Roles and Responsibilities

Roles and Responsibilities of Audiologists

Audiologists play a central role in the guidance, development, implementation, and oversight of hearing screening programs. The professional roles and activities in audiology include clinical services; prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Audiology (ASHA, 2018).

The following roles and responsibilities are appropriate for audiologists.

Education and Advocacy

• Maintain knowledge of the anatomy, physiology, and pathophysiology of the auditory and balance systems.
• Remain informed of research around hearing loss and related disorders.
• Select and/or develop educational materials for patients, families, and the public.
• Provide counseling and education in a comprehensive, person-centered, and health-literate format.
• Provide hearing loss prevention education, promote hearing wellness, and monitor acoustic environments.
• Educate medical professionals about the importance of hearing screening and the impact of chronic diseases and ototoxic medications on hearing.
• Advocate for the communication needs of all individuals, including for the rights to—and funding for—services for those with hearing loss and/or related disorders.

Screening and Assessment

• Provide oversight to hearing screening programs.
• Select screening protocols appropriate for the given setting, population, and screening personnel.
• Ensure that screening equipment and applicable software are updated and calibrated.
• Complete hearing screenings.
• Train and supervise screening personnel (e.g., audiology assistants or other health professionals).
• Develop and implement written policies and procedures on issues such as infection control, screening process, and documentation.
• Communicate screening results to patients as well as families, caregivers, care partners, appropriate program representatives, primary care physicians, and diagnostic audiology centers.
• Complete rescreening and comprehensive diagnostic evaluations of hearing, auditory function, balance, and related systems.

Intervention and Support

• Refer to appropriate professionals to rule out other conditions, determine the etiology of hearing loss, and facilitate access to comprehensive services.
• Collaborate with other professionals to ensure appropriate follow-up and outcomes.

As indicated in the ASHA Code of Ethics (ASHA, 2023), audiologists who work in this capacity should be specifically educated and appropriately trained to do so.

Roles and Responsibilities of Speech-Language Pathologists

Speech-language pathologists (SLPs) play a role in the hearing screening process. The professional roles and activities in speech-language pathology include clinical services; prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

The following roles and responsibilities are appropriate for SLPs.

Education and Advocacy

• Maintain general knowledge of the anatomy, physiology, and pathophysiology of the auditory system and the impact of hearing loss on communication.
• Educate the public and other professionals on the communication needs of individuals with hearing loss and/or related disorders.
• Provide counseling and education in a comprehensive, person-centered, and health-literate format.
• Provide hearing loss prevention education and promote hearing wellness.
• Advocate for the communication needs of all individuals, including for the rights to—and funding for—services for those with hearing loss and/or related disorders.

Screening and Assessment

• Complete hearing screenings.
• Communicate screening results to patients as well as families, caregivers, and care partners.
• Review a patient’s auditory status and their use of any communication devices, amplification devices, and/or hearing assistive technology in advance of speech, language, and cognitive assessment.

Intervention and Support

• Refer to appropriate professionals (e.g., audiologist, physician) to facilitate access to comprehensive services.
• Collaborate with other professionals to ensure appropriate follow-up and outcomes.

As indicated in the ASHA Code of Ethics (ASHA, 2023), SLPs who work in this capacity should be specifically educated and appropriately trained to do so.

Hearing Loss Risk Factors and Associated Conditions

Hearing loss risk factors and associated conditions include

• chronic health conditions (e.g., diabetes, cardiovascular disease, kidney disease);
• disorders of the ear (e.g., Ménière’s disease, otosclerosis, autoimmune inner ear disease);
• exposure to ototoxic and vestibulotoxic medications, such as those prescribed for the treatment of cancer, infection, and pain;
• exposure to ototoxic and vestibulotoxic chemicals, such as some types used in industrial settings;
• exposure to unsafe levels of recreational noise (e.g., personal listening devices) and/or occupational noise;
• genetic factors;
• head trauma/traumatic brain injury;
• history of ear infections;
• history of falls;
• increasing age;
• speech, language, and cognitive impairments (e.g., dementia);
• stroke; and
• tinnitus.

