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ACAE Update and
An Overview of Global Education in Audiology
James W. Hall III
Professor
Salus University and University of Hawaii
Vice Chair and Chair Elect
Accreditation Commission for Audiology Education (ACAE)
Doris Gordon
Executive Director
Accreditation Commission for Audiology Education (ACAE)
[email protected] www.acaeaccred.org
ACAE Update and
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Updates in ACAE
ACAE Update and
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Mission of ACAE
To serve the public by establishing, maintaining
and applying standards to ensure the academic
quality and continuous improvement of audiology
education, reflecting the evolving practice of
audiology.
ACAE Update and
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Purpose of ACAE
 To establish rigorous standards for full scope of
practice for doctoral level audiologists
 To monitor and evaluate programs for high quality
outcomes, so consistency prevails in every
curriculum
 To empower audiologists to practice their chosen
profession autonomously and responsibly
 To prove outcomes that ensure we are providing the
highest level of audiologic care to the public
 To demonstrate readiness for limited license
practitioner status in the US
ACAE Update and
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
ACAE’S Key Advantages
 Expertise in accreditation domestically and globally
 Continually abreast of trends in standards and
higher education
 Extensive experience and commitment in the
profession and accreditation
 Entire team working for program improvement and
successful outcomes
ACAE Update and
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
ACAE: 2016 Standards
 Enhanced competences including but not limited to:
Pharmacology
Genetics
Business/personnel management
Self-advocacy skills for patients and families
 Programs demonstrate how students possess a
working knowledge of all competencies as well as the
ability to incorporate them into practice
 Recipients of AuD degrees will have sound knowledge
and professional skills enabling them to function as
autonomous direct care providers.
ACAE: 2016 Standards
 New areas, including “Health and Safety Standards, e.g.,
Technical standards
Immunizations
Communicable and/or infectious disease policy
Liability insurance
Equipment policies
Emergency action plan
ACAE: 2016 Standards
 Timeline for ACAE standards
ACAE Board of Directors approved standards March
2016
Available at AudiologyNow! Convention April 2016
Effective 2017
Programs have 1 year before 2016 standards take
effect
New programs have the option to be accredited
under the new standards prior to March 2017
Education’s High Standards: is the
A Foundation of the Profession
Practice
Clinical Training
Academic Education
(The Foundation)
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Expanding and Enhancing Audiology Globally:
So Many Ears … So Few Audiologists
The Hearing Journal
Volume 67 (3)
March 2014
Expanding and Enhancing Audiology Globally:
World Health Organization (www.who.int)
Expanding and Enhancing Audiology Globally:
Global Burden of Hearing Loss
90% of World Population is Without Access to Hearing Care
WHO estimated in 2008:
 288 million people have hearing loss > 40 dB HL
• 4.3 % of global population
 664 million people have hearing loss >25 dB HL
• 9.9 % of global population
 “Half of all cases of hearing are avoidable through
primary prevention.”
 “Current production of hearing aids meets less
than 10% of global need.”
 “The majority of people with disabling hearing
loss live in low- and middle-income countries.”
