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  Newsletter 1998-2 - published August 1998 




Editorial 
Hans Verschuure, Secretary-General ISA 

Part of this issue was used as a special issue for the AAA meeting in Los Angeles. It was at that time, unfortunately, not possible to compile a full newsletter. 

We wanted to have a newsletter to distribute at the AAA meeting and
our third newsletter was not particularly interesting as the greater part of its contents dealt with the changed constitution. 

This newsletter focuses on the work of the International Society of Audiology and its global aspects, its connections with the developing world through Hearing International, with Hearing International itself, with the affiliated members and with WHO. 
 
 

One of the HI-IFOS-ISA Centers is located in Costa Rica. The aims of these HI-IFOS-ISA centers are to raise awareness of auditory problems and to find ways to implement services in the country using its own infrastructure. One of the best examples of such a service is the Costa Rica Center that has done a prevalence study in Costa Rica schoolchildren. Preliminary results of this study were reported on a PASA meeting organized at the AAA meeting in Fort Lauderdale last year. Here is an update showing how such an initiative can develop into general acceptance in a country and a good dissemination of knowledge. 



Report from Costa Rica 
Dr. Juan J. Madriz, MD. (Director "Costa Rica IFOS/ISA/HI Regional
Centre"; San José, Costa Rica) 

The year 1997 has been a very productive year in the Central American isthmus, from the point of view of communication disorders and audiology. Major developments are taking place in the different countries of the area, in a moment when democracy and development are rapidly taking over the years of struggle and discontent. 

In Costa Rica, the "First National Prevalence Study on Deafness for School Age Population" completed its data collecting phases and the data analysis has started in the Hearing Research Institute (HRI) of the University of Nottingham (U.K.) and in the National Institute for Deafness and Other Communication Disorders (NIDCS) of the National Institutes of Health (NIH) in the U.S.A. A presentation about the preliminary results of this research was done in Boston at the Annual
Convention of the American Speech-Language and Hearing Association (ASHA) in November. 

Major changes are taking place in the Health Sector in Costa Rica, where the Ministry of Health has engaged in profound reforms concerning the control and surveillance of disabilities. The new Division of Health Development created a unit that will take the "Regional Centre" as a key arm to monitor the status of hearing disorders, working on prevention of deafness and hearing impairment, promotion of ear care, continuous education for professionals in the field and from now on, early
identification activities will be the direct responsibility of the Costa Rican Social Security. 

Several major continuous education activities have taken place in the region - some promoted by the "Costa Rica IFOS/ISA/HI Centre" - including lectures on "Otoacoustic Emissions" (Dr. Ignacio Mora - Mexico), "Screening Methods in Audiology" (Dr. George T. Mencher - Canada), Prevention of Voice Disorders (Dr. Juan J. Madriz - Costa Rica). The University of Costa Rica started training a new generation of technicians in audiometry and the Universidad La Salle graduated its first generation of teacher for the deaf. 

Finally, the first steps have been taken to integrate the audiological efforts of the region through an initiative to network the different institutions, agencies, universities and individuals working in the field of audiology and communication disorders. This is aimed at creating an inventory of resources in the area, supporting needs for development of better services, training programs and facilitating sharing of information through the Internet. The home page (NetSalud) of the Ministry of Health will start a section of Disability and Hearing Disorders. 

  1998 looks as a challenging year ahead and we will show our accomplishments  through this ISA newsletter. 

In our newsletter we publish also announcements of meetings. We received a request from our US Associate Editor to publish this meeting on Tinnitus. 



   Conference announcemen

The Sixth Annual Conference on the Management of the Tinnitus Patient
will be held at The University of Iowa, Iowa City, on September 18-19, 1998.

Professionals who provide tinnitus management and patients who suffer
from tinnitus are invited to attend. 

The Guest of Honor will be Professor Peter H. Wilson, Ph.D., a  psychologist from Flinders University in Australia. He will speak on Attention-Control and Cognitive Restructuring Therapies for Tinnitus
and a critique of Habituation Therapy. Other guest speakers will be Glorio Rech, Ph.D., Director of the American Tinnitus Association and Michael Block, pH, Customer Service Manager at Starkey Laboratories, Minnesota. 

University of Iowa Faculty include Paul Abbas, Ph.D., Auditory Physiologist; Bruce Gantz, MD, Neurotologist; Brian McCabem MD, Neurotologist, Richard Smith, MD, Pediatric Neurotologist, Richard Tyler, Ph.D., Audiologist, Christie Novak, Ph.D., Clinical Psychologist, David Young, MA, Biofeedback Therapist. 

