Presentation given by HEARing CRC CEO Associate Professor Robert Cowan on the Longitudinal Outcomes of Children with Hearing Impairment Study for the New Directions in Audiology New Zealand Audiological Society‘s 38th Annual Conference (2-5 July 2014).

1. creating sound valueTM
Translating Innovation in Hearing Loss
Prevention and Improved Remediation to
Improved Patient Outcomes
Prof Bob Cowan
The HEARing Cooperative Research Centre, Australia
Depts of Otolaryngology & Audiology, The University of Melbourne, Australia
Macquarie University, Sydney, Australia
www.hearingcrc.orgcreating sound valueTM
www.hearingcrc.org

2. creating sound valueTM
Clinical
trial
Investigator
led research
Evidence-based
research
Qualitative
research
study
Translational
research
Defining Terms: “research….”
Outcomes
study
Impact
Pilot
study
“Buzz-word City”!
Innovation

3. creating sound valueTM
Understanding Innovation and Impact
Improved
Product
Improved
Process
Improved
Service
Identification of a Problem (Opportunity)
Use of Outcome creates Impact
Ideas to solve it
Knowledge
transfer
(scientifically-supported
clinical investigation)
Translational research – bridge from theory to clinical treatment
(evidence-based change
to clinical practice)

4. creating sound valueTM
Innovation Scoreboard
“Australia lags well behind in
translating and commercialising
research in comparison to
leading OECD countries”
May 2014

5. creating sound valueTM
Barriers to Innovation
Knowledge Barriers Market Barriers Cost Barriers
Lack of qualified
personnel
Difficulty in finding
cooperative partners
Lack of information
on markets
Lack of information
on technology
Uncertain demand
for innovative goods
or services from
potential end-users
International markets
dominated by one
established player
Lack of funds and
resources within
single organisations
Lack of external
finance to acquire
infrastructure or to
collaborate
High innovation
costs
Source: 2008 National Innovation Survey, AusInnovations
Lack of experience
in managing large
collaborations
“…. Effective collaboration between business and research organisations can
benefit from independent facilitation to build trust/momentum between parties

6. creating sound valueTM
Cooperative Research Centres Program
Industry
&
Other
End-Users
University
&
Research
Institutes
&
Agencies
Competitive
Advantage
Knowledge
& Teaching
C
R
C
• Synergy created by interdisciplinary collaboration, pooling infrastructure
• Adequate time frames (9 year average time lag to impact)
• Scale of the effort to address sector-wide issues/challenges
• User-focused drive ensures ready utilisation of outcomes
• Research leadership – bringing skills together

7. creating sound valueTM
Medical Sector CRCs

8. creating sound valueTM
 Public – prevention of injury / disease
 Patients – improved / novel diagnostic,
treatment or rehabilitative services
 Physicians / health professionals – knowledge
& technology to improve services
 Industry – pharmaceutical /medical devices
 Hospitals / health services – enhanced delivery
models for clinical healthcare practice
 Government – evidence-based research
guiding policy decisions
Med Sector CRCs – many end-users
Key challenge for a CRC is to identify end-users across sector

9. creating sound valueTMcreating sound valueTM 9
The HEARing Cooperative Research Centre (CRC) is focused on the twin
challenges of:
• more effective prevention; and
• improved remediation of hearing and communication disability.
Aims
Through research and its use, the HEARing CRC aims to reduce the
economic impact of hearing loss by focusing member’s expertise on:
• maximising lifelong hearing retention
• reducing loss of productivity resulting from hearing disability
• increasing uptake and use of hearing technology; and
• providing postgraduate and professional education and training
to support uptake and use of prevention and remediation initiatives.
The Strategic Vision

10. creating sound valueTM
Hearing Disorder vs Hearing Disability
10
UnderstandingSoundwaves
HEARING DISORDER:
What’s wrong with the
auditory pathway
HEARING DISABILITY:
What a person cannot
do as a consequence…

