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Vice President of Audiology and Professional Relations, OticonDon Schum currently serves as Vice President for Audiology & Professional Relations for Oticon, Inc. When viewed within the broader context of life change, it is not surprising that so many older adults resist the idea of using hearing aids. To best understand what can be done to compensate for sensorineural hearing loss (SNHL), it is essential to relate treatment approaches to the underlying change in signal encoding. This course discusses the relationship between expected outcome and satisfaction with the hearing aid process.
Director of Clinical Research and Professional RelationsDr Ravi Sockalingam is the director of clinical research and professional relations for Oticon Medical LLC. Vice President of SalesJustin Pfeiffer worked as a Territory Manager for Entific Medical Systems and continued in that role at  Cochlear Americas . The course will describe Oticon Medical’s OptiGrip Implant and OptiFit Abutment and how their design has made it possible for surgeon’s to use other surgical approaches that utilize linear incisions or a punch biopsy and less removal soft tissue in order to optimize the post-operative outcome.
Prescription and verification of hearing aids is an important component to clinical audiological best practices.
This course will examine the indications, benefits, and the pitfalls of both the percutaneous and transcutaneous bone conduction implant systems.
This seminar provides an overview of the auditory implantable technologies that are available to patients today. Unilateral hearing loss (UHL) is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties. This indicates that the majority of people today who are fit monaurally with hearing aids are those with unilateral hearing loss (UHL).  UHL is defined as a loss in one ear of any degree (mild to profound) regardless of the type of hearing loss.
Recent research indicates school-aged children with UHL demonstrate worse oral language scores (worse language comprehension, oral expression, and oral composite) compared with siblings and normal-hearing age peers.5 Academically, children with UHL have been found to perform more poorly than their normal-hearing counterparts. Although the choice to fit infants with moderate or greater degrees of bilateral hearing loss has become standard practice, the decision of whether to fit amplification to children with UHL is less clear. With the introduction of universal newborn hearing screening, UHL can be diagnosed within the first 3 months of life. The treatment of UHL can include sound field systems, FM systems, traditional hearing aids, CROS hearing aids, bone-anchored hearing aids (BAHA), and even a cochlear implant depending on the type, configuration, and degree of hearing loss. The benefits of hearing aids include increased audibility, minimizing of auditory deprivation, as well as ease of listening in both quiet and noisy listening conditions. Johnstone and her colleagues10 investigated the sound localization acuity of children with mild-to-severe UHL ages 6 to 14 years who wore a hearing aid in the impaired ear. Fitting of hearing aid amplification is indicated for some people with unilateral hearing losses. Regarding timing, older children and adults with UHL who are identified as candidates should be fit with amplification as soon as possible. Should hearing aids be fit differently for patients with UHL than for those with bilateral hearing losses? It should be noted that current prescriptive methods are specifically studied and designed for people with bilateral hearing loss.
When doing the initial fitting, be aware that some software will default to a monaural fitting prescription when only one hearing aid is connected if the fitting rule incorporates a binaural correction. As mentioned, the literature on fitting of asymmetric hearing loss can inform how to fit UHL.
One technique12 to achieve the goal of binaural fusion or balance for fitting an asymmetric hearing loss can easily be applied to fitting UHL. Whether hearing aids should be fit differently for those with UHL also extends beyond the gain-frequency response prescription to features of the hearing aids. Children’s limited experience with receptive speech and the importance of overhearing will limit the use of directional microphones. One important consideration when using wireless accessories is that the fitting should be considered open regardless of how the impaired ear is fit.
Frequency lowering (frequency compression, frequency translation, or frequency transposition) algorithms are another common feature in hearing aids today.
UHL is common, and without intervention it can lead to academic, speech-language, and social-emotional difficulties.
The National Acoustic Laboratories (NAL) is the research division of Australian Hearing, a Statutory Authority under the Commonwealth Department of Human Services. NAL is a world leader in research into hearing assessment, hearing loss prevention and hearing rehabilitation.
Click on the links below to access the NAL online shop and other affiliated sites where current active research is taking place.


