Audiology Flashcards

The Profession of Audiology

Learning Outcomes

The chapter introduces audiology, covering its origins, development, and current role in hearing healthcare.
Upon completion of the chapter, the reader should be able to:
- Describe the evolution of audiology as a profession.
- Distinguish between licensure and certification and explain why an audiologist might pursue certification.
- Explain the collaboration between speech-language pathologists and audiologists.
- Discuss the effects of hearing impairment on individuals and society.
- List audiology specialty areas and employment settings.

Introduction

Audiology has grown significantly since its beginnings over seventy years ago.
It started as an effort to help hearing-impaired World War II veterans reintegrate into civilian life.
Now, it serves all population groups and ages with advanced diagnostic and rehabilitative tools.
Audiology students can anticipate a dynamic profession that addresses the hearing needs of a growing patient base.

1.1 The Evolution of Audiology

Before World War II, hearing care was mainly provided by physicians and hearing aid dealers.
High-level noise exposure from weaponry during the war caused hearing problems among service personnel.
This led otology (medical specialty for ear diseases) and speech pathology (now speech-language pathology) to collaborate and establish military-based aural rehabilitation centers (Figure 1.1).
Due to the success of these centers, professionals sought to offer these services in the civilian sector after the war.
Otologists primarily initiated the first community rehabilitative programs, but speech-language pathologists, who developed audiometric techniques and rehabilitative procedures in military clinics, staffed these centers (Henoch, 1979).
Audiology quickly became a distinct profession from medicine in the United States.
Outside the United States, audiology is mainly practiced by physicians, usually otologists.
Audiometric technicians administer hearing tests, but physicians decide on patient management.
Some countries have developed audiology programs and independent audiologists, similar to those in the United States.
Most audiologists globally look to American audiologists as a model for autonomous practice.
The term "audiology" combines a Latin root, audire (to hear), with a Greek suffix, logos (the study of).
It is often said that Drs. Raymond Carhart and Norton Canfield independently coined it in 1945.
However, a 1939 course and a 1935 film titled "Audiology" predate these claims (Skafte, 1990).
Today, an audiologist is defined as a licensed individual who provides services for the identification, assessment, diagnosis, and treatment of auditory or vestibular impairment, and the prevention of such disorders (American Academy of Audiology, 2004).

Academic Preparation in Audiology

In the United States, audiology education evolved with technology advancements, leading to more diagnostic procedures and a broader professional scope (American Academy of Audiology, 2004; American Speech-Language-Hearing Association, 2004d).
Audiology practices now include identifying hearing loss, differential diagnosis of hearing impairment, and non-medical treatment of hearing and balance disorders.
The profession transitioned from a bachelor’s level preparation to a master’s degree requirement for state licensure.
Raymond Carhart recognized the limitations of defining the profession at the master’s degree level (Carhart, 1975).
In 1988, a conference set goals for the profession's transformation to a doctoral level (Academy of Dispensing Audiologists, 1988).
Starting in 1994, academic programs transitioned to the Doctor of Audiology (Au.D.) degree.
The Au.D. typically involves four years of professional preparation beyond a bachelor’s degree, with a focus on didactic instruction initially and increasing clinical practice as students progress.
The final year is a full-time clinical placement, often in a paid position.
Coursework includes hearing and speech science, anatomy and physiology, communication fundamentals and disorders, counseling techniques, electronics, computer science, and diagnostic and rehabilitative services for hearing and balance disorders.
This extensive background helps university programs produce clinicians capable of making independent decisions for their patients.

Licensing and Certification

Audiology practice in the United States is regulated through licensure or registration in every state and the District of Columbia.
This ensures practitioners meet minimum educational standards and maintain current competencies through continuing education.
A license is a legal requirement to practice audiology, protecting consumers, and its loss prohibits practice.
To obtain a license, one must complete a course of study, acquire about 2000 hours of clinical practicum, and pass a national examination.
Certification is not a legal requirement.
Members of the American Speech-Language-Hearing Association (ASHA) must hold a Certificate of Clinical Competence in Audiology, showing a designated level of preparation and continuing education.
Many audiologists voluntarily pursue certification from the American Board of Audiology (ABA) to commit to lifelong learning.
ABA certification demonstrates a higher standard than professional associations or legal licensure documents.
Support personnel, or "audiologist’s assistants," are increasingly used in practice settings.
Their responsibilities are defined by the American Academy of Audiology (1997; 2014).
Licensing laws in nearly half the states specify patient care assignments for assistants.
Assistants can improve practice efficiency and meet the needs of a growing population with hearing loss.
Audiologists must ensure assistants have adequate preparation and training.

