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The Preferred Practice Patterns are part of a continuum of policy documents related to clinical practice. As such, updates are needed periodically to ensure that the Preferred Practice Patterns are consistent with current clinical practice and Association policy. The Vice President for Professional Practices in Audiology convened a Working Group to review and revise where necessary the 1997 Preferred Practice Patterns for the Profession of Audiology. The Working Group participants were Harvey Abrams; Roberta B. Aungst, Monitoring Vice President; Sue Ann Erdman; Jaynee A. Handelsman; Paula P. Henry; Pamela Mason, ex officio (2006); George T. Mencher, Chair; Tina Mullins, ex officio (2005); Frank Musiek; Neil T. Shepard; and Sandra L. Turek. Additional input was provided by Janet Brown, Vic Gladstone, Lemietta McNeilly, and Diane Paul, National Office staff members; Celia Hooper, Vice President for Professional Practices in Speech Pathology (2003–2005); and Teri James Bellis, Gail Chermak, and Teresa Zwolan.
The American Speech-Language-Hearing Association (ASHA) established the Preferred Practice Patterns for the Profession of Audiology [1] to enhance the quality of professional services and for an educational tool for ASHA-certified audiologists, other professionals, members of the general public, consumers, administrators, regulators, and third-party payers. The Preferred Practice Patterns provide an informational base to promote quality patient care delivery in health care, education, industry, and other settings in which audiologists practice. They are sufficiently flexible to permit both innovation and acceptable practice variation yet sufficiently definitive to guide practitioners in decision making for appropriate clinical outcomes. They provide a focus for professional preparation, continuing education, and research activities. In publishing these statements, ASHA does not intend to exclude members of other professions or related fields from rendering services within their scope of practice for which they are competent by virtue of education and training.
The Preferred Practice Patterns are neither a yardstick to measure acceptable conduct nor a set of aspirational principles. Rather, they reflect the standard of care relevant to a particular set of circumstances. There may be legitimate reasons for departing from the practice patterns. Audiologists should make the ultimate judgment regarding the appropriateness of any given procedure. This should be based on individual patient circumstances and often is a collaborative decision with the patient, family, caregivers, and other professionals. These practice patterns are to be used with sensitivity to and knowledge of cultural and linguistic differences and the individual preferences and needs of patients and their families and/or caregivers. Practitioners also need to be aware of the ASHA (2003) Code of Ethics when considering alternative practices.
These practice patterns are organized by procedure and were developed to be consistent with the World Health Organization's (2001) International Classification of Functioning, Disability and Health, as well as the framework of the Scope of Practice in Audiology (ASHA, 2004f; see Figure 1). For each procedure, the Preferred Practice Patterns for the Profession of Audiology specify the expected outcome(s), clinical indications for the procedure, clinical process, others who may perform the procedure, setting/equipment specifications, safety and health precautions, and documentation. For many clinical procedures, the Preferred Practice Patterns direct practitioners to more detailed guidelines in the ASHA Policy Documents and Related References section at the end of each statement as well as to related practice patterns. Adherence to the Preferred Practice Patterns does not guarantee a desired outcome.
It is useful to regard these practice patterns within the conceptual framework of ASHA policy statements ranging in scope and specificity from broad to narrow and general to detailed in content. The categories are defined as follows:
Scope of Practice Statement: A list of professional activities that define the range of services offered within the profession of audiology.
Preferred Practice Patterns: Statements that define generally applicable characteristics of activities directed toward individual patients and that address structural requisites of the practice, processes to be carried out, and expected outcomes.
Position Statements: Statements that specify ASHA's policy and stance on a matter that is important not only to the membership but also to consumers or to outside agencies or organizations.
Practice Guidelines: A recommended set of procedures for a specific area of practice, based on research findings and current practice. These procedures detail the knowledge, skills, and/or competencies needed to perform the procedures effectively.
In applying these practice patterns, all ASHA-certified audiologists are bound by the ASHA Code of Ethics. All professional activity must be consistent with the Code of Ethics and with individual state licensure regulations. Particularly relevant to clinical practice are those provisions for holding paramount the welfare of persons served and providing only clinical services for which one is competent, considering education, training, and experience. The Code of Ethics also requires one to maintain the confidentiality of patient records. In addition, practitioners who hold paramount the welfare of persons served must follow standard health precautions when they are providing clinical services that would place themselves or their patients at risk for transmission of communicable diseases (ASHA, 1991). The Code of Ethics also stipulates that practitioners can only delegate the provision of audiologic services to those individuals who hold appropriate credentials or to support personnel who have appropriate training and who receive appropriate supervision by the audiologist.
Related to the framework of ASHA policy statements are the standards that have been established for the certification of audiologists and the accreditation of graduate education programs in audiology. Standards are formalized rules or requirements that must be attained or adhered to, to become part of a group that claims to have met specified criteria. Associations set standards in a variety of areas, recognizing that certain members or entities have achieved, or maintained, certain qualities or competencies. Standards are important because they assure the public and others in the profession that a specific person or program strives for excellence in practice or delivery of service. When certain standards are met, the person or program can publicly claim that they are “accredited” or “certified” by a body responsible for verifying that the standards have been met. Standards programs help to promote public confidence in the professions.