Hearing: An Important Building Block in the Foundation
for Quality of Life and Independent Productive Citizens
Quality of Life
Communication
Oral Language
Hearing
Expanding and Enhancing Audiology Globally:
Focusing on the Goal
Diagnosis
Identification
•
•
•
•
Screening
History
Self-Referral
Professional
referral
•
•
•
•
•
Immittance
measures
OAEs
Pure tone
audiometry
Speech
audiometry
Special
Tests
Intervention
•
•
•
•
Hearing aids
Aural Rehab
Counseling
Cochlear
implant (s)
• Vestibular
rehab
• Drugs
• Surgery
Outcome
•
•
•
•
•
•
Effective
communication
Efficient
communication
Academic
success
Self-sufficiency
Economic
independence
Quality of life
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Expanding and Enhancing Audiology Globally:
A Systematic Review (2008)
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
The Sun Never Sets on Audiology
Programs in Former British Colonies
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
USA: Doctor of Audiology
Canada: Masters degree
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
Central & South America: Bachelors degree (e.g., Colombia, Brazil) or no
program (e.g., Educador, Guatemala, Peru, Nicaragua, Uruguay & Paraguay)
Brazil: Rapidly
expanding
audiology
profession with
PhD programs
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
UK: Complicated mixture of different degree programs
Audiologists with
AuD degrees from
distance learning
programs in USA
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
Europe, Scandinavia, Russia: Formal bachelors and masters audiology
programs, medical model, physicists, electrical engineers, etc
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
Middle East: Masters & PhD (Israel); Bachelors degree (e.g., Kuwait,
Lebanon, Jordan, Saudi Arabia), MD (Egypt) or no program
Audiologists with
AuD and PhD
degrees from USA,
UK, and Australia
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
Africa: 5 Bachelors, Masters & PhD
in South Africa
No other audiology programs
currently in Africa
The ratio of audiologists to
population size is smaller
in sub-Saharan Africa
than anywhere in the world
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
India: > 12 Bachelors degree programs;
> 4 Masters degree programs
Problems:
Population = > 1.2 billion and
brain drain of PhD audiologists
to USA, UK, Australia, etc
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
Australia and New Zealand:
Many Masters and PhD degree programs
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
Asia: Bachelors programs in Hong Kong,
Malaysia, Singapore, Thailand, South Korea
Masters program now in Singapore and
AuD program planned for
Hallym University in South Korea
Expanding and Enhancing Audiology Globally:
Audiology Education Around the World
ACAE Corner. Audiology Today, 27 (3), May/June, 2015
China and Japan:
Almost all physicians without formal audiology education
China desperately needs many formal
audiology educational programs
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Tele-Health Principles and Practices
Applied in Audiology
Expanding and Enhancing Audiology Globally:
The Many Applications of Tele-Audiology (1)
 Tele-audiology is the audiology application of tele-health
 Two general categories of tele-audiology
 Asynchronous (store-and-forward)
 Synchronous (real time)
 Tele-consultation regarding challenging patients
 Tele-education
 Students in audiology training programs anywhere
 Technicians
 Audiologists
Advanced training
Continuing education
Expanding and Enhancing Audiology Globally:
The Many Applications of Tele-Audiology (2)
 There is peer-reviewed published research evidence
validating the remote provision of audiology services,
including:
 Video-otoscopy
 Pure tone audiometry
 Diagnostic auditory assessment, e.g.,
 Vestibular assessment
 Rehabilitation
Hearing aid fitting and programming
Cochlear implant programming
Aural rehabilitation
Tinnitus and hyperacusis management
Expanding and Enhancing Audiology Globally:
Tele-Audiology
(www.audiologyworld.net)
Original Article
International Journal of Audiology 2010; 49: 195–202
Int J Audiol Downloaded from informahealthcare.com by University of Texas At Dallas
For personal use only.
De Wet Swanepoel1,2
Jackie L. Clark2,3
Dirk Koekemoer4
James W. Hall III5,1
Mark Krumm6
Deborah V. Ferrari7
Bradley McPherson8
Bolajoko O. Olusanya9
Maurice Mars10
Iêda Russo11
Jose J. Barajas12
1Department
of Communication
Pathology, University of Pretoria,
South Africa
2Callier Center for Communication
Disorders, University of Texas at
Dallas, TX, USA
3Department of Speech and Hearing
Therapy, University of Witwatersrand,
South Africa
4Research and Development Department, GeoAxon, South Africa
5Department of Communicative
Disorders, University of Florida,
Gainesville, FL, USA
6School of Speech Pathology and
Audiology, Kent State University, OH,
USA
7Department of Speech Language
Pathology and Audiology, Dentistry
School of Bauru, University of São
Paulo, Bauru, SP, Brazil
8Centre for Communication Disorders,
University of Hong Kong, Hong Kong,
China
9Maternal and Child Health Unit,
Department of Community Health and
Primary Care, College of Medicine,
University of Lagos, Lagos, Nigeria.