11. creating sound valueTM
Hearing Disability
A global problem
 5.3% of the world’s population have a
disabling hearing loss
 80% of adults over 80 years of age have a hearing
disorder that degrades their communication and
increases isolation, known factors contributing to
cognitive decline
“hearing loss is a significant issue affecting
all Australians across their lifetime”*
delaying language development and
impacting educational achievement;
reducing productivity, employment,
leisure and social participation;
accelerating cognitive decline.
CHILDREN
ADULTS
ELDERLY
3
* Australian Senate enquiry “Hear Us”, 2010

12. creating sound valueTM
Age
-
20
40
60
80
100
120
140
160
0 20 40 60 80 100
Thousands
2030 4.8m
2020 3.8m
2011 3.1m
TOTAL AFFECTED
Australianswithhearingloss
12
>88% increase in numbers of people over 65
with hearing loss over the next 20 years
Hearing loss accelerates cognitive decline
Hearing Disability
A future epidemic

13. creating sound valueTM
Long-Term Evidence-based Studies
Ching, NAL, Hearing CRC
LOCHI
… critical need for evidence-base modelling of economic impact
of hearing aid fitting in children (as well as adults & elderly)
Dr Teresa Ching

14. creating sound valueTM
Source: “Listen Hear Australia”, Access Economics 2006
Hearing Disability and Economic Impact
Deadweight
tax losses
Education
and support
services
Direct health
care costs
Cost of
informal
carers
57%27%
8%
6%
2%Deadweight
tax losses
Education
and support
services
Direct health
care costs
Cost of
informal
carers
Productivity
& direct
employment
57%
27%
8%
6%
2%
Contributors to financial impact
$11.75bn p.a. financial impact
$11.30bn p.a. disability & lost well-
being impact
$23.05bn p.a.
Economic Impact of
Hearing Loss on Australia
+
key to successful translation is shared view of
MAJOR CHALLENGE that we are addressing

15. creating sound valueTM
Treating Hearing Disorders
“Clinician-centric” treatment of sensory issues
15
Soundwaves Understanding
DEVICE
SELECTION
DEVICE
FITTING
(RE)HABILITATIONDIAGNOSIS
CLINICIAN-DRIVEN SENSORY ISSUE FOCUSED
CURRENT
MODEL
PREVENTION

16. creating sound valueTM
Age
Preventing Hearing Disability
The need for integrated intervention
16
Performance
Sensing Understanding
Timely sensing and cognitive
intervention to use the brain’s
neuroplasticity is critical to
maintaining/restoring functional
communication and minimising
cognitive degeneration
… added rehabilitation
improves outcomes
…but cannot overcome
neural degradation that
reduces processing ability
…current intervention
overcomes “sensing”
deficit by providing a
hearing prosthesis
Understanding declines over time
with loss in sensing performance…

17. creating sound valueTM
SENSING
Preventing Hearing Disability
The need for integrated intervention
17
 Auditory Processing Disorders (APD)
can result from problems with one or
many parts of the brain
UNDERSTANDING
APD affects ten times more children than
sensory hearing loss or:
 1 in 20 school age children and
 Six times higher in the indigenous
population
Those with APD:
 Are “functionally hearing impaired” when
trying to listen to one speaker with even low
levels of background noise i.e. a classroom
 have problems localising sound in their
environment – making it hard to engage
socially and in sport and just be safe
 may have great difficulty learning

18. creating sound valueTM
Individualised
Solutions
Enhanced Services
Capacity
The Listening
Brain
The Intelligent
Interface
The Research Program
18
1.1 Device impact on communications
1.2 APD and communications
1.3 Deficits and language
2.1 Better intelligibility
2.2 Electro-neural interface
2.3 Delivery systems for molecular therapy
3.1 Optimising candidacy
3.2 Individualising fitting
3.3 Tailored therapies
4.1 Enabling equal access
4.2 Empowering users
4.3 Hearing loss prevention
Hearing aids and cochlear implants
that work better with noise, tonal
languages and music and with better
manufacturability
Using new insights on brain function
to develop new tools to accurately
diagnose and target remediation
Continuation of the LOCHI Study
Evidence-based patient-centric
guidelines for candidacy, fitting and
rehabilitation that best match
technology and services to individual
needs
Automated self-fitting devices and web-
based hearing healthcare delivery
models to engage end-users, ensure
equal access, and provide
regional/rural career opportunities

