State Cerumen Management Requirements
Alabama, Arkansas, California, Florida, Illinois, Maryland, Michigan, Missouri, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, Rhode Island, South Dakota, Texas, Vermont, Virginia, Washington, West Virginia, Wisconsin and Wyoming have laws, regulations or policies related to the use of cerumen management for audiologists, which are summarized below. This information is reviewed on an annual basis. Please be advised that laws, regulations, and policies may change at any time, so always check with your state for the most up-to-date information.
Alabama
870-X-7-.03 Audiology Scope Of Practice.
(b) Conducting otoscopic examinations and removing cerumen from external ear canal;
Alabama Rules and Regulations [PDF]
Arkansas
11.2. The practice of audiology includes:
- J. cerumen management to prevent obstructions of the external ear canal and of amplification devices.
Arkansas Rules and Regulations [PDF]
California
2530.2. Definitions
(k) "The practice of audiology" means the application of principles, methods, and procedures of measurement, testing, appraisal, prediction, consultation, counseling, instruction related to auditory, vestibular, and related functions and the modification of communicative disorders involving speech, language, auditory behavior or other aberrant behavior resulting from auditory dysfunction; and the planning, directing, conducting, supervising, or participating in programs of identification of auditory disorders, hearing conservation, cerumen removal, aural habilitation, and rehabilitation, including, hearing aid recommendation and evaluation procedures including, but not limited to, specifying amplification requirements and evaluation of the results thereof, auditory training, and speech reading, and the selling of hearing aids.
(p) "Cerumen removal" means the nonroutine removal of cerumen within the cartilaginous ear canal necessary for access in performance of audiological procedures that shall occur under physician and surgeon supervision. Cerumen removal, as provided by this section, shall only be performed by a licensed audiologist. Physician and surgeon supervision shall not be construed to require the physical presence of the physician, but shall include all of the following:
- Collaboration on the development of written standardized protocols. The protocols shall include a requirement that the supervised audiologist immediately refer to an appropriate physician any trauma, including skin tears, bleeding, or other pathology of the ear discovered in the process of cerumen removal as defined in this subdivision.
- Approval by the supervising physician of the written standardized protocol.
- The supervising physician shall be within the general vicinity, as provided by the physician-audiologist protocol, of the supervised audiologist and available by telephone contact at the time of cerumen removal.
- A licensed physician and surgeon may not simultaneously supervise more than two audiologists for purposes of cerumen removal.
Florida
64B20-9.001 Scope of Practice
The scope of practice of Speech-Language Pathology and Audiology is affected by the development of new treatment modalities and equipment, as well as by improvements in existing treatment modalities and equipment. Any licensee providing any service or treatment shall have acquired the competence to perform said service or treatment through appropriate education and/or training. Any licensee who provides any treatment or service for which he or she has not been specifically educated or trained shall be deemed to have committed negligence or misconduct in the practice.
Illinois
Section 1465.36 Evaluation and Management Related to Speech-Language Pathology and Audiology
b) Audiology
- Evaluation under audiology means the application of nonmedical methods and procedures for the identification, measurement, testing and appraisal of hearing or vestibular function.
- Management under audiology means habilitation, rehabilitation, counseling, consulting, directing or conducting of programs that are designed to modify disorders related to hearing loss or vestibular malfunction. This includes training in the use of amplification, including dispensing of hearing aids. This also includes removal of cerumen for the purpose of performing evaluation or management procedures.
Illinois Rules and Regulations
Maryland
Chapter 07 – Cerumen Management
.01 Scope.
These regulations govern persons licensed as audiologists in the State.
.02 Definitions.
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Cerumen management" means the removal of cerumen which may affect the successful completion of audiological procedures.
(2) "Medical liaison" means a cooperative arrangement for consultation with a physician, preferably an otolaryngologist.
(3) "Universal precautions" has the meaning stated in COMAR 10.06.01.02B(10).
.03 Limitations.
A. Before the removal of cerumen, the licensee shall obtain the informed consent of the patient, or legally responsible adult, and maintain documentation.
B. During cerumen removal, the licensee shall comply with the principles of universal precautions.
.04 Training, Knowledge, and Skills.
A. The licensee shall be responsible for obtaining the training, knowledge, and skills necessary to perform cerumen management.
