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  Newsletter 1 - Published April 1997

Welcome

This is a new Newsletter. It is an initiative of the ISA to enhance communication on new developments within the Society and to realise co-operation in our field and to realise an international voice of Audiology. It is the forum where you, the members of the Society, can voice your concerns and report your achievements. It is meant to realise what a society is, a symbiosis of people with alike interests who like to share. Please, send in reports to the Editor. 

ISA in change

Hans Verschuure, secretary-general ISA

The International Society of Audiology was founded in the early 50s by a number of highly interested and motivated researchers and clinicians. At that time the number of congresses organised in the medical field was small and there was a definite need for exchange of ideas. The ISA was founded in the way usual at that time: a meeting place for interested individuals and with links to WHO in Geneva.
The structure of the ISA was made accordingly. 

The major activities of the organisation over the years have been: 

     The organization of biannual conferences held every even year 
     The publication of a journal, Audiology 

The field of audiology has developed since then and we face an entirely different world now. The number of people responsible for audiological services have grown from some hundred to many thousands. There still is a need to expand the services because of noise pollution and a population that is growing older. Furthermore the quality of services to be provided is rapidly growing thanks to
new developments in amplification and medical care. Still in many parts of the world, services are restricted and often provided by people whose education in the field might be improved.

There has been a tendency for the congresses to become more clinical, for the journal to become more basal. Still the potential for participation in the conferences is much larger than participation because quite often national and regional meetings are considered more important. Also the potential for the journal does not seem to be used to the full, clinical papers of good quality should be submitted
more. Don't forget that the journal "Audiology" has one of the highest impact rates in the field which makes your publication count. 

The globalisation of the world is an important aspect of modern times. It does not mean that we should simply adopt a model from a well-developed country; it means that we should listen to each other and see what benefit we can get in one country from using the experience in another country.

The provision of sufficient means to cover the costs of services is a real problem all over the world. In the developed countries the fast growing expenses of medical services require containment, in the developing countries funds are very limited and should be used carefully. The awareness of communication problems is not well developed in society. Politicians seem not to recognise the importance of hearing for the development of people and society and the general public is often unaware of the impact of a hearing loss on their performance. The medical profession tends to ignore it as it is no direct threat to life. People seem not to understand its significance for the quality of life, for the development of young children, for the participation (or isolation) of old people in society. We need a voice to support national and international initiatives to protect the quality of life.

The ISA has decided to change and a couple of changes are now taking place. This very newsletter is the first of its kind and will serve to provide information of what is happening in the world of audiology to all members of the Society. Other changes that have taken place are the reduction in the cost of Audiology and the distribution of the Hearing International Newsletter to our membership. Please note, that Audiology publishes papers on basic and clinical audiology. Other
changes are that regional and national societies can now become affiliated members and non-university trained people working in audiology can become associated members. If you are interested, please contact the secretariat by mail, fax, e-mail or on the web (www.eur.nl/fgg/kno/ACTIF/ isa.htm). 

We feel that by making these changes the ISA has become more attractive and appeals to the workers in the field to make audiology a global experience. Read this newsletter just to give you a taste of a global experience.

At the Bari congress in 1996 it was decided to change the structure of the Society to bring it in a modern shape. New forms of membership were opened to make the ISA the international voice of Audiology. Some regional societies have expressed their interest to join the ISA and to use its publications as their official organs. One of the first to ask for affiliated membership was the PanAmerican Society of Audiology. The Society presents itself in this paper of its President. 
 
 

Report from the Americas

Sandy Gerber, Spokane, WA, USA, President of PASA 

Foundation

The PanAmerican Society of Audiology (PASA) is one of the first regional professional societies of audiology. It was founded during the International Congress of Audiology in Japan in 1992. 