19. creating sound valueTM
Treating Hearing Disability
What a new Hearing Healthcare model means
INTERVENTION
PLANNING
DEVICE
FITTING
THERAPY /
REHABILITATION
PREVENTION
& DIAGNOSIS
USER-CENTRIC | SENSORY + COGNITION FOCUS
10
 Timely disability
identification
• sensory
• APD
 Action before
irreversible
cognitive
degradation
 Integrated
intervention
• devices
• therapies
 Tailored to
individual needs
 Individualised
 Automated
 Self-fitting devices
 User-centric
 Combined, tailored
rehabilitation and
cognitive therapy
 User-driven
online/remote
 Delivered cost-effectively
where-ever there is need
NEW
MODEL

20. creating sound valueTM
SYDNEY
CLUSTER
MELBOURNE
CLUSTER
BRISBANE
CLUSTER
HEARing CRC Members
20
hear and
say centre
This research was financially supported by the HEARing CRC established and supported
under the Australian Government’s Cooperative Research Centres Program
www.hearingcrc.org

21. creating sound valueTM
An
internationally
unique
consortium of
skills and
expertise
Building our Strengths
Bio-molecular & biomaterials
Bioengineering / surgical expertise
Clinical trial network / aged care expertise
Electrophysiology / acoustics expertise
Sound coding / engineering expertise
Linguistics / psychology expertise
MEG imaging & functional imaging capability
Collaborative research management framework
21
Expanded rural/
remote trials
3D “real world” facility
spatio-acoustic testing
MEG III imaging for
cochlear implant
Infant and tonal
language experts
Existing strengths
New capabilities
Extended SME engagement
International Linkages

22. creating sound valueTM
Treating Hearing Disability
What a new Hearing Healthcare model means
INTERVENTION
PLANNING
DEVICE
FITTING
THERAPY /
REHABILITATION
PREVENTION
& DIAGNOSIS
USER-CENTRIC | SENSORY + COGNITION FOCUS
10
 Timely disability
identification
• sensory
• APD
 Action before
irreversible
cognitive
degradation
 Integrated
intervention
• devices
• therapies
 Tailored to
individual needs
 Individualised
 Automated
 Self-fitting devices
 User-centric
 Combined, tailored
rehabilitation and
cognitive therapy
 User-driven
online/remote
 Delivered cost-effectively
where-ever there is need
NEW
MODEL
hear and
say centre

23. creating sound valueTM 23
University of
Auckland
Chinese University of
Hong Kong
New York University Medical Centre
Washington University
University of Iowa
Massachusetts Institute of Technology
Sick Childrens Hospital – Toronto
University of Western Ontario
Mayo Clinic
U Wisconsin
U of Texas
Cochlear Corp
CTC Belgium
Medizinische Hochshuule Hannover
University of Freiburg
University of Manchester
Tel Aviv University
Kanazawa Institute
of Technology
International Members selected on basis
of complimentary skills or market entry
• The Hearing CRC collaborates with key international hearing researchers who are opinion
leaders.
International Collaborators
Beijing Culture & Language
University

24. creating sound valueTM
PROGRAM 1: The Listening Brain 2: The Intelligent Interface 3: Individualised solutions 4: Enhanced Service Capacity
PROJECT
Deviceimpacton
communications
APDandcommunications
Deficitsandlanguage
Better
intelligability
Electroneuralinterface
Moleculartherapy
Optimisingcandidacy
Individualisingfitting
Tailoredtherapies
Enablingequalaccess
Empoweringusers
Hearinglossprevention
1.1 1.2 1.3 2.1 2.2 2.3 3.1 3.2 3.3 4.1 4.2 4.3
RESEARCH & EDUCATION
Macquarie University         
NAL          
University of Melbourne          
Bionics Institute  
MCRI     
University of Queensland     
University of Sydney  
University of Western Sydney   
University of Wollongong 
INDUSTRY END USERS
Cochlear       
Siemens    
Attune  
Hybrid Electronics 
Neuromonics 
CLINICAL END USERS
ACCIH    
Audiology Australia   
Hear & Say       
Neurosensory 
RIDBC        
RVEEH      
SCIC & partners       
The Shepherd Centre      
VicDeaf  
PATIENT END USERS
Children         
Adults           
Aged          
Managing & Enhancing Collaboration
24
Cross-program
collaboration
End-users “pull”
industry + clinical end-users
Project outcomes
for all end users
Project
collaboration