ASHA has developed standards in these areas: certification of audiologists and accreditation of graduate-level educational programs. The Council for Clinical Certification (CFCC) sets the standards for the certification of individuals and verifies that individuals have met those standards. The CFCC authorizes the use of the designator CCC-A (Certificate of Clinical Competence in Audiology) after a person's name when it has been determined that the person meets the certification standards. These standards are designed to demonstrate that certified audiologists possess the skills and knowledge levels necessary for entry into the profession of audiology and maintain their expertise though continuing education. The Council on Academic Accreditation (CAA) formulates the standards for the accreditation of graduate educational programs that provide entry-level professional preparation with a major emphasis in audiology and applies those standards in the accreditation of such programs. Accreditation is intended to protect the interests of students, benefit the public, and improve the quality of teaching, learning, research, and professional practice. Through its accreditation standards, the CAA encourages institutional freedom, ongoing improvement of educational institutions and training programs, sound educational experimentation, and constructive innovation.
The original Preferred Practice Patterns (1992) were the product of extensive peer review by ASHA members and contained patterns for the professions of audiology and speech-language pathology. In clinical areas of controversy, working groups of members with expertise were formed to reach consensus on accepted practice patterns. The 1997 revision of the Preferred Practice Patterns updated the original document, developed additional practice patterns for new or emerging areas of clinical practice, and represented the first time audiology documents were separated from speech pathology documents.
The current Preferred Practice Patterns for the Profession of Audiology represent the consensus of the members of the profession after the consideration of available scientific evidence, existing ASHA and related policies, current practice patterns, expert opinions, and the collective judgment and experience of practitioners in the field. Requirements of federal and state governments and accrediting and regulatory agencies also have been considered. They reflect current practice based on available knowledge. Because audiology is a dynamic and continually developing profession, advances are expected to change current practice patterns. Similarly, advances in educational and health care policy and practices influence professional practices. The practice patterns will be updated periodically to reflect new clinical, scientific, and technological developments that occur inside and outside the profession of audiology.
American Speech-Language-Hearing Association. (1991). Prevention of communication disorders tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1998). Support personnel in audiology: Position statement and guidelines. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2001). Scope of practice in speech-language pathology. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2003). Code of ethics (revised). Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004a). Clinical practice by certificate holders in the profession in which they are not certified. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004b). Confidentiality. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004c). Conflicts of professional interest. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004d). Evidence-based practice in communication disorders: An introduction [Technical report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004e). Knowledge and skills needed by speech-language pathologists and audiologists to provide culturally and linguistically appropriate services. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004f). Scope of practice in audiology. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005a). Cultural competence. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005b). Evidence-based practice in communication disorders [Position statement]. Available from www.asha.org/policy.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) Pub L. No. 104-191
World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.
The following guiding principles formed the basis of the Preferred Practice Patterns for the Profession of Audiology:
Keep paramount the welfare of patients served in all practice decisions and actions.
Acknowledge that a primary purpose for addressing communication issues is to effect measurable and functional change(s) in an individual's communication status so that he or she may participate as fully as possible in all aspects of life—social, educational, and vocational.
Recognize that communication is always an interactive process and that the focus of intervention may include training of communication partners (e.g., caregivers, family members, peers, educators).
Maintain sensitivity to and knowledge of cultural and linguistic differences and the individual preferences and needs of patients and their families and/or caregivers.
Acknowledge that the scope of practice for audiologists enables them to engage in activities that identify, assess, diagnose, manage, and interpret test results related to disorders of the auditory, balance, and other neural systems.
Identify appropriate support personnel who may perform certain procedures.
Address the clinical indications for performing any given procedure.
Define appropriate environmental factors related to procedures (e.g., ambient noise, setting, equipment, materials).
Address demographic factors pertinent to the individual (e.g., age, developmental level, education), as well as cultural, ethnic, linguistic, vocational, and social factors.
Consider risk as it relates to the health, safety, and welfare of patients and practitioners; severity of impairment, disability, or handicap; severity of auditory, balance, or other related disorder(s); premorbid health and cognitive status; related conditions and complications; effects of medications, surgery, and other interventions; special needs (e.g., glasses, hearing aid, wheelchair); social needs/support system; and other services needed.
Consider outcomes including prevention of auditory, vestibular, and other related disorders; improvement and/or maintenance of functional communication; and enhancement of the quality of life.
Consider intra- and interdisciplinary approaches to service delivery.
Recognize the dignity and privacy of individuals and consider patient rights, expectations, needs, and preferences.
Recognize the value and importance of obtaining fully informed consent for procedures that may present risk or are part of a research protocol and appropriate releases of information before sharing any information about patients with others.
Recognize a variety of appropriate service delivery models and procedures (e.g., collaborative consultation, participation in multi-, inter-, and transdisciplinary teams, use of support personnel, and new and advanced technologies).