Officers and Membership

The present officers of PASA are Sanford E. Gerber (USA), president, Pedro Berruecos V. (Mexico), vice president for North America; Fausto Coello-Serrano (Ecuador), vice president for South America; George T. Mencher (Canada), treasurer; and Juan José Madriz-Alfaro (Costa Rica), secretary. Any person who resides in any of the 35 nations of the Americas may join PASA, but other people can become associate members. To join PASA, send US$25.00 to the treasurer.
Everyone is welcome. Further forms of membership of PASA is organizational memberships and corporate memberships. So far only ASHA has joined PASA. 

Activities

     PASA meets every two years, in odd-numbered years to avoid conflicting  with the international congresses. 
     PASA publishes a quarterly newsletter called appropriately, "¿QUE
     PASA?" The editor of "¿QUE PASA?" is Dra. Monica Lopez-Vasquez of  Mexico. The newsletter prints a calendar of audiological meetings and events in the Americas and a section of audiology news of the Americas. In addition, it carries a regular news item from the president and a comment  from the editor. 
     At the biennial meetings, the distinguished PASA lecture is given. The first  PASA lecturer was Prof. Dr. Jorge A. Schwartzman of Argentina, the second was Dr. Pedro Berruecos V of Mexico. At the 1997 meeting, we  are honored to present our third distinguished PASA lecturer, Dr. Ross  Roeser of the University of Texas at Dallas and the Callier Center. 

Future Activities

     The next meeting will be in conjunction with the annual meeting of the  American Academy of Audiology. It will be held in Fort Lauderdale, Florida on the 16th of April, the day before the AAA meeting starts. Our agenda will consist of the required business meeting, including election of officers, and the PASA lecture. Every one is invited.   PASA is especially happy to note that the next International Congress of  Audiology will be held in our region, in Argentina in 1998. Of the (then) 24 congresses, only four have been held in the Americas. We have tentative plans to present a PASA-sponsored pre-congress meeting in Quito,  Ecuador. More about that as plans materialize. 

We invite your membership.

For information about PASA, please contact the secretary: 
Dr. Juan José Madriz-Alfaro 
Apdo. 223 - Centro Colon 
San Jose 1007, COSTA RICA
 

Another region of the world with a regional Society is Europe. Its regional society (or federation of societies) seeks co-operation and affiliated status with the ISA. 
 
 

Report from Europe

Jonathan Hazell, London, UK, Secretary of EFAS and Stig Arlinger,
Linköping, Sweden, President EFAS

Foundation

A preliminary meeting to found an European Organisation was held at the Congress of the International Society of Audiology in Tenerife in 1990. It was decided to form a working group and to organise a meeting. The European Federation of Audiology Societies was founded in 1992 at the first European Conference on Audiology hosted by the British Society of Audiology in Cambridge, UK. 

Aim

The aim of EFAS is to promote co-operation between national organisations for audiology, in the same spirit as today's audiology is based on a co-operation between several professional groups. 

Officers and membership

The members of the EFAS can only be national Audiology Societies or in case there is no national Audiology Society persons or representatives of professional organisations that can be considered representative of audiology in that country. Each country is represented in the General Assembly by one voting member and
two non-voting members. The first meeting of the General Assembly took place in Hanover, Germany in 1993 where a provisional board was formed. This council was duly elected at the second EFAS congress, held in Noordwijkerhout, the Netherlands in 1995. The present council of EFAS consists of Stig Arlinger (Sweden), president; Jonathan Hazell (UK), secretary and treasurer; Rene
Dauman (France), president-elect; Jarka Prihodova (Czech Republic), simulated past-president; Hans Verschuure (Netherlands), member-at-large. At Present there are 29 countries represented in EFAS.

Communication between the secretariat and the membership in 29 countries in and around Europe is done almost exclusively by e-mail. A website (currently accessible through www.tinnitus.org) provides information about our aims, representatives and European conferences arranged by the member counties in association with EFAS. 