25. creating sound valueTM
5 Year Program Economics
Leverage & Returns
25
TOTAL PROGRAM = $121m
SOURCE OF FUNDS
$m
28
32.5
60.5
CRC
RESEARCH
&
INSTITUTES
INDUSTRY
38
30
40
13
APPLICATION OF FUNDS
$m
 420 FTE
 14 PhD, 8 top-ups
+ commercial reinvestment
$ from HEARworks ($7m to date)
+ other grants/funds
$662k from NSW MDF
$100k from NSW Gov’t
$41k from Australia-China SRF
BENEFIT / COST
RATIO
PROGRAM
3.9 TOTAL
 $ return to
participants
3.7
3.0
3.8
7.4
THE LISTENING
BRAIN
INTELLIGENT
INTERFACE
INDIVIDUALISED
SOLUTIONS
ENHANCED
SERVICE CAPACITY

26. creating sound valueTM
Program Impact
26
Listening
Brain
Intelligent
Interface
Individualised
Solutions
Enhanced
Service Capacity
ECONOMIC IMPACT
$m NPV
670
1,170
2,800
1,240
Disability Adjusted Life Year (DALY)
reduction $m NPV
990
1,260
8,320
2,570
HEALTH IMPACT
• Productivity improvement
• Reduced carer costs
• Reduced costs special education
• Reduced medical costs
• NPV – effect on cashflow of new products
• DALY = YLL + YLD
- YLL – years of life lost
- YLD – years of life disabled
• Attributed only YLD benefit
• Reduction in DALYs after
innovation vs before

27. creating sound valueTM
Investment into Impact
A credible track record
27
38 PhDs
40% to industry
600 online
registered
clinical users
6,000 Australians
completed on-line
testing
CRCs are about ‘investment’ and ‘impact’
HEARLab®
Shriek
Rejection™
$7m
reinvested in
CRC research &
infrastructure
Trainable
Hearing Aid
Advance™ & Hybrid-L
CI Electrode Arrays
NAL-NL2
Cochlear
Implant
Workshop
Program
3,400 surgeons
& clinicians from
Asia-Pacific trained

28. creating sound valueTM
Translation
Creating outcomes to achieve impact
28
INDUSTRY:
Eliminating barriers to
collaboration and take-up
CLINICAL SERVICES:
Ensuring clinical application and
end-user take-up
Existing strengths
New capabilities
 Added layer of project / IP
process enabling “company-
sensitive” projects in CRC
 Builds on HEARnet and
HEARnet Learning to raise
awareness of research
outcomes and encourage
take-up by clinicians/agencies
 Builds on successful IP and
commercial processes
- first rights to negotiate licences
- third-party licences
- potential for spin-off creation
- contract research projects
 Expanding community and
engagement to new SMEs

29. creating sound valueTMcreating sound valueTM 29
Ensuring a Return from our Research
www.hearingcrc.org

30. creating sound valueTM
MEDIA
Translation
Creating a new awareness & policy environment
30
Social
media
Science Meets
Parliament
Office of Hearing
Services
Committee
Senate Enquiry
into Hearing
Health
Awareness
campaigns

31. creating sound valueTM
Sound Check Australia
creating sound valueTM

32. creating sound valueTM
Survey

33. creating sound valueTM
Hearing Check
creating sound valueTM
OR

34. creating sound valueTM
Total participants registered: 10,091
Dataset: The basics
creating sound valueTM
Started Completed Completion
Rate
Survey 9917 8015 80.8%
Hearing Test 7032 6181 87.8%
Survey+Test 9917 6181 62.3%

