Scope of Practice
The following Scope of Practice statement, jointly crafted by the Academy of Doctors of Audiology (formerly the Academy of Dispensing Audiologists) and the Audiology Foundation of America (7/31/03), is intended to be used by audiologists, allied professionals, consumers of audiological services, and the general public. It serves as a reference for issues of service delivery, third-party reimbursement, legislation, consumer education, regulatory action, state and professional licensure, and inter-professional relations. The document is not intended to be an exhaustive list of activities in which audiologists engage. Rather, it is a broad statement of professional practice. Periodic updating of any scope of practice statement is necessary as technologies and perspectives change.
Definitions
"Audiologist": any person who engages in the practice of audiology. An audiologist is a person who, by virtue of academic degree, clinical training, and license to practice is uniquely qualified to provide a comprehensive array of professional services related to the identification, diagnosis and treatment of persons with auditory and balance disorders, and the prevention of these impairments. Audiologists serve in a number of roles including primary service provider, clinician, therapist, teacher, consultant, researcher and administrator. In addition, the supervising audiologist maintains legal and ethical responsibility for all assigned audiology activities provided by audiology assistants and audiology students.
"Audiology"
- The application of principles, methods, and procedures related to the development and disorders of human audio-vestibular system, which disorders shall include any and all conditions whether of organic or functional origin, including, but not limited to, disorders of hearing, balance, tinnitus, central auditory processing and other neural functions, as those principles, methods and procedures are taught in doctoral programs in audiology at regionally accredited institutions of higher learning.
- Such principles, methods or procedures include, without limitation, those of diagnosis, assessment, measurement, testing, appraisal, evaluation, treatment, prevention, conservation, identification, consultation, counseling, intervention, management, interpretation, instruction or research related to hearing, vestibular function, balance and fall prevention, and associated neural systems, or any abnormal condition related to tinnitus, auditory sensitivity, acuity, function or processing, speech, language or other aberrant behavior resulting from hearing loss, for the purpose of diagnosing, designing, and implementing audiological treatment or other programs for the amelioration of such disorders and conditions.
- Engaging in the practice of prescribing, selecting, specifying, evaluating, assisting in the adjustment to, and dispensing of prosthetic devices for hearing loss, including hearing aids, and hearing assistive devices by means of specialized audiometric equipment or by any other means accepted by the board.
Scope of Practice
The scope of practice of audiologists is defined by the training and knowledge base of professionals who are licensed to practice as audiologists. The audiologist is an independent practitioner who provides services in hospitals, clinics, schools, private practices and other settings in which audiological services are relevant.
Areas of practice include identification, diagnosis and treatment of individuals with auditory and balance disorders, prevention of hearing loss, and research in normal and disordered auditory and balance function.
The central focus of the profession of audiology is concerned with all auditory impairments and their relationship to disorders of communication. Audiologists identify, diagnose, evaluate, and treat individuals with either peripheral or central auditory impairments, and strive to prevent such impairments. All professional activities related to this central focus fall within the purview of audiology. In addition, professional activities related to diagnosis and treatment of persons with balance disorders are within the scope of practice of audiologists.
Audiologists provide clinical and academic training to students in audiology. Audiologists teach physicians and medical students about the evaluation of hearing and balance disorders, prevention of hearing loss, and diagnosis and treatment of persons with hearing and balance impairment. They provide information and training on all aspects of hearing and balance to other professions including psychology, counseling, rehabilitation, education and other related professions. Audiologists provide information on hearing and balance, hearing loss and disability, prevention of hearing loss, and rehabilitation to business and industry. They develop and oversee hearing loss prevention programs in industry. Further, audiologists serve as expert witnesses within the boundaries of forensic audiology.
Identification
Audiologists develop and oversee screening programs to detect individuals of all ages with hearing and balance disorders. Audiologists may perform speech or language screening, or other screening measures for the purpose of initial identification and referral of persons with other communication disorders.
Diagnosis
Diagnosis of hearing status includes the administration and interpretation of behavioral and electrophysiologic measures of the peripheral and central auditory systems. Diagnosis of disorders of balance includes administration and interpretation of clinical and electrophysiologic tests of equilibrium. Diagnosis is accomplished using standardized testing procedures and appropriately calibrated instrumentation, together with the audiologist's interpretation of these measures, case history exploration and use of the audiologist's clinical judgment.
Treatment
The audiologist is the professional who provides services for persons with hearing impairment and balance disorders. The audiologist is responsible for the evaluation and fitting of amplification devices, including assistive listening devices. The audiologist determines the appropriateness of amplification systems for persons with hearing impairment, evaluates benefit, and provides counseling and training regarding their use. Audiologists conduct otoscopic examinations, clean ear canals and remove cerumen, take appropriate ear canal impressions including deep canal impressions for middle ear implantable amplification devices. They prescribe, fit, sell, and dispense hearing aids and other amplification systems. Audiologists diagnose and provide management for persons with tinnitus using techniques that include, but are not limited to, biofeedback, masking, hearing aids, education, counseling, and tinnitus retraining therapy.
Audiologists provide diagnostic evaluations and counseling for functional hearing loss or pseudohypacusis. Audiologists are also involved in the treatment of persons with balance disorders. They participate as full members of a team to prescribe and carry out goals of treatment of balance disorders including, for example, habituation exercises, balance retraining exercises, general conditioning exercises, and adaptation techniques.
Audiologists provide treatment services for infants and children with hearing disorders and their families. These services may include therapy, home intervention, family support, and case management.
The audiologist is the member of the evaluation team who determines candidacy based on auditory and communication information for implantable hearing devices. The audiologist provides pre and post surgical assessment, counseling, auditory rehabilitation, programming of devices, and maintenance of hardware and software.
The audiologist provides habilitation and rehabilitation to persons with hearing and balance impairments, and is a source of information for family members, other professionals and the general public. Counseling regarding hearing loss, the use of amplification systems and strategies for improving speech recognition is within the expertise of the audiologist. Additionally, the audiologist provides counseling regarding the effects of hearing loss on communication and psycho-social status in personal, social, and vocational arenas. The audiologist administers identification, evaluation, and treatment programs to children of all ages with hearing impairment from birth and preschool through school age.
The audiologist administers hearing screening programs in schools, and trains and supervises non-audiologists performing hearing screening in the educational setting. The audiologist is an integral part of the team within the school system, which manages students with hearing impairments and students with auditory processing disorders. The audiologist participates in the development of Individual Family Service Plans (IFSPs), 504's and Individualized Educational Programs (IEPs), serves as a consultant in matters pertaining to classroom acoustics, assistive listening systems, hearing aids, communication, and psycho-social effects of hearing loss, and maintains both classroom assistive systems as well as students' personal hearing aids.
Hearing Loss Prevention Programs
The audiologist designs, implements and coordinates industrial, community, and recreational hearing loss prevention programs. This includes identification and amelioration of noise-hazardous conditions, identification of hearing loss, prescription of and counseling for the use of hearing protection, employee education, and the training and supervision of non audiologists performing hearing screening in the industrial setting.
Neurophysiologic Monitoring
Audiologists administer and interpret electrophysiologic measurements of neural function including, but not limited to, sensory and motor evoked potentials, tests of nerve conduction velocity, and electromyography. These measurements are in differential diagnosis, pre- and postoperative evaluation of neural function, and neuro-physiologic monitoring of central nervous system.
Research
Audiologists design, implement, analyze and interpret the results of research related to auditory and balance systems.