Hearing Screening Settings and Situations

While there is no one agreed-upon hearing screening schedule for adults, there are various factors to consider when deciding when and how often to get screened. These factors include age, comorbidities, risk factors (e.g., history of noise exposure), and access to routine screening (e.g., as part of an annual health appointment). Hearing screenings for adults may take place at or during

• health fairs;
• memory care clinics (McDonough et al., 2021; M. Reed et al., 2022);
• occupational hearing conservation programs;
• remote access hearing screening (e.g., phone-based and online tools and applications);
• research studies;
• residential facilities (e.g., skilled nursing, long-term care) per protocols for hearing screening or assessment (e.g., Centers for Medicare & Medicaid Services: Long-Term Care Facility Resident Assessment Instrument 3.0 [PDF]; Centers for Medicare & Medicaid Services, 2019);
• routine primary care or post-hospitalization medical visits;
• speech-language pathology visits; and
• telepractice visits.

Screening Components

A comprehensive protocol for adult hearing screening may include several components (Schow, 1991; Ventry & Weinstein, 1983; World Health Organization, 2021b):

• A brief case history (e.g., review of chronic diseases, medications, and family history) and a visual and/or otoscopic inspection facilitate screening for pertinent and/or related health conditions.
• The use of calibrated pure-tone signals (and/or otoacoustic emissions [OAEs]) facilitates screening of the auditory system.
• The use of self-report tools facilitates screening for perceived hearing disability and impact on daily activities.

Completing each step of this process allows for more targeted and appropriate referrals and recommendations as well as patient-centered counseling. See the ASHA resource on focusing care on individuals and their care partners.

Screening for Health Condition

Case History

The length and format of a case history for a hearing screening may vary depending on the setting, time permitting, and other factors. A brief case history includes questions designed to identify individuals with possible hearing and/or related disorders. Participation of significant others in the case history process can be valuable. See the ASHA Practice Portal page on Cultural Responsiveness for information on gathering a case history.

A case history may include, but not be limited to, the following questions:

• Do you think you have a hearing loss? If so, is it in one ear or both ears?
• Do you have difficulty understanding speech?
• Have you ever had a sudden or rapid progression of hearing loss?
• Do you hear ringing and/or other noises in your ears and/or head?
• If yes, how often? In noise or quiet or both? In which ear?
• Do you have pain, discomfort, and/or fullness in your ear(s)?
• If yes, in which ear? How often? How severe?
• Have you had any recent drainage from your ear(s)?
• If yes, in which ear? How often?
• Have you had problems with dizziness and/or impaired balance?
• Do you have any chronic diseases?
• What medications (including prescription and over-the-counter) are you currently taking?
• What herbal, homeopathic, and/or alternative forms of treatment are you currently taking?
• Do you have a family history of hearing loss?
• Do you have a history of ear infections or ear surgery?
• Do you have a history of head injury or concussion?
• Have you ever been exposed to loud sounds or noises through work and/or leisure activities?

Otoscopy or Visual Inspection

Otoscopy completed by a trained examiner (e.g., audiologist, audiology assistant, other medical professionals) enables visualization of the tympanic membrane and inspection of the external ear canal for drainage, foreign bodies, impacted cerumen, infection, fluid, or structural abnormalities. A screener who is not trained in otoscopy can perform a general visual inspection of the outer portion of the ear and make note of any anomalies or obvious anatomic abnormalities. The information obtained during visual inspection or otoscopy may have an important impact on screening results and/or referral to medical personnel for further evaluation.

Pass/Refer Criteria: Screening for Health Condition

• A pass or an unremarkable result is documented if ­no concerns are reported during the case history that have not been previously evaluated (e.g., by a physician or an audiologist) and if no abnormal findings are observed during otoscopy.
• A referral is documented if concerns are reported from the case history for which the individual has not received medical/audiological consultation or if otoscopy identifies outer ear, ear canal, or tympanic membrane abnormality or cerumen impaction.