Adhere to the specifications and intent of the current Code of Ethics.
Recognize the importance of documentation and acknowledge that privacy and security of documentation are maintained in compliance with the regulations of the Health Insurance Portability and Accountability Act, the Family Educational Rights and Privacy Act, and other state and federal laws.
1.0 Prevention
2.0 Audiologic Screening
3.0 Speech-Language Screening
4.0 External Auditory Canal Examination and Cerumen Management
5.0 Basic Audiologic Evaluation
6.0 Advanced Audiologic Evaluation
7.0 Pediatric Audiologic Evaluation
8.0 Electrodiagnostic Test Procedures
9.0 Auditory Evoked Response Evaluation
10.0 Intraoperative Monitoring
11.0 Audiologic Management of the Surgical Patient
12.0 Balance System Evaluation
13.0 Tinnitus Management
14.0 Audiologic (Re)habilitation Evaluation
15.0 Audiologic Rehabilitation for Adults
16.0 Audiologic (Re)habilitation for Children
17.0 Hearing Aid Selection and Fitting
18.0 Product Repair/Modification
19.0 Hearing Assistive Technology Systems
20.0 Audiologic Management of the Cochlear Implant Patient
21.0 (Central) Auditory Processing Disorders Evaluation
22.0 Treatment and Management of (Central) Auditory Processing Disorders
23.0 Counseling
24.0 Ototoxicity: Monitoring of the Auditory and Vestibular Systems
25.0 Consulting Services
26.0 Occupational Hearing Loss Prevention and Conservation
27.0 Outcome Evaluation and Follow-Up Measures
Procedures and programs to prevent initial or additional damage to hearing, balance, and related systems.
Prevention is conducted according to the Guiding Principles section of this document.
Preventative actions avoid, eliminate, inhibit, or delay the onset and development of a hearing, balance, or related disorder.
Preventative actions may include minimizing susceptibility to hearing loss and associated auditory disorders or reducing exposure to potentially damaging events for susceptible persons.
Preventative actions are aimed at preventing hearing loss either on an individual or a group/community level.
Prevention services are indicated for the general population (e.g., community awareness or health fairs).
Prevention services are indicated for all patients and their family members/caregivers as an integral part of audiologic services.
Monitoring services are provided for individuals with hearing loss at risk for additional hearing loss due to toxic substances or continued exposure to occupational, environmental, or recreational noise.
Prevention programs for patients with noise-induced hearing loss must be appropriate (it makes sense), adequate (it makes a difference), acceptable (one can live with it), and affordable (to the individual and/or the community).
Design, implementation, coordination, and supervision of prevention programs may include an interdisciplinary team (e.g., industrial hygienists, occupational physicians, nurses, acoustical engineers, and educators).
Prevention services may include one or more of the following:
identifying a need for services
establishing relationships with professionals and community groups
selecting consultation and educational strategies
providing general information about auditory and balance processes and related disorders and their prevention and treatment
facilitating changes in the acoustic environment and developing programs or instrumentation for the prevention of hearing loss and associated auditory disorders
referring to appropriate resources
Support personnel may conduct selected procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals.
Prevention services are offered in home, health care, education, business, industrial, and military settings and government agencies for individuals, families, groups, and organizations.
All procedures ensure the safety of the patient and clinician and adhere to standard health precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Documentation should include prevention plans, pertinent information, educational materials, and recommendations for prevention strategies.
2.0 Audiologic Screening
3.0 Speech-Language Screening
24.0 Ototoxicity
26.0 Occupational Hearing Loss Prevention and Conservation
In addition to those in the Preamble, the following references apply specifically to these procedures:
American Speech-Language-Hearing Association. (1988). Prevention of communication disorders [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991). Prevention of communication disorders tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997). Guidelines for audiology service delivery in nursing homes. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004). The audiologist's role in occupational hearing conservation and hearing loss prevention programs. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005a). Acoustics in educational settings: Position statement. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005b, November). Bylaws and policies associated with the bylaws of the American Speech-Language-Hearing Association. Article II, § 2.1 (3). Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2006, February 27). Healthy People 2010—Health objectives for the nation [ASHA Fact Sheet]. Available from www.asha.org/members/research/reports/healthy_people_2010.htm.
World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.
World Health Organization. (n.d.) Strategies for prevention of deafness and hearing impairment. Retrieved May 9, 2006, from www.who.int/pbd/deafness/activities/strategies/en/index.html
A pass/fail procedure to identify individuals who require further audiologic assessment/evaluation and/or treatment or referral for other professional services.
Hearing screening is conducted according to the Guiding Principles section of this document.
Audiologic screening serves to prevent further consequences from unidentified auditory impairment.
Audiologic screening identifies those persons with auditory impairment or at risk for such impairment that may impact communication, health, education, and psychosocial function.
Audiologic screening may result in recommendations for rescreening, audiologic assessment/evaluation, or referral for other assessment or treatment.
Individuals of all ages (from birth through adult years) are screened as needed, requested, or mandated or when they have conditions that place them at risk for hearing loss. Screen all newborns for impairment at birth or within 3 months of age, at-risk toddlers and preschoolers, and school-age children.
