Community Research and Development Information Service - CORDIS

FP7

AHEAD III Report Summary

Project ID: 200835
Funded under: FP7-HEALTH
Country: Italy

Final Report Summary - AHEAD III (ASSESSMENT OF HEARING IN THE ELDERLY: AGING AND DEGENERATION - INTEGRATION THROUGH IMMEDIATE INTERVENTION)

Executive Summary:
Project AHEAD III has been designed to: i) Provide evidence of the effects of hearing impairment in adults and in elderly; ii) Increase the awareness among administrators, policy makers, health care professionals and the public opinion about early detection and intervention for hearing impairment in adults and in elderly; iii) Analyze costs and benefits associated with the implementation of large scale programs of hearing screening and intervention in adults and in elderly; iv) Provide minimum requirements for screening methods and related diagnostic techniques; v) Develop guidelines on how to implement successful screening programmer using the variety of available methods, and how to begin setting new criteria for recently proposed new technologies; vi) Analyze protocols and models to be tuned to the local, social, and economical conditions of a country or region.
Six closely interconnected issues were addressed: i) Aetiological assessment and epidemiology of age-related hearing loss; ii) Main effects of age-related hearing loss; iii) Screening and Diagnosis: methods and techniques; iv) Organization of an International Conference on Adult Hearing Screening; v) External liaisons and Outcomes measures; vi) Pilot programs of hearing screening in adults in Cyprus, UK and Italy.
Overall the following important achievements have been reached by the activities of project:
- Completion and publication of an up to date and comprehensive review of the prevalence of ARHL in Europe, with the evaluation of more than 1000 references (Roth TN et al., Prevalence of age-related hearing loss in Europe: a review, Eur Arch Otorhinolaryngol 2011, 268:1101-1107).
- Implementation of a two-stage campaign on ARHL in Germany and in the German speaking countries in Europe together with the German Seniors League, in German Deutsche Seniorenliga (DSL, www.deutsche-seniorenliga.de) entitled Hören ist Lebensfreude (Hearing is joy).
- Completion of a review on the most relevant pathophysiological mechanisms and of the most relevant interactions with other health conditions (Freigang C. et al., Evaluation of central auditory discrimination in the elderly, Front Aging Neurosci. 2011 May 2;3:6).
- Completion of a review on classical and recently proposed screening methods (S. Stenfelt et al., e-Health technologies for adult hearing screening, Audiology Research 2011; 1:e14).
- Implementation of a new concept and method for adult hearing screening (A. Paglialonga et al., SUN-test (Speech Understanding in Noise): a method for hearing disability screening, Audiology Research 2011; 1:e13).
- Completion of literature review on interventions following screening for hearing loss (Pronk M et al., Interventions following hearing screening in adults - A systematic descriptive review, Int. J. Audiol, 2011, 50(9):594-609).
- Completion of re-analysis of the notes of patients examined following screening for hearing in Wales (D. Stephens et al. Interventions after screening for hearing difficulties: a retrospective investigation of interventions other than hearing aids, Audiology Research 2011; 1:e21).
- Release of a position statement on adult hearing screening and strategies of intervention (Smith P.A et al., Adult Hearing Screening: What comes next? Int. J. Audiol., 2011; 50(9): 610-612).
- Implementation of hearing screening pilot programmes in Italy and Cyprus (A. Paglialonga et al., Pilot initiatives of adult hearing screening in Italy, Audiology Research 2011; 1:e17; C. Thodi et al., Adult hearing screening: the Cyprus Pilot Program, Audiology Research 2011;1:e18)
- Start of additional hearing screening programmes in Germany, Malta and Belgium.
- Continuing contact with screening programmes in the USA.
- Organization of the International Conference on Adult Hearing Screening - AHS 2010, Cernobbio, Italy, June 10-12, 2010.
- Organization of the AHS 2012 on 7-9 June 2012 at Cernobbio, (Italy).
Project Context and Objectives:
Europe is facing the burden of its ageing population.
Europe is living in an era of unprecedented, rapid and inexorable global ageing (20% over 60 in 2000, 28% by 2020!). The imperative to prevent, delay, minimize and reverse functional decline of elderly is becoming more and more pressing as the size of the older population in Europe grows.
One way of optimising functional status is to identify impairments or problems that may contribute to current functional decline or that are risk factor for future functional decline and to intervene when problems are uncovered.
Various studied have demonstrated that hearing losses are predictors for future functional decline!
Hearing loss is one of the most common chronic health condition in the elderly population, affecting in Europe an estimated 16% of individuals aged 55-64 years, 24% of individuals aged 65-75 years and 39% of individuals over age 75. According to the 2004 report from the World Health Organization, released in 2008, hearing loss is the first among the 20 leading causes of moderate- to-severe disability.
The exact causes of hearing loss in the elderly are not clear and heredity is not the only and/or predominant factor. Hearing loss has important implications for patient quality of life, such as functional decline, depression and social isolation. The diminished ability to hear and to communicate is frustrating in and of itself, but the strong association of hearing loss with depression and functional decline adds further to the burden on individuals who are hearing impaired
In most cases, hearing losses in adults take a long time to develop. It is a progressive process, and often does produce a sort of slow habituation to the impairment. At the beginning, only some types of sounds are not heard. There is the need to increase the volume level of the TV or to ask to repeat once again just a word or a sentence. This happens more frequently in presence of background noise such as traffic noise or when many people do speak all together, such as during a party or a dinner. These phenomena can become more and more disturbing to such an extent that the social life can be very seriously affected. This explains why deafness produces isolation, even within the family. On the mid and long term run, relationships are greatly distorted and the deaf tends to quit any type of communication.
Hearing losses can limit to a great extent communications skills: not to hear means not to understand what is being said. Hence, differently from other types of impairments, deafness does not produce compassion but do often produce a sense of irritation. Words must be repeated many times, sentences are misunderstood, very loud voice must be used thus establishing an unavoidably involuntary association with low capacity of understand and ultimately communication becomes impracticable.
Another very important and much underestimated side effect is that the delayed central processing of auditory and spatiotemporal information can affect balance maintenance, whose dysfunction is a primary risk factor for falls. One third of falls in the elderly is produced by balance disorders, while bone fractures resulting from falls could lead to long-term disability.
Despite the prevalence and burden of hearing loss, hearing impairment is largely underdiagnosed in older persons and undertreated. The reason for this is that one of the most conspicuous signs of a hearing loss is that... it cannot be seen! Actually, this is the reason why deafness does not always receive the necessary attention, neither in infants nor in adults. Too often, the public and still too many health care professionals do underestimate the long term dramatic effects of deafness.
The underdetection and undertreatment of hearing loss are discouraging, because strong evidence support that treatment of hearing loss does improve the quality of life.
In a number of European countries and areas, wearing a hearing aid is still considered as a sign of disability, a reason of shame, much like 50 to 60 years ago for eyeglasses, because it is a symbol of old age in a youth-oriented culture. It is common for men and women to try to ignore or deny hearing loss. Now, eyeglasses became a fashion accessory included in the sophisticated catalogues of all the most celebrated international fashion designers. Also thanks to the increasing numbers of people wearing some hearing devices, such as MP3, mobile phones, pop stars, anchormen at the TV, etc., a hearing aid should no more be a problem at all.
There is substantial evidence that the vast majority of hearing impaired persons are not screened for hearing loss by no means. The reasons for this lack of screening are probably multifactorial and include the usual difficulties of adding screening to an acute-care patient visit along with a lack of organizational structure to facilitate screening, such as reminder systems, together with the lack of guidelines and recommendations.
For screening for hearing loss to become the rule rather than the exception, novel strategies should be explored to make screening a feasible part of routine care.
Findings from the scientific literature indicate that screening and treatment of hearing loss have the potential to significantly improve the quality of life and functional status of elderly.
In the absence of direct clinical trial data, screening program can be advocated if evidence is provided to support each of the three commonly accepted criteria for a community screening program. These criteria are: (1) the burden of disease must be significant enough to justify the effort of screening, (2) an effective treatment must be available for the detected condition, and (3) accurate, practical and convenient screening tests must exist.
As early as in 1991, Mulrow and Lichtenstein (Mulrow CD, Lichtenstein MJ. Screening for hearing impairment in the elderly: rationale and strategy. J. Gen. Intern. Med. 1991; 6: 249-258) have argued that these conditions are satisfied for screening hearing impairment.

In this context, Project AHEAD III has been specifically designed to:
- Provide evidence of the effects of hearing impairment in adults and particularly in the elderly;
- Increase the awareness among administrators, policy makers, health care professionals and the public opinion about early detection and intervention for hearing impairment in adults and particularly 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 implement successful screening programmes using the variety of available methods, and began setting new criteria for recently proposed new technologies (screening over the phone, over the internet, etc.);
- Analyse protocols and models to be tuned to the local, social, and economical conditions of a country or region.

Project Results:

Main Objectives:
Project AHEAD III has been designed to:
- Provide evidence of the effects of hearing impairment in adults and particularly in the elderly;
- Increase the awareness among administrators, policy makers, health care professionals and the public opinion about early detection and intervention for hearing impairment in adults and particularly 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 implement successful screening programmes using the variety of available methods, and began setting new criteria for recently proposed new technologies (screening over the phone, over the internet, etc.);
- Analyse protocols and models to be tuned to the local, social, and economical conditions of a country or region.

Overall strategy
During the AHEAD III project six closely interconnected issues have been addressed:
1. Aetiological assessment and epidemiology of age-related hearing loss (WP3)
2. Main effects of age-related hearing loss (WP4)
3. Screening and Diagnosis: methods and techniques (WP5, WP6, WP7)
4. Organisation of International Conference on Adult Hearing Screening (WP8)
5. External liaisons and Outcome measures (WP9, WP10)
6. Pilot programmes of hearing screening in adults and older adults in Cyprus, UK and Italy.

With the exception of the pilot programs, the areas above were managed by working groups, whose activity mainly comprises the organization of specialist meetings and/or workshops, literature reviews and data collection in order to:
- prepare a systematic overview of the current status of knowledge on the subject of the Working Group
- identify areas in which clear knowledge exists
- identify areas of controversy and in which a consensus could be helpful
- identify areas of insufficient knowledge with need of further research
- prepare the ground for the consensus meeting
- organise specialist meetings
- edit reviews and/or reports and/or statements

The proposed multi-level configuration for Project AHEAD III has ensured the quality of the results and the feasibility in a 3 and half years project for the above objectives. AHEAD III project has explored novel strategies to make screening and early intervention a feasible part of routine care and to make screening for hearing loss the rule rather than the exception. Finally, AHEAD III project has promoted the awareness of the consequences of undetected hearing loss and the diffusion of a positive attitude toward wearing hearing aids.

Firstly, at the beginning of the project an intensive discussion was started on an interesting model which could be very fruitfully applied in the AHEAD III project. This model is the International Classification of Functioning, Disability and Health (ICF) [WHO, 2001; http://www.who.int/classifications/icf/en/] which adopts a bio-psychosocial model of disability. According to this model, disability is a complex phenomenon that included both at the level a person's body and a dimension that is a complex and primarily social phenomenon. Structurally the ICF is based on three levels of functioning (body functions and structures, activities and participation) with parallels level of disability (impairment, activity limitations and participation restrictions).
An application of this model to deafness brings to the following "definitions":
- Impairment: loss in hearing sensitivity (function) due to anatomical and physiological age-related changes (structure);
- Activity limitation: inability to understand spoken messages, such as in a crowded room or in the presence of background noise;
- Participation restriction: not being able to fully participate and enjoy social activities.