Screening of the Auditory System

Pure-Tone Screening

Pure-tone screening is a behavioral test of hearing sensitivity that is typically completed with the use of a pure-tone audiometer. Pure-tone stimuli are routed through either supra-aural earphones or insert earphones. If a pure-tone audiometer is not available or convenient, other options (e.g., laptop-based audiometers) allow for increased portability. Handheld audioscopes allow for otoscopic visualization and pure-tone screening, and some devices will utilize tones at a variety of presentation levels (e.g., 20 dB HL, 25 dB HL, 40 dB HL).

There are also a growing number of online and smartphone applications for hearing screening. These tools may use tone frequency testing and/or other methods (e.g., digits in noise). Advancements in technology allow for self-testing as an alternative method of monitoring hearing status and may help address unmet needs in hearing health care for adults (Wasmann et al., 2022). Self-screening is an option; however, caution is warranted when using these tools due to variability in the applications, requirements for device calibration (Masalski et al., 2018), methods of test administration, and other factors that may impact the accuracy of the results obtained.

An otoacoustic emission (OAE) is sound generated from the cochlea in response to auditory stimulation (e.g., from a handheld OAE screening device). OAE testing can be particularly useful in screening for hearing loss in individuals who cannot or will not reliably perform behavioral hearing screenings, as OAE test results do not rely on behavioral responses to sound stimuli (Jupiter, 2009). Interpretation procedures of screening results via OAE are developed by each screening program individually. OAEs come with a high rate of false positives.

Pass/Refer Criteria: Screening for Body Functions and Structures

• A pass result is documented if responses are obtained in both ears to pure-tone air-conduction stimuli at 20 or 25 dB HL (depending on the protocol used) at 1000, 2000, and 4000 Hz.
• A referral is documented if there is an absent response to pure-tone air-conduction stimuli at 25 dB HL at any screening test frequency in either ear.

The incidence of hearing loss increases with age, and some adults will not pass a pure-tone screening at 25 dB HL, particularly at 4000 Hz. While using higher screening levels may result in lower referral rates, milder degrees of hearing loss may be missed, along with opportunities for further assessment, counseling, and education.

Screening for Hearing Disability

Self-Assessment Tools

Self-assessment tools (e.g., questionnaires/inventories) for disability screening can be used in conjunction with other screening components to help identify those who can be referred for more comprehensive audiologic evaluation, counseling, and management (Louw et al., 2018; Ventry & Weinstein, 1983; World Health Organization, 2021b). These tools may identify an individual’s perceived difficulties related to hearing as well as changes to participation in activities. Hearing disability screening measures can be administered in a verbal, written, or computerized format. Some measures can be completed by family members or significant others. In the absence of an audiometer or other screening technology, these questionnaires can be useful in the identification of individuals at risk for hearing loss and those who may require audiologic follow-up.

Examples of hearing screening self-assessment tools include the following:

• Revised Hearing Handicap Inventory (RHHI) and Revised Hearing Handicap Inventory–Screening (RHHI–S; Cassarly et al., 2020)
• Speech, Spatial and Qualities of Hearing Scale (Gatehouse & Noble, 2004)
• Self-Assessment of Communication (Schow & Nerbonne, 1982)
• Significant Other Assessment of Communication (Schow & Nerbonne, 1982)

A landmark report addressed the lack of a standardized approach for measuring meaningful outcomes of hearing interventions and recommended the use of the self-assessment tool, the Revised Hearing Handicap Inventory (National Academies of Sciences, Engineering, and Medicine, 2025). Using this tool during the hearing screening process can allow for comparison across settings and over time.

Pass/Refer Criteria: Screening for Disability (Activities and Participation)

Before using a self-assessment questionnaire, it is important to review the background publications related to the administration, scoring, and interpretation associated with that specific tool.

Referrals and Recommendations

Referrals and recommendations resulting from adult hearing screening may involve counseling and education, comprehensive audiologic assessment, and/or other examinations or services as indicated. Examples include the following:

• Positive findings on the case history and/or otoscopic inspection indicate a recommendation for an audiologic and/or medical evaluation.
• A result of a referral on the pure-tone screening is an indication for a comprehensive audiologic evaluation.
• When self-reported hearing disability scores fall outside the normal range, recommendations may include counseling, referral for an audiologic assessment (especially if pure-tone screening also results in a referral), and/or other examinations or services.

