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Diagnostic Audiology: Best Practices
James W. Hall III, Ph.D.
Professor
Salus University
Adjunct Professor
Nova Southeastern University
Extraordinary Professor
University of Pretoria South Africa
[email protected]
www.audiologyworld.net
Diagnostic Audiology: Best Practices
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Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
Psychoacoustics Laboratory (PAL)
Harvard University (1940s and 1950s)
SS Stevens
(1906-1973)
Audiology Grandfathers: Clinical Scholars Who
Built the Foundation of Audiology
Georg von Bekesy
(1899 - 1972)
Nobel Prize for
Physiology or Medicine 1961
GSI E800
Bekesy Audiometer
Audiology Grandfathers: Clinical Scholars Who
Built the Foundation of Audiology
PhD from University of Chicago under
Nobel Prize Winner Robert Miliken
Illustrious Career at Bell Telephone
Laboratories
Seminal Publications, e.g.
Fletcher H (1929). Speech and Hearing.
New York: D Van Nostrand
Harvey Fletcher
(1884-1981)
Fletcher H & Steinberg JC (1929).
Articulation testing methods. Bell
System Technical Journal, 8, 806-854
Audiology Grandfathers: Clinical Scholars Who
Built the Foundation of Audiology
Hallowell Davis
(1896 - 1992)
Audiology Fathers: Clinical Scholars Who Built
the Foundation of Audiology
The Hearing Journal, 64 (7), 2011
Ira Hirsh
(1922 - 2010)
Audiology Fathers: Clinical Scholars Who Built
the Foundation of Audiology
The Hearing Journal, 64 (8), 2011
Robert Galambos, PhD, MD
(1914 - 2010)
Audiology Fathers: Clinical Scholars Who Built the
Foundation of Audiology
Demand for Hearing Services During and After WW II
Diagnostic Audiology: Best Practices








Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
Audiology Test Battery: 65+ years Ago
 Test battery at the beginning of our
profession, in order of test administration
 Air-conduction pure tone audiometry
 Bone-conduction pure tone
audiometry
 Speech reception thresholds
 Word recognition (PB word lists)
 Uncomfortable loudness level (UCL),
i.e., loudness discomfort level (LDL)
Source: Wiener F & Miller G. Hearing
aids. In Combat Instruments II.
Washington, D.C. NDRC Report 117,
216-232, 1946
Raymond Carhart
Clinical Scholars Who Built the Foundation of Audiology
James Jerger, PhD
Father of Diagnostic Audiology; Founder of American Academy of Audiology
Susan Jerger
Audiology Equipment in the 1950s and 1960s:
Doesn’t it look a little dated?
GSI 162
Speech
Audiometer
Early Maico Audiometer
GSI E800
Bekesy
Audiometer
Diagnostic Audiology: Best Practices
Modern Audiometers
GSI AudioStar Audiometer
KUDUwave Automated Audiometer
Audiologic Test Battery: An Update is Long Overdue
Procedure
% Performing Procedure
Pure tone audiometry: air conduction
Pure tone audiometry: bone conduction
Word recognition
Speech reception threshold
UCL (LDL) for speech
Tympanometry
UCL (LDL) for tones
Acoustic reflexes
Otoacoustic emissions (OAEs)
Source: The Hearing Journal, December, 2002
100%
100%
95%
91%
83%
45%
45%
20%
4%
Diagnostic Audiology: Best Practices

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
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


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Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
Best Practice is Evidence-Based Practice (EBP)
"Those who fall in love with practice without science are
like a sailor who steers a ship without a rudder or
compass, and who can never be certain whither he is
going.”
Leonardo Da Vinci (1452-1519)
Best Practice is Evidence-Based Practice (EBP)
 Evidence-based practice is “the integration of best
research evidence with clinical expertise and patient
values” (Sackett et al, Evidence-Based Medicine: How to
practice and teach EBM. London: Churchill, 2000, p. 1)
 EBP is a five step process
 Focused clinical question
 Evidence is sought to answer the question
 Clinician evaluates the quality of evidence
 Clinician must integrate the evidence with the patient’s
clinical findings and preferred outcome to develop
intervention plan
 Document outcome and identify ways to improve it
Categories for Strength of Evidence used in
Developing Clinical Guidelines
 Grade I: Evidence is strong and usually obtained from
randomized controlled trials or well-designed clinical
studies.
