CAA 2025 Agenda

Description: 

Social isolation and loneliness are at epidemic proportions in the United States, especially among older adults - a population with a high prevalence for hearing loss. Research suggests that many older persons with hearing loss lack effective coping skills and tend to avoid social interactions, often deepening their isolation and loneliness. This course explores the relationship between hearing loss and social "connectedness", including how properly fitted hearing aids and other audiological interventions might promote better social engagement through improved communication in multi-talker, noisy situations, reduced listening-related fatigue, restored music enjoyment, increased confidence and positive social impact. Additionally, this course will provide a working framework for how audiologists can more thoroughly assess and treatâ¯social disconnectedness with various person-centered interventions.

Learning Objectives: 

Upon completion, participants will be able to:

• Describe the relationship between age-related hearing loss and social connectedness. 
• Describe how the fitting of hearing aids could improve the various facets of social engagement. 
• Define social isolation and loneliness as separate, interrelated constructs that affect well-being 

Description: 

Hearing aid technology is undergoing a rapid transformation from single-function devices that optimize sound quality and speech intelligibility in challenging listening environments for end-users with hearing loss to multi-sensory and multi-functional communication and health devices. Recent advances in computation hardware and memory capacity have facilitated new AI applications, including advanced deep neural network (DNN) technology that pave the way for new approaches to auditory prosthetics that augment behavioral abilities and provide unparalleled optimization and personalization for individual hearing aid user’s auditory ecological preferences.     

Specifically, the presentation will discuss a new sound processing system that mimics the cortical computation with a power-efficient hardware-accelerated DNN architecture embedded within the processor chip of a hearing aid device, and the results obtained for speech enhancement in various listening situations.     

The presentation will also detail the incorporation of an intuitive user interface to guide the AI processing scheme with listener intents based on context as well as a natural language processing scheme to assist with hearing aid adjustments, control, and rehabilitation  

Finally, discussion will focus on a summary of AI-based technologies in development that will transform hearing aids into multipurpose hearing healthcare, communication and personal assistance devices.   

Learning Objectives: 

Upon completion, participants will be able to:

• Explain the difference between machine learning and DNN applications in hearing aids 
• Assess the expected improvements in speech intelligibility and sound quality made possible with AI 
• Demonstrate possible use of natural language processing to improve hearing aid functionality 

Description:

The Legislative Session serves as a pivotal forum for attendees to engage directly about legislative developments affecting audiology in California. This session provides updates on policy changes relevant to audiologists, discussions of advocacy strategies, and guidance on how to influence legislative processes . It is ideal for clinicians, educators, and students eager to learn about advocacy efforts, regulatory updates, and opportunities to support legislative initiatives that impact scope of practice, reimbursement, access to care, and more.

In addition, this session provides valuable insights into recent and upcoming updates from the licensing board, and how these changes may impact your practice in the coming year. This session will also highlight the critical role of statutory and regulatory requirements in maintaining your audiology license and offer practical tips for staying compliant with continuing professional development and license renewal standards.

Learning Objectives:

Upon completion, participants will be able to:

• Name three ways to participate and stay informed of legislative and regulatory updates from the Board. 
• Explain three changes to the continuing professional development requirements for renewal as an audiologist or dispensing audiologist. 
• Describe three ways to ensure compliance during an audit of their continuing professional development records. 
• Describe the political and policy efforts this year in California as well as the specific activities that CAA was involved in that directly impact audiologists. 
• Assess how certain laws and regulations governing audiologists will impact their practices. 
• Explain how rules and regulations affecting audiologists are made and how the California Academy of Audiology influences these efforts.

Description: 

Sex differences in auditory function have become an emerging focus in both basic science and clinical research. Large-scale clinical studies have revealed a strong sex bias in hearing loss prevalence. Growing evidence suggests that males and females differ in auditory physiology, function, and susceptibility to hearing loss. While women generally have a lower overall prevalence of hearing loss, approximately 8.3 million are affected, with 1.67 million experiencing onset during middle age. Hearing loss in women often worsens after menopause, particularly in the low- and mid-frequency ranges critical for speech perception. Additionally, autoimmune-related hearing impairment is more prevalent among women, likely due to their increased susceptibility to immune disorders. However, the mechanisms underlying the physiological differences remain poorly understood, posing challenges for diagnosis and treatment advancements.     