Previous to his position at Oticon in Somerset, Don served as the Director of Audiology for the main Oticon office in Copenhagen Denmark.
This seminar examines techniques developed by related professions in encouraging the older patient to be willing to make a health care change.
In this seminar, we will examine what we know about how patients become aware of the presence of hearing loss and how they react to this new reality in their life.
Given the inherent limitations imposed by sensorineural hearing loss, there will be limits to how well a newly fit patient will be able to perform with amplification. A native of Singapore, he completed his training in speech pathology and audiology at the University of Queensland, Brisbane, Australia where he also received his PhD in Audiology. However, bone anchored devices present a challenge to the prescription and verification procedures. The indications, and the pros and cons of commonly used middle ear implants, osseointegrated implants, cochlear implants and auditory brain stem implants will be discussed.
Research shows sound localization test scores were significantly poorer for the children with UHL than for the children with normal hearing.
In a study of 60 children with UHL, Bess and Tharpe6 found that 35% of the children had repeated at least one grade in school, and an additional 13.3% required resource assistance, such as academic tutoring. It has been shown that fitting of aids soon after identification can minimize language delay; however, there can be a delay of up to 7 months in provision of amplification for children with mild and UHL. In this article, we will only discuss the fitting of conventional hearing aid amplification. Their results showed that a hearing aid can provide bilateral localization benefit to some children with UHL.
The decision to fit a patient with unilateral hearing loss should be made on an individual basis, taking into consideration the person’s or family’s preferences, as well as audiologic, developmental, educational, and communication needs.
Those with moderately severe or better UHL are likely to accept the use of a hearing aid, whereas those with a severe or profound UHL may not comply with hearing aid usage at all.
For infants, there is still debate whether they should be fit before or after 18 months of age. Although the prescription may provide targets for a monaural versus binaural fitting, it might not specifically address the needs of people with UHL. NAL-NL2 is an example of a prescription that provides binaural correction for both pediatric and adult patients, while DSL 5.0 only has a binaural correction for adults.
Directional microphones can be fitted according to the patient’s communication needs for adults with UHL. When a directional microphone is used, it is recommended to keep it in the automatic mode.  There is some evidence that directional microphones in the automatic mode will switch appropriately between a directional and omnidirectional response for the given environment approximately 90% of the time.
But there is only limited literature about hearing aid fitting for patients with UHL; some of the ideas have to borrow from asymmetry hearing loss fitting. Fitting of a hearing aid should be individually based and using your own expertise, taking consideration of patient age, degree of hearing loss, speech development, communication needs, and other morbidities, etc. Monaural hearing aid fitting considerations for Patients with unilateral hearing loss: Who should receive unilateral fittings, and how should you fit them? Hearing Review. The research that NAL conducts is critical to helping people lead more fulfilling and productive lives. In addition, he served as the Director of the Hearing Aid Lab at the University of Iowa, School of Medicine (1990-1995) and as an Assistant professor at the Medical University of South Carolina (1988-1990).
However, satisfaction with the process can still be high, especially if the focus is placed on the professional care provided by the audiologist.
As a full time faculty in audiology he had taught and undertaken research in various areas of audiology in Australia, Israel, Canada, China, New Zealand. This course is a compilation of three courses on the topic of bone anchored hearing solutions, and will provide information on how to implement these procedures for audiologists who have patients with bone anchored devices, including the pediatric population. In the ensuing years, as the benefits of binaural hearing aid fittings became apparent, the proportion of monaural-to-binaural fittings did a dramatic flip-flop.
Localization acuity in younger children with UHL was significantly improved, but not in the group of older children; time of intervention is also a main factor affecting the localization benefit. On the one hand, it is unknown what degree of UHL may result in auditory deprivation and what is the critical time to provide amplification thereby avoiding these effects. That is, we do not yet know if people with UHL prefer the gain generated by a prescriptive method designed for monaural fitting of a bilateral hearing loss.7 But we can get some inspiration from fitting experiences with asymmetrical hearing loss. While a program button to access multiple listening programs may be of little relevance for patients with UHL, a volume control is a must.
WDRC will automatically adjust the gain of the hearing aid based on the input sound level to ensure natural perception of loudness.


For children, the use of directional microphone may be beneficial in some listening situations, such as when the target signal is located in front of the listener; however, decreased performance with directional response has been noted when the target signal was located to the side or behind the listener.
Such hearing aids can receive an audio signal from a remote location to improve signal-to-noise ratio (SNR) and can be of particular benefit when listening in noisy environments. The time of arrival of the streamed wireless signal to the impaired ear should not be delayed too much relative to the good ear receiving the signal acoustically to avoid disturbing perceptual effects.
Noise reduction has not been found to improve or degrade speech understanding in adults or school-aged children, but it can improve comfort and ease-of-listening in realistic listening situations. Since the good ear will receive undistorted normal sound, the frequency lowered sound may interfere with binaural processing. The role of aided ear is to provide more useful information to help understand speech and for binaural processing. The relevance of other treatment options than conventional hearing aids, such as FM, CROS, BAHA, and a cochlear implant, also should be considered and communicated to the patient. Amplification considerations for children with minimal or mild bilateral hearing loss and unilateral hearing loss. Sound localization acuity in children with unilateral hearing loss who wear a hearing aid in the impaired ear. An evidence-based systematic review of amplitude compression in hearing aids for school-age children with hearing loss. Fewer wires, less complexity, and more connections: The new challenge for wireless hearing instruments. Click on the links below to read more about NAL's world-renowned scientific investigations and to find out how you can participate in this research.
Prior to joining Oticon Medical LLC in Dec 2010, he was the senior audiologist and manager of audiology communications at Oticon’s international head quarters in Smorum, Denmark for three years. Currently, Justin is employed by Oticon Medical  where he is the Vice President of Sales. The children with UHL also had significantly poorer speech-recognition scores than their normal-hearing peers.
Children who were fit earlier showed bilateral benefit, whereas children who were fit later showed bilateral interference. Thus, any binaural correction should be used even though only one hearing aid is being fit to compensate for binaural summation effects. Then, ask the patient about where they perceive your voice to be coming from when you are sitting in front of him or her. This is because it won’t be known how the poor ear with amplification will interact with the good ear in real-world situations.
An example of a wireless accessory that could be used for this purpose is a companion microphone that can be held or worn by a conversational partner or speaker-of-interest. When the poor ear has a severe hearing loss, the aided sound can reach the brain, but it may not be helpful. Unilateral hearing loss is associated with worse speech-language scores in children: a case-control study. Schum has been an active researcher in the areas of Hearing Aids, Speech Understanding, and Outcome Measures. And, without hearing aid amplification, localization performance in children with UHL rarely equals that of peers. Increase or decrease gain accordingly until the patient reports hearing your voice at the front and center of the head.
The patient should have the opportunity to make volume adjustments to match the good ear.11 For young children, the volume control may need to be deactivated for safety concerns. The speaker’s voice will be picked up by the microphone and transmitted wirelessly to the hearing aid. An evidence-based systematic review of directional microphones and digital noise reduction hearing aids in school-age children with hearing loss. Difference in hearing threshold between traditional bone-conduction (gray) and BC in-situ measures (red).Figure 10. Audiological considerations of the Ponto Bone-anchored Hearing System before and after surgery.
Upward spread of masking, hearing loss, and speech recognition in young and elderly listeners, 87(3), 1266-1271.Plomp, R.



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