Neonates should receive audiologic screening before hospital discharge in accordance with the guidelines of the Joint Committee on Infant Hearing. When resource limitations or other restrictions preclude screening all newborns, all infants who receive neonatal intensive care or special care and all infants who have conditions that place them at risk (with indicators) for hearing impairment should be screened. Infants who are not tested as newborns should be screened before 3 months of age. Infants at risk for progressive or late-onset hearing loss should be screened every 6 months until 3 years of age and at appropriate intervals thereafter.
Infants and toddlers should be screened for otologic disorder and auditory impairment as needed, requested, or mandated or when they have conditions that place them at risk. Screen at well-baby visits up through 60 months of age or if family/caregiver expresses concern.
Screen school-age children on initial entry to school and annually in kindergarten through 3rd grade and in 7th and 11th grades.
Adults should be screened at least every decade through age 50 and at 3-year intervals thereafter, or more frequently on exposure to noise, toxic medications, or other risk factors associated with hearing loss.
Audiologic screening includes
concern on the part of an individual and/or caregiver
consent of patient or family/caregiver
case history
note of problems with hearing, balance, tinnitus, and speech-language
otoscopic examination
Audiologic screening procedures may include
for neonates and young infants, birth through 6 months, appropriate (electro)physiological measures in accordance with Joint Committee on Infant Hearing guidelines
for children and adults, developmentally appropriate assessment procedures and stimuli and response methods
for patients who fail the audiologic screening, referral to an audiologist for further audiologic assessment/evaluation
Support personnel may conduct selected procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals.
Audiologic screening is conducted in a clinical or natural environment conducive to obtaining valid and reliable screening results, which may, of necessity, at times include nontraditional settings such as bedside, home, or hospice.
Electroacoustic equipment meets American National Standards Institute (ANSI) and manufacturer's specifications. Ambient noise levels may not always meet ANSI standards for pure-tone threshold testing but are sufficiently low to allow accurate and reliable screening.
All procedures ensure the safety of the patient and clinician and adhere to standard health precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Documentation should include identifying information, a case history, screening results, and recommendations including the need for rescreening, audiologic assessment, counseling, or referral.
1.0 Prevention
3.0 Speech-Language Screening
4.0 External Auditory Canal Examination and Cerumen Management
23.0 Counseling
In addition to those in the Preamble, the following references apply specifically to these procedures:
American National Standards Institute. (2002a). Mechanical coupler measurement of bone vibration (ANSI S3.13 R2002). New York: Author.
American National Standards Institute. (2002b). Specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance) (ANSI S3.39-R2002). New York: Author.
American National Standards Institute. (2003). Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-R2003). New York: Author.
American National Standards Institute. (2004). Specifications for audiometers (ANSI S3.6-R2004). New York: Author.
American Speech-Language-Hearing Association. (1987). Calibration of speech signals delivered via earphones [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1988). Prevention of communication disorders [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991). Prevention of communication disorders tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997a). Guidelines for audiologic screening. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997b). Guidelines for audiology service delivery in nursing homes. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1998). Support personnel in audiology: Position statement and guidelines. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2002). Guidelines for audiology service provision in and for schools. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004a). Clinical practice by certificate holders in the profession in which they are not certified. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004b). Guidelines for the audiologic assessment of children from birth to 5 years of age. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005). Guidelines for manual pure-tone threshold audiometry. Available from www.asha.org/policy.
Joint Committee on Infant Hearing. (2000). Year 2000 position statement: Principles and guidelines for early hearing detection and intervention programs. Available from www.asha.org/policy.
A pass/fail procedure to identify individuals receiving audiology services who may require speech (articulation, voice, resonance, fluency) and/or language assessment.
Speech-language screening is conducted according to the Guiding Principles section of this document.
Speech-language screening identifies those persons likely to have speech, language, and/or cognitive disorders that may interfere with communication, health, education, and psychosocial function.
Failed screening results in referral for a speech-language pathology assessment/evaluation and/or other examinations or services, as appropriate.
Individuals of all ages are screened as needed, requested, or mandated or when they have conditions that place them at risk.
Screen for speech production skills: articulation, fluency, resonance, and voice characteristics.
Screen for comprehension and production of language, including the cognitive and social aspects of communication.
Patients who fail the screening are referred to a speech-language pathologist for further assessment/evaluation and/or other examinations or services, as appropriate.
Support personnel may conduct selected procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals.
Speech-language screening is conducted in a clinical or natural environment conducive to eliciting a representative sample of the patient's speech and language.
All procedures ensure the safety of the patient and clinician and adhere to standard health precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Documentation should include identifying information, screening results, other pertinent information, and recommendation for further assessment.
In addition to those in the Preamble, the following references apply specifically to these procedures:
American Speech-Language-Hearing Association. (1988). Prevention of communication disorders [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991). Prevention of communication disorders tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004). Scope of practice in audiology. Available from www.asha.org/policy.
World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author.
