Suzdal/Russia - Once Again the Capital of Russian Audiology!

The Fifth National Congress of Audiologists and the Ninth International Symposium on Contemporary Issues in Hearing Physiology and Pathology were held May 14-16, 2013 in the town of Suzdal, as has become the tradition. Audio info Russie asked Professor George Tavartkiladze, director of the Russian Research Centre for Audiology and Hearing Aids and organizer of the event, to describe the main issues addressed by the congress and to summarise it.

The ancient Russian town of Suzdal, Vladimir region, part of the Golden Ring of Russia and about 200 miles east of Moscow, has traditionally been host to hearing specialists. The Fifth National Congress of Audiologists and the Ninth International Symposium on Contemporary Issues in Hearing Physiology and Pathology brought together more than 280 participants, not only from all across Russia, but also from Kazakhstan, Uzbekistan, and Ukraine. Numerous lectures, presentations by various companies, and workshops were held at the scientific forum. In the lobby of the tourist centre, where the congress was in progress from May 14 to 17, 2013, there was an exhibition of modern audiology equipment to which major Western and Russian manufacturers of hearing aids, cochlear implants, and diagnostic equipment brought their latest products. Suzdal meetings have already become de rigeur for Russian audiologists.

Not abandoning tradition

For Russian audiologists, the name “Suzdal” has long signified a scientific forum, with several days of actively exchanging opinions, presenting one’s work, discussing, and having a good time. Upon arrival, participants were met by a folk music ensemble and were not allowed to register for the forum unless they partook of the local beverage, mead. The festive good mood, which the organizers of this major scientific congress managed to keep going until the end, helped young presenters overcome stress and reduced fatigue in those participating in negotiations and business meetings.

Despite the long distances that many meeting participants have to travel, they try not to miss the Suzdal Congress. "People come here because it’s Suzdal!” George Tavartkiladze noted proudly. “In other words, they come for the knowledge, to share their new findings in audiology. There simply aren't any other such events in the country. Our congress is different from other events - there are no company-sponsored lectures in its scientific program. Those have a separate time and place.”

After the congress was officially opened, the first lecture was delivered by James Hall, an American professor. He spoke about the historical development of the science of hearing electrophysiology from 1930 to 2013 and held a seminar. The organizers of the scientific forum particularly emphasized his involvement as a very serious and major world-class audiologist. It is no accident that James Hall, as one of the founders of the American Academy of Audiology (AAA) and a director of the American Speech and Hearing Association (ASHA), was the first to speak at the congress. Hall was invited to the Congress through the involvement of the company GSI, which arranged financial support for him. "I have twice been to scientific conferences in Moscow and once in St. Petersburg,” noted Hall. “Judging by the questions I was being asked by Russian specialists after my lecture, and after discussing certain topics with Russian audiologists, I can say that there is a very high level of audiologist training and development in the country."

The Hearing Screening Programme

The congress, as usual, covered a rather wide range of issues, but audiology screening still remains a priority. It provides the opportunity for earlier rehabilitation, including cochlear implantation, to achieve the optimal effect in hearing restoration and speech development.

On the first day of the congress, development trends and the effectiveness of audiology centres/offices over the last three years were analysed. Yevgeniya Tsygankova noted that maternity hospitals with a capacity of more than a thousand births per year, as well as audiology offices that are part of National Project Health, are rapidly being equipped for newborn hearing screening, so that the percentage of coverage of children who underwent diagnosis reached high levels, in some regions up to 98%. This means that now every child in the maternity home can have an objective hearing study.

The age demographics of children with newly diagnosed hearing loss have changed. The percentage of children under one year of age in 2012 reached 16-20%. There was also a marked downward trend in the age at which children first received hearing aids or implants.

"Today, screening equipment has been provided to all maternity centres, while diagnostic equipment has been provided to all regional audiology centres,” said Tavartkiladze. In other words, the equipment is there, and all the professionals are trained; today all that is missing is the last organizational link. Furthermore, after a project ends, money is being allotted every year for additional equipment purchases. Too bad we still do not have a system for programmed screening follow-through.”

Thus far, not all children in whom hearing loss is suspected at the first stage of screening reach the second diagnostic stage. Since the tracking system is not operational, the figures are sometimes artificially inflated: Some regions have reported 98-99% of children were screened. But actually, sometimes a sick child does not pass the screening at the hospital and repeats the test at a polyclinic. This is the same child, but he is counted twice.