10Department of TeleHealth, Nelson R.
Telehealth in audiology: The need and
potential to reach underserved communities
Abstract
Sumario
Permanent hearing loss is a leading global health care burden, with 1 in 10 people affected to a mild or greater degree.
A shortage of trained healthcare professionals and associated
infrastructure and resource limitations mean that hearing
health services are unavailable to the majority of the world
population. Utilizing information and communication technology in hearing health care, or tele-audiology, combined
with automation offer unique opportunities for improved
clinical care, widespread access to services, and more costeffective and sustainable hearing health care. Tele-audiology
demonstrates significant potential in areas such as education
and training of hearing health care professionals, paraprofessionals, parents, and adults with hearing disorders; screening for auditory disorders; diagnosis of hearing loss; and
intervention services. Global connectivity is rapidly growing
with increasingly widespread distribution into underserved
communities where audiological services may be facilitated
through telehealth models. Although many questions related
to aspects such as quality control, licensure, jurisdictional
responsibility, certification and reimbursement still need to
be addressed; no alternative strategy can currently offer the
same potential reach for impacting the global burden of hearing loss in the near and foreseeable future.
La pérdida auditiva permanente es una importante carga para
los cuidados de la salud a nivel mundial, con 1 de cada 10
personas afectadas en grado ligero o mayor. La escasez de
profesionales entrenados en cuidados de la salud y de infraestructura asociada y la limitación de recursos determina que
los servicios de salud auditiva no estén disponibles para la
mayoría de la población mundial. La utilización de información y tecnología de la comunicación para los cuidados de la
salud auditiva o teleaudiología, combinada con la automatización, ofrece oportunidades únicas para mejorar los cuidados
clínicos, ampliar el acceso a los servicios y tener cuidados de
salud auditiva costoefectivos y sustentables. La Teleaudiología
ha demostrado un potencial significativo en áreas como las
de educación y adiestramientio de profesionales de la salud
auditiva, profesionales afines, padres y adultos con problemas
auditivos; tamiz de problemas auditivos; diagnóstico de pérdidas auditivas y servicios de intervención. La conectividad
global está creciendo rápidamente y ha aumentado de manera generalizada su distribución en comunidades con pocos
servicios, en donde los servicios audiológicos pueden facilitarse a través de modelos de telesalud. No obstante, existen
muchas dudas que deben resolverse y que están relacionadas
con aspectos como control de calidad, regulación del ejercicio profesional, responsabilidad jurisdiccional, certificación y
reembolso de servicios, pero no existe como alternativa ninguna otra estrategia que pueda ofrecer actualmente el mismo
potencial, para impactar el peso global de las pérdidas auditivas en el futuro cercano o previsible.
Tele-Audiology in Rural India:
Identification and Diagnosis of Infant Hearing Loss
Vidya Ramkumar,
Senior Lecturer, Part time-PhD,
Dept of Speech, Language and
Hearing Sciences,
Sri Ramachandra University,
Chennai, India.