35. creating sound valueTM
10
Ototoxic
Substances
2929
5 Full noise
history: work
and leisure
5987
8
Personal
Audio
Device use
4315
6
Social impact
of HL
3125
4 & 4.1
Attitudes to
noise for
15-17s & 18-25s
2620
9a
Clubbing
preferences
551
1
Demographics
2 Hearing
& general
health
3 Recent Noise Exposure:
Work, Leisure,
& Personal audio device (PADs)
+ + = 9234
9b
Gigging
preferences
375
10
Ototoxic
Substances
2929
5
18-25s’ Full
noise history
work & leisure
5987
8
Personal
Audio
Device use
4315
6
Social impact
of HL
3125
4 & 4.1
Attitudes to
noise for
15-17s & 18-25s
2620
9a
Clubbing
preferences
551
Participants per Module
1
Demographics
2 Hearing
health &
symptoms
3 Recent Noise Exposure
Work & Leisure
+ + = 9234
9b
Gigging
preferences
375

36. creating sound valueTM
551 respondents
Attended nightclubs at least twice per month
Mean age: 24.1 years
Males: 57% Females: 43%
A quick dip into “Nightclub” Module
creating sound valueTM
maybe a
little
56%
a lot
40%
not sure
1%
not at all
3%
Is the noise level at nightclubs harmful to your hearing?

37. creating sound valueTM
0%
5%
10%
15%
20%
25%
30%
TTS tinnitus
never occasionally sometimes frequently always
39%43%
Have you ever… noticed that you were not able to hear as well as usual,
or that your ears felt ‘blocked’ or ‘dull’… experienced tinnitus (ringing in
your ears)… following a visit to a nightclub?
Nightclubbers’ symptoms
creating sound valueTM

38. creating sound valueTM
How do you find the music?
creating sound valueTM
not loud
enough
2%
just right
13%
loud but
tolerable
59%
louder
than liked
26%
0
2
4
Louder
than
liked
Loud but
tolerable
Just right
SymptomScore(outof5)
Attitude to noise is related to symptoms of hearing damage

39. creating sound valueTMcreating sound valueTM
0%
25%
50%
When I go out clubbing, I want to chat with my friends as well as dance so I'd prefer it if there were some quieter
places to sit and chat when we're taking a break.
strongly disagree disagree neutral agree strongly agree
84%
Can we have some quiet, please?

40. creating sound valueTM
Translation
Education to build skills and create new end-users
40
POSTGRADUATE:
Industry-ready graduates
with additional skills in
project management & IP
PROFESSIONAL:
Up-skilling working professionals
Enabling new careers in regional
& rural communities
Existing strengths
New capabilities
 CRC Mentors program
 PhD, MClinAud, MEd programs
with multidisciplinary / end-user
supervision
 Fully integrated into research
 Value-add skills development
program
 Biomed Research Management
 Cochlear Implant & Hearing
Technology Workshops
 International Symposia
 HEARnet & HEARnet Learning
 Expanded accredited on-line
continuing professional
development (CPD) program
 Regional/rural Clinical Internship
Support Program

41. creating sound valueTM
Supporting Audiology Australia CPD

42. creating sound valueTM
HEARnet & HEARnet Learning

43. creating sound valueTM
 56% of GPs surveyed do not routinely evaluate their patients for
hearing loss
 Main reasons for not routinely evaluating hearing loss:
GP Survey Results (n=191)
53%
45%
25%
0% 10% 20% 30% 40% 50% 60%
Insufficient time
No testing equipment in
practice
Only evaluate if patient reports
a hearing problem

44. creating sound valueTM
47%
38%
24%
20%
19%
0% 10% 20% 30% 40% 50%
Methods used by GPs to evaluate hearing
Whisper/watch tick test
Tuning fork
Audiogram in office
Patient self assessment
Audioscope
Issue: how to better inform or educate GPs about effective hearing
screening options?