 Grade II: Evidence is from clinical studies that were
based on retrospective data analysis, clinical trials that
were not randomized and/or carefully-controlled, or from
panel consensus based on existing guidelines and
practice patterns.
 Grade III: Evidence is secondary in that it is based on
current or long-standing practice without substantial
supporting basic or clinical data.
Evidence-Based Practice:
Categories of Research Evidence (ASHA, 2004)
 1a: Well-designed meta-analysis of randomized
controlled trials
 1b: Well-designed randomized controlled trials
 2a: Well-designed controlled studies without
randomization
 2b: Well-designed quasi-experimental studies
 3: Well-designed non-experimental studies, i.e.,
correlational and case studies
 4: Expert committee reports, consensus conferences
and clinical experience
Evidence-Based Practice is Standard of Care:
Definitions of Standard of Care
 Consistent with local, regional or national clinical practice
 Follows guidelines or recommendations on clinical practice
approved by national multi-disciplinary professional
committees or panels, e.g., Joint Committee on Infant Hearing
 Follows guidelines on clinical practice approved by national
professional organizations, e.g., AAA or ASHA
 Is consistent with statements of
 Scope of Practice
 Code of Ethics
 Is in compliance with Federal guidelines for clinical practice
and services, e.g., Joint Committee on Accreditation of
Healthcare Organizations (JCAHO)
Diagnostic Audiology: Best Practices








Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
The Concept of Value Added Tests (VATs):
Rationale for Inclusion in a Test Battery
 Procedure adds value to the description of auditory status for
the patient, including information that is:
 Not available from other procedures and/or
 Obtained quicker than with another procedure and/or
 Poses less risk than an alternative procedure and/or
 Costs less than a comparable procedure
 Findings are more reliable or valid than an alternative test
 Highly sensitive to auditory dysfunction
 Provides site-specific information on auditory dysfunction
 Contributes to more accurate diagnosis
 Useful in managing the patient and/or
 Information leads to better outcome for the patient
The Concept of Value Added Tests (VATs):
Old versus New Procedures
 Some old procedures almost always add value, e.g.,
 Tympanometry
 Acoustic reflexes
 Some more recent procedures almost always add value, e.g.,
 Otoacoustic emissions
 Some traditional test procedures do not invariably add value,
e.g.,
 Speech recognition threshold (SRT)
 Bone conduction pure tone audiometry
 Word recognition in quiet at 40 dB SL
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Speech Recognition Threshold (SRT)
 University of Florida student project (Emily Roscher)
 2005 NAFDA convention poster paper
 Email survey of random sample of clinical audiologists
 90% routinely perform SRT measurement
 53% routinely calculate pure tone average
 Criteria for an acceptable PTA vs. SRT difference ranged from 5 to 12%
 N = 1000 subjects
 Age 2 to 92 years
 570 males (57%) and 430 (43%) females
 Hearing loss
 74% sensorineural
 16% normal
 6% mixed
 3% conductive
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Speech Recognition Threshold (SRT)
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Speech Recognition Threshold (SRT)
 Significant differences between PTA vs. SRT (> +/- 5 dB) were
related to selected factors
 Age
Children (< 20 years)
Older adults ( > 66 years)
 Hearing loss
Greater PTA-SRT difference for SNHL
Greater PTA-SRT difference for sloping hearing loss
 No significant difference between PTA and SRT for
 Gender
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Speech Recognition Threshold (SRT)
 Significant differences between PTA vs. SRT (> +/- 5 dB) were
related to selected factors
 Age
Children (< 20 years)
Older adults ( > 66 years)
 Hearing loss
Greater PTA-SRT difference for SNHL
Greater PTA-SRT difference for sloping hearing loss
 No significant difference between PTA and SRT for
 Gender
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Speech Recognition Threshold (SRT)
Margolis RH & Saly GL (2008). Distribution of hearing loss characteristics
in a clinical population. Ear & Hearing, 29, 524-532
For 53% of 16,818 patients, age was between 20 to 70 years.
