaded in the weblog
New frontiers in the remote cochlear implant fitting (Vigen Bakhshinyan)
The full text and slides will be uploaded in the weblog
Perception of temporal cues of environmental and speech sounds by
cochlear implanted patients (I. Koroleva)
Videos of her work with children in St. Petersburg were shown
The role of the initial period in the rehabilitation of deaf children after
cochlear implantation (Albina Sataeva)
Videos of her work with children in the Institute in Moscow were shown
Speech-hearing system formation of hearing impaired children
(Emilija Leongard)
Emilija changed the title and spoke about a natural and auditory verbal approach in
working with children with CI.
We will receive her manuscript in Russian and English and will upload it in the
weblog

12. Day 2
Cochlear Implantation II
Chaired by Monika Lehnhardt and Sandro Burdo
The development of musical pitch perception and production in children
with hearing aids and children with cochlear implants (P. Boyle)
Impressive videos where shown and the only question was: “ Why not use music in
the rehabilitation for children with CI? “
FOX Fitting to Outcomes eXpert: preliminary results of a multi-centric study
in Advanced Bionics’ users (D. Gazibegovic)
This software seems to improve the fitting process, especially in the early time (first
two weeks). It is recommendable for all CI manufacturers to agree on a common
platform for fitting CI
Development of a Mandarin expressive and receptive vocabulary test for
children using cochlear implants (Lena Wong)
There are 27,8 Mio hearing impaired people in China (2,1% of the total population)
2006–2013 the total number of CI will be 17.750 and 2012-2015 another 16.000!!!
There are only 100 audiologists in the country, no speech therapists!
What a challenge!!
Electrode array impedances fluctuation in normally functioning cochlear
M. (M. Litvak)
L.S. Vygotsky: “Deafness does not change only the child’s attitude to
the world but primarily has an influence on his/her relationship with
people”.

13. Day 3
Evidence Based Practice in Audiology
Moderator : L. Hickson
Panelists: L. Wong, G. Keidser, A. Laplante-Levesque
This was an excellent symposium with highly competent ladies who
discussed whether
Evidence based practice is the way
the profession has to go?
A very vivid discussion with pros and cons
concluded this session

14. Day 3 Key-note lecture of this conference
Auditory biophysics and instrumentation –
important pillars of audiology
The outstanding presenter was David Kemp from the UK – the discoverer of otoacoustic
emissions
He highlighted how long it can take from detecting / inventing something to application in
practice.
What makes a discovery to invention? How long does it take to clinical application?
What turns a laboratory phenomenon into a useful clinical test?
Application is often handicapped by lack of common standard for normal thresholds.
He illustrated the phenomenon how long it takes :
We waited 1700 years for steam to cause the industrial revolution!
He spoke about Roentgen, Thomas Gold, Bekesy, Alexander Graham Bell, David Edward
Hughes – the inventor of the radio and audiometer in 1879
David believes that middle ear power diagnostics is the future!
We see 15 dB variations /deviations in the commonly used OAE machines, which is
unacceptable
The vast majority of sensory hearing loss involves the outer hair cell dysfunction, but this
is not true for all hearing dysfunctions
OAE are a leakage of energy of the functioning cochlea – they are only a by-product!
The cochlear functional homeostasis is a bounce effect – a reaction to loud sound, i.e.
challenge. This is not fatigue, this is excitation.
David Kemp proved again to be a visionary.

15. Day 3
Experimental data on protection against inner ear
damages
Advanced Bionics Satellite Symposium
Gaetano Paludetti had another invited lecture on Experimental data on protection
against inner ear damages”
At lunch time Advanced Bionics held their Satellite Symposium
A New Era of Innovation
Mike Sundler presented data on hearing aids and cochlear implants
• 10 Mio hearing aids p.a. and a turnover of 15 billion CHF;
• 30.000 cochlear implants p.a. with a turnover of 800 million CHF;
• The performance for speech perception increased dramatically from 10% with the
early coding strategies to 100% with the latest (in quiet)!
• He stated that the original goal of designers of CI was to develop an aid to lip reading.
All their expectations were surpassed.
• Clearvoice was approved in 2012.
• Neptune – the latest speech processor of ABC – is appealing to consumers
(cosmetically, “designed to be used in the swimming pool”)
• There is a technology match between Sonova and Advanced Bionics, there is potential
for synergy.
• The FOX fitting system addresses the increasing number of recipients and lack of
audiologists . There are better results after two weeks, there is continuous progress,
less deviation.

16. Day 3 afternoon
Early Hearing Detection and Intervention
for Adults
This was a special session
moderated by F. Grandori from Milano, Italy
Hearing loss in adults /elderly is happening very slowly. Habituation is evident!
“Integration through immediate intervention” was funded by the EC
in the years 2008 to 2011.
SUN – Speech Understanding in Noise Test
Hearing “Acuity”, supra-threshold performance.
This is a multi-choice test with a touch screen interface
It is available in Italian, German, English, French, Spanish and Mandarin,
not in Russian yet
It is easy, fast, comfortable, low cost, tested in non-clinical setting
Adrian Davis spoke about the fact that there are 4,9 Mio people with a Hearing Loss in
the UK and 3,8 Mio do not have a Hearing Aid!
We are faced with a “demographic time bomb”.
We need to address the current need, prevalent need and future need.
Screening helps us to address all of these.
Should there be a universal screening for the population over 60 years of age?
Probably all we need is a target / sub-population screening.
It should be opportunistic, e.g. in hospitals or at the General Practitioner.
There were several sessions on Hearing Aids and
one on the vestibular function

17. Day 3
Evidence Based Practice
Chaired by A. Laplante-Lévesque
Presenters: Louise Hickson, Adrian Davis
Cost effectiveness was proven by Davis et al in 2007 but what about 2012?
“To think that the needs of hearing impaired people can be met by hearing
aids is insane. The majority of people do not want a hearing aid”.
Research was done to find out, whether older people hear better
nowadays, and the answer is Yes.
30% of the population that is older than 70 years wears a hearing aid.
People with a hearing loss are more likely to have depressions, cataract
and diabetes at the same time.
How do we respond to unmet needs? Universal Hearing Screening is not
the answer. A targeted Hearing Screening might be.
Beyond hearing aids: We need to increase awareness, increase capacity
and ensure quality of service. Hearing aids are not the only option. Aural
Rehabilitation programs are promising.
Participative decision making is increasingly important. New clients want
an
option. We need to take into account key predictors – the self-reported
difficulty in hearing and the readiness for change!

18. Day 4 Closing
This high level scientific congress was closed on May 3rd.
With Robert Cowan as the new President and
George Tavartkiladze as the new General Secretary
the International Society of Audiology will enter into
A New Era!