This presentation will provide an overview of the latest research on sex differences in auditory function, exploring the cellular, molecular, and physiological mechanisms that influence auditory perception. We will examine the role of sex in age-related and noise-induced hearing loss, as well as other auditory disorders. Additionally, we will discuss how sex hormones modulate hearing sensitivity and cochlear function, with implications for conditions like hearing loss and tinnitus. Beyond biological mechanisms, this presentation will highlight the clinical significance of these findings. We will explore sex-specific risk factors for auditory disorders, including genetic predispositions, environmental influences, and differential responses to auditory stressors. Furthermore, we will examine sex differences in the perceived impact of hearing loss and hearing aid use, including variations in communication difficulties, emotional well-being, and social consequences. Understanding these perceptual differences is crucial for developing more effective, tailored clinical interventions.     

Incorporating sex as a biological variable in auditory research can refine diagnostic criteria, enhance treatment strategies, and lead to more personalized interventions for hearing loss and other auditory conditions. By bridging fundamental research with clinical applications, this presentation aims to emphasize the importance of considering sex differences in auditory function. A deeper understanding of these differences can improve patient outcomes, inform hearing conservation strategies, and advance personalized medicine in auditory health.   

Learning Objectives: 

Upon completion, participants will be able to:

• Identify key sex differences in auditory physiology, function, and susceptibility to hearing loss 
• Explain the importance of sex differences in auditory function for clinical diagnosis and treatment 
• Demonstrate how sex hormones influence hearing sensitivity and auditory function  

Description: 

Since the inception of audiology, the default test of speech recognition in the routine test battery has been word-recognition in quiet. While this approach has guided hearing healthcare for millions of patients, it has significant limitations for quantifying hearing difficulties reported by individuals. For example, the top complaint of individuals with hearing loss remains difficulty understanding speech in noise (SPIN), yet SPIN abilities cannot be predicted from pure-tone thresholds or word-recognition scores, and are inconsistently measured in routine audiologic practice. The inability of the routine test battery to predict SPIN abilities may limit the capacity of artificial intelligence (AI) algorithms to develop individual solutions for SPIN deficits, because appropriate data do not exist to train such models.  

To address these issues, we have published a series of recent articles in which we demonstrate that SPIN can replace word-recognition in quiet as the default test of speech recognition in most instances. In this work, we also provide data-driven guidelines as to when word-recognition scores are likely to be clinically meaningful and should be measured. Here we will summarize this work, and our new and ongoing research. These topics include: 

• The first demonstration that health literacy can affect performance on tests of speech recognition in quiet and noise   
• Between-session reliability of speech-recognition abilities in quiet and noise, including new guidelines to determine a significant difference on the QuickSIN 
• Data-driven recommendations to label performance on word-recognition and the QuickSIN to standardize interpretation 
• New tools to characterize hearing loss in large audiologic datasets which align better with AI principles and may replace the pure-tone average. 
• Using AI techniques, we have built a tool which will automatically score any test of speech recognition in any language. We will cover our validation efforts with this tool and show our preliminary efforts to quantify listening effort.   
• A brief overview of our machine-learning models to characterize SPIN abilities in individual patients.  

Ultimately, our goal is to provide audiologists with better tools to characterize individual hearing deficits, and set the stage for future innovations in hearing healthcare. 

Learning Objectives: 

Upon completion, participants will be able to:

• Identify when word-recognition scores are likely to be excellent and do not need to be measured.   
• Articulate recommendations for labeling performance on speech recognition in quiet and noise. 
• Describe how automatic speech recognition can be used in audiologic practice.   

Description: 

While all audiologists navigate complex clinical decisions, pediatric amplification presents unique challenges; from considerations to programming to supporting entire families through the journey of hearing loss. This session takes a practical approach to current amplification trends by walking through real pediatric cases that reflect the nuances of early intervention, school-age management, and atypical progress. Each case will be paired with recent literature to highlight evidence-based recommendations, clinical flexibility, and patient-centered care. Through interactive polling, attendees will engage in collaborative decision-making and reflect on their own approaches. This session aims to offer relevant insights, clinical validation, and a deeper understanding of what it takes to make “big choices” for little ears. 