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
 Bone conduction pure tone audiometry
 An adult patient has no history of middle ear disease
 Findings available prior to pure tone audiometry
Normal tympanograms bilaterally
Acoustic reflex thresholds at expected normal levels
Otoacoustic emission amplitudes within normal limits
 Air conduction pure tone audiometry shows sloping
high frequency hearing loss
 Bone conduction pure tone audiometry will
Waste valuable test time
Not add value to the diagnosis
Not add value to referral or management decisions
Not lead to improved patient outcome
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Bone Conduction Pure Tone Audiometry
Margolis RH & Saly GL (2008).
Distribution of hearing loss
characteristics in a clinical
population.
Ear & Hearing, 29, 524-532
The Concept of Value Added Tests (VATs):
A Critical Look at Three Traditional Procedures
Word Recognition in Quiet
 Patient is an adult with the chief complaint of difficulty
hearing in noisy settings
 Patient converses easily in the clinic without visual cues
 Pure tone audiometry findings are entirely normal
 Word recognition in quiet wil
 Waste valuable test time
 Not add value to the diagnosis
 Not add value to management
 Not lead to improved patient outcome
 Instead
 Perform a test of speech perception in noise
 Consider other tests of auditory processing
The Concept of Value Added Tests (VATs):
Comparative Times for Different Tests
“Remember that time is money”
Benjamin Franklin
Advice to a Young Tradesman
1748
Best Practices in Audiology: Efficient and Sensitive
Assessment of the Peripheral Auditory System
(Figure: Hall JW III (2014). Introduction to Audiology Today. Boston: Pearson)
Best Practices in Audiology: Efficient and Sensitive
Assessment of the Central Auditory Nervous System
(Figure: Hall JW III (2014). Introduction to Audiology Today. Boston: Pearson)
Copyright © Pearson 2014
The Cross-Check Principle in Pediatric Audiology
(Jerger J & Hayes D. Arch Otolaryngol 102: 1976)
Comparative Test Times for Selected Procedures:
Both Ears with Masking as Indicated
Time in Minutes
25
20
15
10
5
0
OAE
Tymp
ART
PTA-AC
PTA-BC
SRT
WR
Audiologic Procedure
Comparative Test Times for Selected Procedures:
Both Ears with Masking as Indicated
Audiologic Procedures in Two Basic Test Batteries
PTA-AC
PTA-BC
SRT
WR (25 word lists)
45 mins
OAE
Tymp
PTA-AC
WR (10 most difficult words 1st)
15 mins
45 mins
30 mins
15 mins
30 mins
Best Practices in Audiology Today:
Initial Steps in the Assessment
History
Reason for Assessment
Immittance
Measures
Abnormal?
Diagnostic
DPOAEs
Abnormal?
Normal?
Normal?
AC + BC
PT & speech
audiometry
Audiologic or
Medical
Management
AC PT & speech
audiometry*
* SRT as indicated; WR 10 most difficult words
Diagnostic Audiology: Best Practices








Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
Best Practices in Audiology: Practical Guidelines Today
Excitement About Clinical Pathways in the 1990s
“Clinical pathways are pre-conceived patient care algorithms, or
paths, that are intended to reduce variability and cost, increase
efficiency, and ultimately improve patient care.
Whether or not such efforts prove to be effective in achieving such
goals, many institutions are proceeding to develop such pathways.
While many policies and procedures must of necessity be
constructed locally, there is likely enough common ground across
institutions such that sharing pathways may be of great benefit. In
other words, why should each center be forced to "reinvent the
wheel?"
Best Practices in Audiology: Practical Guidelines Today
Excitement About Clinical Pathways in the 1990s
 The good news … advantages of clinical guidelines
 The main benefit is to improve quality of patient care.
 Improve consistency in care, i.e., same procedures administered
with patients presenting with the same clinical problem.
 Help patients to know what they should expect in healthcare, i.e.,
patients are empowered.
 With the power of the internet, patients may educate health care
providers on what care should be provided.
 Clinical guidelines can influence public policy, and may influence
reimbursement trends.
 Reassure health care providers who are uncertain about the
appropriateness of their diagnostisor treatment for a patient.
 Reinforce evidenced-based clinical practice.
 May reduce inefficient, costly, and even dangerous practices.
Best Practices in Audiology: Practical Guidelines Today
Excitement About Clinical Pathways in the 1990s
 The bad news … disadvantages of clinical guidelines
 Legal considerations … professional liability if not followed closely
 Clinical guidelines can quickly become outdated. They must be
updated or clinical practice is out of date.