Follow-Up

There is limited information in the literature about how often adults follow recommendations after a hearing screening and on the long-term outcomes of those referrals (Dillard, McRackan, et al., 2026; Meyer et al., 2011; Thodi et al., 2013; Zazove et al., 2020). Hearing screenings offer the opportunity to educate adults about the full range of rehabilitative options available to those with hearing loss (e.g., environmental modifications, auditory training, amplification). Knowledge of a wide range of options may increase the chance that an individual will pursue some follow-up services.

Program Management

Equipment Calibration

Audiometric equipment must meet applicable specifications of the American National Standards Institute (ANSI)/Acoustical Society of America S3.6-2025 standard (ANSI, 2025, or current standard) and/or manufacturer recommendations to ensure accurate results. Calibration should be performed annually using instrumentation traceable to the National Institute of Standards and Technology. Functional inspection, performance checks, and biologic listening checks should be conducted to verify equipment performance prior to each use (ANSI, 2025). All calibration activities should be conducted by a trained audiologist or an external company or individual properly trained in performing such tasks.

Screening Environment

A clinical or natural environment that is conducive to the task and screening tool being used will be free from auditory and visual distractions and interruptions and will allow for privacy, confidentiality, and obtaining reliable hearing screening results.

Performing daily listening checks can rule out defects in major pure-tone screening components. Ambient noise levels may exceed ANSI standards (S3.1-1999; ANSI, 2023, or current standard) for pure-tone threshold testing in audiometric test rooms but must be sufficiently low to allow accurate screening. The clinician may use a sound level meter, if available, to establish maximum permissible noise levels at 25 dB HL—which allows for use of the earphone (i.e., supra-aural, circumaural, insert) during screening. There are some smartphone-based sound level meters available that can be used to measure ambient noise; however, these applications may require calibration, and results may vary. When a sound level meter is not available, a biologic check can be conducted.

Universal Precautions

It is important to follow universal precautions and appropriate infection control procedures during screenings. See ASHA’s page on infection control resources for audiologists and speech-language pathologists for detailed information.

Personnel Training

Audiologists overseeing screening personnel can ensure proper screening skills by providing both initial and refresher training and validating the results of screeners.

The ASHA Assistants Program page provides details regarding the audiology assistant career path and certification.

Documentation

Documentation typically includes the date of screening, patient demographics, positive concerns from the case history, screening results, and recommendations and referrals. Any educational resources should be provided in a health literacy–focused and person-centered format. For an example of a hearing screening template for adults, see Hearing Screening (Adults) [PDF].

Reimbursement

For information on audiology and speech-language pathology services as well as issues related to Medicare, Medicaid, private health plans, and billing codes, see the ASHA resource on billing and reimbursement.

ASHA Resources

• ASHA Assistants Program
• ASHA Core Outcome Set Implementation Toolkit
• ASHA Disappointed in USPSTF Final Recommendation on Adult Hearing Screening
• Audiology Patient Education Handouts
• Billing and Reimbursement
• Communication Health Support Association: Online Hearing Screener
• Focusing Care on Individuals and Their Care Partners
• Health Literacy
• Hearing-Related Topics: Terminology Guidance
• Hearing Screening (Adults) [PDF]
• Infection Control Resources for Audiologists and Speech-Language Pathologists

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• Centers for Medicare & Medicaid Services: Long-Term Care Facility Resident Assessment Instrument 3.0 [PDF]
• Occupational Safety and Health Administration: Occupational Noise Exposure
• National Institute for Occupational Safety and Health (NIOSH): Noise and Hearing Loss
• Safe Listening Devices and Systems: A WHO-ITU Standard [PDF]
• World Health Organization: Hearing Screening Considerations for Implementation [PDF]

Hearing Screening Tools

This list of resources is not exhaustive, and the inclusion of any specific tool does not imply endorsement from ASHA. These tools do not replace a diagnostic hearing evaluation completed by a licensed and certified audiologist.