A Blending of Art and Science

Audiology is a scientific discipline based on research in hearing and balance, the impacts of related disorders, and diagnostic and treatment technology.
It's important to avoid overemphasizing the technological aspects of service delivery.
Counseling and rehabilitative aspects may be more crucial to patient success than technological advances (Hawkins, 1990).
The combination of audiology's science with patient treatment makes it a rewarding profession.
The humanistic aspect allows audiologists to connect with patients and families, making the outcomes rewarding.
Patients bring their own experiences and limitations to clinics.
Audiologists should listen supportively to gather patient histories, allowing for tailored diagnostics and rehabilitation (Clark & English, 2014).

1.2 People and Places

Audiologists serve patients of all ages, from neonates to the elderly.
Patients with hearing and balance disorders are seen in various professional settings by general audiologists or specialists.
Several associations support audiologists by providing forums for information exchange and continuing education.

Prevalence and Impact of Hearing Loss

Audiology's growth in the civilian sector was driven by the prevalence and impact of hearing loss.
Reported prevalence varies based on estimation methods, criteria for defining hearing loss, and the population sampled.
Table 1.1 presents the prevalence of hearing loss and related disorders:
- 360 million (5.3%) persons in the world have a debilitating hearing loss
- 50 million (1.5%) Americans experience tinnitus (ear or head noises)
- 48 million (1.47%) Americans report some degree of hearing loss
- 30 million (0.9%) Americans are exposed to hazardous noise levels or ototoxic chemicals at work.
- 16 million (33%) Americans have a hearing loss at age 65 or older
- 14 million baby boomers (14.6%) have hearing problems
- 10 million (0.3%) Americans have some degree of permanent, noise-induced hearing loss
- 7 million (15%) school-aged children have some degree of hearing loss
- 6 million Generation Xers (7.4%) already have a hearing loss
- 5 out of 6 children (83%) in America experience ear infections by 3 years of age.
- 2-3 of every 1000 children (0.03%) in America are born with hearing loss in one or both ears

Clinical Commentary

Speech-language pathologists often work closely with audiologists.
This is common with children, where hearing loss affects speech and language development, and with older adults, who have age-related communication disorders.
The American Speech-Language-Hearing Association includes hearing-screening procedures, audiological rehabilitation, and hearing aid checks within the scope of practice for speech-language pathologists (ASHA, 2001, 2004b).
Goman, Reed, and Lin (2017) estimated that over 44 million adults (15%) in 2020 had bilateral hearing loss, projecting a rise to over 73 million (22.6%) by 2060.
Hearing loss is most prevalent among older adults, exceeding 55% of those over 70 in 2020.
While fewer children have permanent hearing loss than adults, mild transient ear infections can affect speech, language, and academic performance.
75% of children in the United States have at least one ear infection before age three (National Institute on Deafness and Other Communication Disorders, 2010a).
Recurrent ear infections can lead to delays in articulatory and phonological development, language skills, grammar, syntax, vocabulary, auditory memory, auditory perception, and social maturation (Clark & Jaindl, 1996).
Some studies show children with early ear infections may catch up by the second year of elementary school (Roberts, Burchinal & Zeisel, 2002; Zumach, Gerrits, Chenault & Anteunis, 2010), while others show little or no association (Roberts, Rosenfeld & Zeisel, 2004).
A study found a greater range in abilities for third- and fourth-grade students with a history of ear infections, even without significant differences in speech understanding in noise (Keogh et al., 2005).
Factors beyond fluctuating hearing abilities may influence learning (Davis, 1986; Williams & Jacobs, 2009), but intervention is still necessary.
Severe and permanent hearing loss significantly affects a child’s speech, language, educational performance (Diefendorf, 1996), and psychosocial dynamics (Altman, 1996; Clark & English, 2014).
Adults diagnosed with permanent hearing loss may feel as devastated as caregivers of children with hearing loss (Martin, Krall & O’Neal, 1989).
Hearing loss must be diagnosed before its effects can be addressed.
Untreated hearing loss in adults can harm relationships and is linked to poor health, decreased physical activity, and depression.
Progressive hearing loss in older adults is associated with physical and psychosocial dysfunction (Bess, Lichtenstein, Logan, Burger, and Nelson, 1989).
Hearing loss has significant personal, social, and financial costs.
The annual cost of treating childhood ear infections in the United States may be as high as 5 billion (National Institute on Deafness and other Communication Disorders, 2010b).
Including educational programs, rehabilitation, and lost income, the costs are substantial.
Northern and Downs (1991) estimate the economic burden of deafness for a child with severe hearing impairment to exceed 1 million over a 71-year life expectancy.
A Better Hearing Institute survey reported that untreated hearing problems collectively cause at least 100 billion in annual income loss (National American Precis Syndicated, 2007).
Most people with hearing loss are in their prime, including one in six baby boomers (ages 41-59).
Hearing aid use can reduce lost income effects by nearly 50%, but only one in four seek treatment.