Activities

     Audiology has not been well-established in Europe and differences between  the countries are enormous. The first goal will be to make an inventory of  available services and the training of the people providing the services. The  process was started in 1993 and is still pursued.  Provision of help where it is needed and requested for training in Audiology.  Last year the first European Audiology course took place financed by the  EU Tempus programme and some European industries. Pupils came from Romania, and the Czech and Slovak republics and received training from selected teachers in six leading European clinics. They returned to their own countries to set up local teaching programmes. As a second phase of  that Romania is now running a first training course ever for audiology assistants with 20 students coming from all over the country.  EFAS has a role in representing the view and needs of member counties  through their national societies, and since its inception has prompted the  formation of 7 national societies where before there was none. This helps
 not only in a European programme of advancement, but also nurtures
 academic audiology and encourages high standards of audiological practice and hearing health care in each country. It is essential that the national societies take an active interest in EFAS deliberations at their yearly  general assemblies, held at EFAS or ISA conferences. 
The organization of biannual European conferences in the odd years when  there is no international congress. Past congresses took place in Cambridge and Noordwijkerhout.  EFAS takes great care to liase and interface with ISA, Hearing  International and other regional organizations where appropriate. Several  representatives and officers have dual roles which facilitates this process. 

Future activities

     The next meeting will be held in Prague, 18-21 June, 1997. Information can be obtained from the Secretariat of the 3rd EFAS conference, Dept. of Paediatric Otolaryngology, Faculty Hospital Motol, V. Uvalu 84, 18 Prague 5, Czech Republic, Fax.nr. +42 2 2443 2620.   The meeting after that will take place in Oulu, Finland in 1999, organised by  Prof. Martti Sorri  Make an inventory of training and education of service providers in Europe. Establish minimum requirements for service providers to guarantee quality and make the exchange over national borders possible.  Promote audiology and hearing care with the European Commission and with national governments. 

We are a young organisation but one with a bright future, and we are fulfilling a definite need within Europe. 

Further information on the EFAS can be obtained from the secretary: 

Dr J W P Hazell 
RNID Medical Research Unit 
3rd Floor Middlesex Hospital Annexe 
Cleveland Street 
London W1P 5FD, UK 
Tel: +44 171 380 9308 
Fax: +44 171 580 6726 
email jon.hazell@ucl.ac.uk
 
 

Oto-acoustic emissions have become an important issue in Audiology. Its implications for hearing science have been studied quite extensively and are not fully understood. Its clinical application is gaining interest. One of the clinical researchers of tot-acoustic emissions, Dr. Bert van Zanten, presents a survey of the subject. 
 
 

Oto-Acoustic Emissions

Bert G.A. van Zanten, PhD (clinical-physicist/Audiologist), Hearing & Speech - Centre, Sophia Children's Hospital, Erasmus University Medical Centre Rotterdam, the Netherlands

Introduction: 

             The discovery of the phenomenon of Oto-Acoustic Emissions,
             OAEs, by Kemp in 1978 has lead to tremendous developments
             both in basic auditory research and in health-care applications.
             Kemp already indicated in his paper the clinical potential of the
             phenomenon. Although Kemp's basic finding was repeated
             within one year by others, the acceptance of the clinical potential of the OAE-phenomenon grew rather slowly. The recording of the OAE phenomenon (originally called the Evoked Cochlear Mechanical Response) requires the use of a sealed probe in the ear canal. The probe contains a telephone and a microphone. A click is presented through the telephone. The microphone now records the sound in the ear canal consisting of the stimulus and a reproducible sound wave.

The two panels of the figure show an example of the recording from the microphone. Both panels show the sound pressure amplitude as a function of time. The panel to the left shows the waveform of the stimulus, which last only a couple of ms and the panel underneath show the signal recorded up to 20 ms after the start of the stimulus. Please, mind the large difference between the amplitude scales being almost three orders of magnitude.

 It has been shown in the literature that this signal is generated in the cochlea, transferred through the middle ear and radiated into the ear canal by the tympanic membrane acting like the diaphragm of a loudspeaker. All kinds of lesions to the cochlea make the OAE phenomenon disappear or change, such as a noise trauma, the ototoxic effect of a drug, asphyxia, and others. When the inner
ear function is abnormal and pure-tone audiometry shows a hearing loss of more than 20-30 dB at all frequencies, the OAE can not be recorded anymore as a response to click-stimulation. 