• BetterHearing: Online Hearing Checks
• hearWHO
• Mimi Hearing Test App
• SHOEBOX: Portable Audiometric Testing and Hearing Screening

American National Standards Institute. (2023). Maximum permissible ambient noise levels for audiometric test rooms (Rev. ed.; ANSI S3.1-1999). Acoustical Society of America.

American National Standards Institute. (2025). Specification for audiometers (Rev. ed.; ANSI S3.6-2018). Acoustical Society of America.

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology [Scope of practice]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2018). Scope of practice in audiology [Scope of practice]. https://www.asha.org/policy/

American Speech-Language-Hearing Association. (2023). Code of ethics [Ethics]. https://www.asha.org/policy/

Bennett, R. J., Conway, N., Fletcher, S., & Barr, C. (2020). The role of the general practitioner in managing age-related hearing loss: A scoping review. American Journal of Audiology, 29(2), 265–289. https://doi.org/10.1044/2020_AJA-19-00090

Cassarly, C., Matthews, L. J., Simpson, A. N., & Dubno, J. R. (2020). The Revised Hearing Handicap Inventory and screening tool based on psychometric reevaluation of the Hearing Handicap Inventories for the Elderly and Adults. Ear and Hearing, 41(1), 95–105. https://doi.org/10.1097/AUD.0000000000000746

Centers for Medicare & Medicaid Services. (2019). Long-term care facility Resident Assessment Instrument 3.0: User’s manual (Version 1.17.1).

Dillard, L. K., Dubno, J. R., Perro, M., Drawdy, A. V., Marrison, S. T., & McRackan, T. R. (2026). Factors associated with responses to hearing screening questions among older adults. American Journal of Medicine Open, 15, Article 100128. https://doi.org/10.1016/j.ajmo.2026.100128

Dillard, L. K., McRackan, T. R., Drawdy, A. V., Perro, M., Marrison, S. T., & Dubno, J. R. (2026). Outcomes of a large-scale pilot hearing screening program at an academic medical center. American Journal of Medicine Open, 15, Article 100127. https://doi.org/10.1016/j.ajmo.2026.100127

Gatehouse, S., & Noble, W. (2004). The Speech, Spatial and Qualities of Hearing Scale (SSQ). International Journal of Audiology, 43(2), 85–99. https://doi.org/10.1080/14992020400050014

Genther, D. J., Betz, J., Pratt, S., Kritchevsky, S. B., Martin, K. R., Harris, T. B., Helzner, E., Satterfield, S., Xue, Q.-L., Yaffe, K., Simonsick, E. M., & Lin, F. R. (2015). Association of hearing impairment and mortality in older adults. The Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 70(1), 85–90. https://doi.org/10.1093/gerona/glu094

Genther, D. J., Betz, J., Pratt, S., Martin, K. R., Harris, T. B., Satterfield, S., Bauer, D. C., Newman, A. B., Simonsick, E. M., & Lin, F. R. (2015). Association between hearing impairment and risk of hospitalization in older adults. Journal of the American Geriatrics Society, 63(6), 1146–1152. https://doi.org/10.1111/jgs.13456

Hsu, A. K., McKee, M., Williams, S., Roscigno, C., Crandell, J., Lewis, A., Hazzard, W., & Jenerette, C. (2019). Associations among hearing loss, hospitalization, readmission and mortality in older adults: A systematic review. Geriatric Nursing, 40(4), 367–379. https://doi.org/10.1016/j.gerinurse.2018.12.013

Jia, J., Li, H., & Xu, C. (2025). Hearing loss and its association with all-cause and cause-specific mortality: A meta-analysis of cohort studies. PLoS One, 20(10), Article e0333125. https://doi.org/10.1371/journal.pone.0333125

Jiam, N. T.-L., Li, C., & Agrawal, Y. (2016). Hearing loss and falls: A systematic review and meta‐analysis. The Laryngoscope, 126(11), 2587–2596. https://doi.org/10.1002/lary.25927

