American Academy of Audiology Scope of Practice PDF

American Academy of Audiology Scope of Practice Published 1992 Updated 1996 Updated January 2004 Updated April 2023  Scope of Practice Introduction The Scope...

American Academy of Audiology Scope of Practice Published 1992 Updated 1996 Updated January 2004 Updated April 2023  Scope of Practice Introduction The Scope of Practice describes the professional activities and capabilities of audiologists. This document reflects the current and evolving Scope of Practice for audiologists. It defines audiologists as independent practitioners and provides examples of settings in which they are engaged. It is not intended to exclude involvements in activities outside those described in the document. There may be additional audiologic services, other than those described in this document, that are appropriate for audiologists with the applicable expertise. The main principle is that members of the American Academy of Audiology will provide only those services that they are competent and licensed to perform based on their education, training, and experience and that their practice is consistent with the Code of Ethics of the American Academy of Audiology. Purpose The purpose of this document is to define the scope of practice for the audiology profession and to outline and inform those activities that are within the expertise of members of the profession. The Scope of Practice is intended for use by audiologists, allied health professionals, educators, consumers of audiologic services, employers, and the general public. It also serves as a reference for matters of service delivery, third-party reimbursement, legislation, consumer education, regulatory action, state and professional licensure, and interprofessional relations. Definition of Audiologist This Scope of Practice defines audiologists as independent practitioners who, by virtue of their postgraduate education, training, and license to practice, engage in the profession of audiology. Audiologists serve as point-of-entry health-care providers for persons with auditory and vestibular disorders. Audiologists are uniquely qualified to provide a comprehensive array of professional services related to the identification, assessment, diagnosis, management, and treatment of persons with suspected loss of auditory and/or vestibular function; to the prevention of hearing and vestibular loss; and to the mitigation of associated comorbidities. Audiologists may serve in a number of roles, including clinician, educator, consultant, researcher, and administrator. The audiologist, as an independent practitioner, provides services in hospitals, clinics, schools, private practices, and other settings in which audiologic services are relevant and administers screening, assessment, diagnosis, and treatment programs to persons of all ages. The audiologist may provide services either in person or remotely via telehealth © 2023. American Academy of Audiology. All rights reserved. 1 | Page  Scope of Practice options. Audiologists provide services to individuals regardless of age, sex, gender identity, religion, race, ethnicity, disability, or nationality. Audiologists provide culturally competent services to all individuals. Scope of Practice The Scope of Practice for audiology is complex, dynamic, and constantly evolving. The areas of audiologic practice described in this document include screening and identification, assessment and diagnosis, treatment and management of auditory and vestibular loss, hearing conservation, neurophysiological monitoring, research and academic activities, public health, and additional expertise. Screening and Identification Audiologists develop and oversee screening programs for persons of all ages to detect individuals with changes in auditory and/or vestibular function and decide who should undergo a diagnostic evaluation. Audiologists may also perform speech/language screening, cognitive screening, or other screening measures as necessary to identify associated comorbid conditions or life circumstances that may impact treatment plans or patient welfare, or for the purpose of identification and referral to appropriate providers. Audiologists may supervise nonaudiologic personnel in conducting screening activities. Assessment and Diagnosis The assessment of auditory function includes the administration and interpretation of behavioral (psychoacoustic), bioacoustic, and electrophysiological measures of the peripheral and central auditory systems. The assessment of balance and vestibular function includes administration and interpretation of physical examination and laboratory tests of the vestibular system. Assessment of either auditory or vestibular function is accomplished using quantitative and qualitative measures, including subjective report, observation, and standardized testing procedures via properly calibrated instrumentation, which leads to an accurate diagnosis of auditory and/or vestibular functional status. The evaluation process also includes the integration of case history, clinical data, test outcomes, evidence-based practice, and other relevant information before the diagnosis and determination of auditory or vestibular functional status. Treatment and Management Audiologists provide a range of managing services for loss of auditory and/or vestibular function. Audiologists are uniquely qualified for the recommendation, selection, evaluation, fitting, and verification of amplification devices, including assistive listening devices. Audiologists determine the appropriateness of amplification systems, including both 2|Page  Scope of Practice prescriptive and over-the-counter hearing aids, for persons with hearing loss; evaluate benefit; and provide counseling and training regarding their uses and expected outcomes. Audiologists also provide audiologic rehabilitation services to enhance communication and mitigate the impact of hearing loss. Audiologists may remove cerumen when necessary. Audiologists may delegate and supervise non-audiologists (e.g., health-care technicians, clinical assistants, etc.) in the provision of assessment, treatment, or management services. Audiologists assess, diagnose, and provide audiologic treatment for persons with tinnitus using contemporary techniques that include, but are not limited to, biofeedback, tinnitus retraining, masking, hearing aids, education, and counseling. Audiologists provide treatment for persons with certain vestibular conditions. They play an