It is important to keep in mind that the middle ear is the channel transferring this weak sound from the source in the inner ear to the recording system in the outer ear canal. The OAE in normal adult ears is rather weak, on average about 10 dB SPL. Small losses caused by minor middle abnormalities can cause the OAE to be too weak to be recorded.

In summary, the click-evoked OAE is a weak sound generated by the cochlea. It is only present if the cochlea shows no significant sensitivity loss and if the middle ear is normal. Only one exception to this rule has been reported up to now. In a hydroptic cochlea, such as in Meniere's disease, the OAE can be present in spite of cochlear losses of up to 60 dB measured with pure tone audiometry.

Other types of OAEs have been recorded since 1978. Two main classes are known, the spontaneous oto-acoustic emissions (SOAE) and the evoked oto-acoustic emissions (EOAE). SOAEs are generated in the cochlea without external stimulation. They usually are stable over time and they are continuously present. The Evoked OAEs, EOAEs, are generated in the cochlea as a response to external sounds. It usually is not easy to differentiate between the stimulus and
the cochlear response because of the large level difference. This is done presently either in time or in frequency. Transiently evoked OAEs, TEOAEs, are elicited by very short stimuli. The weak response is recorded separately after the end of the strong stimulus. Kemp's original recordings were made after the shortest stimulus possible, the click, had ended. Distortion product OAEs, DPOAEs, are pure tones
generated in response to two externally presented pure tones under certain conditions. They are generated as distortion products by the cochlear mechanism when processing these pure tones. The distortion products can also be heard and are called cubic difference tones.

Research applications 

The OAE-phenomenon was totally at odds with the current theories in 1978 on cochlear mechanics. Many researchers and clinicians found it unbelievable that the ear would generate sounds. This is one of the reasons for the slow start of research on the clinical application of OAEs. The auditory theory had to be modified first into the concept of an 'active' cochlea, generating OAEs. Presently, OAEs are viewed as the by-products of cochlear amplification of weak sounds in order to make them detectable for the mechano-neural transducer. In this concept the outer hair cells (OHCs) amplify sounds of levels of roughly 0 to 60 dB SPL. The inner hair cells (IHCs) function as transducers for sounds with levels of between 60 and 120 dB SPL. The range of the IHCs is extended downward by 60 dB through the OHC mechanism. More basic research is still needed to find out the details of the transduction and the amplification mechanism. OAEs can be
modified by contra-lateral stimulation. This enables non-destructive assessment of the central control of the inner ear by the efferent fibres of the acoustic nerve. 

Clinical applications 

The OAEs are usually weak sounds which means that confounding sounds are easily picked up by a sound recording system. In fact it is much easier to make a sound recording system that oscillates in response to a stimulus than it is to make a reliable OAE-recording system. The first commercially available systems were unreliable when used in clinical conditions. As a result people lost confidence in
the use of OAE recordings for clinical purposes. Furthermore a patent on OAE recordings was filed in a number of significant countries which allowed the patent holders to fully control further commercial developments. As a consequence commercial developments were hampered. Kemp's view that he could better 'publish' significant parts of his lab's knowledge on methods of reliable OAE-recording in the form of equipment lead to the OtoDynamics company, presently dominating the world market of OAE recording equipment. 

(Remark by author: I'm not in favour of a 'pharmaceutical' approach to scientific knowledge, but in this case I'm not so sure that it was wrong. It appears that most of the developments done or supported by OtoDynamics would not have been done at all or else much later.) 

Presently the major clinical application of OAE recording is the screen for ear-dysfunction in all neonates or in targeted groups of neonates. This development was started around 1989 and is growing rapidly. In the US the number of neonates screened almost doubles every year and was over 120,000 in 1995. Half of the screens were done by proving OAE presence, the other half by auditory-brainstem-response screens. In a recent report by the EU concerted action programme, an inventory of European sites of neonatal hearing screens was made. It showed a rapid growth in Europe too, although Europe still lags behind the US. In the north-western European countries there was a tradition of behavioural hearing screens; here only studies on the feasibility and the efficacy of neonatal screens by OAEs have been done or are presently being done. In countries that lack an universal screen the decision to screen neonates universally has been made or is about to be made. The decision to use OAE recordings for neonatal screens has been taken in a number op eastern European countries.