Procedures to assess the external auditory canal and tympanic membrane and, if necessary, to remove debris.
External auditory canal examination and cerumen management are conducted according to the Guiding Principles section of this document.
External auditory canal examination identifies the presence of external auditory canal/tympanic membrane abnormalities.
Cerumen management results in the removal of debris from the external auditory canal to facilitate the performance of other audiologic procedures and/or to improve hearing sensitivity.
External auditory canal examination is performed on all patients in preparation for other audiologic procedures.
Cerumen management is required when the external auditory canal has an accumulation of debris that would preclude performing necessary services.
Otoscopic examination is conducted to identify abnormalities of the external auditory canal and tympanic membrane and the need for cerumen management.
Cerumen is removed from the external auditory canal using established procedures to include one or more of the following:
mechanical removal
irrigation
suction
Appropriate referrals are made for further management, as required.
Support personnel may conduct selected procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
Otoscopic examinations are performed with an otoscope with appropriate magnification and light source and with clean specula of appropriate size. Cerumen management is conducted in an environment that facilitates the performance of a safe and effective procedure.
All procedures ensure the safety of the patient and clinician and adhere to standard health precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Documentation includes pertinent background information and a written statement of results of the external auditory canal examination and cerumen removal procedures.
In addition to those in the Preamble, the following reference applies specifically to these procedures:
American Speech-Language-Hearing Association. (1991). External auditory canal examination and cerumen management [Position statement]. Available from www.asha.org/policy.
Procedures to assess, evaluate, and monitor the status and function of the peripheral auditory system, which includes the external, middle, and inner ears as well as the auditory nerve.
Basic audiologic evaluation is conducted according to the Guiding Principles section of this document.
Pure-tone and speech audiometry is conducted to determine the existence, type, and degree of hearing loss on the basis of behavioral responses to acoustic stimuli.
Acoustic immittance procedures are conducted to assess middle ear function.
Results from the audiologic assessment will be interpreted and may result in recommendations for dismissal or further audiologic assessment/evaluation; audiologic (re)habilitative evaluation; speech-language evaluation; or medical, psychological, and/or educational referral.
Basic audiologic assessment is prompted by self-referral, family/caregiver referral, failure of audiologic screening, or referral from other professionals.
Assessment includes the following:
a case history
external ear examination
otoscopic examination
acoustic immittance procedures (tympanometry, static immittance, and acoustic reflex measures)
air-conduction and bone-conduction pure-tone threshold measures with appropriate masking
speech reception thresholds or speech detection/awareness thresholds with appropriate masking
word recognition measures with appropriate masking
speech-language screening
Other procedures may be completed to supplement the basic audiologic assessment:
otoacoustic emissions screening
communication inventories and needs assessment inventories
screening for central auditory processing disorders or other auditory disorders
Interpretation of the assessment may indicate one or more of the following:
hearing within normal limits
identification and quantification of hearing loss
hearing loss identified but further testing required
patient could not be tested using procedures
Evaluation may result in one of the following:
discharge and/or recommendations for routine follow-up
referral for audiologic rehabilitation evaluation
referral for further audiologic evaluation and/or other services
Support personnel may conduct selected assessment procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
Assessments are conducted in a clinical environment with calibrated acoustic stimuli (e.g., pure tones, broadband noise, speech stimuli) conducive to obtaining reliable and valid results. Electroacoustic and electrophysiological equipment and ambient noise meet American National Standards Institute and/or manufacturer's specification. Testing environment should meet the permissible ambient noise levels for audiometric test rooms.
All procedures ensure the safety of the patient, audiologist, and others who participate in the clinical process and adhere to the standard precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Documentation contains identifying information, case history, assessment results, interpretation, prognosis, and specific recommendations.
1.0 Prevention
2.0 Audiologic Screening
3.0 Speech-Language Screening
4.0 External Auditory Canal Examination and Cerumen Management
23.0 Counseling
In addition to those in the Preamble, the following references apply specifically to these procedures:
American National Standards Institute. (2002a). Mechanical coupler for measurement of bone vibration (ANSI 3.13-2002R). New York: Author.
American National Standards Institute. (2002b). Specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance) (ANSI S3.39-R2002). New York: Author.
American National Standards Institute. (2003). Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-R2003). New York: Author.
American National Standards Institute. (2004a). Method for manual pure-tone threshold audiometry (ANSI S3.21R2004). New York: Author.
American National Standards Institute. (2004b). Specifications for audiometers (ANSI S3.6 R2004). New York: Author.
American Speech-Language-Hearing Association. (1988a). Guidelines for determining threshold level for speech. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1988b). Prevention of communication disorders [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1990). Guidelines for audiometric symbols. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991a). Acoustic immittance: A bibliography. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991b). Prevention of communication disorders tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1992). External auditory canal examination and cerumen management [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1994). Guidelines for the audiologic management of individuals receiving cochleotoxic drug therapy. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997a). Guidelines for audiologic screening. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997b). Guidelines for audiology service delivery in nursing homes. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2000). Guidelines for graduate education in amplification. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2002). Guidelines for audiology service provision in and for schools. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004a). Clinical practice by certificate holders in the profession in which they are not certified. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004b). Guidelines for the audiologic assessment of children from birth to 5 years of age. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005a). Audiologists providing clinical services via telepractice: Position statement. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005b). Guidelines for addressing acoustics in educational settings. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005c). Guidelines for manual pure-tone threshold audiometry. Available from www.asha.org/policy.