Topics covered will include Epidemiology, Physiology, Audiological Measurement, Psychology, Habituation Training, Cognitive Behavior Therapy, Medical and Surgical Evaluation and Management, Hearing Aids and Maskers, Hyperacusis, Tinnitus in Children, Support Groups, Psychotherapy, Relaxation Therapy, and a Patient Forum. 

 For registration information please contact, Richard Tyler, The University of  Iowa Department of Otolaryngology -- Head & Neck Surgery, 200 Hawkins    Drive C21GH, Iowa City IA 52242 phone (319) 356-2471; FAX (319)  353-6739; email rich-tyler@uiowa.edu. 



   ISA and IFOS have been involved together in trying to establish centers around the world. Originally this was done by direct action, later an  organization was founded, Hearing International. The goings of this
 organization has not always been smooth, particularly not in relation to ISA.  On the other hand some enthusiastic people, primarily from Japan and  Thailand have raised interest and money. A report on the nitty-gritty of  international cooperation. 


     ISA and Hearing  International 
     Hans Verschuure,
     Secretary-General 

     There has been an ongoing
     discussion in the ISA Board
     about the cooperation with
     Hearing International (HI).
     This had to do with the fact
     that procedures in Hearing International were unclear and actions were not accounted for in an acceptable way. Some friction had built up over the last couple of years. 

     The governing principle of the relationship between HI and ISA has always been full support of the goals of Hearing International. ISA as one of the  founding organization of Hearing International has never questioned the  intentions or the goals. ISA has shown its commitment in the past. After the call for action by Sir John Wilson at the Santa Barbara congress (1984) the ISA funded activities of newly formed centers in Bangkok and Mexico. 

     It was our perception that the role of ISA was played down and our attitude was often considered as uncooperative. Our problems had to do with sharing responsibilities of the work and a lack of accountability. 

     The issues were discussed with a group from the Board of HI in Bari and the ISA group had the impression that our concerns were to a great extent accepted. Unfortunately this did not result in action then. 

     After a change in the Board of HI we discussed matters again with the
     new Secretary-General of HI at the EFAS conference in Prague. The
     issues were recognized and a meeting was proposed between HI and its two parent organizations, IFOS and ISA. Prof. A. Parving of Copenhagen organized this meeting that was held in Copenhagen in November. At the  same time a Board meeting of HI was organized to which ISA was invited, although not represented in the Board. 

     The issues were discussed in a group of representative of HI (Prof. Suzuki,Prof. V. Newton and Prof. S. Prasansuk), IFOS (Prof. P. Alberti, Prof. E. Offeciers) and ISA (Prof. A. Parving, Prof. G. Mencher and myself). Most of these people also form the HI Centers’ Committee. Because of preparatory work the issues were discussed and in a one-day talk the issues could be settled. 

     These include: 
          A new and detailed application procedure for new Centers was
          developed  Criteria for the acceptance of centers were formulated; a center should be located preferably in the developing world, should have a reach-out program, should have a clear educational goal and should
   be well established (financially, economically and politically) in that
   particular country or region of the world 
    A procedure for the advisory board of a center was drafted 
    A visitation procedure was established before the actual acceptance
   as a center 
    A review procedure was established after the first two years and
    every four years thereafter 
   The different membership categories of HI were discussed. It was
   decided that recognized centers could be no members but would be
   targeted as recipients of support of which reports should be widely
  published 
     An auditing procedure was established 

     The new rules would involve more contacts with the centers and this would unfortunately increase the overhead costs if members of the Centers’  Committee would always do visitations. It was accepted that ISA or IFOS or HI members living nearby or on a visiting trip could do the visitation. 

     These Rules were accepted at the next-day board meeting of the HI
     attended by Sir John and Lady Jean Wilson, Prof. Hinchcliffe and the
     others mentioned above. Also Dr. A.W. Smith of the WHO office
     (PHD-Program) in Geneva participated in the meeting. 

     National chapters of Hearing International and its goal. 

     A major issue at the meeting was the establishment of national chapters.  These national divisions are essential for the work of Hearing International. They are functioning now only in Japan, Thailand and India and one will  soon start in the UK. The significance and role of national divisions was  discussed at length: the major goal of Hearing International is to raise awareness of hearing impairment and of the consequences for those suffering from it. A second (but not unimportant) goal is to raise money for research projects in the country itself and in the developing world. Such fundraising is usually done in cooperation with service organizations like Rotaries or industrial companies. One has to realize that awareness campaigns can only be effective if well-defined and appealing goals can be formulated. A list of good projects in a number of countries should be made available. It will give HI the possibility to present projects to interested  service organizations or companies for research support. Hearing  International (and through it IFOS and ISA) should guarantee the quality of the project and should organize the monitoring and auditing of the project. In this respect the new rules for the recognition of centers are important,
  although projects should not be limited to the HI-Centers. It is
     understandable that good projects from recognized centers will be
     prioritized; good projects from other centers will be closely monitored and recipients have to accept monitoring and auditing. 