Learning Objectives: 

Upon completion, participants will be able to:

• Apply clinical reasoning to real-world pediatric cases involving diverse audiologic profiles, family dynamics, and developmental considerations. 
• Reflect on personal clinical practices through interactive polling and peer discussion to identify areas of alignment or growth. 
• Describe current trends and evidence-based recommendations in pediatric amplification, including updates in fitting practices, verification, and emerging technologies.  

Description: 

Over the last three years VA Northern California Health Care System has created and successfully implemented a thriving Teleaudiology program to deliver care to underserved clinics in the region. To provide hearing aid aftercare for the Teleaudiology sites, the virtual Same Day Care Clinic (SDC) was constructed. At its inception, this model provided hearing aid aftercare for all five of its Teleaudiology sites. Due to the efficiency of this virtually supported clinic at the Teleaudiology sites, it is also being introduced to traditional face-to-face sites. This model has proven to be highly effective in providing care to underserved areas, rural areas, and urban areas. The goal of this presentation is to provide an overview of how to implement Teleaudiology supported audiology SDC clinics for hearing aid follow-up care. Included in the presentation is a workflow used for the launch of services at Teleaudiology sites including; assessment of need, overview of training staff, equipment/space needed and ultimately, the roll-out of services. The advantages of this model including improved access to care, reduced wait times, optimized resource utilization, and improved patient satisfaction, will be discussed as well as a synopsis of potential barriers to executing service delivery. 

Learning Objectives: 

Upon completion, participants will be able to:

• Perform a needs assessment for virtual support in your current model of care. 
• Identify and enumerate space and equipment to launch the program.  
• Articulate a rationale to stakeholders for changing modality of care in your practice.   

Description:

Difficulty understanding speech in the presence of background noise is a primary complaint among those with hearing loss, severely impacting their quality of life. Speech-in-noise (SIN) performance is a critical aspect of auditory processing and communication, as it reflects the ability to isolate speech from background noise. Clinical populations often experience difficulties in SIN tasks, making the assessment of SIN performance a key component in diagnosing hearing and auditory processing disorders. The most commonly used clinical SIN test is the Quick Speech in Noise (QuickSIN), which provides a rapid assessment of a patient’s ability to understand speech in background noise by presenting sentences with decreasing signal-to-noise ratios against a four-talker babble noise. A key characteristic of QuickSIN performance is the significant variability in scores among individuals and can be influenced by several demographic favors including age and sex. 

The objective of this study was to examine the relationships between severities of hearing loss, QuickSIN performance, and word recognition in quiet (WRQ) abilities in age- and sex-matched population and clinical data. Audiologic data of over 200 patients from the University of the Pacific Hearing and Balance Center in the Stockton and San Francisco clinics were analyzed. Patients with 4F-PTA that exceeded the ISO 7029:2017 normative data, based on their age and sex, were excluded from our analyses. Statistical analyses performed included one- and two-way ANOVAs and linear regressions. Pilot data revealed a strong negative correlation between SNR loss and 4F-PTA (p < 0.001). We also observed significant variations in SNR loss in patients with similar WRQ scores, highlighting the variability in SIN performance. Having a deeper understanding of the relationship between the above-mentioned variables can help improve diagnostic practices and therapeutic interventions. Overall, considering demographic factors when interpreting SIN performance in clinical settings may affect the accuracy of diagnostic results and the effectiveness of interventions. 

Learning Objectives: 

Upon completion, participants will be able to:

• Explain the importance of speech-in-noise testing in the clinical setting 
• Identify demographic factors that influence speech-in-noise performance. 
• Discuss the relationship between hearing loss, speech-in-noise performance, and word recognition.