B. Failure to obtain the training before performing cerumen management may subject the licensee to disciplinary action.
C. The licensee shall obtain training that includes:
(1) Principles of cerumen management including the anatomy of the ear canal and the ear drum and classification of cerumen;
(2) Use of instruments;
(3) Techniques for cerumen removal;
(4) Recognition of complications;
(5) Recognition of contraindications including but not limited to:
(a) Only hearing ear,
(b) Perforated tympanic membrane,
(c) Inflammation, tenderness, or drainage from the ear canal or middle ear,
(d) Ear surgery within the past 6 months or tympanostomy tubes,
(e) Diabetes mellitus, HIV infection, bleeding disorder, or other medical contraindications,
(f) Actual or suspected foreign body,
(g) Stenosis or bony exostosis of the ear canal,
(h) Dizziness occurring during cerumen removal,
(i) Cerumen impaction that totally occludes the ear canal; and
(6) Clinical experience gained under the direct supervision of a qualified professional.
D. The licensee shall maintain documentation evidencing the satisfactory completion of the required training.
.05 Precautions.
A. The licensee shall have established a medical liaison as defined in Regulation .02B of this chapter before performing cerumen removal.
B. The licensee shall refer patients to or consult with as needed the medical liaison for patients requiring cerumen removal who exhibit contraindications.
Maryland Rules and Regulations [PDF]
Michigan
333.16801 Definitions; scope of practice; limitation.
(vii) Routine cerumen removal from the cartilaginous portion of the external ear in otherwise healthy ears except that if the audiologist, while engaged in routine cerumen removal, discovers any trauma, including, but not limited to, continuous uncontrolled bleeding, lacerations, or other traumatic injuries, he or she shall, as soon as practically possible, refer the patient to a person licensed in the practice of medicine or osteopathic medicine and surgery.
Missouri
Chapter 345, Section 345.015
345.015. As used in sections 345.010 to 345.080, the following terms mean: (1) "Audiologist", a person who is licensed as an audiologist pursuant to sections 345.010 to 345.080 to practice audiology; (2) "Audiology aide", a person who is registered as an audiology aide by the board, who does not act independently but works under the direction and supervision of a licensed audiologist. Such person assists the audiologist with activities which require an understanding of audiology but do not require formal training in the relevant academics. To be eligible for registration by the board, each applicant shall submit a registration fee, be of good moral and ethical character; and:
(k) Provides assessment of external ear and cerumen management
Montana
24.222.525 AUDIOLOGY SCOPE OF PRACTICE
(1) The scope of practice of audiology includes but is not limited to:
(b) otoscopic examination and external ear canal management for removal of cerumen in order to:
(i) evaluate auditory/vestibular disorders;
(ii) make ear impressions;
(iii) fit hearing protection or prosthetic devices; and
(iv) monitor the continuous use of hearing aids;
Nebraska
38-507 Practice of audiology, defined.
Practice of audiology means the application of evidence-based practice in clinical decision-making for the prevention, assessment, habilitation, rehabilitation, and maintenance of persons with hearing, auditory function, and vestibular function impairments and related impairments, including (1) cerumen removal from the cartilaginous outer one-third portion of the external auditory canal when the presence of cerumen may affect the accuracy of hearing evaluations or impressions of the ear canal for amplification devices and (2) evaluation, selection, fitting, and dispensing of hearing instruments, external processors of implantable hearing instruments, and assistive technology devices as part of a comprehensive audiological rehabilitation program. Practice of audiology does not include the practice of medical diagnosis, medical treatment, or surgery.
Nebraska Practice Act [PDF]
Nevada
NRS 637B.050 “Practice of audiology” defined. “Practice of audiology” means the application of principles, methods and procedures relating to hearing and balance, hearing disorders and related speech and language disorders and includes, without limitation:
- The conservation of auditory system functions;
- Screening, identifying, assessing and interpreting, preventing and rehabilitating auditory and balance system disorders;
- The selection, fitting, programming and dispensing of hearing aids, the programming of cochlear implants and other technology which assists persons with hearing loss and training persons to use such technology;
- Providing vestibular and auditory rehabilitation, cerumen management and associated counseling services;
- Conducting research on hearing and hearing disorders for the purpose of modifying disorders in communication involving speech, language and hearing;
- Providing referral services for medical diagnosis and treatment; and
- At the request of a physician, participating in the diagnosis of a person.