     After the two-days meeting it was felt that partners had come much closer together and could / should cooperate more. The differences of opinion were removed and a common position was reached on a number of points. It was also felt that if HI would not get to a good start within the next year, we should rethink our strategy. 
 
 

 An example of a working chapter of Hearing International is Hearing
   International Thailand, which organized a conference and a fund
   raising meeting. A report. 



     Thailand International
     Conference on Pediatric ORL
     and Otology Update. 
     Hans Verschuure, Secretary General
     International Society of Audiology 

     In January 1988 Prof. S. Prasansuk in  Bangkok organized a fund-raising  activity. Additionally to this fund-raiser a  congress was organized as an update of  the activities of the Bangkok HI Center. HRH Princess Mahachakri Sirindhorn opened the congress. A round Table was organized to get a  survey of the result of 15 year activity in Bangkok to raise awareness in  South-East Asia and to discuss the relationship between the Bangkok center, Hearing International, Hearing International-Thailand and the founding organizations IFOS and ISA. 

     Most impressive were presentations from Thailand, Indonesia, India, the Philippines and Malaysia. In these countries audiological services were virtually non-existent 15 years ago. Now surveys have been carried out and prevention programs have been started, particularly primary (how can we avoid people from becoming hearing impaired) and secondary (how can we restore impaired hearing to normal hearing) prevention programs. Sofar rather little attention has been giving to tertiary prevention programs (like  hearing aid provision etc). 

     At the same time a meeting of the Board of Hearing International took
     place. In this meeting the developments since Copenhagen and the
     difficulties of implementing the changes were discussed, particularly the deviating structure in the only HI division that really raises substantial amounts of money, Japan. The decisions of Copenhagen were endorsed and the financial reports were discussed in view of these decisions. 

     The importance of national chapters was reiterated and key persons were identified. We call upon all our members to think about starting a national chapter or division. It seems a necessity to raise awareness in the population and amongst politicians. Hearing impairment is one of the most common health problems but is not recognized as such in many countries. It should get its proper place and the foundation of a national division of Hearing International in which professionals, industry, service organizations and political organization can work together seems to be essential. 

Further  information can be obtained from the 
Secretary-General of Hearing International, Prof. Valerie Newton, e-mail: newton@fs1.ed.man.ac.uk 

or  by mail: Prof. V.E. Newton, Centre of Audiology, University of
     Manchester, Dept. of Education of the Deaf and Speech Pathology, Oxford  Road, Manchester, M13 9PL Manchester, UK 
 

     ISA also participates in consultations with WHO. At WHO is a program  for the Prevention of Deafness and Hearing impairment (PDH). This  program organizes informal consultation each year. This years
 meeting was held 3-4 February 1998 at the WHO headquarters in  Geneva, Switzerland. 


     Consultation meeting of the PDH-program of the WHO 
     Hans Verschuure,
     Secretary-General ISA 

     In a two-day meeting in  which amongst others  Hearing International, IFOS,  the WHO-Centers and ISA  participated the results of      last-years activities were  discussed, as was the  program for the coming year.  Some reports from interesting activities were given like an awareness campaign in Brazil and an educational training program was presented. The importance of further education adapted to the needs of the country involved was stressed. 

     Further discussions involved strategic planning. The old concepts of
     pathology, impairment, disability and handicap will be abandoned by WHO  as this emphasizes the negative aspects; positive words like activities and participation will be used instead.

     Attention was given to the themes of the program. In the past the primary and secondary aspects were strongly emphasized in OME programs and  the program on the use of ototoxic drugs. From the floor (primarily IFOS and ISA) came the suggestion to start programs on tertiary prevention, which means rehabilitation. There is a high prevalence of sensorineural  hearing impairment and it is growing through noise pollution and aging. The  number of hearing aids in use is small. The reasons for the discrepancy have to be further assessed. An important issue seems the lack of an infrastructure in the majority of the countries. This and cultural problems could even be more important than the price of an aid. A meeting will be organized at the end of the year to discuss these problems and to find solutions for the future. 
 