Description: 

Effective communication is the cornerstone of quality healthcare; yet for hard of hearing patients, barriers in communication can lead to misunderstandings, frustration, and even compromised care. Early-career healthcare providers play a vital role in ensuring that all patients, regardless of their hearing abilities, feel heard, understood, and respected. The purpose of this study was to design and examine the effectiveness of a training program to equip early-career healthcare providers with the essential skills to communicate more effectively with hard-of-hearing patients. Through discussions, real-world scenarios, and interactive exercises, participants learned how to recognize communication barriers, utilize assistive technologies, and implement techniques to foster clearer, more inclusive interactions. A total of 144 early career healthcare professionals (114 dental school students and 30 nursing program students) were recruited for this study, and a 40-minute lecture and discussion on the topic was carried out in the classroom. Topics included barriers for deaf and hard-of-hearing (DHH) patients to patient care, clinicians’ perception of DHH patient care, and strategies and technologies that can help enhance communications with DHH patients around the clinic and at the appointment. A questionnaire on the participants’ awareness and attitudes on this topic was carried out before and immediately after the discussion. A total of 10 questions were asked, including areas of their confidence in recognizing the needs of a DHH patient, as well as knowledge and attitudes on strategies and technologies to help with DHH patients. A non-parametric Wilcoxon matched-pairs signed rank test was performed for each of the questions. Results revealed statistically significant differences for most of the questionnaire (p < 0.001), suggesting a significant change in the awareness and attitudes towards better communication with DHH patients. Results of this study demonstrated that an effective training program can help educate early-career healthcare professionals in better helping DHH patients. In turn, this program helps them enhance their ability to provide patient-centered care, contribute to reducing healthcare disparities for DHH individuals, bridge the communication gap, and ensure that every patient receives the care and respect they deserve. 

Learning Objectives: 

Upon completion, participants will be able to:

• Recognize the role of providers in ensuring all patients feel heard, understood, and respected. 
• Discuss the effectiveness of a training program to better help DHH patients. 
• Recognize barriers for DHH patients to patient care and learn strategies to enhance communication. 

Description: 

Previous research has shown that music and dental professionals are exposed to various levels of occupational noise on a daily basis. Dental equipment and musical instruments often produce noises that are either at or above critical levels according to industrial standards, such as OSHA and NIOSH regulations. In addition, most musicians and dental professionals are not fully aware of the damaging effects associated with prolonged noise exposure in their occupational setting. The current study aimed to provide information to early career dentists and musicians with information on hearing loss and noise exposure, as well as the importance of using hearing protection when in occupational situations with potential noise exposure hazards. The objective of this study was to examine whether attitudes and/or beliefs towards occupational noise exposure would change after completing such program. Attitudes and beliefs about noise exposure were investigated during the orientation of doctoral level dental students (n=140) and at the dean’s seminar for students majoring in music studies (n=75). The Perception on Hearing Protection and Hearing Loss Questionnaire was adapted from the U.S. National Institute for Occupational Safety and Health (NIOSH) for this study and was administered before and immediately after the educational intervention program. Eight subcategories of questions will be analyzed including: 1) perceived susceptibility to hearing loss, 2) perceived severity of consequences, 3) perceived benefits of preventive action, 4) perceived comfort, 5) perceived important sound awareness, 6) social norms, 7) behavioral intentions, and 8) self-efficacy. A non-parametric Wilcoxon matched-pairs signed rank test was performed for each of the categories. Results from the statistical analysis revealed statistically significant results in all eight sub-categories of the questionnaire (p < 0.001), suggesting a significant change in the awareness and attitudes towards occupational noise exposure in these early career professionals. In summary, this study investigated the efficacy of a hearing conservation program for early-career music and dental professionals about the dangers of occupational noise exposure. Results suggest that such program could be adopted and used with other early-stage professionals who may be exposed to occupational noise in their future careers. 

Learning Objectives: 

Upon completion, participants will be able to:

• Describe the damaging effects of prolonged noise exposure in musician/dental occupational settings 
• Discuss the importance of hearing protection in occupational situations with noise exposure hazards 
• Discuss the effectiveness of a hearing conservation program for early-career professionals 

Description: 

Although the FDA approved OTC hearing aids in October of 2022, not much has changed during the first two years. OTC sales were relatively small and prescription hearing aids continued to grow at the traditional 3-5% annual rate as they had for decades. Recently, new technologies and algorithms have allowed new form factors to emerge which include AI technologies and relatively invisible hearing aids which serve to eliminate the significant ongoing Hearing Aid Stigma. Hearing Aid Stigma is often dismissed by hearing care professionals, yet it remains a powerful antagonistic force in hearing healthcare. In this presentation, we will review the background and recent history of amplification and we will review many of the new technologies which are available as prescription and OTC devices. Above-mentioned variables can help improve diagnostic practices and therapeutic interventions. Overall, considering demographic factors when interpreting SIN performance in clinical settings may affect the accuracy of diagnostic results and the effectiveness of interventions. 