New Jersey
13:44C-7.1A SCOPE OF PRACTICE—CERUMEN MANAGEMENT
a) The purpose of this section is to set forth standards for the performance of cerumen management by a licensed audiologist. Cerumen management is within the scope of practice of an audiologist who meets the requirements of this section.
b) "Cerumen management," as used in this section, shall mean the removal of wax like secretions from the cartilaginous portion of the external ear in otherwise healthy ears.
c) A licensed audiologist may perform cerumen management only if he or she;
1) Completed initial education pursuant to N.J.A.C. 13:44C-3.2, 3.3 or 3.4, which included instruction in the topics required by (d) below; or
2) Has successfully completed a 12-hour seminar or workshop in cerumen management, which qualifies for American Speech-Language Hearing Association (ASHA), American Academy of Audiology (AAA) or Academy of Doctors of Audiology (ADA) continuing education credit and which includes instruction in the topics required by (d) below.
d) Initial education or a course in cerumen management shall include:
1) Recognizing the presence of medical preexisting contraindications that warrant referral to a physician, such as:
i) A patient who has hearing in only one ear;
ii) A perforated tympanic membrane;
iii) Inflammation, tenderness, open wounds or traces of blood in the external ear canal;
iv) Drainage from the external ear canal or middle ear;
v) Ear surgery within the last six months;
vi) A patient who has tympanostomy tubes;
vii) Diabetes mellitus, HIV infection or bleeding disorders;
viii) Actual or suspected foreign body in the ear;
ix) Stenosis or bony exostosis of the ear canal;
x) Cerumen impaction that totally occludes the ear canal;
xi) Cerumen located beyond the isthmus; or
xii) Inability to see the tympanic membrane;
2) Recognizing patient distress and appropriate action to take if complications are encountered;
3) Infection control practices, including:
i) Universal health precautions;
ii) Decontamination;
iii) Cleaning, disinfection and sterilization of multiple use equipment; and
iv) Universal precautions for prevention of the transmission of human immunodeficiency virus, hepatitis B virus and other blood borne pathogens; and
4) Methods for removal of cerumen, for example, cerumen loop, gentle water irrigation, suction and use of material for softening.
e) In addition to the education requirements of (c) above, a licensed audiologist shall complete the following prior to performing cerumen management:
1) Observe a minimum of 2 cerumen management procedures using a cerumen loop, 2 cerumen management procedures using gentle water irrigation and 2 cerumen management procedures using suction performed by either a licensed audiologist who has met the requirements of this section, an audiologist authorized to perform cerumen management in another state or a physician; and
2) Successfully perform, under the supervision of a licensed audiologist who has met the requirements of this section, an audiologist authorized to perform cerumen management in another state or a physician, a minimum of 2 cerumen management procedures using a cerumen loop, 2 cerumen management procedures using gentle water irrigation and 2 cerumen management procedures using suction.
f) A licensed audiologist shall perform cerumen management only in a healthcare facility licensed by the Department of Health and Senior Services or in his or her office.
g) A licensed audiologist shall not perform cerumen management and shall refer a patient to a physician if any of the pre-existing contraindications listed in (d)1 above occur.
h) A licensed audiologist shall not perform cerumen management on a patient who is six years old or younger.
i) A licensed audiologist shall not perform, or shall cease performing, cerumen management if patient reports:
1) Tenderness during manipulation of the pinna or at any time during the cerumen removal procedure; or
2) Dizziness occurring during cerumen removal.
j) A licensed audiologist shall refer a patient for immediate treatment from a physician if a complication arises during the performance of cerumen management.
k) A licensed audiologist who performs cerumen management shall maintain a case history for every patient and informed consent signed by the patient as part of his or her records.
New Jersey Practice Act [PDF]
New Mexico
61-14B-5. Scope of practice; audiologists. (Repealed effective July 1, 2016.)
The scope of practice for audiologists shall include:
- D. cerumen management;
New York
Audiologists may only perform cerumen removal when it is necessary to do so in order to perform audiometric test procedures.
Rhode Island
§ 5-48-1 Purpose and legislative intent – Definitions
(9) "Practice of audiology" means rendering or offering to render any service in audiology, including prevention, screening, and identification, evaluation, habilitation, rehabilitation; participating in environmental and occupational hearing conservation programs, and habilitation and rehabilitation programs including hearing aid and assistive listening device evaluation, prescription, preparation, dispensing, and/or selling and orientation; auditory training and speech reading; conducting and interpreting tests of vestibular function and nystagmus; conducting and interpreting electrophysiological measures of the auditory pathway; cerumen management; evaluating sound environment and equipment; calibrating instruments used in testing and supplementing auditory function; and planning, directing, conducting or supervising programs that render or offer to render any service in audiology.
South Dakota
36-24-1.6. Scope of audiology
The scope of practice of audiology includes:
(1) Activities that identify, assess, diagnose, manage, and interpret test results related to disorders of human hearing, balance, and other neural systems;
(2) Otoscopic examination and external ear canal management for removal of cerumen in order to evaluate hearing or balance, make ear impressions, fit hearing protection or prosthetic devices, and monitor the continuous use of hearing aids;
Texas
Sec. 401.403. PRACTICE BY AUDIOLOGISTS.