45. creating sound valueTM
GPs and Hearing Health – Australian context
0%
10%
20%
30%
40%
50%
60%
70% Disagree
Neutral
Agree
Strongly Agree
HAs an effective
rehabilitation tool
Difficulty adjusting
to HAs
Costs of HAs is
too high
Gilliver & Hickson, Int J Audiol. 2011
GP Perceptions on Barriers to Hearing Aid Use

46. creating sound valueTM
Self-Reported Knowledge
HIGH/
ABOVE AVG
AVERAGE BELOW
AVG/LOW
Hearing Aids 18.7% 56% 25.3%
Cochlear Implants 6.6% 29.7% 63.8%
Sensorineural HL 17.6% 67% 14.3%
Conductive HL 24.2% 65.9% 8.8%
Age Related HL 20.9% 73.6% 5.5%
Tinnitus 31.9% 59.3% 7.7%
Tinnitus Management 22% 54.9% 22%
Decreased Sound Tolerance 6.6% 47.3% 46.2%
CAPD 2.2% 30.8% 67.1%
Broad distribution of knowledge on hearing health topics; Clear
opportunity for providing further education to Australian GPs.

47. creating sound valueTM
Where do GPs obtain their information on Hearing Loss?
Information Sources
83% of GPs surveyed would use a hearing health-based online training module
as part of their ongoing career professional development requirements.
54%
49%
26%
24%
18%
0% 10% 20% 30% 40% 50% 60%
Medical journals
Ask a colleague
Australian Hearing
Internet search
GP conferences

48. creating sound valueTM
“Learning” area: Mixed Hearing Loss

49. creating sound valueTM
“Technology” area: Middle Ear Implant

50. creating sound valueTM
A New Era in Hearing Healthcare
50
THE NEED:
A new model of hearing
healthcare that delivers…
 Disability Prevention
Intervention before
irreversible degradation
 Integrated Intervention
Sensory + cognitive
 Patient-centric Model
Tailoring service to
individual need
 Effective Outreach
Accessible, efficient,
tailored services – for
Australians of all ages
Individualised
Solutions
Enhanced
Services
Capacity
The Listening
Brain
The Intelligent
Interface
 Changing our Hearing Healthcare model will
unlock great value for Australians
 Only a collaboration involving all end-users in the
hearing healthcare chain can change the model
 Both research and translation are needed to
create the framework for change
 The CRC is the only program enabling and
leveraging this scale of sector-wide collaboration
THE PROGRAM
THE RATIONALE

51. creating sound valueTM
Benefits….
 combined knowledge
 multidisciplinary teams
~ novel approaches
~ new skills
 market driven
 shared infrastructure
 focused on achieving
of outcome & return
 project management
Challenges….
 creating shared “culture”
 building trust (takes time)
 agreeing
~ research, IP, staff
technology transfer, funds
 long-term commitment
 less autonomy & control
 geographic issues
 complexity
Managing Collaboration to Impact

52. creating sound valueTM
Magnetoencephalographic Imaging (MEG)
• The child MEG system at CCD
is a custom sized whole-head
MEG system designed specifically
for pre-school aged children.
• The challenge in designing the
CI MEG system was to distinguish
brain signals from larger signals
emitted by the CI
Seek / Invest in World-Unique Ideas

53. creating sound valueTM
Brain Activation for Tonal Languages
Identify International Partners

54. creating sound valueTM
Focus on Connectivity & Ease of Use
“Made for iPhone” hearing aid
accessories
Apple – US Patent application on
February 7th for a system that will
automatically detect a hearing aid
and incorporating switching modes
The dominant device for people with mild and moderate loss (the most
numerous segment) will be a combined hearing aid and hands-free device for
their mobile phones, tablet devices, GPS, and other wi-fi enabled devices
Anticipate/Scan for Trends
“The reality is that direct-to-consumer
hearing instrument sales are not going
away - Audiology Today February 2013
Increasingly, professionals will need to seek market differentiation from
direct-to-consumer web sites or insurance/pharmacy companies.

55. creating sound valueTM
The Future Evolution
A framework to build on
2014 2019
Sourcing
revenue
Maintaining and
building new
relationships
55
CRC
Extension
A radical change to Hearing Healthcare:
 hearing disorder  hearing disability management
 clinician  user-centric management
 central services  services where users are
Transition Plan