Colombia: 9th National Congress and Expo on Audiology

February saw Colombian audiologists meet with those of neighbouring countries in Bogotá to review the subjects currently swaying the direction of the profession. They reflected on the immediate future of specialists and analysed new opportunities for hearing loss patients.

Some 180 hearing professionals spent three days following national and international experts speaking as part of the academic programme at the "9th National Congress and Expo on Audiology", organised by the Colombian Audiology Association (Asoaudio) with the help of several hearing sector firms.

Four main themes dominated the scientific content of the Congress: evaluation and treatment in vestibular rehabilitation; hearing amplification with emphasis on real ear measurement; hearing rehab and cochlear implants; and electrophysiology and professional issues. The Congress methodology proved spot on, blending masterful speeches with practical workshops, giving hearing professionals plenty of added value. The international scientific input came from Michael Strupp, neurologist at the Department of Neurology of the Ludwig Maximilian University of Munich, Germany; Hilda María Furmanski, speech-language pathologist specialising in child hearing problems and lecturer in Audiology at several Argentinian universities; and Earl Edward Johnson, Advanced Practice Audiologist for the Mountain Home VA Medical Center, Tennessee, USA.

Meanwhile, the national quota at the Congress came from recognised Colombian specialists, among them Patricia Rangel, Ángela María López, Amanda Páez, Martha Lucía Tamayo, Rocío Molina, Iván Darío Flórez, Victoria Molina and José Alberto Prieto.

An original topic

Dr. Michael Strupp's presentation on the subject of vertigo was warmly received by delegates since it questioned the obligatory use of technological equipment in making a real diagnosis of vertigo, certainly a change in thinking compared to the tradition on this topic in Colombia.

In the words of Claudia Gutiérrez, Asoaudio President, "Strupp's presentation was original because it offered a dynamic review of something the local audiological sector does not regularly deal with; for him, diagnosis of dizziness, central or peripheral vertigo can be carried out using a protocol whose only technological requirement is the use of a simple tool (glasses) to gauge the characteristics of nystagmus, with this analysis being added to the case notes, symptomatology, and physical tests carried out by the specialist to provide a differential diagnosis."

In his presentations, Michael Strupp stressed the importance of good case notes in order to reach an accurate diagnosis. Vertigo is a multi-sensorial syndrome with diverse etiologies and pathogeneses, and also one of the most common symtoms presented in medical surgeries, with a prevalence of 20% to 30%. For this reason, correct treatment depends on the diagnosis.

Strupp centred on the clinical examination of the motor system in order to distinguish between peripheral and central vertigo; he also described laboratory examinations of patients with vertigo and vestibular disorders. This German expert's lines of research cover the vestibular system, imaging techniques, post-lumbar puncture headaches, and multiple sclerosis. Outstanding amongst his work in the vestibular area is his interest in peripheral vestibular disorders, treatment of downbeat and upbeat nystagmus, evaluation of the nystagmus mechanism and nicotine induced nausea.

Focus on children

Hilda María Furmanski is an expert when it comes to working with children and she showed this during her participation at this National Congress of Audiology. Is treatment necessary for children who are given early implants? This was one of the questions she posed in dealing with new challenges for audiologists in the use of hearing aids for very small children. Her answer was a firm yes.

"Children who are no longer babies and who receive hearing aids or cochlear implants need daily instruction in many aspects of language. It is hoped they will develop hearing abilities to help improve their communication conditions, the qualities of their voices, and speech production," explained Furmanski.

This professional sees auditory-verbal management as very apt for babies and very small children given the principles at work in her practice. "Although the focus is not so structured and children learn to use their hearing in natural, incidental, and spontaneous situations, this does not mean they are normal. Children will not develop the language just by being given equipment or implants early and by communicating with them how we do with children who do not have hearing problems," she added.

Given this, very small children do still need certain structured activities in order to boost their hearing development, "even more so bearing in mind that recent research suggests that children with hearing loss are not as interested in speech as normal-hearing kids, even after having received an implant at a very early age," said the Argentinian audiologist.

Hilda Furmanski also spent some time describing the evolution of child cochlear implant cases beginning to listen at different ages. In this respect, she stressed a series of variables which influence efforts by children, among those their chronological age, the duration of their deafness, previous hearing abilities, cognitive and linguistic development, participation of their families in treatment, the availability of support services, educational atmosphere, the presence of other pathologies, and the results of medical and radiological studies.

One of the main conclusions on this topic was that in view of all the variables mentioned, "both in Argentina and many other countries the expectation is that implants are going to be given for many years to children with congenital or prelingual deafness at very advanced ages," she assured.

The convenience of hearing aids

US audiologist, Earl Edward Johnson, showed delegates a new and necessary way of verifying the convenience of hearing aids using technological advances.