The fact that there are children who do not reach the second stage may come from parents who did not pay attention to the initial diagnosis of hearing loss in the hospital and did not take the child for further examination. Creating a single tracking system will help to avoid these errors.

Genetic Studies

One new area of research that has developed rapidly in recent years is research into the genetic basis of hearing loss and deafness; a lot of attention was devoted to this field at the congress. Congenital hearing loss occurs in approximately 1 in 1,000 neonates. It is believed that the hereditary forms comprise 50%. Currently, newborn hearing screening provides very effective early identification of children with hearing impairment, and the number of children for whom the cause of the hearing loss is unclear at the time they are identified has been increasing. Molecular diagnosis or the detection of mutations in the GJB2 gene is further confirmation of the hearing screening results, which give parents the opportunity to take timely measures.

Tatyana Markova emphasized in her lecture the urgency of developing programs which combine audiological and molecular genetic screening of newborns, saying that under the present conditions, only DNA diagnosis can objectively evaluate the causes of congenital sensorineural hearing loss.

Based on the genetic testing results for one child, an approach to audiology examination can be identified for the other children in the family.

Implant Technologies

Many lectures were devoted to cochlear implants, the result of the development of audiology and the implant technologies themselves. "We always try to go beyond pure audiology, and we take, for example, otology or otoneurology. The emphasis at every conference changes; this time, there was a lot of attention paid to auditory evoked potentials,” said Tavartkiladze. “And the emphasis for them has also changed. Previously the discussion was about the potentials on the auditory periphery, but today we're talking about the potentials of the auditory cortex. Middle ear implants and partially implantable bone vibrators have come on the scene and are finding wider application. They have all been registered in Russia and are gradually appearing on the Russian market, and therefore interest in them has increased correspondingly.”

For the third consecutive year, the government has allocated funds for 1400 implants. For now these funds are primarily allocated to children, but this situation could change soon. In Russia today, a child has surgery for congenital hearing loss only as late as age five. If the hearing loss was acquired, and the child is older, but he can speak and is studying in an ordinary school, then with proper justification such children also have the right to free cochlear implantation. Even if the rehabilitation of such children is slower, these children are given the chance.

The primary task connected with the increasing number of cochlear implants is setting up rehabilitation centres across the country for patients who have received implants. Secondly, the planned replacement of speech processors, which are half the cost of an implant, is an issue being addressed. Patients will no longer have to look for sponsors or spend their own money. "I think this is a fantastic achievement, and I hope that it will be implemented,“ added Tavartkiladze. “And finally, we are now waiting for the publication of a new policy to provide audiology assistance that clearly prescribes what and how it should be done. This applies to equipping offices and the load on the specialists. And that is also quite important.”

For now, surgery for adults is not paid in full, but given the global trend, this situation could change quickly. "Soon we may be dealing with the issue of increasing the percentage of adults who are candidates for implantation,” says Tavartkiladze. “I hope that it will increase, in other words that implantation will be covered for acquired deafness caused by trauma, meningitis, or treatment with antibiotics or other drugs that have ototoxic effects."

Officially, binaural cochlear implantation is not yet permitted, but the situation with that should eventually change as well. "Today it is possible to perform simultaneous surgeries; the main funding comes from the federal budget, but it can be used in parallel with the local budget, which occurs, for example, in Moscow or St. Petersburg,” adds the professor. The child undergoes anaesthesia once instead of twice, which is very important. We have already performed dozens of binaural implants, with the same amount in the northern capital, so it's already working."

Conclusions of the Congress

At this year's Suzdal forum there were a lot of new young faces, and the lectures were overall of high quality. Of course, the better-trained scientists come from the cities where there are institutions, there are real schools, but it's safe to say that practitioners are drawn to knowledge.

There is an increasingly broader range of issues that not only are relevant today from a research point of view but also are of great interest to practising physicians. The Congress also highlighted the positive outcomes of project financing. In recent years the government has allocated about a billion roubles to the newborn hearing screening program organization, and implants are being purchased every year at a cost of one and a half billion roubles.

"It's very important that we gather at these forums,” said Tavartkiladze in conclusion. “Communication is always beneficial, especially when you are interacting with professionals who work out in the community. We get a lot of positive energy from them. Without an exchange of views, there will not be such rapid development of audiology in the country."

© N.B.

Nina Beliaeva, correspondent for Audio infos in Russia