 Conflicts between national “consensus” guidelines and community
practice
 Are guidelines “politics disguised as science”?
 Guidelines can be time consuming and inefficient.
 Guidelines can oversimplify complex health care decisions.
 Flawed guidelines may be developed and used inappropriately to
gain reimbursement for services, or to limit reimbursement for
clinical services.
 Is there a danger in relying on expert versus clinical judgment?
 And ….
Best Practices in Audiology: Practical Guidelines Today
Excitement About Clinical Pathways in the 1990s
 More bad news … disadvantages of clinical guidelines
 Coverage may be dropped for services not delineated in guidelines.
 Professions engage in “turf wars” to control guidelines.
 Evidence is often lacking for guidelines.
 Inflexible guidelines do not permit the clinician to take into account
all factors in the patient’s history and personal circumstances.
Individualized patient care suffers.
 Guidelines are not a “magic bullet” for inferior health care.
 There is scant evidence that clinical guidelines actually do improve
quality of patient care, and patient outcome
 Guidelines may be wrong for an individual patient.
Diagnostic Audiology: Best Practices








Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiologic test battery
Focusing on the ultimate goal of clinical care
Joint Committee on Clinical Practice
(1999)
 Representation
 American Academy of Audiology (AAA)
 American Speech-Language-Hearing Association (ASHA)
 Department of Veterans Affairs (VA)
 Practice guidelines and statements (N = 5)
 Overview of audiologic services
 Comprehensive audiologic assessment (adult)
 Comprehensive audiologic assessment (pediatric)
 Hearing aid selection and fitting
 Cochlear implant assessment, programming, and
audiologic rehabilitation (adult)
Best Practices in Audiology Today:
Joint Committee on Clinical Practice
“The overall goal of the Joint Committee on audiology
practice was to maximize the value of health care
delivered to patients and clients. National consensus
was sought on ideal practices, on maximizing quality
through achieving desired outcomes, on customer
satisfaction, and on efficient and appropriate use of
procedures and resources.”
Joint Audiology Committee:
11 Categories of Definitions in Practice Guidelines
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Personnel
Referrals
Procedures (CPT codes)
Populations
Clinical indicators
Objectives
Expected outcomes
Clinical process
Equipment and test environment
Safety and health precautions
References
Joint Audiology Committee:
Components of Audiologic Assessment
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History
Appropriate physical examination (e.g., otoscopy)
Cerumen management
Air conduction pure tone thresholds (w/ appropriate masking
Bone conduction pure tone thresholds (w/ appropriate masking)
Speech thresholds (w/ appropriate masking)
Speech recognition measures (w/ appropriate masking)
Acoustic immittance
 Tympanometry
 Acoustic reflexes
 Acoustic reflex decay
Otoacoustic emissions
High frequency audiometry
Stenger (pure tone and speech)
Rehabilitation needs assessment
Communication inventory
Joint Audiology Committee: Further Diagnostic
Assessment Options Based on Need
 Non-organic?
 Non-organic assessment
 VIIIth nerve/peripheral brainstem pathology?
 Electrophysiologic assessment
 CNS/APD disorder?
 APD assessment
 Balance disorder?
 Balance assessment
 Tinnitus problems?
 Tinnitus assessment
Joint Audiology Committee Algorithm on Comprehensive
Audiologic Assessment (Age 5 through Adult)
Case History
Medical
Management?
Yes?
No?
Referral or Consultation to
Appropriate
Medical Personnel?
Otoscopy & P.E.
Comprehensive
Audiologic
Assessment
(A, B, I)
Cerumen Mgt
by Audiologist
Audiologist
Determines
Need for Further
Dx Assessment
for
(1, 2, 3, 4, or 5)
American Academy of Audiology
Clinical Guidelines Development
Clinical Guidelines for Ototoxicity
Assessment and Monitoring (2009)
 Task Force Members
 John Durrant (Chair)
 Kathleen Campbell
 Stephen Fausti
 O’Neil Guthrie
 Gary Jacobson
 Brenda Lonsbury-Martin
 Gayla Poling
American Academy of Audiology
Clinical Practice Guidelines for Ototoxicity Monitoring
(2009)
 Assessment and Monitoring Techniques
 Pure tone audiometry
Conventional test frequencies
High frequency audiometry (HFA)
 Distortion product otoacoustic emissions (DPOAEs)
Determine reliability during baseline measurement
High frequency protocol with many frequencies/octave
 Frequency-specific electrophysiological measures as
indicated
ABR (tone burst and chirp stimuli)
ASSR
AAA Clinical Guidelines on Auditory Processing Disorders:
A Manual for Evidence Based Assessment and Management
(www.audiology.org)
Clinical Guidelines:
Auditory Neuropathy Spectrum Disorder (2010)
 In June 2008, at the invitation of Deborah
Hayes, a panel of experts met in Comoﾊ, Italyﾊ
at the NHS 2008 Conference to develop
Guidelines for the Identification and
Management of Infants and Young Children
with Auditory Neuropathy.