Generally, hearing care pros in Latin America guage satisfaction of hearing aids based on qualifying the benefits. Dr. Johnson, however, proposes basing benefit assessment on the technological advances offered by hearing aids, for example by measuring the satisfaction of use or functionality offered by microphones, speech enhancement, noise reduction, frequency transposition, as well as the impact of the benefit from acoustic memory with gain and output algorithms. One of Johnson's presentations focussed on the performance of hearing aid prescriptions and product features with respect to the abilities of patients with normal auditory sensitivity; in another speech related to programmable aids for children, Johnson reviewed the progression of compression parameters for programmable hearing aids and the importance of performance in the first year of fittings in relation with the degree of hearing loss and the presence of other characteristics.

This US expert is now involved in key research into the efficacy of hearing aids related to their features, signal processing, supply of hearing aids, and practical trends. His recent studies have centred on a comparative study in prescriptive and validated methods for assigning amplification parameters in adults and children based on data gathered from audiometric testing. For these findings, there have been improvements in quantitative calculation and descriptions of the benefits and performance of voice recognition achievable by hearing loss patients, on average, through hearing aids.

National experts at the Congress

Colombian audiologists also reaffirmed the leadership of Colombia in the region. "Columbia has a special place among Spanish-speaking countries in Latin America because of the consolidation of the hearing sector, and specialists have an outstanding clinical foundation, as acknowledged by the presence of international experts speaking at this year's Congress," said Claudi Gutiérrez, President of the audiological profession in the country.

While the international contribution drew a wide audience, so too did regional topics handled by Colombian specialists, who gave ample coverage to day-to-day problems facing not only Colombia but also neigbouring states. This year, the effects of fluctuating hearing loss due to serous otitis media was covered by the audiologist María Patricia Rangel, who pointed out that this illness affects children between 0 and 9-years-old and can cause short or long-term hearing loss which generally involves problems in language development, as well as in learning, behaviour, and schooling.

Meanwhile, Ángela María López, audiologist and ex-President of Asoaudio, presented on the importance and reach of ototoxicity research, a subject she has studied for many years in order to identify how ototoxicity and otoprotection can bring new opportunities in audiology practice and research. "On understanding the underlying mechanisms of ototoxic hearing loss, we have the chance to develop new medicines in the near future which do not bring ototoxicity as a secondary effect," stated López.

Genetics and disability in the health sphere were covered by Colombian audiologist Martha Lucía Tamayo, who gave an analysis of different genes causing syndromal and non-syndromal deafness; in respect of disability, she spoke of the experience in Colombia and the role of health professionals and of both integrated approaches and the impact of the lifestyle of deaf or hypoacusic persons, weighing up diagnosis, rehabilitation, assessment, and support.

Iván Darío Flórez, paediatric doctor, clinical epidemiologist, and sub-director of Guides to Clinical Practice and Evidence produced by the Institute of Technological Evaluation (IETS), highlighted evidence based medicine (EBM), explaining to participants the acheivements of the new IETS, a body set up to support the Ministry of Health in decision making by using the best methods to summarise evidence in the most transparent way, guaranteeing the participation of all agents involved in the process in Colombia.

On the question of the social responsibility of higher education centres in integrating the hearing impaired, speech-language expert Rocío Molina spoke on research revealing a triangular relationship between disability, education, and institutional policy. In particular, she explored and analysed schemes, programmes, and actions run by university bodies, finding that the real application of equal opportunities policies for this institutional population is not in evidence, so the social responsibility aspect is not materialised beyond the planning stage of the mission and vision of educational projects.

Other subjects covered also highlighted the challenges of the obligatory system of quality guarantees, whose modifications were set out by Victoria Eugenia Molina, leading to debate on the actual conditions of services provided by audiologists.

The floor also heard from audiologist Amanda Páez on vestibular hearing disorders associated with occupational accidents and illnesses, while Dr. José Alberto Prieto explained the physiology of the vestibular system and the relevance of technical aids.

Expo 2014

This year's trade displays were provided by the key firms operating in the Colombian hearing market, among them Starkey, Unitron, Phonak, Widex, LabService, Auditek, Silvher, Serviequipos, and Technic, all of them with their latest equipment packed with technological advances to provide customers with greater access and meet all their needs.

The venue for the next Congress next year will be in the Colombian city of Bucaramanga, capital of the Santander Department, where "we hope to be accompanied by regional specialists, since every two years we try to decentralise the Congress away from Bogotá and take our scientific programme to other cities in the country," concluded Claudia Gutiérrez, Asoaudio President.

Mara Bruges, editor in chief of Audio infos America Latina

Translation: P.W., Photos: Rubén Muñoz - Asoaudio