Learning Objectives: 

Upon completion, participants will be able to:

• Explain the two main reasons the FDA adopted OTC Hearing Aids 
• Name the primary non-FDA reason most people avoid hearing aids 
• Discuss the three benefits of OTC alternative form factors. 

Description: 

Audiology is at a crossroads, facing a rapidly changing landscape shaped by economic, legislative, and competitive pressures. This session will explore the critical challenges threatening the profession, provide insight into areas for improvement within individual practices, and assess whether audiology remains a viable and profitable career path.    

Key issues include the impact of third-party payers and declining insurance reimbursements, both of which have made traditional practice models increasingly difficult to sustain. The rise of big-box retailers, online discount sellers, and over-the-counter (OTC) hearing aids has added further competition, changing patient expectations and eroding the role of audiologists as primary providers of hearing healthcare.   

Additionally, we will examine workforce challenges, including the declining number of students entering the field, the rising cost of audiology education, and a decreasing interest in private practice. Are fewer audiologists pursuing independent practice, and if so, what are the consequences for the profession? We will also discuss how overlapping scopes of practice with other healthcare professions may impact audiology’s role in patient care.   

Legislative changes, such as Reese’s Law, which affects battery packaging, are reshaping industry regulations, while the sheer number of organizations claiming to represent audiology’s interests can create division rather than unity in advocacy efforts.   

This session will have Drs. Gosalia and Kjeldsen debate each topic to allow for further discourse of the opportunities and challenges of audiology in 2025. With these insights, attendees will leave equipped to navigate the evolving audiology landscape and make strategic decisions to ensure their professional success.  

Learning Objectives: 

Upon completion, participants will be able to:

• Explain which areas of audiology are truly threatened 
• Identify areas of their practice that can be improved  
• Discuss whether audiology is a viable and profitable profession 

Description: 

56% of patients who are lesbian, gay, or bisexual and 70% of patients who are transgender or non-binary say they have faced healthcare discrimination and 28% of transgender respondents have postponed medical care due to fear of disrespect and harassment. These numbers are even higher for LGBTQ+ people of color, individuals with HIV, and with lower incomes. Additionally, elderly members of the LGBTQ+ community face additional barriers to care due to higher rates of isolation, decreased family supports, and limited availability of social services. Within audiology, a survey of LGBT individuals found that 79% of respondents felt their LGBT identity was a barrier to receiving hearing services and only 4% disclosed their identity to their hearing healthcare provider. The American Academy of Audiology Code of Ethics first principle stipulates that “Members shall help; respect the dignity, worth, and rights of those served”; and its first rule goes on to state that members “shall not discriminate in the provision of services to individuals on the basis of sex, race, religion, national origin, sexual orientation, or general health.” (AAA, 2021). Based on the results of this survey, it seems that audiologists are failing to meet the standards agreed to in the Code of Ethics as it pertains to members of the LGBTQ+. The goal of this presentation is to provide audiologists with concrete strategies to create an environment that honors the commitment set forth by the Code of Ethics and begins the work of undoing the systemic barriers preventing members of the LGBTQ+ community from accessing vital hearing care services.   

This presentation will provide an overview of current research on individual and systemic barriers to healthcare for LGBTQ+ patients and help attendees identify how these barriers are present in their own clinics and communities. Attendees will be given specific strategies to address these barriers to help provide optimal and affirming healthcare to LGBTQ+ patients and their families. To assist attendees in developing these strategies, the presentation will include targeted questions and discussion of case studies, with additional opportunities for attendee questions and small group interactions.  

Learning Objectives: 

Upon completion, participants will be able to:

• Describe two barriers to seeking and receiving audiologic care for LGBTQ+ patients and families. 
• Demonstrate three ways audiologists can create affirming and welcoming environments for LGBTQ+ patients 
• Discuss two benefits and consequences of an LGBTQ+ patient coming out to a provider. 