It was therefore decided to apply the ICF model in the framework of project AHEAD III in a twofold context:
- Screening: to move from the screening of an impairment (which is a loss or abnormality in body structure or physiological function) to a screening of activity limitations or participation restriction. The basic idea is that impairment information is only a partial picture of disability and it is not predictor of the lived experience of disability.
- Intervention: to match the three levels of disability (body functions and structures, activities and participation) with three different levels of intervention.

These concepts were used as starting points for the development of the work program during the project, within all the relevant work packages. For each WP in the following the main results and the description of the work done during the lifetime of the project AHEAD III are detailed.

WP1 - Coordination Activity - COORD

Objectives
Ensure the basic infrastructure to the Coordination Action, to make project AHEAD III to proceed as planned.
Description of work
In the course the project's lifetime, the WP has provided the necessary background, in terms of co-ordination to the network as a whole, and to all the demanding activities that have been planned for project AHEAD III.
The Coordinator has supervised and has contributed to monitor progress as frequently as possible of all the Working Groups and of the components that have been established within this Coordination Action.
The Coordinator, with the assistance of many other partners, has:
- cooperated to organise all the WP meetings
- contributed to finalize the agendas and the minutes of all WP and expert meetings
- ensured the liaison with the EU
- cooperated to establish an efficient information and communication network to support interactive working among the partners
- created and maintained the project website
- prepared Reports and revised (or prepared) Deliverables whenever required
- monitored the project outcomes and their coherence with the original objectives and milestones by reviewing and approving all the deliverables
- organised special sessions or round tables at quite many international or national conferences
- disseminated the project achievements both towards Health Care authorities and in international and national scientific conferences and symposia enhancing the impact of the project outside the network itself
- assisted promotion, if so required by national partners, of public awareness campaigns - at local or national level - focused on the crucial role of identification and intervention in hearing loss in older adults linked with the ongoing European research activities in the field.
Deliverables
D1.1 - AHEAD III Website (Month 3)
D1.2 - Review of periodical reports of WP3-WP8 (Month 12)
D1.3 - Review of periodical reports of WP3-WP8 (Month 24)
D1.4 - Submission of an editorial to a scientific journal in the area of Audiology, Otolaryngology and/or Gerontology (Month 30)
D1.5 - Review of periodical reports of WP3-WP8 (Month 42)

WP2 - Management Activity - MANAG

Objectives
Ensure the basic infrastructure to the Coordination Action for administration and management to make project AHEAD III to proceed as planned, on time and within budget.
Description of work
In the course the project's lifetime, the WP has:
- Maintained the consortium agreement
- Ensured financial and administrative management
- Ensured Management of legal and ethical aspects
- Prepared Cost Statements whenever required
- Prepared Interim and Final Reports whenever required, in cooperation with WP1
- Identified an Independent Expert Panel (IEP)
- Reacted to cope with comments in the reports from IEP
Deliverables
D2.1 - Interim Report and Cost statement (Month 18)
D2.2 - Final Report and Cost statement (Month 42)

WP3 - Aetiological Assessment and Epidemiology - AETIOL

Objectives
- Evaluate the variety of aetiological factors of age-related hearing loss.
- Provide information about the occurrence of age-related hearing loss in as many EU states as possible.
- Monitor time trends for this specific sensory impairment in the elderly.
- Initiate and support collaborations and information/data exchange between health professionals and manufactures.
Description of work
Since "presbyacusis" is a multifaceted common phenomenon, with a broad spectrum of causes and consequences, it is necessary to better understand the aetiological and epidemiological factor of age-related hearing loss. Only by an accurate aetiological assessment any further follow-up and intervention strategies can be significantly improved.
The main purpose of this WP was to obtain reliable information on the prevalence of age-related hearing loss (ARHL) in Europe. This aim was reached with the completion and publication of an up to date and comprehensive review of the prevalence of ARHL in Europe, in which also the time trends of ARHL were evaluated.
It has become clear during the work that the knowledge and help of public health specialists had to be included to get well founded and valid information. A firm and fruitful collaboration was established with the public health section of the Swiss Tropical and Public Health Institute, Department Epidemiology and Public Health of the University of Basel, in particular with Prof. Elisabeth Zemp and Dr. Dirk Hanebuth. This exchange has also led to a great enhancement of the awareness on age-related hearing loss and its problems in the Public Health sector.
In the course of the project a comprehensive review of the literature has been carried out with evaluation of more than 1000 references. This review has been published in a peer review journal (Roth TN et al., "Prevalence of age-related hearing loss in Europe: a review", Eur Arch Otorhinolaryngol 2011, 268:1101-1107). To allow for an overview of this work, the abstract of the paper is here included.
Roth TN et al., "Prevalence of age-related hearing loss in Europe: a review", Eur Arch Otorhinolaryngol 2011, 268:1101-1107- Abstract:
Populations are becoming progressively older thus presenting symptoms of diminished organ function due to degenerative processes. These may be physiological or caused by additional factors damaging the organ. Presbyacusis refers to the physiological age-related changes of the peripheral and central auditory system leading to hearing impairment and difficulty understanding spoken language. In contrast to epidemiological data of other continents, the prevalence of age-related hearing loss (ARHL) in Europe is not well defined, due in part to the use of different classification systems. We performed a systematic literature review with the aim of gaining a picture of the prevalence of ARHL in Europe. The review included only population and epidemiological studies in English since 1970 with samples in European countries with subjects aged 60 years and above. Nineteen studies met our selection criteria and additional five studies reported self-reported hearing impairment. When these data were crudely averaged and interpolated, roughly 30% of men and 20% of women in Europe were found to have a hearing loss of 30 dB HL or more by age 70 years, and 55% of men and 45% of women by age 80 years. Apparent problems in comparing the available data were the heterogeneity of measures and cut-off for grades of hearing impairment. Our systematic review of epidemiological data revealed more information gaps than information that would allow gaining a meaningful picture of prevalence of ARHL. The need for standardized procedures when collecting and reporting epidemiological data on hearing loss has become evident. Development of hearing loss over time in conjunction with the increase in life expectancy is a major factor determining strategies of detection and correction of ARHL. Thus, we recommend using the WHO classification of hearing loss strictly and including standard audiometric measures in population-based health surveys.
Deliverables
D3.1 - Draft of the Report from WP3 (Month 12)
D3.2 - Update of the Report from WP3 (Month 24)
D3.3 - Final Review on aetiological factors and epidemiology of age-related hearing loss (Month 42)
Milestones
M1 - Collection of available/published data on prevalence, incidence and aetiological factors of age-related hearing loss (Month 12)
M4 - Analysis of available/published data on prevalence, incidence and aetiological factor of age related hearing loss (Month 32)

WP4 - Main effects of age-related hearing loss - EFFECTS

Objectives
- Evaluate the psychological impact on everyday life of age-related hearing impairment.
- Promote awareness of the consequences of undetected hearing loss.
- Promote a change in the attitude to hearing aids and assistive devices.
Description of work
Hearing impairment is an important psychosocial problem. Its effects on speech communication can reduce a person's physical, functional, emotional and social well-being. Isolation and depression often accompany hearing loss. All of this can be frustrating, embarrassing and even dangerous. In addition to affecting basic psychoacoustic abilities, sensorineural and/or central hearing impairment affects listening (i.e. the process of hearing with intention and attention), comprehending (i.e. reception of information) and communicating (i.e. bi-directional transfer of information).
The main purpose of this WP was to evaluate the psychological impact on everyday life of age-related hearing impairment. This aims was reached by a systematic data collection and literature review on psychological and social impact of hearing loss. In the review special emphasis was given on the following aspects: i) psychosocial effects (define criteria to evaluate and assess the impact of presbycusis on everyday life); ii) impairment of listening and communication plus aural rehabilitation; iii) central age-related hearing loss (ARHL); iv) non-auditory additional effects of ARHL (interaction with other health conditions in the elderly, i.e. decline in cognition, spatial orientation and alerting) and genetics of ARHL; v) public and patients' awareness of ARHL and promotion of awareness of ARHL (prospective measures and actions in the past); vi) promotion of hearing aid use (evaluation of the impact of being ashamed of hearing loss and how to promote the use of hearing aids). Major detail are given in the Deliverable 4.3 "Final Review on the main effects of age-related hearing loss".
In addition to the literature review, this WP was also involved in the evaluation of the auditory discrimination ability in adults and older adults. This work was published in a peer-reviewed journal (Freigang C. et al., "Evaluation of central auditory discrimination in the elderly", Front Aging Neurosci. 2011 May 2;3:6). To allow for an overview of this study, the abstract of the paper is here included.
Freigang C. et al., "Evaluation of central auditory discrimination in the elderly", Front Aging Neurosci. 2011 May 2;3:6- Abstract:
The present study focuses on auditory discrimination abilities in older adults aged 65-89 years. We applied the "Leipzig inventory for patient psychoacoustic" (LIPP), a psychoacoustic test battery specifically designed to identify deficits in central auditory processing. These tests quantify the just noticeable differences (JND) for the three basic acoustic parameters (i.e., frequency, intensity, and signal duration). Three different test modes [monaural, dichotic signal/noise (s/n) and interaural] were used, stimulus level was 35 dB sensation level. The tests are designed as three-alternative forced-choice procedure with a maximum-likelihood procedure estimating p = 0.5 correct response value. These procedures have proven to be highly efficient and provide a reliable outcome. The measurements yielded significant age-dependent deteriorations in the ability to discriminate single acoustic features pointing to progressive impairments in central auditory processing. The degree of deterioration was correlated to the different acoustic features and to the test modes. Most prominent, interaural frequency and signal duration discrimination at low test frequencies was elevated which indicates a deterioration of time- and phase-dependent processing at brain stem and cortical levels. LIPP proves to be an effective tool to identify basic pathophysiological mechanisms and the source of a specific impairment in auditory processing of the elderly.
Additional aims of this WP were to promote awareness of the consequences of undetected hearing loss and to promote a change in the attitude to hearing aids and assistive devices. In this perspective, WP4 members were among the promoter of the beginning and implementation of a two-stage campaign on ARHL in Germany and in the German speaking countries in Europe together with the German Seniors League, in German "Deutsche Seniorenliga" (DSL, www.deutsche-seniorenliga.de) entitled "Hören ist Lebensfreude" (Hearing is joy). In the course of the project, the media campaign on ARHL (with the GSL) had a media reach of 27 mio readers.
The activity of WP4 was also widely covered by the media (TV programmes, newspaper etc..)( for more details see the Section "Use of foreground and dissemination activities during this period" in both the periodic report describing the dissemination activities toward the Broad public).
Moreover, members of this WP4 were invited to design the hearing test protocol (with special emphasis on major effects of ARHL and central auditory processing disorders) for the BASE II study. BASE II is a new study design for a longitudinal study in elderly (beginning June 2009) at age 70 and will go on until 2039 (this is the financing frame as guaranteed by the German Ministry of Education and Research), coordinated by Mde. Prof. Steinhagen-Thiessen from the Dept. Geriatrics at Charite.
Deliverables
D4.1 - Draft of the Report from WP4 (Month 12)
D4.2 - Update of the Report from WP4 (Month 24)
D4.3 - Final Review on the main effects of age-related hearing loss (Month 42)
Milestones
M2 - Collection of available/published data on main effects of age related hearing loss (Month 12)
M5 - Analysis of available/published data on main effects of age related hearing loss (Month 32) - Comments: Availability of reports and paper on peer-reviewed journal

WP5&WP6 - Classical screening devices: quality standards and minimum requirements - SCREEN & Newly proposed screening technologies - NEWTECH

