Establishing the test retest reliability of contralateral auditory suppression of transient evoked oto-acoustic emissions in a cohort of normal healthy individuals

Please note that this research project has been approved by the Research Ethics Board at The University of Prince Edward Island.

Some basic guiding principles for the partnership between the researchers and the participants

I have read the information sheet for this study and have been given permission to print any information I wish. I have also been provided a contact number of the Principal Investigator and an invitation to ask questions about the study or my participation in the study.

I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my legal rights being affected and I give consent for any data already given to be retained and used.

I understand that I will not benefit financially if this study leads to the development of education and training or future research/education/technological developmental outcomes.

I know how to contact the study team if necessary.

I understand that by submitting the letter of informed consent with this study I am agreeing to participate in this study.

I understand that a written summary of the findings will be available to participants through reports produced by the study team and disseminated via professional and academic journals and conferences.

If you would like to participate in this research, please provide authorization as indicated below. This form is necessary for you to participate.
Please be aware that you will not be permitted to participate in this study if you have the following conditions:
1. The participant is currently experiencing pain in the ears
2. The participant is currently experiencing swelling or tenderness in the ears
3. The participant has a skin rash in or around their ears
4. The participant is currently experiencing discharge (excessive drainage) from the ears

I have read the information provided for the research conducted by the researchers at UPEI related to establishing reliability estimates for concussion testing as described in the associated information page. My questions have been answered to my satisfaction and I agree to participate in this study. I voluntarily choose to participate in this study but understand that my consent does not take away my legal rights in the case of negligence or other legal faults of anyone who is involved in this study.

After reading through the background information you can contact us if you have any questions. At your first scheduled test session, you will be asked to complete and to sign this statement of consent, in order to confirm that you agree to participate in this research study.

You can authorize your consent by printing this page, signing it and bringing it to the clinic when you begin your participation.

I give my consent to the following items:

• I have read and understood the material about the study.

• I understand that my participation is voluntary and that I have the freedom to not complete any part of the tests, including any surveys. I also have the freedom to choose to not answer any questions.

• I understand that I can print a copy of any information for my files.

• I understand that by submitting the letter of informed consent with this study I am agreeing to participate in this study.

• I understand that I can contact the following organization if I have any concerns about the ethical conduct of this study:
UPEI Research Board: 902-620-5104 or email at reb@upei.ca

AUTHORIZATION

—————————- for office use only below this line —————————

Name: ________________________________________ Date: _____________________________

Witness: ________________________________________ Date: _____________________________