Fulbright Doctoral Research Fellow,
Dept of Speech pathology and Audiology,
Kent State University,
Kent, Ohio, USA
Expanding and Enhancing Audiology Globally:
Latest Breakthrough in Technology
International Journal of Audiology 2014; Early Online: 1–9
Original Article
Smartphone hearing screening w ith integrated quality control
and data management
De Wet Swanepoel*,†,‡,#, Hermanus C. Myburgh$, David M. Howe*,$, Faheema Mahomed*
& Robert H. Eikelboom*,†,‡
*Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa, †Ear Sciences Centre, School of Surgery,
The University of Western Australia, Nedlands , Australia, ‡Ear Science Institute Australia, Subiaco , Australia, #Callier Center for Communication
Disorders, University of Texas at Dallas , USA, and $Department of Electrical , Electronic and Computer Engineering ,
University of Pretoria, Pretoria, South Africa
Expanding and Enhancing Audiology Globally:
Calibration of SmartPhone
Expanding and Enhancing Audiology Globally:
Hearing Screening with SmartPhone
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Expanding and Enhancing Audiology Globally
 Introduction
 The global challenge … so many ears and so few audiologists
 An international perspective on models for audiology
education … a whirl-wind trip around the world
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 One or more highly motivated and committed audiologists
who reside in the country
 Development of a formal university-based program for
education and training of audiologists
Expanding and Enhancing Audiology Globally:
Automated Audiometry
KUDUwave Automated Audiometer
 Swanepoel D, MaclennanSmith F & Hall JW III (2013).
Diagnostic pure tone
audimometry in schools:
Mobile testing without a
sound-treated environment.
JAAA, 24, 992-1000
 Swanepoel D, Matthysen C,
Eikelboom R, Clark, J, Hall JW
III (2014). Automated pure tone
audiometry outside a soundbooth using earphone
attenuation and integrated
ambient noise monitoring. Int J
Audiology, October 2015
Expanding and Enhancing Audiology Globally:
Automated Audiometry
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Facilitator Training:
International Hearing Care Technician Certificate
(www.aicme.com)
James Saunders, M.D., F.A.C.S.
James W. Hall, III, Ph.D.
Jackie Clark, Ph.D.
Spanish Language Instructors
Alexandra Feliz, Au.D.
Abraham Garcia, Au.D.
International Hearing Care Technician Certificate:
Curriculum (www.aicme.com)
Core Curriculum:
Designed to provide general knowledge and skills required by a hearing
care technician who will work under the supervision and direction of a
physician, otolaryngologist or audiologist. Successful completion of the
core curriculum leads to a Hearing Care Technician Certificate.
Each Course Features:
A 48-60 minute instruction through a narrated PowerPoint presentation on
a focused topic. Presentations include text, figures, and video
demonstrations to enhance the learning experience.
Selected readings and resources, including websites and other internet
sources information, are recommended for each topic.
International Hearing Care Technician Certificate:
Courses are Grouped Into One of Three Categories
Basic hearing courses cover general knowledge of sound,
acoustics, auditory anatomy and physiology.
Auditory disorders courses provide a brief overview of
disorders and diseases commonly encountered in patient
population.
Assessment Techniques category provides information needed
in preparation for conducting techniques commonly applied in
hearing assessment, such as otoscopic inspection, pure tone
hearing screening and threshold assessment, tympanometry,
and measurement of otoacoustic emissions.
International Hearing Care Technician Certificate:
Grouping 1 (Basic Hearing Courses)
 Auditory anatomy and physiology
 Sound and acoustics
 Professional responsibilities and liabilities
 Universal precautions
 Infection control
 Patient confidentiality
 Privacy and security
 History taking and record keeping
 Patient needs and counseling
 Medical and audiological terminology
International Hearing Care Technician Certificate:
Grouping 2 (Common Ear Disorders and Diseases)
 External ear
 Middle ear
 Inner ear
 Retrocochlear
International Hearing Care Technician Certificate:
Grouping 3 (Assessment Techniques)
 Otoscopic inspection and ear examination
 Hearing Screening and identification of hearing loss
 Introduction to the audiometer
 Pure tone hearing test techniques:
 Air conduction
 Bone conduction
 Masking theory and techniques
International Hearing Care Technician Certificate:
Grouping 3 (Assessment Techniques Continued)*
 Audiogram patterns
 Simple speech audiometry
 Tympanometry
 Otoacoustic emissions
 Introduction to diagnostic hearing assessment
 Introduction to hearing aids and other management options
* Special course modules are in preparation, e.g., hearing aids
International Hearing Care Technician Certificate:
Student Performance...Measuring Outcomes
(www.aicme.com)
 Each course concludes with an assessment of learner
outcome that includes questions within different domains of
learning as defined by revised Bloom’s Taxonomy,
specifically:
 Remembering (formerly knowledge)
 Understanding (formerly comprehension)
 Applying, analyzing, evaluating, and creating
 For each course, recommendations and guidelines are
offered for acquisition of related clinical and technical skills
by technicians enrolled in the core curriculum.