Objectives
- Set quality standards and minimum requirements for the classical screening techniques and procedures.
- Evaluate preliminary results from recently proposed screening methods.
- Improve and adapt audiological techniques and equipments to the special needs for the aged.
Description of work
At the onset of the work of WP5 and WP6 it was realized that it was difficult to classify a specific hearing screening technology as "classical" or "newly proposed". Moreover, the participants in the two work groups are almost all the same. In order to avoid overlapping activities it was decided to join the activities of the two workgroups. The joint meetings increased efficiency and effectiveness as time spent traveling decreases and the knowledge transfer between the working groups are immediate and easier. Therefore, both work groups are conducting the work defined in the work programme but instead of two separate work groups they are conducting it jointly. It should also be emphasized that both work group leaders (WP5: Thomas Janssen; WP6: Stefan Stenfelt) are still responsible for their defined tasks but share leadership in overlapping areas.
The final goal of the present task is to define and evaluate screening methods for age-related hearing loss in view of the intervention strategies. WP5 and WP6 were devoted to the evaluation and analysis of screening methods, while WP7 was mainly devoted to the study of different intervention strategies after hearing screening.
Main aims of WP5 and WP6 were to review classical and recently proposed screening methods; to set quality standards and minimum requirements for the classical and newly proposed screening techniques and procedures; to identify audiological techniques and equipments that have to be improved and adapted to the special needs for the aged.
In the course of the project lifetime WP5 and WP6 activities were mainly focused on the completion of a review on classical and recently proposed screening methods. This work has led to the preparation of specific reports (see Appendix I: "23-point template" for reviewing the different technologies; Appendix II: Description of some methods and technologies for AHS; Appendix III: Key feature tables of some methods and technologies for AHS of the Deliverables D5.3/D6.3 - Report from WP5 (SCREEN) and WP6 (NEWTECH)).
The literature on possible methods and technologies and their feasibility in adult hearing screening (AHS) was searched in relevant national and international databases (e.g. Pub-med, Cinahl, Cochrane) from 1960 onwards. Reference lists of relevant articles were also screened for additional papers. Articles containing specific information were included. Inclusion criteria were: i) the screened population is specified with regard to age and type of population (e.g. nursing home residents, GP patients, working adults etc); ii) detailed information about the methods and technologies are provided (sensitivity, specificity, duration, costs, etc).
A 23-points template was defined to describe and review the different screening methods and technologies. The template includes: the description of the method and characteristics (such as the targeted dysfunction, need for training/instructions, calibration..), together with more specific issues that are relevant to adult hearing screening (AHS), such as sensitivity, specificity, reliability, test duration, reliability of the screening outcome, and estimated costs (see Appendix I of Deliverable D5.3 and D6.3). The template is intended as a general tool that can be adapted on a case-by-case basis to describe a particular method. Based on this template, each of the methods considered in this document was described and discussed in detail (see Appendix II of Deliverable D5.3 and D6.3):
- Pure tone screening
- Self-assessment screening instruments- Questionnaires
- Speech tests
- Screening for auditory processing disorders (non speech based)
- Otoacoustic emissions
- Auditory brainstem responses and steady state responses
- Distributed screening (internet and telephone based screening)
- Genetic screening
Main features were summarized in distinct 'key feature' tables (Appendix III of Deliverable D5.3 and D6.3) for the following methods:
- Screening pure tone audiometry
- Self-report screening questionnaires (HHIE-S, HHIA-S, SAC, single- questions)
- Speech-in-Noise tests
- New speech-based screening tests
- Screening for auditory processing disorders, non speech based
- Otoacoustic emissions
- Early auditory evoked response potentials tests
- Telephone and internet based screening
Moreover, a preliminary analysis was started to calculate the costs for screening. As there are different health care systems and wages throughout Europe, costs for each method varies from country to country. Two main factors have to be considered: equipment and personnel. As costs for equipment the following items have to be considered: costs for devices, as well as accessories (printer, modem, probe, headphone, ...), consumables (ear tips, electrodes, printer labels, cleaning, ...), periodic technical check up and annual maintenance (e.g. 2% of device cost). Personnel costs per minute depend on monthly wages, holiday entitlement and average status of employee's illness. Total personnel costs also include training course time and test time including preparation and instruction. Furthermore cost per person screened depend on depreciation period for devices and on number of persons being screened in that period. Screening programme costs also depend on prevalence (of targeted disability or impairment) and number of persons in target population, sensitivity/specificity of screening method, costs for refer confirmation and treatment costs. In summary, to calculate costs for a screening programme in a specific country using methods and technologies mentioned in this report, valid figures for this country have to be provided for each of the above-mentioned variables.
This work has led to the publication of a paper in a peer review journal (S. Stenfelt et al., "e-Health technologies for adult hearing screening", Audiology Research 2011; 1:e14). Moreover, these WPs worked also on the implementation of a new concept and method for adult hearing screening published in a peer review journal (A. Paglialonga et al., "SUN-test (Speech Understanding in Noise): a method for hearing disability screening", Audiology Research 2011; 1:e13).
To allow for an overview of these studies, the abstracts of the papers are here included.
S. Stenfelt et al., "e-Health technologies for adult hearing screening", Audiology Research 2011; 1:e14
Abstract:
The development of hearing diagnosis methods and hearing screening methods are not isolated phenomena: they are intimately related to changes in the cultural background and to advances in fields of medicine and engineering. In the recent years, there has been a rapid evolution in the development of fast, easy and reliable techniques for low cost hearing screening initiatives. Since adults and elderly people typically experience a reduced hearing ability in challenging listening situations [e.g., in background noise, in reverberation, or with competing speech (Pichora-Fuller & Souza, 2003)], these newly developed screening tests mainly rely on the recognition of speech stimuli in noise, so that the real experienced listening difficulties can be effectively targeted (Killion & Niquette, 2000). New tests based on the recognition of speech in noise are being developed on portable, battery- operated devices (see, for example, Paglialonga et al., 2011), or distributed diffusely using information and communication technologies. The evolutions of e-Health and telemedicine have shifted focus from patients coming to the hearing clinic for hearing health evaluation towards the possibility of evaluating the hearing status remotely at home. So far, two ways of distributing the hearing test have primarily been used: ordinary telephone networks (excluding mobile networks) and the internet. When using the telephone network for hearing screening, the predominantly test is a speech-in-noise test often referred to as the digit triplet test where the subjects hearing status is evaluated as the speech-to-noise threshold for spoken digits. This test is today available in some ten countries in Europe, North America and Australia. The use of internet as testing platform allows several different types of hearing assessment tests such as questionnaires, different types of speech in noise tests, temporal gap detection, sound localization (minimum audible angle), and spectral (un)masking tests. Also, the use of the internet allows audiovisual presentations as well as visual interaction and cues in the tests for a more ecological approach. Even if several new and novel approaches for hearing assessment using the internet are surfacing, the validated tests are based on questionnaires or speech-in-noise. Although the internet allows for a broader flora of pure auditory and audiovisual tests for hearing health assessment, calibration problems such as timing uncertainty, output levels and modes of presentation (speakers or earphones) limits the usability at present.
A. Paglialonga et al., "SUN-test (Speech Understanding in Noise): a method for hearing disability screening", Audiology Research 2011; 1:e13
Abstract:
The SUN-test (Speech Understanding in Noise) is a speech-in noise test to screen adults and older adults for hearing disability. The SUN-test consists in a short list of intervocalic consonants (VCV, vowel-consonant-vowel) in noise that are presented in a three-alternatives forced choice (3AFC) paradigm by means of a touch-screen interface. Based on the number of stimuli correctly identified, the tested subject gets one of three possible test outcomes: no listening difficulties, a hearing check would be advisable, or a hearing check is recommended. This paper reviews the main results obtained with the SUN test in the Italian language in a population of nearly 1,300 adults and older adults with varying degrees of audiometric thresholds and audiometric configurations, tested both in low and in high ambient noise settings. Results obtained in the tested population revealed that the outcomes of the SUN-test were in line with the outcomes of pure-tone testing, and that the test performance was similar both in low and in high ambient noise (up to 65 dB A). Results obtained with the SUN test were not biased by the age of the subject because the performance of younger and older subjects in the test was similar. The mean duration of the SUN-test was nearly 40 s/ear, and was lower than 1 minute per ear even in subjects older than 80 years so that both ears could be tested, on average, in 2 minutes. The SUN-test was considered easy or slightly difficult by nearly 90% of subjects; test duration was judged short or fair by nearly 95% of subjects, and the overall evaluation of the test was pleasant, or neutral, in more than 90% of subjects. Overall, results of this study indicated that the SUN-test might be feasible for application in adult hearing screening. The test is fast, easy, self convincing, and reflects differences in hearing sensitivity between the tested subjects. The outcomes of the SUN-test were not influenced by the noise level in the test room (up to 65 dB A) indicating that the test, as such, might be feasible to screen adults and older adults both in clinical and in non clinical settings, such as convenient care clinics, hearing aid providers, or pharmacies, where the ambient noise is, typically, not controlled.
Deliverables
D5.1 - Draft of the Report from WP5 (Month 12)
D6.1 - Draft of the Report from WP6 (Month 12)
D5.2/D6.2- Update of the Report from of WP5&WP6 (Month 24)
D5.3/D6.3 - Final Report on quality standards and minimum requirements for screening methods (Month 42)
Milestones
M7 - Minimum requirements for screening with Pure Tone Audiometry in the Elderly (Month 10)
M8 - Minimum requirements for screening with otoacoustic emissions (Month 20)
M9 - Minimum requirements for screening with telephone check, internet testing, sensitivity/specificity of questionnaires (Month 22)