(a) An audiologist may:
(1) engage in any act necessary to:
(A) evaluate hearing;
(B) train in the use of amplification, including hearing instruments;
(C) make earmolds for hearing instruments;
(D) fit, dispense, and sell hearing instruments; or
(E) manage cerumen;
Vermont
§ 4451. Definitions
(8) "Practice of audiology" includes:
(K) management of cerumen.
Virginia
18VAC30-21-145. Limited cerumen management.
A. In order for an audiologist to perform limited cerumen management, he shall:
- Be a graduate of a doctoral program in audiology that is accredited by the Council on Academic Accreditation of the American Speech-Language-Hearing Association or other accrediting body recognized by the board and that included didactic education and supervised clinical experience in cerumen management as specified in subsection B of this section; or
- Complete a course or workshop in cerumen management that provides training as specified in subsection B of this section and that is approved by the American Speech-Language Hearing Association or the American Academy of Audiology.
B. An audiologist shall maintain documentation evidencing satisfactory completion of training in cerumen management to include the following:
- Recognizing the presence of preexisting contraindications that necessitate referral to a physician;
- Recognizing patient distress and appropriate action to take if complications are encountered;
- Use of infection control precautions;
- Procedures for removal of cerumen, including cerumen loop, gentle water irrigation, suction, and the use of material for softening;
- Observation of each type of cerumen management procedure performed by a qualified audiologist or physician; and
- Successful performance, under direct supervision by an audiologist qualified to perform cerumen management or a physician, of each type of cerumen management procedure.
C. An audiologist shall not perform cerumen management on a patient who has any of the following preexisting contraindications:
- A perforated tympanic membrane;
- Inflammation, tenderness, drainage, or open wounds or traces of blood in the external ear canal;
- History of ear surgery that results in distortion of the external ear canal;
- HIV infection or bleeding disorders;
- Actual or suspected foreign body in the ear, excluding hearing aid components that are located in the lateral one-third portion of the ear canal;
- Stenosis or bony exostosis of the ear canal; or
- Cerumen impaction that totally occludes the visualization of the tympanic membrane.
D. An audiologist performing cerumen management shall:
- Obtain informed consent of the patient or legally responsible adult and document such consent and the procedure performed in the patient record.
- Refer patients to a physician if they exhibit contraindications or experience any complication, such as dizziness, during the procedure.
Washington
WAC 246-828-095. Audiology minimum standards of practice.
Standard procedures for providing audiology services may include one or more of the following:
(b) Cerumen management to clean the external canal and to remove excess cerumen for the preservation of hearing.
Washington Rules and Regulations
West Virginia
§30-32-14. Scope of practice for audiology
(7) Cerumen removal;
Wisconsin
HAS 6.175 Definitions
In this subchapter and in subchapter II of ch. 459, Stats.:
(1) "Cerumen management" means the removal of cerumen from the external auditory canal by the utilization of methods and techniques performed in accordance with minimum standards and procedures established in the audiological profession.
(f) Failed to clearly state the full terms of sale on a receipt, as required in s. 459.24 (3m), Stats., or failed to comply with those terms. The full terms of sale shall include all of the following:
- The amount and method of payment.
- The date and place of delivery.
- The terms of any personal guarantee.
- The nature and duration of the trial period and extension, if any.
- The refund policy and amount, if any.
- The product return and exchange policy, if any.
The product repair policy, if any.
(g) Failed to perform cerumen management in a competent manner.
Wisconsin Rules and Regulations [PDF]
Wyoming
Section 3. Definitions.
In addition to the definitions contained in the Act, the following definitions shall apply herein:
(e) "Audiology" means the application of principles, methods and procedures of measurement, testing, evaluation, prediction, consultation, counseling, instruction, habilitation or rehabilitation related to hearing and disorders of hearing for the purpose of evaluating, identifying, preventing, ameliorating or modifying such disorders and conditions in individuals or groups of individuals.
(m) "Measurement" includes but is not limited to, facilitating where applicable the conservation of auditory system function; developing and implementing environmental and occupational hearing conservation programs; cerumen management; screening, identifying, assessing and interpreting, diagnosing, preventing, and rehabilitating peripheral and central auditory system dysfunction; providing and interpreting behavioral and electro-physiological measurements of auditory and vestibular functions, such as auditory evoked potential assessment, neurophysiologic intraoperative monitoring or balance system assessment; providing aural rehabilitation and related counseling services to hearing impaired individuals and their families; and screening of speech-language and other factors affecting communication function for the purposes of an audiologic evaluation and/or the initial identification of individuals with other communication disorders.