Jupiter, T. (2009). Screening for hearing loss in the elderly using distortion product otoacoustic emissions, pure tones, and a self-assessment tool. American Journal of Audiology, 18(2), 99–107. https://doi.org/10.1044/1059-0889(2009/08-0020)

Lin, F. R., & Ferrucci, L. (2012). Hearing loss and falls among older adults in the United States. Archives of Internal Medicine, 172(4), 369–371. https://doi.org/10.1001/archinternmed.2011.728

Lin, F. R., Metter, J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives of Neurology, 68(2), 214–220. https://doi.org/10.1001/archneurol.2010.362

Liu, C.-M., & Lee, C. T.-C. (2019). Association of hearing loss with dementia. JAMA Network Open, 2(7), Article e198112. https://doi.org/10.1001/jamanetworkopen.2019.8112

Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., . . . Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 404(10452), 572–628. https://doi.org/10.1016/S0140-6736(24)01296-0

Loughrey, D. G., Kelly, M. E., Kelley, G. A., Brennan, S., & Lawlor, B. A. (2018). Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: A systematic review and meta-analysis. JAMA Otolaryngology—Head & Neck Surgery, 144(2), 115–126. https://doi.org/10.1001/jamaoto.2017.2513

Louw, C., Swanepoel, D. W., & Eikelboom, R. H. (2018). Self-reported hearing loss and pure tone audiometry for screening in primary health care clinics. Journal of Primary Care & Community Health, 9, 2150132718803156. https://doi.org/10.1177/2150132718803156

Lucas, J. C., Arambula, Z., Arambula, A. M., Yu, K., Farrokhian, N., D’Silva, L., Staecker, H., & Villwock, J. A. (2022). Olfactory, auditory, and vestibular performance: Multisensory impairment is significantly associated with incident cognitive impairment. Frontiers in Neurology, 13, Article 910062. https://doi.org/10.3389/fneur.2022.910062

Masalski, M., Grysiński, T., & Kręcicki, T. (2018). Hearing tests based on biologically calibrated mobile devices: Comparison with pure-tone audiometry. JMIR mHealth and uHealth, 6(1), Article e10. https://doi.org/10.2196/mhealth.7800

McDonough, A., Dookhy, J., McHale, C., Sharkey, J., Fox, S., & Kennelly, S. P. (2021). Embedding audiological screening within memory clinic care pathway for individuals at risk of cognitive decline—Patient perspectives. BMC Geriatrics, 21(1), Article 691. https://doi.org/10.1186/s12877-021-02701-0

Meyer, C., Hickson, L., Khan, A., Hartley, D., Dillon, H., & Seymour, J. (2011). Investigation of the actions taken by adults who failed a telephone-based hearing screen. Ear and Hearing, 32(6), 720–731. https://doi.org/10.1097/AUD.0b013e318220d973

National Academies of Sciences, Engineering, and Medicine. (2025). Measuring meaningful outcomes for adult hearing health interventions [Consensus study report]. National Academies Press. https://doi.org/10.17226/29104

Reed, M., Freedman, M., Mark Fraser, A. E., Bromwich, M., Santiago, A. T., Gallucci, C. E., & Frank, A. (2022). Enhancing clinical visibility of hearing loss in cognitive decline. Journal of Alzheimer’s Disease, 86(1), 413–424. https://doi.org/10.3233/JAD-215377

Reed, N. S., Altan, A., Deal, J. A., Yeh, C., Kravetz, A. D., Wallhagen, M., & Lin, F. R. (2019). Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngology—Head & Neck Surgery, 145(1), 27–34. https://doi.org/10.1001/jamaoto.2018.2875

Schow, R. L. (1991). Considerations in selecting and validating an adult/elderly hearing screening protocol. Ear and Hearing, 12(5), 337–348. https://doi.org/10.1097/00003446-199110000-00006

Schow, R. L., & Nerbonne, M. A. (1982). Communication screening profile: Use with elderly clients. Ear and Hearing, 3(3), 135–147.