WP7 - Intervention Strategies - INTERV

Objectives
Evaluate strategies of interventions and identify links between screening/diagnosis and intervention strategies to build an integrated model of care.
Find ways of optimising bridges between Early Hearing Detection and Intervention programme (EHDI) and the global health strategy.
Description of work
Main aims of WP7 were to evaluate strategies of interventions and identify links between screening/diagnosis and intervention strategies to build an integrated model of care. In the course of the project's lifetime, the WP7 has completed different subprojects which are listed below.
Brainstorm session
At the first WP7 meeting in Birmingham, it was discussed as to which interventions could follow screening for hearing. It is known that, in general, hearing aids are regarded as the main and only intervention applicable to those with hearing impairment. However, there is ample evidence showing that:
- there is a large number of people who would benefit from interventions other than hearing aids, in particular those with mild hearing impairment. These people will not benefit from hearing aids, so pushing them into the system would be a waste of money, as they will end up not wearing hearing aids.
- This leads to the conclusion that, within AHEADIII (and in general), we should be more inventive with regard to this 'middle' group. A quick intervention based on non-technical approaches might be helpful for these people.
The brainstorming session revealed that the following intervention strategies could be performed both pre or post diagnosis - audiometric and clinical:
- Intervention pre-screening (e.g. raising awareness, publicity campaigns)
- Medical interventions (onward referral, wax removal, full diagnosis, surgery)
- Filtering of potential benefiters of hearing aids
- Information provision (websites / leaflet / oral)
- Hearing aids
- Try hearing aid
- on the spot test as to how beneficial HA would be
- demonstrate how hearing aid sounds
- how you look like with a hearing aid
- Hearing Monitoring
- Notify general practitioner (GP), occupational physician about your hearing loss
- Someone calls back (facilitating the care plan)
- Long term monitoring
- Sms-service- mobile phone message
- Question(naire): What more do you want from us?
- Assistive listening devices / assessment of home situation
- Advice about hearing protection
- Environmental modification
- Auditory training
- Assertiveness training
- Hearing tactics
- Counselling (e.g. individual/group/cognitive behavioural therapy)
- Interventions including family (e.g. home visit)
- Peer support / HoH organisation
- No intervention (only as part of a scientific study looking at effectiveness of intervention)
The brainstorm session also revealed that a number of questions ought to be considered, before any screening programme can be implemented. These are:
- How should interventions be designed so that the effectiveness of screening becomes greater?
- Which groups of people with hearing problems would benefit from which intervention?
- What do we aim to achieve with the intervention?
- When shall (an intervention after) screening be regarded as successful? If there is an increase in the number of people showing compliance with the advice given?, If there is an increase in the uptake of hearing aids? If there is an increase in the number of people whose disability has reduced after screening AND intervention?
Expert Survey
Interventions following hearing screening in adults: views from the experts (Pauline Smith and Adrian Davis)
As the preliminary results of the literature review revealed that so little was found to indicate any interventions following hearing screening in adults that was NOT hearing aid intervention, WP7 decided to survey international experts on the subject. A letter was written, and a short questionnaire of 6 questions was designed. The letter contained a list of possible non-hearing aid interventions and respondents were asked about any local screening, their views on screening, and were invited to contribute relevant case histories.
The letter and questions were sent to a total of about 150 individuals, and were posted on the AHEAD III website. The individuals were identified as experts from the following sources: WP7 members, ICRA members, British Academy of Audiology Service Quality Committee members, IDA Institute participants from January 2009 seminar, other individuals who had expressed an interest in the subject at a recent EFAS meeting and at other times. Following the initial mailing, the details were also posted on a UK Hearing Therapy website, and a newsletter article was written for the British Society of Hearing Audiologists.
A total of 22 experts responded, of whom 15 answered the questions, 3 more made a comment but did not answer the questions and 4 more sent detailed replies and included relevant documents. The respondents were from around the world, and represented a mix of Audiology professionals. During discussion, members of WP7 were of the view that the low response was probably not due to lack of interest, (as most individuals had actively asked to contribute) but rather due to a general lack of non-hearing aid intervention, or at least a lack of documentation of any that was provided.
Of the respondents, none reported any systematic hearing screening for adults, although there was some ad-hoc screening reported, e.g. free tests once a year offered by hospitals. Of the 15 respondents to the questionnaire, 12 of them would consider introducing screening. Many respondents commented on the cost and cost effectiveness of a screening programme, and many also commented on the need for diagnosis after screening and before intervention.
Other useful and relevant information that was sent included information on the ACE, (Active Communication Education) rehabilitation programme, and the ASHA (American Speech and Hearing Association) guidelines for audiologic screening.
Despite a lack of case histories to demonstrate use of non-hearing aid interventions (possibly due to poor documentation), there was general agreement that intervention following screening should include much more than hearing aids.
The most important conclusions of this survey are outlined in an editorial which is published in an issue of the International Journal of Audiology (Smith PA, Davis AC, Pronk M, Stephens D, Kramer SE, Thodi C, Anteunis LJ, Parazzini M, Grandori F. Adult hearing screening: what comes next? (editorial) International Journal of Audiology, 50(9):610-612, 2011.). The paper is attached to the report.

Blaengwynfi and Llantrisant data - re-examination of data
Interventions after screening: a retrospective approach to results from Blaengwynfi and Llantrisant (Dafydd Stephens and Ioanis Gianopoulos)
There have been a number of studies on screening of hearing in adult populations. Despite the high importance of interventions following screening for hearing difficulties (impairment/disability), there is a dearth of information on the nature of interventions following such screening, other than hearing aid fitting (HA) or referral to audiology/ENT departments.
In the late 1980s and early 1990s four studies were performed in Wales, which offered such other interventions to those individuals indicating hearing disabilities in screening questionnaires (eg Stephens et al, 1990; Davis et al, 1992).
The majority of the patient notes from these studies were still accessible and have been examined to extract the following information:
- What interventions were used other than hearing aids?
- Who received these interventions?
- Would they have been more appropriate than HAs for some of those fitted?
The aim of this study was to list the interventions provided in these studies and relate them to the initial complaints of those indicating hearing problems. Three studies, for which most information was available, were targeted. The studies concerned were:
- Glyncorrwg - 1987-88 - n=127 (National Study of Hearing closed set questionnaire (NHS) plus audiograms, Social Hearing Handicap Index [SHHI -Ewertsen & Birk Nielsen, 1973] and Emotional Response Scale [ERS - Noble and Atherley, 1970])
- Blaengwynfi - 1989-90 - n=93 (WHI open-set questionnaires, audiogram, SHHI, ERS)
- Llantrisant - 1990-92 - n=63 (Welsh Hearing Institute open-set questionnaires, audiogram, Hearing disability and Handicap scale [Hétu et al, 1994]).
The study revealed that those fitted with hearing aids and not using them in the long-term had hearing levels which did not differ significantly from those of the long-term users, but had lesser hearing disabilities. This highlights the need for the use of a questionnaire in any screening measure rather than the use of audiometric or speech recognition measures alone if we are to provide a cost-effective service. This is in agreement with the results of a large review of the literature on factors influencing hearing help seeking, hearing aid uptake, hearing aid use and satisfaction with the device (Knudsen et al., 2010). In addition, it is important to realise that what we should be addressing are the problems and needs of the individuals screened rather than their hearing levels. A range of appropriate interventions should be available to meet the needs of the individuals within the population reporting hearing disabilities.
This work has led to the publication of a paper in a peer review journal (Stephens D. et al., Interventions after screening for hearing difficulties: a retrospective investigation of interventions other than hearing aids. Audiology Research, 1, 79-81,2011). The paper is attached to the report, while to allow for an overview of this work, both abstracts are here included.
Stephens D et al., Interventions after screening for hearing difficulties: a retrospective investigation of interventions other than hearing aids. Audiology Research, 1, 79-81,2011
Abstract:
There have been a number of studies on screening of hearing in adult populations. Despite the high importance of interventions following screening for hearing (Wilson and Jungner, 1968) there is a dearth of information on the nature of interventions following such screening, other than hearing aid fitting (HA) or referral to audiology/ENT departments (Pronk et al., 2011). In the late 1980s and early 1990s four studies were performed in Wales, which offered such other interventions to those individuals indicating hearing disabilities in screening questionnaires (eg Stephens et al., 1990; Davis et al., 1992). The majority of the patient notes from these studies were still accessible and have been examined to extract the following information: i) what interventions were used other than hearing aids? ii) who received these interventions? iii) would they have been more appropriate than HAs for some of those fitted? The aim of this paper is to list the interventions provided in these studies and relate them to the initial complaints of those indicating hearing problems.

IV. Systematic Review
Interventions following hearing screening in adults: a systematic review (Marieke Pronk, Sophia Kramer, WP7 members)
The group started conducting a systematic review of the scientific literature to list and describe all types of aural rehabilitative interventions that were offered to adults with hearing impairment identified through a hearing screening procedure in a general adult population. A search strategy was developed to search all relevant databases ( e.g. EMBASE, PubMed, CINAHL). The systematic review was performed according to the Cochrane guidelines. Whereas the search yielded more than 3000 articles, a total of 37 were found to be eligible according to the inclusion and exclusion criteria. This work led to the publication of an article describing this review in an international scientific peer reviewed journal (Pronk M. et al., Interventions following hearing screening in adults - A systematic descriptive review. Int. J. of Audiology, 50(9):594-609, 2011). To allow for an overview of this work, the abstract is here included.
Pronk M et all, Interventions following hearing screening in adults - A systematic descriptive review. International Journal of Audiology ,50(9):594-609, 2011 Abstract
Objective Adult hearing screening may be a solution to the under-diagnosis and under-treatment of hearing loss in adults. Limited use and satisfaction with hearing aids indicate that consideration of alternative interventions following hearing screening may be needed. The primary aim of this study is to provide an overview of all intervention types that have been offered to adult screen-failures.
Design Systematic literature review. Articles were identified through systematic searches in PubMed, EMBASE, Cinahl, the Cochrane Library, private libraries and through reference checking.
Results Of the initial 3027 papers obtained from the searches, a total of 37 were found to be eligible. The great majority of the screening programmes (i.e., 26) referred screen-failures to a hearing specialist without further rehabilitation being specified. Most of the others (i.e., 7) led to provision of hearing aids. Four studies offered alternative interventions comprising communication programme elements (e.g., speechreading, hearing tactics) or advice on environmental aids.
Conclusions Interventions following hearing screening generally comprised referrals to hearing specialists or directly offered hearing aid rehabilitation. Some programmes offered alternative rehabilitation options. These may be valuable as an addition to or replacement of hearing aid rehabilitation. It is recommended that this be addressed in future research.
Deliverables
D7.1 - Draft of the Report from WP7 (Month 12)
D7.2 - Update of the Report from WP7 (Month 24)
D7.3 - Final Review on Intervention Strategies (Month 42)
Milestones
M3 - Collection of available/published data on intervention strategies (Month12)
M6 - Analysis of available/published data on intervention strategies (Month 32)

WP8 - International Conference on Adult Hearing Screening (WP8 AHS)

Objectives
- Organise the European Consensus Development Conference on Hearing Screening in the Elderly.
- Release a Position Statement on hearing screening in the elderly with the response to key questions concerning advantages/disadvantages of hearing screening in the elderly, preferred models for screening, important decision for future research in the field.
Description of work
The "International Conference on Adult Hearing Screening - AHS 2010", was held in June 10-12, 2010 in Cernobbio, Italy. More than 250 delegates representing several countries from the Europe, USA and other continents participated in the first international meeting. More than 70 oral communications and 47 posters have been presented and discussed in three concurrent Sessions. The scientific programme was entirely devoted to early identification and treatment of auditory dysfunction and disability in adults and older adults. The Book of Abstracts of all the presentations can be downloaded from here: see also Deliverable D8.1- Book of abstracts - AHS2010 - International Conference on Adult Hearing Screening. Moreover a Special Issue of the journal "Audiology Research" included a number of selected contributions among the numerous communications presented at this Conference and contained reports on epidemiology and aetiology of hearing, investigations on auditory temporal processing and auditory functionality, effects of ageing on hearing, methods, economic issues and planning strategies for adult hearing screening, new trends in intervention strategies and development of hearing aids.
Awareness on these issues rose significantly during the past few years thus stimulating new research and intense discussions on practical models and guidelines to cope with the increasing demand of new hearing care for adults and older adults. Also, the development of technology of hearing aids and of hearing screening methods has played an important role. Therefore, following the success of the first AHS 2010, a second conference AHS 2012 will be held on 7-9 June 2012 at Cernobbio, (Italy). The conference will focus on a comprehensive spectrum of issues and disciplines related to early identification and treatment of auditory dysfunctions in adults and elderly.
Deliverables
D8.1 - Book of abstracts (Month 30)
D8.2 - Position Statement of the ECDC on Hearing Screening in the Elderly (Month 42)
Milestones
M10 - European Development Consensus Conference on Hearing Screening in the Elderly (Month 30)
M11 - Position Statement of the ECDC on Hearing Screening in the Elderly (Month 42)

WP9 - Outcome measures - OUTCOME

Objectives
Monitor progress of the implementation of EHDI Programmes (Early Hearing Detection and Intervention) in the European Area.