OAEs can also be used for the discrimination between cochlear and
retro-cochlear pathology. The OAEs are in fact purely a cochlear phenomenon. Their presence is hardly influenced by retro-cochlear dysfunction. In a case of a neural hearing disorder the presence of an OAE can proof the (almost) normal function of the peripheral ears although the audiogram is abnormal. This is important knowledge for hearing rehabilitation and for the planning of surgical intervention in cases of cerebello-pontine angle tumours.

At the Santa Barbara Congress in 1984 it was decided to support initiatives to establish ear and hear services in the developing world. The decision to do so was taken after an appeal by Sir John Wilson. This initiative has led to co-operation with the International Federation of Otolaryngology Societies, IFOS and the eventual founding of Hearing International. One of the first initiative to be established was a Centre in Bangkok for the prevention of deafness. Here you find two reports on this activity supported by ISA. Other
reports can also be found in the Hearing International newsletter. 
 
 

Report From Asia

News from the Otological Centre, the Bangkok Unit of the Faculty of Medicine Siriraj Hospital 

Dr. Suchitra Prassansuk, Director 

Structure

The Otological Centre, the Bangkok Unit was established on 12th March 1985 as first ISA-IFOS Centre for the prevention of hearing impairment and deafness. It has become the first WHO collaborating centre in July 1988. It is situated at the ENT Department of the Faculty of Medicine of the Siriraj Hospital of Mahidol University and is under the directorship of Dr. Suchitra Prassansuk. The purpose of  stablishing the centre was to realise the initiative taken by ISA and IFOS for a global campaign on ear and hearing care. 

WHO requirements

The centre is a WHO centre for which it has to fulfil certain criteria, called the terms of reference. These are: 

   1.to provide courses to upgrade the audiological capabilities of ENT doctors within the region. 
        1.to disseminate ENT technology of specialists and non-specialist  hospitals and personnel, as well as at the level of primary health  care. 
   2.to act as a referral centre for patients with known or suspected auditory disabilities, particularly when there is uncertainty of diagnosis or problems in  management. 
   3.to provide or advise on suitable medical, surgical and rehabilitative
     management of patients with auditory disorders. 
   4.to construct a data base on the nature and extent of auditory disorders in  the region. 
   5.to formulate prescriptive screening programmes within the context of  various regional countries. 
   6.to advise governments in the region on prevention programmes for auditory disability appropriate to the structure in these countries. 
   7.to undertake research into how essential ear care can best be socially and  cost-effectively provided at community and district health levels. 
   8.to collaborate in the regional Fellowship programme in graduate and post graduate ENT specialist training. 

Achievements

     The Otological Centre, the Bangkok Unit has already accomplished 11 successful Oto-audiology Update Courses with almost 500 participants  from over 20 countries. 
     Survey and Service for ear and hear care were done through out Thailand. 
     Manpower development and service have been extended to neighbouring  countries in greater need such as Laos, Myanmar, Mongolia. 
     The Otological Centre, Bangkok Unit has been a centre of excellence and  has helped in establishing other centres in the region in Jakarta and Manila. 

The report shows the good outcome of the initiative in that in the some 10 years after starting the work ear and hear care has been established in ASIAN Countries and has flourished. It shows that a network can be set up in the area and that co-operation can be established to the advantage of all countries.

Another such an initiative took place in Mexico City, on which its director now reports. 
 

Report from Mexico

Prof. Dr. Pedro Berruecos, President of the IMAL 

THE MEXICAN/Latin-American MODEL FOR THE TRAINING OF
SPECIALISTS IN THE AUDIOLOGICAL FIELD: Graduate and Postgraduate Programs.