Joint Committee on Infant Hearing. (2000). Year 2000 position statement: Principles and guidelines for early hearing detection and intervention programs. Available from www.asha.org/policy.
Procedures beyond basic audiologic evaluation to further assess, evaluate, and monitor the status and function of the peripheral auditory system (external, middle, and inner ears as well as the auditory nerve) and the central auditory nervous system.
Please refer to Section 7: Pediatric Audiologic Evaluation for assessment of infants, children, and those whose developmental levels preclude the use of a basic audiologic evaluation.
Advanced audiologic evaluations are conducted according to the Guiding Principles section of this document.
Advanced audiologic evaluations are conducted to determine the existence, type, and degree of hearing impairment on the basis of behavioral, physiological, or electrophysiological response to acoustic stimuli.
Results from the advanced audiologic diagnostic procedures will be interpreted and may result in recommendations for discharge or audiologic (re)habilitative evaluation; speech-language evaluation; or medical, psychological, and/or educational referral.
Advanced audiologic evaluations are prompted by inconclusive and/or inconsistent results on the basic audiologic evaluation or referral from other professionals.
Advanced audiologic diagnostic measures should not be completed in the absence of results obtained from a basic audiologic evaluation. Specific procedures will vary depending on practitioner judgment and patient need.
Assessment may include the following:
basic audiologic evaluation
acoustic reflex patterns
acoustic reflex decay
auditory evoked potentials
performance intensity function with standardized speech materials
otoacoustic emissions
Stenger tests
central auditory processing disorder evaluation
tinnitus evaluation
dynamic range assessment
high-frequency audiometry
Interpretation of the assessment may indicate one or more of the following:
normal hearing
nonorganic hearing loss
existence, type, and degree of hearing loss
site of lesion
hyperacusis
inconclusive test results
Evaluation may result in one or more of the following:
discharge and/or recommendations for routine follow-up
referral for audiologic rehabilitation evaluation
referral to other professionals
Support personnel may conduct selected assessment procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
Assessments are conducted in a clinical environment with calibrated acoustic stimuli (e.g., pure tones, broadband noise, speech stimuli) conducive to obtaining reliable and valid results.
Compact discs and disc players or high-quality tapes and tape players should be used.
Electroacoustic and electrophysiological equipment and ambient noise must meet American National Standards Institute and/or manufacturer's specification.
Testing environment should meet the permissible ambient noise levels for audiometric test rooms.
All procedures ensure the safety of the patient, audiologist, and others who participate in the clinical process and adhere to the standard precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Documentation contains identifying information, case history, assessment results, interpretation, prognosis, and specific recommendations.
3.0 Speech-Language Screening
4.0 External Auditory Canal Examination and Cerumen Management
5.0 Basic Audiologic Evaluation
8.0 Electrodiagnostic Test Procedures
9.0 Auditory Evoked Response Evaluation
21.0 (Central) Auditory Processing Disorders Evaluation
23.0 Counseling
In addition to those in the Preamble, the following references apply specifically to these procedures:
American National Standards Institute. (2002a). Mechanical coupler measurement of bone vibration (ANSI S3.13 R2002). New York: Author.
American National Standards Institute. (2002b). Specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance) (ANSI S3.39-R2002). New York: Author.
American National Standards Institute. (2003). Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-R2003). New York: Author.
American National Standards Institute. (2004). Specifications for audiometers (ANSI S3.6-R2004). New York: Author.
American Speech-Language-Hearing Association. (1987a). Calibration of speech signals delivered via earphones [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1987b). Short latency auditory evoked potentials [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1988). Guidelines for determining threshold level for speech. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1990). Guidelines for audiometric symbols. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991). Sound field measurement tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1994). Guidelines for audiologic management of individuals receiving cochleotoxic drug therapy. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997). Guidelines for audiology service delivery in nursing homes. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1998). Support personnel in audiology: Position statement and guidelines. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1999a). Role of audiologists in vestibular and balance rehabilitation: Guidelines. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1999b). Role of audiologists in vestibular and balance rehabilitation: Position statement. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1999c). Role of audiologists in vestibular and balance rehabilitation: Technical report. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2002). Guidelines for audiology services in the schools. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2003). Guidelines for competencies in auditory evoked potential measurement and clinical applications. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004a). Cochlear implants [Technical report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004b). Guidelines for the audiologic assessment of children from birth to 5 years of age. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005a). (Central) auditory processing disorders—The role of the audiologist [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005b). (Central) auditory processing disorders [Technical report]. Available from www.asha.org/policy.
Procedures to determine the status of the auditory system in individuals whose developmental levels preclude use of a basic audiologic evaluation.