Description of work
In the course of the project's lifetime, WP9 has monitored as early and frequently as possible the progress of recently established adult hearing screening programmes in countries of the EU. Moreover, this WP has evaluated and verified the increase of the level of awareness among professionals, clinicians and Health Care administrators about the importance of early detection of hearing impairment in adults and older adults.
The activities of project AHEAD III contributed to homogenise the quality of screening programmes and the standards of care in the EU, starting for example from the health models launched in the United Kingdom and (partially) in the Netherlands, where a hearing screening program specifically for the elderly has already started, or collecting data in Cyprus and in Italy, where it has been possible to start the implementation of pilot programs of hearing screening in adults and older adults that could serve as a models for other areas or countries. Additionally, thanks to the support of the AHEAD III initiatives, it was possible to start other screening programs not planned at the beginning of the project, in Germany, Malta and Belgium.
This activities has led to the publications of articles on peer review journal (A. Paglialonga et al., "Pilot initiatives of adult hearing screening in Italy", Audiology Research 2011; 1:e17; C. Thodi et al., "Adult hearing screening: the Cyprus Pilot Program", Audiology Research 2011;1:e18). Updated details of the screening programs are given below.
Pilot program of hearing screening in older adults in UK
Significant large scale initiatives are being promoted and discussed in a national programme in the UK (coordinator: Adrian Davis, from MRC Hearing and Communication Group, Royal Free Hampstead NHS Trust, London and Director of the Newborn Hearing Screening Programme for England) also in the framework of project AHEAD III. Specifically, a conceptual model of hearing screening has been developed by Professor Davis. His work has shown that screening programmes are effective and provide good value for money. In the UK, they are targeted at a specific hearing deficit in people about ten years earlier than the average person who consults would have done so. However this model cannot be easily applied to other countries and it should be tuned to local, social, and economical conditions of a country or region.
Another activity in UK is the project conducted in Leicester which aims to evaluate the use of the Siemens HearCheck Screener. In this project, the screener is mainly used as a triage tool rather than as a screening device. The patients get into the system by visiting their GP with complaints about their hearing problems. Once they are in, the Siemens Screener is highly useful in identifying those who will benefit from an open fitting carried out during a 90 minute "assess and fit" appointment as opposed to those who need a more traditional approach to intervention, which is a 60 minute assessment appointment, followed later by a 60 minute hearing aid fitting appointment.
Data are being collected on screener results, as well as pure tone thresholds, intervention, and eventual outcome. The study involved 97 new referrals from GP to Audiology, of whom 27% were fitted with hearing aid/s during a single assess and fit appointment. Patient related outcomes were not compromised by the shorter pathway. This work is currently being extended to many more GPs in the area, and has the potential to make the service more efficient as well as encouraging younger people and those with milder hearing losses into the service. The work has been published by NHS Improvement, 2011, and it will continue beyond the AHEADIII Project, with particular emphasis on raising awareness of hearing loss in GPs, and offering hearing screening at GP open days and health fairs. Moreover a questionnaire survey (with Siemens UK) to find out how people are using the screeners was carried out. This questionnaire attracted only 13 replies out of 55 sent, (1 charity, 3 NHS primary care, 6 in large dispensing companies and 3 from independent dispensers). The independent sector providers used them for walk-in screening, whereas the charity and NHS providers used them for mainly at events and by appointment.
Pilot program of hearing screening in older adults in Cyprus
The Health system in Cyprus provides health coverage at-no-charge to public employees, people with lower income, and people with disabilities. Hearing Health Care is included in the system in terms of evaluation. Intervention (hearing aids) is available for some categories: people with congenital hearing loss receive vouchers for amplification every four years, based on recommendations and approval of the Public Hospital System. Pensioners receive a nominal compensation (€170) for amplification every four years, based on Public Hospital System recommendation and approval. There are no adult hearing screening services in Cyprus.
The pilot adult hearing screening program launched by AHEAD III through the Cyprus Audiology Center (CAC) targeted adults older than 63 years (retirement age). Public announcements through pensioner magazines and news papers, as well as television show participation were initially implemented in order to publicize the project. The program consisted of screening hearing at scheduled dates, following agreement with pensioner organizations and municipalities. Pensioner organization and municipality newsletters announced specific dates when screening was to be held at particular locations; and members signed up for screening. Screening sessions were held at pensioner organization gatherings and activity centers, as well as municipality activity centers.
Participating adults filled out a demographic/short history form, accompanied by a five-item list extracted from the Hearing Handicap Inventory for the Elderly (Screening Version), and the informal question "do you believe that you have a hearing loss?". Screening included otoscopy, and pure tone audiometry at 250-4000 Hz at 35 dBHL. TEOAE screening was performed at the beginning or the project, however due to high failure rates it was omitted from the screening procedure. A screening device (Siemens) was part of the battery in selected sites in order to compare outcomes.
Over 2000 adults were screened by the program, but data for about 1940 people were included in the final analysis after removal of incomplete data sets. Of the people screened, a total of 46% were referred. The high referral rate is probably related to the fact that thescreening program was based on participation of willing adults after a general invitation: people who suspected a hearing problem were more likely to participate. Cerumen removal or medical evaluation (medical referral) was recommended for 17% of participants, audiological evaluation/hearing aid evaluation was the suggested venue for 43% of participants. There is overlap between the "cerumen removal" and hearing/hearing aid evaluation groups due to non-occluding cerumen findings. Participants who failed the hearing screening were also offered suggestions for improving visibility of the speaker, seating suggestions for noisy environments, and assertiveness reinforcement.
Structured follow-up interviews were administered to a portion of the referred patients in order to assess compliance with referrals, and the project impact on people's perspective on hearing, decisions on interventions, and quality of life. The results showed high compliance rate: almost all referred participants complied with at least one of the referral recommendations. Of the people referred for amplification devices, more than half had not tried or acquired a hearing aid 1-2 years after referral. The vast majority of people who were referred did not seek further information after the screening. People who decided to seek help reported that screening had a severe impact on their decision. People found the screening overall helpful, and affirmed that in should be offered widely. There seemed to be very few or no negative aspects to people's experience with the screening process.
Pilot program of hearing screening in older adults in Italy
During the first period, two initiatives of adult hearing screening were conducted in Italy. The first adult hearing screening program was administered to people attending to courses at the Universities of the Third Age of Sesto S. Giovanni (Milan, Italy), Cinisello Balsamo (Milan, Italy), and Castellanza (Varese, Italy) in March, April, and November 2009. Screening was administered to 488 people, ranging from 50 to 88 years, mean age 65±5 years. A battery of screening tests was used: for the screening in Sesto S. Giovanni and Cinisello, the test battery included pure tone audiometry at 1, 2, and 4 kHz and a speech in noise 3AFC test, based on the recognition of consonants; for the screening in Castellanza, the test battery consisted in pure tone audiometry at 1, 2, and 4 kHz, speech audiometry with Italian disyllabic words, and a speech in noise 3AFC test, based on the recognition of consonants. Subjects were tested mono-aurally. The duration of the screening session was about 15 minutes per subject (both ears tested). Results of the screening revealed that 75% of subjects had no hearing disability, whereas 15% were identified with serious hearing disability.
The second adult hearing screening program was performed during the months of October and November 2009 in the city of Milan as a result of a protocol agreed with the municipal Health Care Authority (Assessorato Sanità). Screening was administered to 1052 people, ranging from 17 to 89 years, mean age 53±16 years. A battery of screening tests was used, which included pure tone audiometry at 1, 2, and 4 kHz, the Hearing Handicap Inventory for the Elderly HHIE-S questionnaire (10 questions) and a speech in noise 3AFC test, based on the recognition of consonants. Subjects were tested monoaurally. The duration of the screening session was about 15 minutes per subject (both ears tested). The screening campaign was advertised through regional broadcasting, newspapers and internet.
Results of the screening revealed that 1160 ears were found with PTA thresholds within 25 dB HL at all the three audiometric frequencies 1-4 kHz, 411 ears had thresholds greater than 25 dB HL at one of the three audiometric frequencies 1-4 kHz, 119 ears had thresholds greater than 25 dB HL at two of the three audiometric frequencies 1-4 kHz, and 333 ears head thresholds greater than 25 dB HL at all of the three audiometric frequencies 1-4 kHz. According to the outcomes from the HHIE-S questionnaire and the speech-in-noise test, 46% of subjects had no hearing disability, whereas 34% had hearing disability of mild degree and 20% were identified with serious hearing disability.
During the second reporting period, a series of new pilot initiatives of adult hearing screening were conducted in 14 large and small-size cities in Italy, involving an overall population of 1623 subjects (age range 16-89; mean age 64±10 years). These new initiatives, together with those conducted in the first reporting period (i.e., the Universities of the Third Age of Sesto S. Giovanni, Cinisello Balsamo, Castellanza and the Milan screening program with the municipal Health Care Authority), led to an overall screened population of about 3200 adults. Most of these new screening initiatives were held at some "Universities of the Third Age" (Sesto S. Giovanni, Lainate, Brugherio, Paderno Dugnano, Senago, San Giuliano Milanese, San Donato Milanese, Arluno, and Milano) with the collaboration and support of the Lions Clubs International in Italy; some other initiatives were held in supermarkets and public places (Abbiategrasso, Pantigliate, Cinisello Balsamo, Pioltello, Segrate, and Milano). Three different screening tests were used to assess hearing ability in the participants, i.e.: screening pure tone audiometry at 1, 2, and 4 kHz (PTA), an automated speech in noise 3AFC screening test, based on the recognition of consonants (the SUN test in the Italian language), and a screening questionnaire of self-perceived hearing handicap (the Hearing Handicap Inventory for the Elderly, HHIE-S, in its Italian standardized version). Typically, a combination of two of these tests was used (PTA and SUN test, or HHIE-S and SUN test); in some initiatives, all the three screening tests were used. Based on the outcomes of the screening tests, those subjects who were found to have hearing problems were referred for further audiological assessment. Results of the screening revealed that about 77% of subjects had no hearing disability or had hearing impairment of mild degree, whereas 23% were identified with moderate or severe hearing impairment and handicap. The duration of the whole screening session was less than 10 minutes per subject when two tests were combined and, on average, less than 15 minutes when all the three screening tests were used. Thanks to the limited test time, an average of nearly 150 subjects could be screened every week and, in the biggest cities, up to 250 subjects per week. Results of a survey conducted among participants revealed that most subjects had never check their hearing before the screening, and that nearly 15% had a previous hearing check opportunistically or because of surveillance programs (for example, at their workplace); at the same time, the survey revealed that most subjects felt the need to have their hearing checked either because they believed they had hearing problems (46% of subjects), or because their relatives or friends told them that they probably had hearing problems (27% of subjects). Overall, the survey indicated that often people who actually have hearing problems, or simply doubt their hearing, might pay no attention to this and not seek evaluation for their hearing. Screening initiatives like those conducted within the framework of the AHEAD III project allow people to easily have their hearing checked, and to become aware of the need to monitor their hearing as they become older. Thanks to the support of AHEAD III, our experience with the pilot initiatives demonstrates that screening adults for hearing problems is feasible in non clinical settings, and can be performed easily and quickly using available screening technologies. It is therefore very important that further efforts are done in this direction in order to better understand the key aspects related to the organization and management of adult hearing screening programs, and that further initiatives will be organized to define a roadmap to implement adult hearing screening of local, regional, or national dimension.
Pilot initiatives of adult hearing screening in other European Countries
During the second reporting period, some new pilot initiatives of adult hearing screening were started in Germany (from October 2010), Malta (from March 2011) and in Belgium (from May 2011). In Germany, screening is performed at the Department of Otolaryngology at the Klinikum rechts der Isar (Munich) and at the Jean-Uhrmacher-Institut für klinische HNO-Forschung at the Universität zu Köln (Koln). In Malta, adult hearing screening is being performed at the ENT Outpatients & Audiology Clinic at the Mater Dei Hospital (Msida). In Belgium, screening is performed in three clinics: the Service d'Oto-Rhino-Laryngologie at the Cliniques Universitaires Saint-Luc (Bruxelles), the Centre d'Audiophonoligie at the Ecole de Santé Publique, Université Catholique de Louvain (Bruxelles), and the Clinique Notre Dame, Centre Hospitalier de Wallonie Picarde (Tournai). The Consortium has made direct contacts with the clinics and has given them full support and coordination to establish and implement the screening initiatives. Following the protocols used in Italy, screening is performed using three different screening tests, i.e.: screening pure-tone audiometry at 1, 2, and 4 kHz (PTA), an automated speech-in-noise 3AFC screening test, based on the recognition of consonants (the SUN test in the German, English, and French languages), and a screening questionnaire of self-perceived hearing handicap (the Hearing Handicap Inventory for the Elderly, HHIE-S, in its German, English, and French standardized versions).
Deliverables
D9.1 - Interim Report on the progress of the implementation of EHDI Programmes (Month 18)
D9.2 - Final Report on the progress of the implementation of EHDI Programmes (Month 42)