Description: 

Current methods to determine an individual’s degree of hearing loss are typically based on pure-tone audiometry and speech testing. However, literature indicates that individuals with similar degrees and configurations of hearing loss can have varying degrees of disability. Patient-reported outcome measures are standardized, validated questionnaires that evaluate factors which a patient may perceive as challenging. The modified Amsterdam Inventory for Auditory Disability (mAIAD) is such a questionnaire and is comprised of 28 questions in Dutch. Responses are used to determine the subjective degree of disability and hearing difficulties. The mAIAD includes 5 subdomains of listening difficulties: speech-intelligibility-in-noise (SIN), speech-intelligibility-in-quiet, localization of sound, recognition of sound, and detection of sound. Scores in each subdomain are examined independently and then summed across all questions to determine the participants overall listening difficulty. Lower scores suggest greater listening difficulties and are reported in those with hearing loss or central auditory nervous system (CANS) dysfunction without audiometric abnormalities. Effects of noise or jet fuel exposure on the CANS are documented in animal models and humans. Thus, we conducted a study to screen military personnel with varying degrees of noise exposure using an English translation of the mAIAD questionnaire. We assessed whether concurrent jet-fuel and noise (JFN) exposures potentiate central auditory difficulties compared to noise only exposures. Results revealed non-significant differences in hearing thresholds between groups, despite higher noise exposures for the JFN group. Lower mAIAD scores were discovered for the JFN group compared to the noise only group. Further, a stratified JFN subgroup reporting more listening difficulty exhibited statistically significant lower SIN subdomain scores. When attempting to compare our results to norms for the English translation of the mAIAD, none existed. In this presentation we will describe response patterns for the English translation of the mAIAD subdomain and total scores for English-speaking adults with and without hearing impairment. Characterization of the mAIAD responses for 103 and 101 participants with normal hearing and hearing impairment, respectively, will be presented. Findings from the English translation of the mAIAD will be compared to findings from other translations as well as discussing the clinical applications of the mAIAD.  

Learning Objectives: 

Upon completion, participants will be able to:

• Discuss different clinical populations that would benefit from filling out the mAIAD. 
• Explain how the overall and subdomain scores of the mAIAD can be interpreted. 
• Describe the mAIAD responses in military personnel exposed to jet-fuel and noise or noise alone. 

Description: 

Falls are a leading cause of injury and death among older adults, highlighting the need for effective fall-risk identification methods. The CDC developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) protocol, which uses validated mobility assessments to predict fall risk with reasonable accuracy. Enabling patients to self-administer these assessments could eliminate barriers to STEADI implementation in clinical settings, making care plans that reduce falls by up to 40% more accessible. We aim to assess whether self-administered fall-risk assessments using hearing aids with built-in inertial measurement units (IMU-HAs) can serve as a reliable alternative to clinician-administered assessments. This study's objectives are to (1) evaluate the feasibility of IMU-HAs for independent assessments via the STEADI protocol, (2) identify barriers participants may face while using the app, (3) assess the accuracy of the IMU-HA scoring algorithm, and (4) determine which demographic variables contribute to fall risk. Participants used IMU-HAs while completing STEADI, scored by a phone app. In-person testing showed scores closely matched those from a trained observer, suggesting suitability for fall-risk monitoring. Some participants completed the protocol at home, but over 20% encountered challenges. To address these difficulties, we repeated the protocol in a controlled lab setting with remote clinician monitoring.   

Our study included 50 participants aged 55-100 who self-reported fall risk. Each was fitted with IMU-HAs and completed the CDC STEADI assessments, including the Timed Up and Go, 4-Stage Balance Test, and Chair Stand Test. Testing occurred in both laboratory and at-home environgments, with participants guided by the HA app and observed remotely by a clinician. The clinician scored the protocol and noted any challenges faced. Initial results show strong agreement between the HA app scores and trained observer scores across all assessments. However, some participants experienced difficulties with the app, particularly confusion. Key demographic variables influencing results were age, presence of arthritis, and physical activity. These findings support the potential of IMU-HA technology for identifying individuals at risk of falling via the STEADI protocol. However, the app's usability must improve, especially for users uncomfortable with technology. Attention to reading level is also essential for accessibility.  

Learning Objectives: 

Upon completion, participants will be able to:

• Describe the CDC STEADI protocol 
• Report whether hearing aids can predict fall risk according to the STEADI protocol  
• Identify barriers to successful use of hearing aids to identify fall risk.