important role on a balance management team, providing rehabilitation services for patients with impaired balance and vestibular dysfunction. Vestibular treatment and therapy protocols may include, but not be limited to, canalith repositioning procedure and liberatory maneuvers for the treatment of benign paroxysmal positioning vertigo; adaptation, habituation, and substitution trainings; gaze stabilization exercises to strengthen the vestibulo-ocular reflex; and static and dynamic balance activities. Audiologists are members of the multidisciplinary implant health-care team (e.g., cochlear implants, middle ear implantable hearing devices, fully implantable hearing devices, osseointegrated hearing devices, and all other amplification/signal processing devices) who determine audiologic candidacy based on hearing and communication information. Audiologists provide input on device selection and are principally responsible for device programming to ensure optimal outcomes. They conduct pre- and post-surgery auditory and communication assessment, counseling, and all aspects of audiologic management, including auditory training, rehabilitation, and maintenance of implant hardware/software for patients and their families. Audiologists can be the source of information for patient’s family members, other professionals, third-party payers, public health organizations, and the general public on treatment for auditory and vestibular disorders. In addition, audiologists provide counseling and education regarding the effects of hearing loss on communication, improving speech recognition, and social-emotional well-being status in personal, social, educational, and vocational arenas. Audiologic services may also include home intervention, family support, and case management. The audiologist is an integral part of the team within the school system who manages students who are d/Deaf or hard of hearing and students with central auditory processing 3|Page  Scope of Practice disorders, through participation in the development of Individualized Family Service Plans (IFSPs), Individualized Education Programs (IEPs), and Section 504 accommodation plans, serving as the expert in matters pertaining to classroom acoustics, assistive listening systems, hearing aids, communication, and social-emotional effects of hearing loss; maintaining both classroom assistive systems and students’ personal hearing aids; and instructing teachers and other school personnel on the proper use of the devices in the classroom. The audiologist may administer hearing screening programs in schools, which may include training and supervising non-audiologists or audiology students performing hearing screening in the educational setting. Hearing Loss Prevention Audiologists can design, implement, and coordinate programs to prevent the onset or progression of hearing loss due to noise exposure. These programs include industrial, military, entertainment, and community hearing conservation programs. This role includes identification and rectification of noise-hazardous conditions, identification and monitoring of hearing loss, recommendation and counseling on use of hearing protection, and employee education. It also includes the training and supervision of non-audiologists performing hearing screening in the industrial and military setting. Audiologists may provide information on hearing and balance, hearing loss and disability, prevention of hearing loss, and treatment to the business, military, and entertainment industry. Audiologists also plan and implement programs due to other potentially adverse conditions, such as ototoxic drugs and chemicals, and plan and implement programs to lower the risk of developing hearing loss. When needed, audiologists can serve as expert witnesses within the boundaries of medico-legal and forensic audiology. Neurophysiological Monitoring Audiologists administer and interpret electrophysiological measurements of neural function, including, but not limited to, sensory and motor evoked potentials, tests of nerve conduction velocity, and electromyography. These measurements are used in differential diagnosis, pre- and postoperative evaluation of neural function, and intraoperative monitoring of cranial nerve and spinal cord function. Research and Academic Endeavors Audiologists with the appropriate training and expertise may design and conduct basic, clinical, and translational research in persons who have normal and impaired auditory and vestibular systems. The outcomes of this research benefit audiology education and services and facilitate evidence-based practice. Audiologists not only provide clinical and academic training to students in audiology but also teach physicians (including students, residents, 4|Page  Scope of Practice and fellows) and other health-care providers and stakeholders about the auditory and vestibular systems. Specifically, they provide detailed instructions about identification, assessment, diagnosis, prevention, and treatment of patients with suspected auditory and/or vestibular loss. Public Health Audiologists participate in the broader public health education as a professional leader of hearing and balance initiatives that address auditory and/or vestibular issues, or as a participant on public health teams improving the quality of life for individuals with hearing and/or vestibular loss. Audiologists actively promote the awareness of hearing and balance disorders and educate the public about the importance of early identification and treatment, as well as promote cognitive health, social engagement, vocational success, and educational achievement across the life span. Additional Expertise By virtue of education, experience, and personal choice, some audiologists may choose to specialize in an area of practice not otherwise defined in this document, including administrative or leadership positions within their work settings. This document shall not be construed to prohibit individuals’ choice in this regard, assuming that the activity is consistent with the American Academy of Audiology Code of Ethics. The profession of audiology will continue to evolve as new knowledge, technologies, assessment, diagnosis, or treatment options for auditory and vestibular systems emerge. This document will be reviewed, revised, and updated periodically to reflect contemporary demands of audiologists and to keep pace with the changes in scope of practice reflected by future advances and innovations in this specialty. 5|Page