WP10 - Liaison Officers- LIAISON

Objectives
Pursuing ways of networking with National, European and International Societies and Organisations.
Disseminate information among Associate and Third Countries.
Description of work
Of great importance to achieving the objectives of present project was the activity of Liaison Officers (WP10), responsible for contacting with national, European and International Organisations, outside the present network. In the course of the project's lifetime, quite a number of European and International Societies and Organizations outside the present network were contacted. Full information about AHEAD III project was transferred to these organizations and positive feedback was received from several of them. A special attention was given to make contact with the USA initiatives in the field of early hearing screening and intervention in elderly and recognize the ways and possible extent of future collaboration in that there are several group discussions on adult hearing screening and there is a willingness of exchanging knowledge with AHEAD III consortium.
The participants in this Working Group have:
- made contact with Societies and Organisations
- made contact with the USA initiatives in the field of early elderly hearing screening and intervention
- made contact with the ongoing EU projects in the field and with external stakeholders (i.e. WHO in Geneva)
In the first period, this WP has contacted the following European and International Societies and Organizations outside the present network:
- the European Federation of Audiological Societies (EFAS): contact with the Chairperson Linda Luxon (United Kingdom) and past Chairperson: Kajsa-Mia Holgers (Sweden)
- the International Society of Audiology (ISA): contact with Ieda Russo (Sao Paulo, Brazil) and the president-Elect : José Juan Barajas de Prat
- the International Association of Physicians in Audiology (IAPA): contact with the President Linda Luxon
- the American Auditory Society (ASO) contact with the Chairman Michael Gorga (USA)
- the American Speech and Hearing Association (ASHA) contact with the President Sue T. Hale (USA)
- the International Centre for Hearing and Speech Research (ICHSR) in Rochester, N.Y: contact with the Chairman D. Robert Frisina (USA)
- the International Commission on Biological Effects of Noise (ICBEN): contact with the Chairman Stephen A. Stansfeld (UK)
- the World Health Organization (WHO): contact with Dr. Andrew Smith
The information about AHEAD III project was disseminated at four international conferences (two in Europe, one in the USA and one in Asia), and one Polish national symposium.
The network with American initiatives in the field of early hearing screening and intervention in elderly has been established, and current state of knowledge in this country has been summarized.
While there is a widespread recognition of the liabilities presbycusis imposes on people and their family/friends, currently there is no national efforts nor programmes on early diagnosis of presbycusis in the States. Diagnoses are typically made through referrals from the primary care or family physician, when the patient or patient's family start to notice a significant hearing loss that interferes with work or family life. There are, however, many researchers and clinicians who share the concerns about early detection of hearing impairment in aging people. This is because it has been calculated that increased longevity and aging of the baby boomer generation will result in a doubling of the population older than 65 by the year 2030. The number of individuals older than 85 is expected to quadruple during the first half of this century, making this cohort the fastest-growing segment of the population. Therefore, the implications for audiology practice are immense.
One of the organizations most involved in developing initiatives in this field is ASHA (American Speech and Hearing Association), Washington, DC.
In 2006, ASHA Professional Development sponsored the 3-day Web seminar "Audiology 2006, The Aging Patient: New Perspectives in Audiology Service Delivery", that featured an interdisciplinary panel of experts. Now ASHA intends to extend periodic hearing screening in neonates to childhood and adulthood. This is a part of ASHA Phase II Campaign of the EHDI (Early Hearing Detection and Intervention) Programme, which is an extension of Phase I forwarded to babies. This project is currently focused on gathering of the appropriate information and planning of further stages. The main goal is to update the documents on hearing screening so that they were evidence-based and helpful in accomplishing the aims of hearing screening in various adult populations. There are several group discussions on hearing screening for a lifetime and there is a willingness of exchanging knowledge with our group.
There are also several American research projects forwarded to age-related hearing loss detection and intervention. Such programmes are currently running at the Medical University of South Carolina, University of Maryland, University of Washington, as well as at the International Centre for Hearing and Speech Research in Rochester, to mention the most important.
A large NIH-funded programme which includes a longitudinal study of older humans, now in its 21st year is currently conducted by the group of dr Judy Dubno at the Medical University of South Carolina. In addition to the longitudinal study, it includes experiments related to age-related changes in auditory function, hearing aids, speech recognition, and cortical function (neuroimaging) as well as a translational project using stem cells derived from bone marrow.
Research of dr Sandra Gordon-Salant and colleagues from the University of Maryland concentrates on problems in auditory temporal processing by elderly listeners as assessed in speech perception experiments using temporally altered signals and in psycho-acoustic experiments of duration and rhythm discrimination for simple and complex signals. Also, current research interest of dr George Gates and his colleagues from the University of Washington is in the aging brain and its significant contribution to the problems of hearing against background noise. They suspect that much of what passes for "nerve deafness" is really early cognitive impairment. Since hearing aids are of limited benefit for this problem, they hope to spur interest in auditory rehabilitation through training modalities (such as L.A.C.E).
According to dr. Robert Frisina, the leader of ICHSR - an NIH-funded group of scientists in Rochester, the methods for studying hearing impairment and auditory problems of the aging people can include the assessment of auditory sensitivity (audiograms, noise thresholds, speech discrimination), outer hair cell system (otoacoustic emissions - transient, distortion product), efferent feedback system (contralateral supression of otoacoustic emissions), timing and frequency (spectral) processing (gap detection, amplitude modulation), speech processing in noise (speech in noise - SPIN, hearing in noise test - HINT), spatial processing - hearing in noise test (HINT), ear and brainstem physiological processing (auditory brainstem response), and cerebral cortex function (auditory late and event-related potentials).
There is a willingness of researchers mentioned above to exchange knowledge and their experience, as well as to participate in seminars and conferences in Europe organized under AHEAD III project in the future for establishing the best protocols for hearing screening and intervention in elderly.
In the second period this WP supported the contacts with several International Societies and Organizations outside of the present network that were listed in the first year WP10 deliverables. In addition this WP contacted the following new International, North and South American and South African Societies:
- International Federation of Otorhinolaryngological Societies (IFOS)
- International Evoked Audiometry Study Group (IRSEAG)
- American Academy of Audiology (triple "A")
- Brazilian Society of Speech Therapy and Audiology
- South African Association of Audiology (SAAA)
WP10 members organized the AHEAD III Structured Session at the IAPA 2010, the XVth Anniversary Conference of the International Association of Physicians in Audiology in Krakow (Poland), September 20, 2010.
WP10 members also organized an International Session of the AHEAD III project on "Age-related hearing loss" at the 7th Annual Conference "Otorhinolaryngology" Lodz (Poland), on October 15, 2010 in collaboration with the Polish Society of Audiology and Phoniatrics.
Moreover, to increase the contacts with Asian otorhinolaryngologists and audiologists, a plenary session comprising the reports from each continent on hearing screening in neonates and elderly will be organized under the leadership of prof. Ferdinando Grandori during the 20th World Congress of the International Federation of Otorhinolaryngological Societes (IFOS) to be held in Seoul, Korea in 2013. Prof. Mariola Sliwinska-Kowalska has been proposed to become a chair of the IFOS Audiology and Phoniatrics Subspeciality subgroup, and has been given the chance to make the problems of hearing loss in elderly more visible through organizing other sessions at this and following IFOS congresses. A plenary session that includes the topics of age-related and noise-induced hearing loss is planned to be organized in Seoul in 2013.
Deliverables
D10.1 - 1st Yearly report (Month 12)
D10.2 - 2nd Yearly report (Month 24)
D10.3 - Final report (Month 42)
Potential Impact:
Potential Impact
Hearing impairment in the elderly is an important health and psychosocial problem.
The inevitable deterioration in hearing ability that occurs with age is a multifactorial process that can vary in severity from mild to substantial. Left untreated, presbyacusis of a moderate or severe degree affects communication and may lead frequently to isolation and depression.
These psychological effects are largely reversible with an appropriate and timely rehabilitative treatment.
Comprehensive identification and rehabilitation is available but underused because, in part, of social attitude that undervalue hearing in addition to the cost and stigma of hearing aids. Moreover, because the process of loss is gradual, people whose hearing is impaired may not realize that their hearing is progressively worsening. Without being aware of it, people with presbyacusis may make small adjustments over time, for example, standing closer to someone who is speaking or turning up the TV volume, that allow them to perceive the sounds and cues they otherwise would miss. At some point, the loss may become so severe that these adjustments become ineffective. Hearing impairment is not visible, an invisibility facilitates denial
Identification and remediation of presbyacusis is, hence, an important contributor to increase quality of life of the elderly, reducing additionally the risks of falls (secondary prevention) and providing a self-supporting life-style and increasing in self confidence in everyday life. It is therefore important to provide new strategies and new solutions for age-related hearing loss.
A big benefit of the implementation of the present project AHEAD III is that it has contributed significantly 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 or region in the EU area.
This Coordination Action has contributed to homogenise the quality of screening programmes and the standards of care in the EU. AHEAD III project has explored novel strategies to make screening and early intervention a feasible part of routine care and to make screening for hearing loss the rule rather than the exception.
Another big benefit in the long term of the project AHEAD III is the bringing together of groups of researchers with different background, and researchers and clinicians.
Moreover, HEAD III project translated achievements and knowledge into new solutions for age-related hearing loss
Finally, AHEAD III project has promoted the awareness of the consequences of undetected hearing loss and the diffusion of a positive attitude toward wearing hearing aids.

