RESOURCES
A Professional Practice Profile for Hearing Health Professionals
Hearing instrument dispensing includes several professions that overlap. There are traditional hearing aid dispensers, Board Certified hearing health professionals, hearing aid practitioners, hearing instrument specialists, audioprosthologists, audiologists, doctors of audiology, otolaryngologists and other doctors of medicine. This document summarizes the scope of dispenser services as defined by the 1999 NBC-HIS Role Delineation Study of Hearing Aid Dispensers (D’Costa, 1999). It does not replace or supersede current state and federal regulations governing the practice of hearing instrument dispensing, but is specific to the training and legitimate professional activities of those practitioners licensed in hearing instrument dispensing.
Simply put, the purposes of this document are twofold: to provide a model hearing instrument dispenser practice plan for state/provincial licensing boards and to provide consumers, government agencies and other interested parties official information about the specific services and understandings a patient has the right to expect from a competent hearing health professional.
The following guiding principles and assumptions were used in the development of this profile:
- Only those professionals who hold professional licenses which allow hearing aid dispensing and who have appropriate training and experience may provide specific procedures.
- Safety and health of the patient are the most important considerations in all practice decisions and actions.
- All dispensing procedures are performed in a manner as to prevent bodily injury and infection.
- Hearing aids may be only part of the answer for improved communication; therefore, it is important to recognize and to encourage the use of other assistive listening devices for patients.
- Hearing healthcare requires a team effort. Dispensers must work with other professionals, as needed, to maximize patient care and interprofessional collaboration.
- Dispensers form a partnership with each of their patients to help achieve total communication with their own world, thus enabling their development and participation in all aspects of their life.
- All equipment must be maintained according to the manufacturer’s specifications and recommendations. Equipment must be properly calibrated and necessary records maintained.
- Decontamination, cleaning and disinfection of multiple-use equipment must be carried out according to facility-specific infection-control policies and manufacturer’s guidelines.
- Ambient noise levels in the test environment must be appropriate to the practice setting.
- Documentation must be maintained in accordance with local regulations and in keeping with good professional practice.
The NBC-HIS 1999 Role Delineation Study analyzed the responses of survey responders to 100 tasks in terms of the frequency with which each task was performed, and in terms of the level of supervision occurring with each task performance. Sixteen broad procedures were identified using statistical clustering of the tasks and are listed below.
- Elicit patient/client case histories, including medical, otological, pharmacological, previous amplification history and patient attitudes and expectations.
- Administer otoscopy for the purpose of identifying possible otological conditions, including but not limited to the FDA red flag conditions that may indicate the need for medical referral or which may have a bearing on needed rehabilitative measures, outcomes and/or recommendations.
- Administer cerumen management in the course of examining ears, taking ear impressions and/or fitting of hearing instruments.
- Administer and interpret tests of human hearing, including appropriate objective and subjective methodology and measures.
- Determine candidacy for hearing instruments, assistive devices or referral for cochlear implant evaluation or other clinical/rehabilitative/medical intervention.
- Prescribe, select and fit appropriate hearing instruments and assistive devices including appropriate technology, electroacoustic targets, programming parameters and special applications as indicated.
- Assess hearing instrument efficacy utilizing appropriate fitting verification methodology, including all available fitting validation methods.
- Take and prepare ear impressions for prosthetic adaptation of hearing instruments, assistive devices, telecommunications applications, ear protection and other related applications.
- Design and modify earmolds and auditory equipment requisite to meet individual patient needs.
- Provide rehabilitative advice and counseling in the use and care of hearing instruments and assistive devices and in effectively utilizing communication coping strategies and other approaches to foster optimal patient rehabilitation.
- Counsel family member(s) and other interested parties relative to psychosocial and rehabilitative considerations for optimal patient outcomes.
- Provide long-term patient care, including periodic audiometric updates and recommendations for modifying rehabilitation programs to help meet patients’ changing needs over time.
- Refer and cooperate with other allied professionals in meeting the needs of the hearing impaired.
- Provide supervision and in-service training of those entering the dispensing profession.
- Maintain and update knowledge and skills in current and future diagnostic and technological advancements within the hearing industry.
- Consult with industry in the development of products and services relating to aiding hearing impairment.
The sixteen procedures listed above were then grouped into six major areas as follows:
- Assess patient presenting problem and needs
- Test and analyze patient hearing
- Prescribe and analyze hearing aid
- Fit, adjust, program and service hearing aid
- Counsel and help rehabilitate patient
- Manage office and practice
The following section addresses the expected outcomes, indication for procedure and procedure methods for each of the six categories.
ASSESS PRESENTING PROBLEM AND NEEDS
Expected Outcomes:
- Identification of factors in the patient’s background that may put him/her at risk for hearing problems.
- Identification of FDA red flags that would require a referral for medical evaluation.
- Identification of other medical problems that may have an impact on the methods used for procedures and/or expected outcomes of hearing aid fitting.
- Identification of family members’ concerns regarding patient’s hearing difficulties.
- Exploration of patient attitudes and expectations of amplification.
- Identification of problems with hearing and understanding.
- Identification of daily activities and impact of hearing loss on lifestyle.
- Identification of impact of hearing loss on family, friends and in the workplace.
Indication for Procedure:
- Individuals being seen for either hearing screening or hearing evaluation
Procedure Methods:
- Typically consists of a combination of written answers to a series of questions, elaboration of those answers by oral questioning and behavioral observation.
- Areas covered include but are not limited to: family history of hearing loss; incidence and duration of childhood hearing-related illnesses; information regarding dizziness, loss of balance or tinnitus; current medication/drug history; and history of noise exposure and acoustic trauma. In addition, it is critical to elicit family members’ concerns about the patient’s hearing difficulties, the patient’s attitudes and expectations regarding amplification, and the patient’s own assessment of their hearing difficulties.
- Additional areas that must be covered include but are not limited to questions regarding history of ear surgeries, diseases and treatments; information regarding past experiences with amplification; and questions and observations regarding ear deformity, pain, sudden hearing loss, ear infection, disease, drainage or blockage requiring medical referral.