Pediatric audiologic evaluation is conducted according to the Guiding Principles section of this document.
Infants and toddlers at risk for hearing impairment that may affect communication, development, health, and education are identified.
Pediatric audiologic assessment is conducted to determine the existence, type, and degree of hearing loss on the basis of behavioral, physiological, or electrophysiological responses to acoustic stimuli.
Acoustic immittance procedures are conducted to assess middle ear function, irrespective of hearing status.
Results from the audiologic assessment will be interpreted and may result in recommendations for discharge or further audiologic assessment/evaluation; audiologic (re)habilitative evaluation; speech-language evaluation; or medical, psychological, and/or educational referral.
Assessment of infants, children, and those whose developmental levels preclude the use of a basic audiologic evaluation is prompted by failure of an audiologic hearing screening, presence of an at-risk indicator associated with hearing impairment, parental/caregiver concern, or referral.
Children who are at risk for late onset or progressive hearing loss require periodic monitoring of their auditory status.
Before evaluating a child, consent must be obtained from the parent or legal guardian. State statutes, regulations, or institutional policies may supersede this recommendation.
Assessment may include the following
a case history
external ear examination
otoscopic examination
acoustic immittance procedures (tympanometry, static immittance, and acoustic reflex measures)
otoacoustic emissions testing
developmentally appropriate behavioral procedures (e.g., behavioral observation, visual reinforcement audiometry, conditioned play audiometry) to obtain frequency-specific and ear-specific information regarding auditory status
developmentally appropriate behavioral procedures to obtain speech detection/awareness/reception thresholds with appropriate masking
word recognition measures with appropriate masking
auditory evoked potentials
speech-language screening
Other procedures may be completed to supplement the basic audiologic assessment:
a case history
physiological tests of central auditory function
communication inventories and needs assessment inventories
Interpretation of the assessment may indicate one or more of the following:
hearing within normal limits
identification and quantification of hearing loss
hearing loss identified but further testing required
patient could not be tested using procedures
Evaluation may result in one or more of the following:
discharge and/or recommendations for routine follow-up
ongoing audiologic evaluation and monitoring
parental counseling
audiologic habilitation evaluation
referral to or collaboration with other professionals (e.g., physician, speech-language pathologist, early
intervention program, genetic counselor, educator)
Support personnel may conduct selected assessment procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
Assessments are conducted in a clinical environment with calibrated acoustic stimuli (e.g., pure tones, broadband noise, speech stimuli) conducive to obtaining reliable and valid results.
Electroacoustic and electrophysiological equipment and ambient noise must meet American National Standards Institute and/or manufacturer's specification.
Testing environment should meet the permissible ambient noise levels for audiometric test rooms.
All procedures ensure the safety of the patient, audiologist, and others who participate in the clinical process and adhere to standard precautions (e.g., prevention of bodily injury and transmission of infectious disease).
When sedation is necessary, proper administration is ensured, and all protocols regarding procedures and equipment are strictly followed.
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
Document contains identifying information, case history, assessment results, interpretation, prognosis, and specific recommendations.
3.0 Speech-Language Screening
4.0 External Auditory Canal Examination and Cerumen Management
5.0 Basic Audiologic Evaluation
6.0 Advanced Audiologic Evaluation
8.0 Electrodiagnostic Test Procedures
9.0 Auditory Evoked Response Evaluation
21.0 (Central) Auditory Processing Disorders Evaluation
23.0 Counseling
In addition to those in the Preamble, the following references apply specifically to these procedures:
American National Standards Institute. (2002a). Mechanical coupler for measurement of bone vibration (ANSI 3.13-2002R). New York: Author.
American National Standards Institute. (2002b). Specifications for instruments to measure aural acoustic impedance and admittance (aural acoustic immittance) (ANSI S3.39-R2002). New York: Author.
American National Standards Institute. (2003). Maximum permissible ambient noise levels for audiometric test rooms (ANSI S3.1-R2003). New York: Author.
American National Standards Institute. (2004a). Method for manual pure-tone threshold audiometry (ANSI S3.21-R2004). New York: Author.
American National Standards Institute. (2004b). Specifications for audiometers (ANSI S3.6-R2004). New York: Author.
American Society of Anesthesiologists. (2002). Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology, 96, 1004-1017.
American Speech-Language-Hearing Association. (1987). Calibration of speech signals delivered via earphones [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1988). Guidelines for determining threshold level for speech. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1990). Guidelines for audiometric symbols. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991). Sound field measurement tutorial [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1992). External auditory canal examination and cerumen management [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1993). Definitions of communication disorders and variations. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1994). Guidelines for audiologic management of individuals receiving cochleotoxic drug therapy. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997a). Guidelines for audiologic screening. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1997b). Maximizing the provision of appropriate technology services and devices for students in schools: Technical report. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2002). Guidelines for fitting and monitoring FM systems. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2003). Guidelines for competencies in auditory evoked potential measurement and clinical applications. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004). Guidelines for the audiologic assessment of children from birth to 5 years of age. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005a). Acoustics in educational settings: Technical report. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005b). Guidelines for addressing acoustics in educational settings. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005c). Guidelines for manual pure-tone threshold audiometry. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2006). Roles, knowledge, and skills: Audiologists providing clinical services to infants and young children birth to 5 years of age. Available from www.asha.org/policy.