Main dissemination activities and exploitation of results
The Consortium has deemed dissemination and exploitation of the project results an important issue. Moreover, it was considered of great importance to share objectives and achievements of present project to maintain close contacts with "affluent" national, European and International societies and organisations outside the present network. For this reason, one specific work package has been dedicated to this activity of establishing systematic external liaisons (WP10).
The dissemination activities has been performed at different levels considering different target audience:
Broad public:
WEBSITE IMPLEMENTATION (http://www.ahead.polimi.it)

AHEAD III on EC "Cordis News"

MEDIA (print media, press conference, TV, radio):

- RAI 3 (national broadcaster), Radio Interview on Adult Hearing Screening on May 11, 2008 (responsible: F. Grandori, Italy)
- Potsdamer Neueste Nachrichten, Potsdam (Germany), October 22, 2008:„Für ein anderes, besseres Hören"(in English: For another, better hearing; responsible: A. Ernst)
- AERZTEZEITUNG, Frankfurt, (Germany), May 28, 2009: " Häufig ignoriert: Altersschwerhörigkeit (in English: Presbycusis-frequently ignored disease; responsible: A. Ernst)
- Frankfurter Allg. Zeitung (FAZ), Frankfurt, (Germany), May 26, 2009: „Spitzen-Ärzte tagen im ICC''(in English: Top doctors gather at ICC, in Berlin during the Capital Congress; responsible: A. Ernst)
- TAGESSPIEGEL, Berlin, (Germany), August 30, 2009: "Knopf am Kopf"(in English: Button at the head - hearing implants for ARHL; responsible:, A. Ernst)
- Berliner Morgenpost, Berlin, (Germany), Sept 9, 2009: "Die Hemmung, ein Hörgerät zu tragen,nimmt deutlich ab" (in English: The mental reservation to use hearing aids could be clearly reduced over the last few years; responsible:, A. Ernst)
- Il giorno, Milan, (Italy), October 14, 2009: "Sentire bene è vivere meglio, ecco la giusta prevenzione (in English: Better hearing is better life, this is the right prevention responsible: F. Grandori) (daily newspaper with national circulation)
- Press Conference, October 14, 2009, Milan, (Italy), Press room Palazzo Marino: "Ottobre, il mese dell'udito" (in English: October, the month on hearing, responsible: F. Grandori)
- M. Buschermöhle, B. Kollmeier: "Mittwoch im Zeichen von Psychoakustic und Hören im Alter", Audiological Acoustic , 48, Nr. 4/2009, pp:186
- ARD/RBB TV, Berlin, (Germany), May 6, 2009: "Altersschwerhörigkeit und Hörimplantate" (in English: ARHL-new ways to deal with; responsible: A. Ernst)
- Newsletter describing the Greek program for Screening- Intervention-Hearing-Participation to lifeto all local chapters of the Union of Cypriot Pensioners - PEO (UCP-PEO), the largest pensioner organization in Cyprus (responsible: C. Thodi, Cyprus);
- Frequent labor newspaper presentations of the Greek screening program and activities (Cyprus)
- Two PLUS TV program in Cyprus dedicated to pensioners informed the public about the screening activities:
- On March 3rd, 2009, there was a discussion of adult hearing loss, consequences, and interventions. Volunteers were screened and counseled on the air (responsible: C. Thodi)
- On June 26th, there was discussion on hearing loss, with emphasis on interventions. The show included demonstration of hearing aids, and discussion of possible outcomes. (responsible: C. Thodi)
- Public discussions of the Greek screening program with the pensioner organizations' membership (responsible: C. Thodi, Cyprus)
- Radio Zeta (national broadcaster), Interview on Adult Hearing Screening on November 6, 2009 (responsible: F. Grandori, Italy)
- Italian National TV RAI 1 (F. Grandori) recorded interview on hearing of about 15 minutes, broadcasted on "Tutto benessere", January 9, 2010
- Newspaper "Il Diario del Nord Milano" (November 3, 2010) "Il computer misura le capacità di ascolto" (in English: The computer measures hearing abilities)
- Newspaper "Lion - Edizione italiana "(January 2011, Year LIII, n.1) "Screening uditivo al 56° Europa Forum" (in English: Hearing Screening at the 56° Europa Forum).
- Newspaper Settegiorni (January 28, 2011) "Esami dell'udito con l'UTE" (in English: Hearing Screening with the Universities of the Third Age).
- Hearing screening project for "Le Piazze della Salute", an initiative of the Municipality of Milan. April-May 2011 (web: http://www.lepiazzedellasalute.it/tema_.asp?ID=12)
- Leaflets to advertize the hearing screening in Segrate (Milan), initiative in collaboration with of the Lions Club Segrate Milan (web: http://www.mondolions.org/images/stories/Screening_auditivo_Segrate.pdf)
- Auditory screening project for the "Lions Days 2011", "initiative of the Lions District 108 IB4 "la Grande Milano". (Web: http://www.mondolions.org/index.php?option=
com_content&view=article&id=671:i-lions-day-2011&catid=148:progetti-distrettuali&Itemid=287)
- Leaflets to publicize the auditory screening program at the Universities of the Third Age" (Sesto S. Giovanni, Lainate, Brugherio, Paderno Dugnano, Senago, San Giuliano Milanese, San Donato Milanese, Arluno, and Milano) ;
- Leaflets to advertise about the auditory screening program in supermarkets and public places (Abbiategrasso, Pantigliate, Cinisello Balsamo, Pioltello, Segrate, and Milano)
- The media campaign on AHL in Germany (with the GSL, with a media reach of 27 min readers)

SCIENTIFIC AND MEDICAL COMMUNITY AND RELATED ASSOCIATIONS:
- Periodical circular email on AHEAD III progress and news to experts from the EU, Associated countries and Third Countries with an internationally recognised expertise in a specific topic.
- Brochure/leaflet on the AHEAD III project (one A4 page)
- AHS 2010 International Conference on Adult Hearing Screening, June 10-12, 2010, Cernobbio, Italy

SPECIAL SESSION/ROUND TABLE/INVITED SPEAKER:

- AHEAD III Special Session at the AHS 2010: The European Project AHEAD III on Adult hearing. Program: AHEAD III Assessment of Hearing in the Elderly: Aging and Degeneration - Integration through Immediate Intervention (F. Grandori); Intervention Strategies following screening for hearing in adults. (S. Kramer); New technologies for adult hearing screening (S. Stenfelt); Methods and technologies for performing adult hearing screening (AHS) (T. Janseen).
- AHEAD III Structured Session at the IAPA 2010, the XVth Anniversary Conference of the International Association of Physicians in Audiology in Krakow (Poland), September 20, 2010. Program: Deriving human audiometric phenotypes in age-related hearing loss from animal models - Judy Dubno (USA); Validated measures of functional hearing ability to screen individuals for hearing-critical jobs - Sigfrid Soli (USA); Effects of age and hearing loss on recognition of time-compressed speech - Jose Juan Barajas de Prat, Frank Zenker, A.B. Carballo Gonzalez, R. Fernandez Belda (Spain); Quality of life in the elderly with hearing impairment - Nadia Kamal (Egypt); The European Project AHEAD on Adult Hearing Care. Achievements and consensuses - Ferdinando Grandori (Italy).
- AHEAD III Structured Session at the EFAS 2011, The 10th European Federation of Audiology Societies Congress in Warsaw, June 22-25, 2011. Program: Adult hearing screening and the European project AHEAD III (F. Grandori); Screening for hearing problems in the adult population (A. Davis); Screening for hearing disability and communication disorders in adults: what should we focus on? (G. Tognola); Strategies following screening for hearing disability in adults(S. Kramer);
- AHEAD III booth at SIAF 2011, Italian Society of Audiology and Speech Therapy", Bari (Italy), October, 5-8, 2011 .
- Organization of a Meeting on Presbyvertigo and therapy options with experts from Europe (on Dec 5, 2009) in Berlin;
- Presentation of Sun Test in the Path Medical Solution Booth at EUHA Congress, Hannover, Germany, October, 14-15, 2010
- Presentation of Sun Test in the Path Medical Solution Booth at EUHA Congress, Nuremberg, Germany, November, 20-21, 2011
- Organization of the "Day of the Elderly with Sensory Impairment" at URANIA Seniors' Academy in Berlin (March 21, 2010) on Age-related Impairment of Hearing, Vision and Balance
- Special Session of AHEAD III at the German Annual ENT Meeting in Wiesbaden presenting project results and initiative (on May 13, 2010).
- "Screening, identification and early intervention" invited presentation by F. Grandori at the Seminar on hearing loss, Sofia, Bulgaria, 20 March, 2010
- "Epidemiology and aetiology of age related hearing loss" invited presentation by R. Probst at the International Conference on Adult Hearing Screening AHS 2010, June 10-12, 2010, Cernobbio, Italy;
- "Genetics and age related hearing impairment" invited presentation by G. Van Camp at the International Conference on Adult Hearing Screening AHS 2010, June 10-12, 2010, Cernobbio, Italy;
- "A systematic review of interventions following screening for hearing in adults" invited presentation by M. Pronk, October 2011, at the Swedish Institute for Disability Research Orebro, Sweden.
- "Hearing Screening in Adults and Elderly is Gaining Momentum" invited presentation by Ferdinando Grandori at the Phonak International Conference "Hearing Care for Adults 2009 - The Challenge of Aging", November 16-18, 2009, Chicago, Illinois, USA
- "Epidemiology of aging and hearing loss related to other chronic illnesses" invited presentation by Adrian Davis at the Phonak International Conference "Hearing Care for Adults 2009 - The Challenge of Aging", November 16-18, 2009, Chicago Illinois, USA
- "Hearing Impairment, Work and Vocational Enablement" invited presentation by Sophia E. Kramer at the Phonak International Conference "Hearing Care for Adults 2009 - The Challenge of Aging", November 16-18, 2009, Chicago Illinois, USA
- Round Table of the Annual Meeting of the German Audiology & Neurotology Society (ADANO) devoted to Age-Related Hearing loss and Central Presbycusis (Bad Arolsen, October 7, 2008), moderators: A. Ernst, R. Rubsamen
- AHEAD III Round Table at Capital Congress on Medicine in Berlin, May 28, 2009. Topics were: The European project AHEAD III on Assessment of Hearing in Adults and the Elderly (F. Grandori), Aetiological Assessment and Epidemiology (R. Probst), Intervention Strategies (S. Stenfelt), UK program - RNID (M. Downs), Presbycusis - a French perspective (B. Frachet), Hearing Amplification in the Elderly - GN Resound (N. Bisgaard).
- AHEAD III Structured Session on Hearing Screening in Adults at The European Federation of Audiology Societies (EFAS) Congress in Tenerife, June 21-24, 2009. Program: The European project AHEAD III on assessment of hearing in adults and the elderly (F. Grandori), Main effects of age related hearing loss (M. Walger). Strategies of intervention after screening for hearing in adults/elderly (S. Kramer), Pilot programme in UK (A. Davis)
- AHEAD III booth at EFAS Congress in Tenerife, June 21-24, 2009.
- AHEAD III Special Session at the 7th Annual Conference Otorhinolaryngology, October 15, 2009, Lodz, Poland Program: G. Tognola: The AHEAD III project; M. Walger: Main effects of age-related hearing loss; M. Sliwinska-Kowalska: Otoaocustic emissions in age-related and noise-induced hearing loss; E. Hojan: Hearing aids in adults and the elderly
- Special session of the Annual Meeting of the German Audiology & Neurotology Society devoted to Presbyvertigo, Koblenz, October 22, 2009

SCIENTIFIC PAPERS:

