Cultural competence is as important to the audiologic encounter as clinical competence. Both contribute significantly to successful diagnosis and rehabilitation. Our success as clinicians depends on our ability to make sure that any cultural differences that may exist do not bias or affect our results.

Cultural background is a major factor in how individuals perceive illness, disease, health-care seeking behaviors, and acceptance. Members of culturally and linguistically diverse backgrounds typically do not know that they can seek hearing health care from an audiologist, and many place hearing and hearing health care as low priorities. Some individuals view hearing loss as just part of the normal process of aging, largely because of a lack of education and educational materials that address their specific needs. If hearing loss is not perceived as a condition that may be improved, individuals will certainly not seek the assistance of an audiologist.

Audiologists have developed tools and procedures to measure levels of hearing regardless of the patient's ability (age, cognitive state, language) or willingness to participate. Although necessary, this alone does not constitute a diagnostic or lead to a rehabilitative treatment process or outcome. It is at this point that clinical competence without cultural competence will result in less than maximal outcome. Communicating results, explaining follow-up, addressing psychosocial needs and fears and patient or family acceptance, and participation in communication training depend on our ability to understand the culture and beliefs of all of our patients in an honest and nonjudgmental manner.

Children from racial and ethnic minorities who are deaf or hard of hearing and who come from non-English-speaking homes may be inappropriately diagnosed or identified at a later age. Children have been placed in classrooms without consideration that bilingual speakers show decreased performance on speech testing in noise compared to monolingual English speakers. Decisions about follow-up diagnostic testing, amplification, and rehabilitation of adults have been made without valid speech audiometry and tests for auditory processing disorders-or have used inappropriately normed materials and tests-when audiologists are not aware of differences in outcomes related to language and culture.

Audiologists should approach cultural competence as they do clinical competence: with a commitment to lifelong learning. Although the body of literature in audiology and the number of courses available have not been vast, they are growing. We need to seek and apply new knowledge so that we can successfully meet the hearing health care challenges presented by the rapidly changing demographics of the United States.