Joint Committee on Infant Hearing. (2000). JCIH year 2000 position statement: Principles and guidelines for early hearing detection and intervention programs. Available from www.asha.org/policy.
National Institutes of Health. (1993). Early identification of hearing impairment in infants and young children. NIH Consensus Statement, 11(1), 1-24.
Procedures to assess the functional status of the central or peripheral neural pathways and associated sensory systems using electrophysiological testing methods.
Electrodiagnostic test procedures are conducted according to the Guiding Principles section of this document.
Electrodiagnostic tests are conducted to determine the sensory sensitivity and/or functional status of the auditory, vestibular, visual, and/or somatosensory systems or pathways.
Electrodiagnostic tests may be conducted to monitor change in one or more sensory systems.
Results of electrodiagnostic assessment will be interpreted and may result in recommendations for discharge, further electrodiagnostic assessment, the need for rehabilitation assessment, and/or referral for specialized medical evaluation.
Electrodiagnostic testing is prompted by inconclusive and/or inconsistent results on audiologic evaluation or as part of a site of lesion test battery.
Electrodiagnostic testing may also be conducted with patients who are difficult to test or when supplemental information is required.
Electrodiagnostic procedures may be indicated for an individual with signs, symptoms, or complaints of a possible central or peripheral neural pathway disease or disorder.
Electrodiagnostic testing can be performed as a component of a complete evaluation of sensory system function. Specific tests will vary depending on practitioner judgment, medical referral, and patient need and ability.
Meaningful data descriptors are extracted from the electrophysiological response. These data are compared with normative data.
Electrodiagnostic assessment may include the following:
auditory evoked response assessment
balance system assessment
visual evoked response assessment
somatosensory evoked response assessment
Interpretation of the assessment may indicate one or more of the following:
normal sensory and neural system function
abnormal sensory and neural system function
determination of site of lesion
inconclusive test results
Evaluation may result in one or more of the following:
discharge and/or recommendations for routine follow-up
recommendation for further evaluation
referral for audiologic rehabilitation evaluation
referral to other professionals
Support personnel may conduct selected assessment procedures under the supervision of a certified audiologist but may not interpret the clinical results or provide referrals or recommendations.
Power-line-operated instruments conform to minimum American National Standards Institute (ANSI) safety requirements. Recording and stimulating electrodes conform to acceptable sterile conditions.
Electrodiagnostic testing is conducted in an environment that is satisfactorily free of electrical interference. Ambient noise levels meet ANSI specifications, and calibrated acoustic stimuli are used as appropriate.
All procedures ensure the safety of the patient and clinician and adhere to standard health precautions (e.g., prevention of bodily injury and transmission of infectious disease).
Decontamination, cleaning, disinfection, and sterilization of multiple-use equipment before reuse are carried out according to facility-specific infection control policies and procedures and according to manufacturer's instructions.
AC-line-powered equipment is grounded adequately for equipment and patient.
The audiologist performing electrodiagnostic test procedures is familiar with facility-specific emergency medical protocols and adheres to all hospital, state, and federal regulations.
Safe levels of electrical stimulation are presented.
Documentation contains identifying information, case history, pertinent procedural details (e.g., electrodiagnostic equipment, electrode types and sites, electrical stimulation probes, acoustic transducers, and stimulating and recording parameters) and documentation of clinical events (e.g., patient sleep status, sedation, procedural problems, patient comments). Documentation also includes assessment results, interpretation, prognosis, and specific recommendations.
4.0 External Auditory Canal Examination and Cerumen Management
5.0 Basic Audiologic Evaluation
6.0 Advanced Audiologic Evaluation
9.0 Auditory Evoked Response Evaluation
12.0 Balance System Evaluation
23.0 Counseling
In addition to those in the Preamble, the following references apply specifically to these procedures:
American National Standards Institute. (1993). Safe current limits for electromedical apparatus (ANSI/AAMI ES1-1993). New York: Author.
American Society of Anesthesiologists. (2002). Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology, 96, 1004-1017.
American Speech-Language-Hearing Association. (1987a). Calibration of speech signals delivered via earphones [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1987b). Short latency auditory evoked potentials [Relevant paper]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1991). External auditory canal examination and cerumen management [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1992). Neurophysiologic intraoperative monitoring [Position statement]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (1999). Role of audiologists in vestibular and balance rehabilitation: Technical report. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2003). Guidelines for competencies in auditory evoked potential measurement and clinical applications. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004a). Cochlear implants [Technical report]. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2004b). Guidelines for the audiologic assessment of children from birth to 5 years of age. Available from www.asha.org/policy.
American Speech-Language-Hearing Association. (2005). Guidelines for manual pure-tone threshold audiometry. Available from www.asha.org/poli