Audiology Specialties

Most audiology programs train audiologists as generalists.
Many audiologists specialize as their careers progress.
Specialty areas offer research opportunities for clinical understanding.
Audiologists often collaborate with speech-language pathologists or educators, especially when clients are young or have speech/language difficulties.
The varied nature of audiology makes it stimulating and rewarding.
Audiologists report high job satisfaction due to the interesting and challenging nature of their careers (Martin, Champlin & Streetman, 1997).
Audiology was ranked the fourth most desirable profession in the United States in 2016, based on hiring outlook, income potential, work environment, stress levels, and physical demand (CareerCast, 2016).
The variety of specialty areas and employment settings enhances the appeal of audiology.

Medical Audiology

Most audiologists work in medical environments such as hospitals, physicians’ offices, and HMOs.
Audiologists in military programs, VA medical centers, and public health departments often specialize in medical audiology.
Services focus on diagnostic assessments to determine the cause of hearing or balance disorders (Figure 1.2).
Medical audiologists use a range of diagnostic procedures for patients of all ages.
Audiological assessment results are combined with findings from other professionals to reach a diagnosis.
Medical audiologists may also work in newborn-hearing-loss-identification programs and monitor hearing levels of patients on ototoxic medications.
Additional responsibilities include hearing aid dispensing.

Educational Audiology

Following Public Laws 94-142 (1975) and 99-457 (1986), the need for audiologists in schools increased.
However, fewer than half the required audiologists serve in public schools.
Educational audiologists minimize the impact of hearing loss on children's education, working closely with educators and speech-language pathologists.
Responsibilities include identifying children with hearing loss, referring them to services, providing rehabilitative activities, creating hearing-loss-prevention programs, counseling, and selecting/evaluating amplification (Johnson & Seaton, 2011).

Pediatric Audiology

Work with children and families has significant effects.
Pediatric audiologists must be proficient in diagnostic evaluation and empathetic to families during difficult times.
A primary role is to support parents in meeting rehabilitative challenges.
Professionals in communication and education for children with hearing loss often collaborate with pediatric audiologists.
Pediatric audiologists are commonly found in pediatric hospitals, rehabilitation centers, and community-based hearing and speech centers.

Dispensing/Rehabilitative Audiology

ASHA lifted its ban on audiologists dispensing hearing aids over 40 years ago.
Audiologists are now increasingly involved in total hearing rehabilitation (Chapters 14 and 15).
Many audiologists establish dispensing practices in hospitals or physicians’ offices, while others prefer the autonomy of independent practice.
Growing numbers of audiologists are employed in commercial outlets.
Hearing aid dispensing is a common responsibility.