The Mexican Institute of Hearing and Speech-Language (IMAL), is a non government, non profit organization, first of its kind in Latin America, and was founded in 1951. Since 1995, IMAL has been nominated as one of the 11 Affiliated Centers of IFOS/ISA/HI. Medical Doctors, Speech and Language Therapists, Teachers for the Deaf and Technicians in audiometry, have been trained at the IMAL since the 50s and have taken part in the establishment or in the reinforcement of an important number of institutions all over Mexico and Latin America. The first Mexican specialists were trained at the IMAL and they inaugurated the Mexican Society and the Mexican Board of Audiology and Phoniatrics, 20 and 10 years ago, respectively. The Mexican Society today has more than 500 members and the Mexican Board has certified more than 200 Medical Doctors specialized in Audiology.

After the experiences over 45 years in the training of personnel in the audiological field, the IMAL is now working in 4 main programs: 

     Training of technicians in audiometry and auditory rehabilitation 

It is a two-year training program for technicians who will be in charge of the diagnostic and therapeutic electro-acoustic equipment in the clinical setting and who will fit hearing aids. The training incorporates ear mold production, lip reading and auditory training 

     A graduate program for speech and language therapists and teachers for  the deaf 

It is a four-year training program and graduation permits their professional involvement in rehabilitation clinics or in special education settings 

     A medical specialization in audiology and phoniatrics 

It is a three-year program for MDs, conducted on the basis of an agreement with our biggest medical center, the General Hospital of Mexico, with the academic approval of the National University of Mexico 

     A master degree in hearing, speech and language pathology 

This is the first postgraduate program of its kind in Latin America. Its main objective is to train high-level professors and researchers in the fields

All IMAL programs received the official approval of the Department of Higher Studies and Scientific Research of the Ministry of Education of Mexico.

The program brings IMAL in a privileged position to improve the quality of diagnosis and therapy in the field of audiology, catering for the needs of a 450 million population in the Spanish speaking countries. IMAL´s main objectives are also aiming at a spin off: an improvement of the academic and professional standards of our disciplines all over the Latin-American region.
 
 

The next congress of the ISA will take place in Buenos Aires, Argentina. We received the following report from the organiser 
 
 

XXIV INTERNATIONAL CONGRESS OF AUDIOLOGY 

Dr. Jorge Schwartzman, President XXIV Congress ISA

Focus of congress

We would like this Congress to be an opportunity to integrate audiologists from Latin-American, which due to economic reasons cannot often afford to travel, with audiologists from Europe and the USA. Of the vast amount of American audiologists only a very few take part in these international events, while others tend to attend only national conventions. We would be very pleased of this event could be a way of integrating colleagues from all over the world in a meeting where we can share our experiences, research and knowledge. At this moment, entering the third millennium, with the special characteristic that everything goes global, let us hope that this event be a way to globalisation of audiology. Hot topics like effects of drugs and surgery on the treatment of hearing loss, regeneration and plasticity of hearing cells, re-engineering of auditory pathways, cochlear implants, oto-acoustic emissions, and others will be discussed by the most prominent specialists of this field. Apart from this primary goal of the congress, the congress and its venue have more to offer. 

Argentina

It is located at the Southern extreme of the American continent. Argentina is the eighth largest country of the word and, I can assure you, one of the most beautiful countries. It is a place to enjoy for all four seasons and you can see every type of scenery imaginable. Each region of the country offers something different because Argentina contains areas with all physical conditions known to man: heat, cold,
forest, desert, mountains, endless plains and big cities. 

Buenos Aires: 

The town is built along the Rio de la Plata. It is the most elegant city of South America. It is a booming capital by day and ablaze with entertainment by night. Doted with luxurious palaces and modern buildings, Buenos Aires is one of the most fascinating cities in the world. It is a city where the traveller yields to the charm of the Tango. Theatres and museums, parks and boulevards, shops and hotels, and a wide choice of restaurants in which one can sample the  word-famous Argentinean beef. For the European, Buenos Aires is the cosmopolitan city given to the outdoors, with unique hospitality, cultural activity and charm
 
 
 
 
 

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