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Expanding and Enhancing Audiology Globally:
Kenya as an Example
Sustainable
Regional Access to Quality
Hearing Care in a Country
Automated
Audiometry
TeleAudiology
Trained
Technicians
Dedicated Formally Educated Audiologist
Expanding and Enhancing Audiology Globally:
Building Audiology Infra-Structure in a Country
Stephanie Cox in Kenya
(stephanie.cox.sim.org)
Expanding and Enhancing Audiology Globally:
Building Audiology Infra-Structure in a Country
Motto of Kenya: “Let Us All Pull Together”
Trained Assistant Elizabeth
Fitting a Hearing Aid
Stephanie Cox
(stephanie.cox.sim.org)
with 2 AuD Students from USA
An Overview of Global Education in Audiology
 ACAE Update
 Mission and Purpose of ACAE
 Key Advantages
 New 2016 Standards
 The global challenge … so many ears and so few audiologists
 International perspective on models for audiology education
 Strategies for expanding and enhancing audiology globally
 Tele-audiology
 Automated technology for auditory assessment
 Trained hearing care technicians
 Highly motivated and committed local audiologists
 Formal university-based audiology educational program
Expanding and Enhancing Audiology Globally
Audiology Today, 27 (3), May/June, 2015
Expanding and Enhancing Audiology Globally
Audiology Today, 27 (4), July/August, 2015
Expanding and Enhancing Audiology Globally:
Long-Term Solution
Sustainable
Widespread Access
To Quality Hearing Care in a Country
Automated
Audiometry
TeleAudiology
Trained
Technicians
Dedicated Formally Educated Audiologist (s)
+ Audiology Degree Program
Strategies for Expanding and
Enhancing Audiology Globally
 Development of a formal university-based program for
education and training of audiologists
 Audiologists residing in country
 Upgrade educational credentials for audiologists in country
Bachelors to masters degree or AuD
PhD education in USA, Australia, or UK
 Identify academic institution with interest in developing
audiology program
 Secure support of relevant government ministries (e.g.,
education and health)
 Full commitment of one or more audiologists in the country
 Initial contributions and support of well-known audiologists
Expanding and Enhancing Audiology Globally:
University Affiliations
Salus University
American University Beirut
Lebanon
University of Hawaii
University Pretoria
South Africa
Salus University
Osborne College of Audiology
Online International Audiology Education

International AuD-Bridge Degree Program for Masters level
audiologists who wish to earn a Doctor of Audiology degree
•
http://www.salus.edu/audiology_bridge/index.html
 Advanced Studies Certificate Programs
•
http://www.salus.edu/audiology/index.html
•
Advanced Studies: Cochlear Implants
•
Advanced Studies: Tinnitus & Hyperacusis
•
Advanced Studies: Vestibular Sciences & Disorders
 Masters of Science (MSc) in Advanced Clinical Audiology
•
Online degree with onsite workshops
•
For bachelors level audiologists
Expanding and Enhancing Audiology Globally:
Rationale and Motivation
 Altruism … it’s the right thing to do. Millions of people need
access to quality hearing health care.
 Business opportunity for hearing health care manufacturers
… greatly expand the market for products related to
diagnosis and rehabilitation for hearing loss.
 National security and business interests … More developed
countries with more consumers of products from USA and
with more stable USA-friendly populations
THANK YOU!
QUESTIONS?
AUDIOLOGY