Industrial Audiology

High noise levels are a primary cause of hearing loss (Chapter 10).
Many industries produce noise levels that can permanently damage employees’ hearing.
Over 30 million U.S. workers are exposed to hazardous noise levels (National Institute for Occupational Safety and Health, 2001).
Noise-induced occupational hearing loss is a common occupational disease.
The U.S. Department of Health has set allowable noise exposure levels.
Audiologists in industry design hearing-conservation programs to identify and measure noise, reduce noise levels, monitor employee hearing, educate employees, and fit hearing protection.
Some audiologists work full-time in industrial settings, while most provide services as contracted consultants.
Audiologists collaborate with attorneys, physicians, nurses, hygienists, safety engineers, and personnel officers.

Recreational and Animal Audiology

Most audiologists who work in recreational or animal audiology do so as a smaller part of their employment responsibilities.
Recreational audiologists provide hearing-conservation services to individuals engaging in loud recreational activities (Chapter 10).
Animal audiologists assist non-human animals, particularly dogs (Figure 1.3).
There are over 80 breeds of dogs with documented congenital hearing loss, and many experience age-related hearing decline.
Animal audiologists counsel on dog safety and communication issues (Scheifele, Clark & Scheifle, 2012).
Hearing conservation for service animals is a concern, especially considering the investment in their training.
Ongoing research focuses on hearing-loss prevention and management for canines (www.fetchlab.org).

Tele-Audiology

80% of those with hearing loss live in low- and middle-income countries with limited access to audiologic care (World Wide Hearing, 2014).
The average ratio of audiologists to people is 1:20,000 (Goulios & Patuzzi, 2008), and many lack readily available access to audiologic care,even within developed countries.
Eikelboom and Swanepoel (2016) state that the shortage of hearing health professionals is an emerging global challenge.
Tele-audiology is an area within tele-health that reaches remote areas to provide audiologic services.
The World Health Organization (WHO) reports that hearing loss is the number one disability.
Special models need to be developed for different geographic, cultural, and financial situations.

Clinical Commentary

Audiologists often work in multiple areas of practice.
For example, balance disorder specialists may also assist with hearing aids, and private practice audiologists may work in industry, schools, or research.
This variety contributes to audiology's ranking as one of the most rewarding professions.
More audiologists work in medical environments than in any other setting (American Academy of Audiology, 2016).
Private practice is the second largest employment affiliation and the most rapidly growing.
Private practices focus on dispensing/rehabilitative efforts but may also offer diagnostic services.

Professional Societies

Professional societies have evolved to advance the interests of audiologists and those they serve.
The American Speech Correction Association (founded in 1927) adopted audiology in 1947 and became the American Speech and Hearing Association (ASHA).
ASHA (www.asha.org) sets standards for audiology and speech-language pathology and accredits academic programs.
It provides continuing education and journals for these professions.
The American Academy of Audiology (AAA) (www.audiology.org) was founded in 1988 to represent audiology's unique needs.
AAA has over 10,000 members and promotes audiological services, public awareness, and governmental advocacy.
AAA's journals and continuing education programs help audiologists maintain expertise.
AAA, along with ASHA, sets practice standards and guidelines.
Practitioners may also belong to organizations like the Academy of Rehabilitative Audiology (www.audrehab.org), the Academy of Doctors of Audiology (www.audiologist.org), or the Educational Audiology Association (www.edaud.org).
The American Auditory Society (www.amauditorysoc.org) allows audiologists to interact with professionals working with those who have hearing impairment.
Some audiologists affiliate with consumer-oriented associations like the Hearing Loss Association of America (www.hearingloss.org) and the Alexander Graham Bell Association for the Deaf and Hard of Hearing (www.agbell.org).

Summary

Audiology emerged from otology and speech pathology during World War II.
It grew rapidly due to the high prevalence and impact of hearing loss.
Audiologists collaborate with speech-language pathologists and educators to support needs, especially in the pediatric population.
A mutual respect leads to the highest level of remediation.
The profession supports a variety of specialty areas.
Students entering audiology will find career opportunities due to projected population demographics.