Shan, A., Ting, J. S., Price, C., Goman, A. M., Willink, A., Reed, N. S., & Nieman, C. L. (2020). Hearing loss and employment: A systematic review of the association between hearing loss and employment among adults. The Journal of Laryngology & Otology, 134(5), 387–397. https://doi.org/10.1017/S0022215120001012

Shao, L., Shi, Y., Xie, X.-Y., Wang, Z., Wang, Z.-A., & Zhang, J.-E. (2023). Incidence and risk factors of falls among older people in nursing homes: Systematic review and meta-analysis. Journal of the American Medical Directors Association, 24(11), 1708–1717. https://doi.org/10.1016/j.jamda.2023.06.002

Shukla, A., Harper, M., Pedersen, E., Goman, A., Suen, J. J., Price, C., Applebaum, J., Hoyer, M., Lin, F. R., & Reed, N. S. (2020). Hearing loss, loneliness, and social isolation: A systematic review. Otolaryngology—Head and Neck Surgery, 162(5), 622–633. https://doi.org/10.1177%2F0194599820910377

Simpson, A. N., Matthews, L. J., Cassarly, C., & Dubno, J. R. (2019). Time from hearing aid candidacy to hearing aid adoption: A longitudinal cohort study. Ear and Hearing, 40(3), 468–476. https://doi.org/10.1097/AUD.0000000000000641

Thodi, C., Parazzini, M., Kramer, S. E., Davis, A., Stenfelt, S., Janssen, T., Smith, P., Stephens, D., Pronk, M., Anteunis, L. I., Schirkonyer, V., & Grandori, F. (2013). Adult hearing screening: Follow-up and outcomes. American Journal of Audiology, 22(1), 183–185. https://doi.org/10.1044/1059-0889(2013/12-0060)

Ventry, I. M., & Weinstein, B. E. (1983). Identification of elderly people with hearing problems. ASHA, 25(7), 37–42.

Wasmann, J.-W., Pragt, L., Eikelboom, R., & Swanepoel, D. W. (2022). Digital approaches to automated and machine learning assessments of hearing: Scoping review. Journal of Medical Internet Research, 24(2), Article e32581. https://doi.org/10.2196/32581

World Health Organization. (2021a, March 3). World report on hearing [Global report]. https://www.who.int/publications/i/item/world-report-on-hearing

World Health Organization. (2021b, September 3). Hearing screening: Considerations for implementation [Handbook]. https://www.who.int/publications/i/item/9789240032767

World Health Organization. (2025, February 26). Deafness and hearing loss [Fact sheet]. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss

Yueh, B., Shapiro, N., MacLean, C. H., & Shekelle, P. G. (2003). Screening and management of adult hearing loss in primary care: Scientific review. JAMA, 289(15), 1976–1985. https://doi.org/10.1001/jama.289.15.1976

Zazove, P., Plegue, M. A., McKee, M. M., DeJonckheere, M., Kileny, P. R., Schleicher, L. S., Green, L. A., Sen, A., Rapai, M. E., & Mulhem, E. (2020). Effective hearing loss screening in primary care: The Early Auditory Referral–Primary Care study. Annals of Family Medicine, 18(6), 520–527. https://doi.org/10.1370/afm.2590

Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Adult Hearing Screening page.

Primary Version

• Kathleen Cienkowski, PhD, CCC-A
• Deborah Culbertson, PhD, CCC-A
• Kathryn Dowd, AuD, CCC-A
• Wafaa Kaf, PhD, CCC-A
• Anna Kharlamova Meehan, AuD, CCC-A
• Anne Olson, PhD, CCC-A
• Gabrielle Saunders, PhD
• Pamela Souza, PhD, CCC-A
• Barbara Weinstein, PhD, CCC-A

Secondary Versions

• Lauren Dillard, PhD, CCC-A (2026)
• Maureen Fischer, MS, CCC-A (2026)
• Cornetta Mosley, PhD, CCC-A (2022)
• Gayla Poling, PhD, CCC-A (2022)

ASHA seeks input from subject matter experts representing differing perspectives and backgrounds. At times, a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.

Citing Practice Portal Pages

The recommended citation for this Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Adult hearing screening [Practice portal]. https://www.asha.org/Practice-Portal/Professional-Issues/Adult-Hearing-Screening/