- Roth T.N., Hanebuth D., Probst R. "Prevalence of age-related hearing loss in Europe: a review". Eur Arch Otorhinolaryngol 2011, 268:1101-1107 [DOI 10.1007/s00405-011-1597-8];
- Pronk M., Kramer S.E., Davis A.C., Stephens D., Smith P.A., Thodi C., Anteunis L. J.C., Parazzini M., Grandori F. "Interventions following hearing screening in adults - A systematic descriptive review", Int. J. Audiol, 2011, 50(9):594-609 [DOI: 10.3109/14992027.2011.582165].
- Smith P.A, Davis A.C., Pronk M., Stephens D., Kramer S.E., Thodi C., Anteunis L. J.C., Parazzini M., Grandori F. "Adult Hearing Screening: What comes next?" Int. J. Audiol., 2011; 50(9): 610-612 [DOI: 10.3109/14992027.2011.585668]
- Freigang C., Schmidt L, Wagner J, Eckardt R, Steinhagen-Thiessen E, Ernst A, Rübsamen R. Evaluation of central auditory discrimination abilities in older adults. Front Aging Neurosci. 2011 May 2;3:6. DOI 10.3389/fnagi.2011.00006
- F. Grandori, G. Tognola, Preface, Audiology Research 2011; 1:e1; [DOI: 10.4081/audiores.2011.e1]
- A. Paglialonga, G. Tognola, F. Grandori, "SUN-test (Speech Understanding in Noise): a method for hearing disability screening", Audiology Research 2011; 1:e13, [doi:10.4081/audiores.2011.e13]
- S. Stenfelt, T. Janssen, V. Schirkonyer, F. Grandori, "e-Health technologies for adult hearing screening", Audiology Research 2011; 1:e14; [doi:10.4081/audiores.2011.e14]
- A. Paglialonga, G. Tognola, F. Grandori, "Pilot initiatives of adult hearing screening in Italy", Audiology Research 2011; 1:e17; [doi:10.4081/audiores.2011.e17]
- C. Thodi, M. Parazzini, S.E. Kramer, A.C. Davis, S. Stenfelt, T. Janssen, D. Stephens, P.A. Smith, M. Pronk, L.J.C. Anteunis, F. Grandori, "Adult hearing screening: the Cyprus Pilot Program", Audiology Research 2011;1:e18; [doi:10.4081/audiores.2011.e18]
- D. Stephens, I. Gianopoulos, S.E. Kramer, "Interventions after screening for hearing difficulties: a retrospective investigation of interventions other than hearing aids" Audiology Research 2011; 1:e21; [doi:10.4081/audiores.2011.e21].
- Z. Pisky, R. Mozes, A. Burian, P. Revesz, I. Gerlineger, J. Pytel., "Early detection of age related hearing impairments", Ful-Orr-Gegegyogyaszat, 2011; 57(3):138-144
- Paglialonga A., Tognola G., and Grandori F., "SUN test (Speech Understanding in Noise): un test automatico per lo screening uditivo dell'adulto," Otorinolaringologia, vol. 61(4), pp. 101-109

PRESENTATIONS/DISSEMINATIONS AT INTERNATIONAL CONFERENCES:

- Sliwinska-Kowalska et al, "The European Project AHEAD III on Adult Hearing", AAA Academy Research Conference ARC 2010 April 14, 2010, San Diego, USA;
- D. Stephens et al., "A retrospective investigation of interventions other than hearing aids", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- M. Pronk et al., "A systematic review of interventions following screening for hearing", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- C. Thodi et al., "Adult Hearing Screening: the Cyprus Pilot Program-AHEAD III", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- A. Paglialonga et al., "Hearing ability screening programs in adults in cooperation with the Lions Clubs International in Italy", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- F. Grandori et al., "A new test for screening hearing ability in adults", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- F. Grandori, "Screening adults for hearing. concepts and criteria", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- A. Ernst et al., "Hearing and balance impairments in the elderly are a risk to fall", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- E.M. Schedlbauer et al, "Bimodal hearing and cochlea implantation in the elderly with severe SNHL", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- F. Wagner et al., "Subjective handicap assessment of a profound hearing loss per and post implantation with VSB system in the elderly", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- A. Ernst et al., "Media Campaign "Age-related hearing loss": an initiative of the German seniors league" International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- M. Sliwinska-Kowalska et al., "Aging of professionally active populations - medicolegal dilemmas", International Conference on Adult Hearing Screening (AHS2010), June 10-12 2010, Cernobbio, Italy.
- M. Sliwinska-Kowalska et al., "The European Project AHEAD III on Adult Hearing" XVth Anniversary Conference of the International Association of Physicians in Audiology in Krakow (Poland), September 20, 2010
- M. Sliwinska-Kowalska et al., "The European Project AHEAD III on Adult Hearing" 46th Congress of the South African Society of Otorhinolaryngological ENT2010: A Laryngeal Odyssey, Drakenberg, South Africa, 23-28 October, 2010.
- M. Sliwinska-Kowalska et al., Aging of professionally active populations - medicolegal dilemmas, 46th Congress of the South African Society of Otorhinolaryngological ENT2010: A Laryngeal Odyssey, Drakenberg, South Africa, 23-28 October, 2010.
- Grandori F., Tognola G., and Paglialonga A., "Hearing next.... how to cope with the increasing demand of good hearing," The International Association of Lions Clubs - 56th Europa Forum, Nov 3-5, 2010, Bologna.
- F. Grandori "Early hearing detection and intervention", 4th International Conference "Towards Excellence in Health Care", Amman (Jordan), May 4-5, 2011
- C. Thodi et al., "Adult Hearing Screening: Follow up and outcome measures", X European Federation of Audiology Societies (EFAS) Congress, June 22-25 2011, Warsaw, Poland.
- A. Paglialonga et al., "A speech in noise test to screen hearing ability in adults," X European Federation of Audiology Societies (EFAS) Congress, June 22-25 2011, Warsaw, Poland.
- S.E. Kramer et al., "Intervention Strategies following screening for hearing in adults: a systematic review" FAS-IT Conference on e-health in hearing, October 2011, Linköping, Sweden
- A. Paglialonga et al., "The Speech Understanding in Noise (SUN) test: an application of intervocalic consonants as a screening tool," Aging and Speech Communication (ASC) Research Conference, Oct 10-12 2011, Bloomington, Indiana (USA).
- XXIX International Congress of Audiology ICA Hong Kong, 8-12 June, 2008. Poster: Grandori et al, "Assessment of hearing in the elderly: aging and degeneration -Integration through immediate intervention"
- IX International Tinnitus Seminars Göteborg, Sweden,15-18, June, 2008. Poster: Grandori et al, "Assessment of Hearing in the Elderly: Aging and Degeneration - Integration through Immediate Intervention"
- 9th International Congress on Noise as a Public Health Problem, ICBEN Mashantucket, Connecticut, USA, 21-25, July 2008. Poster: Sliwinska-Kowalska et al., "AHEAD III - Assessment of Hearing in the Elderly: Aging and Degeneration - Integration through Immediate Intervention"
- XIV International Symposium in Audiological Medicine IAPA 2008, Ferrara, Italy, 18-21, September, 2008; Poster: Grandori et al., "AHEAD III- Assessment of Hearing in the Elderly - Aging and degeneration - integration through immediate intervention"
- International Federation of Otorhinolaryngological Societies IFOS World Congress, Sao Paolo, Brazil, 1-5 June, 2009
- XXI International Evoked Audiometry Study Group Conference IERASG, Rio de Janeiro, Brazil, 8-11, June 2009; Poster Grandori F. et al "Assessment of hearing in the elderly: aging and degeneration -Integration through immediate intervention - AHEAD III"
- Phonak International Conference "Hearing Care for Adults 2009 - The Challenge of Aging", November 16-18, 2009, Chicago Illinois, USA; Poster: Grandori F. et al "The European Project AHEAD III on Adult Hearing"

PRESENTATIONS AT NATIONAL CONFERENCES:

- R. Probst, A. Ernst, F. Grandori: "Koordinierte EU-Aktion (AHEAD III) zur Altersschwerhörigkeit: Ist eine Früherkennung möglich?" 81st Annual Meeting of the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery in Wiesbaden May 13, 2010.
- Hanebuth D., Roth T., Zemp-Stutz E., Probst R. "Prevalence estimation of age-related hearing loss ARHL in elderly people aged 60 years and above in Europe", Swiss Public Health Conference, August 25-26, 2011 Basel.
- National conference for Technical Audiology in Eskilstuna, Sweden (STAF 2010). Presentation by S. Stenfelt on WP5 and WP6 AHEAD III activities
- Paglialonga A et al., "Il SUN test (Speech Understanding in Noise) per lo screening uditivo dell'adulto: i risultati ottenuti con il test in lingua italiana e nelle principali lingue europee," XXXIII Congresso della Società Italiana di Audiologia e Foniatria (SIAF2011), October 5-8 2011, Bari (Italy).
- Paglialonga A et al., "Uso del SUN test (Speech Understanding in Noise) in campagne pilota di screening uditivo dell'adulto: i risultati ottenuti su 3155 soggetti," XXXIII Congresso della Società Italiana di Audiologia e Foniatria (SIAF2011), October 5-8 2011, Bari (Italy)
- 6th Annual Conference "Otorhinolaryngology" Lodz, Poland, 23-25 October, 2008.
- NVA meeting (Dutch Society of Audiology), Utrecht, The Netherlands, 24 September 2009- presentation given by Dr. Kramer: "Interventions following hearing screening in adults - A systematic review".
- XXXII SIAF Congress (Italian Society of Audiology and Speech Therapy), Firenze, Italy, 7-10 October 2009; Poster: Grandori F. et al., "Il progetto Europeo AHEAD III sulla disabilità uditiva nell'adulto e nell'anziano"

UNIVERSITY SEMINARS
- In February 2009, Professor Ernst gave an overview of the initiative AHEAD III at Berlin Charite Seniors' University

EXPERT CONSULTATIONS/MEETINGS:
- Questionnaires on interventions strategies posted on the AHEAD III website (see Enclosed)
- Questionnaires on interventions strategies send directly to 150 email addresses of experts (i.e. ICRA members, British Academy of Audiology Service Quality Committee members, etc.)
- BSHAA Newsletter on intervention strategies
- Moscow on October 6, 2009: most of the head of ENT or Audiology department of the large majority Commonwealth of Independent States (CIS) (more than 20-25 people) took part to a meeting organised by professor George Tavarkiladze (Secretary of the International Society of Audiology and Director of the National Research Center for Audiology and Hearing Rehabilitation in Moscow) who agreed with Ferdinando Grandori (AHEAD III Coordinator) to share most of the achievement of the project.

SCREENING PROGRAMME UNDER PLANNING
Direct contact with the following screening programmes:
- Pilot program of hearing screening in older adults in UK (A. Davis, P. Smith)
- Pilot program of hearing screening in older adults in Cyprus (C. Thodi)
- Pilot program of hearing screening in older adults in Italy (F. Grandori, G. Tognola)
- Pilot initiatives of adult hearing screening in Germany (from October 2010, Munich and Koln, F. Grandori)
- Pilot initiatives of adult hearing screening in Malta (from March 2011, Msida, F. Grandori)
- Pilot initiatives of adult hearing screening in Belgium (from May 2011, Bruxelles and Tournai, F. Grandori)
- Purposive Screening for hearing (HearCom) Netherlands: contact with: Prof. Tammo Houtgast, Dr. Marcel Vlaming. Some AHEAD III members took part at the final meeting of the HearCom Workshop on Hearing Screening and new Technologies Brussels 28, 29 January 2009

EUROPEAN AND INTERNATIONAL SOCIETIES AND ORGANIZATIONS
Direct contact with the following organisations:
- the European Federation of Audiological Societies (EFAS)
- the International Society of Audiology (ISA)
- the International Association of Physicians in Audiology (IAPA)
- the American Auditory Society (ASO)
- the American Speech and Hearing Association (ASHA)
- the International Centre for Hearing and Speech Research (ICHSR) in Rochester, N.Y
- the International Commission on Biological Effects of Noise (ICBEN)
- the World Health Organization (WHO)

Contact

Ferdinando Grandori, (Director)
Tel.: +39-02-23993345
Fax: +39-02-23993367
E-mail
Record Number: 196162 / Last updated on: 2017-03-24
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