     By changing our constitution the possibility has opened for affiliated
     membership. Affiliation was offered to all regional Societies and
     national Societies. The two regional Societies of which we are aware
     joined us. They are the PanAmerican Society of Audiology and the
     European Federation of Audiology Societies. Their logo will be
     printed on the cover page of Audiology from now on. 

     Logos of some of our affiliated regional
     members, PASA and EFAS. By clicking the EFAS
     logo you can link to the EFAS website

      Other affiliated members are the national Societies. We have been present  at the conventions of these two. Our Vice President was at the convention of the ASHA and  reported on his ISA activities. We show their logo to show their commitment to global activities. Clicking the logo connects you to the website.

The other national affiliate Society is the American Academy of Audiology  which held its annual convention in Los Angeles last April. Report on ISA’s  presence at the AAA convention. The meeting took place in a rainy and rather cold Los Angeles with presence of the Vice-President and the  Secretary General. Again, you can connect to their website by clicking the  logo.



     ISA at the AAA convention 
     Hans Verschuure, Secretary-general ISA 

     In April our affiliate member the American Academy of Audiology met for  its yearly convention in Los Angeles. At last year’s meeting there had been consultations between the AAA-Board and the ISA board about affiliate membership and we were very happy to hear shortly afterwards that AAA  had decided to join the ISA as an affiliate national member. The benefits  for AAA and ISA had to be worked out and some of these became visible at the Los Angeles meeting. 

     Featured ISA Lecture 

     First of all the ISA organized a sponsored presentation. After some
     discussion it was decided that this featured session would be organized by  your Secretary-General and would focus on his special interests and  research activities. A session on research in digital hearing aids in a number of European universities was organized. The idea was to present ISA as a scientific organization with strong links in clinical work and a global interest. The global part was stressed in the Americas by talking about European research. We hope to reverse the honor sometime on an European congress. 

     The timing of these featured sessions is somewhat unlucky, on Sunday  morning with the convention ending at noon and thus most of more than  6000 participants gone. Nevertheless there was an audience of more than 100 interested participants. The program consisted of a number of high-quality papers: 
          Verschuure (Erasmus Medical Center Rotterdam, the Netherlands)
          on concepts of compression   Hohmann (Carl von Ossietzky University, Oldenburg, Germany) on noise reduction using algorithms based on  Boone (technical University Delft, the Netherlands) on noise
          reduction by array-microphone design  Dreschler (Academic Medical Center Amsterdam, the Netherlands) on the necessity, the opportunities and risks of field studies showing  the results of two field studies. 

     The presenters included also some work done in other European
     universities. Verschuure stressed the notion that Europe is unifying at
     present and that much of the present work is no longer supported by
     national governments but is funded in direct competition by the European  Commission in Brussels (the European counterpart of funding by  Washington). 

     Exhibition 

     A second sign of presence was at the exhibition. The AAA had given the  ISA some free space at their Global Village booth, emphasizing their
 commitment to worldwide activities. 

     The ISA presented their major activities in the booth that was manned by our Vice-President George Mencher, our ex-congress President (1984) and  present PASA President Sandy Gerber, the next congress President Jorge Schwartzmann and our Secretary-General Hans Verschuure. The activities shown were: 
          Our journal Audiology (in cooperation with Decker publishers) of
          which free copies were handed out to interested people 
          The 1998 congress in Buenos Aires, Argentina, showing some
          posters, registration forms and, for those willing to register and pay
          up a discount registration fee. 

          The 2000 congress in the Hague, the Netherlands, with some posters  Our interest in the activities of Hearing International with posters and some leaflets  Our affiliation with the Pan-American Society of Audiology 

                                                                 
    . In my opinion activities like this are worthwhile enabling us to
     show ourselves and to get people together in an effort to join forces. See  you in Miami Beach, next year, to follow the beat and to further advertise our activities including the next congress in The Hague. 


                        Announcement 

     In Buenos Aires there will be a meeting of the Executive
     Committee at opening Sunday. This will be the last meeting of its
     kind. At the General Assembly meeting an election will take place
     of the new Assembly and the officers. From then on the new
     constitution, adopted in Bari and passed by our law-firm in Geneva,
     Switzerland will be effective. 

     Attend the General Assembly and hear reports on our activities,
     see our financial statements, decide on how we go on from here. Be
     involved. Bring in new members, full members (University degree)
     of associated members (all working in the field without a University
     degree) and affiliated members (your national Society). We hope to
     announce in Buenos Aires the opportunity for students to become
     student members. Phonak, Stäfä, Switzerland, will sponsor their
     membership. Make your students members of ISA. 

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