 The panel consisted of:
 Yvonne Sininger, Ph.D.
 Arnold Starr, M.D.
 Christine Petit, M.D., Ph.D.
 Gary Rance, Ph.D.
 Barbara Cone, Ph.D.
 Kai Uus, M.D., Ph.D.
 Patricia Roush, Au.D.
 Jon Shallop, Ph.D.
 Charles Berlin, Ph.D.
Identification and Diagnosis of
Auditory Neuropathy Spectrum Disorder (ANSD):
Minimal Test Battery (2010 ANSD Guidelines)
 Tests of cochlear hair cell function
 Otoacoustic emissions (OAEs)
 Cochlear microphonic (ECochG and ABR)
 CM may be present when OAEs are absent (e.g., with middle ear
dysfunction)
 Tests of auditory nerve function
 ABR for high intensity click stimulation (e.g., 80 to 90 dB nHL) with
separate averages for:
 Rarefaction stimulus polarity
 Condensation stimulus polarity
 Additional tests
 Acoustic reflex measurement
 Suppression of otoacoustic
Other Procedures Important in the Diagnosis and Management
of Auditory Neuropathy Spectrum Disorder (2010 Guidelines)
 Components of assessment
 Pediatric and developmental history
 Otologic evaluation, plus
Imaging of cochlea with CT
Imaging auditory nerve with MRI
 Medical genetics evaluation
 Ophthalmologic evaluation
 Neurological evaluation to assess:
Peripheral nerve function
Cranial nerve function
 Communication assessment
Examples of Some of the Current American Audiology
of Audiology Clinical Guidelines
(There are Many More and More are Coming)
 2007 Joint Committee on Infant Hearing (JCIH) Position
Statement
 2008 2010 American Academy of Audiology Clinical Practice
Guidelines: Childhood Hearing Screening
 2012 American Academy of Audiology: Audiologic Guidelines
for the Assessment of Hearing in Infants and Young Children
 2013 American Academy of Audiology Clinical Practice
Guidelines: Pediatric Amplification
 2014 American Academy of Audiology Tinnitus Retraining
Therapy: Clinical Guidelines and Patient Counseling Guide
 American Academy of Audiology Clinical Practice Guidelines:
Otoacoustic Emissions (in progress)
Examples of Some of the ASHA Audiology Guidelines
(www.asha.org)
 Guidelines for Audiologic Screening (1997)
 Guidelines for Audiology Service Delivery in Nursing Homes
(1997)
 Guidelines for Fitting and Monitoring FM Systems (2002)
 Guidelines for Audiology Service Provision in and for Schools
(2002)
 Clinical Practice Guidelines: Cerumen Impaction (2008)
 Clinical Practice Guidelines: Benign Paroxysmal Positional
Vertigo (2008)
 Guidelines for Audiologists Providing Informational and
Adjustment Counseling (2008)
Diagnostic Audiology: Best Practices








Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
A Modern Diagnostic Audiologic Test Battery
In the order of testing for new patients. Test time ~ 30 - 45 minutes.
 Objective measures
 Otoacoustic emissions (OAEs)
 DPOAEs 500 to 8000 Hz
 Normal versus present but abnormal versus absent
 Aural immittance measures
 Tympanometry
 Acoustic reflexes (crossed vs. uncrossed conditions )
 Behavioral measures
 Pure tone audiometry (automated technique as appropriate)
 Inter-octave frequencies (e.g., 3000 and 6000 Hz)
 High frequency (> 8000 Hz) audiometry as indicated
 Bone conduction measurement only as indicated
 Speech audiometry
 SRT as indicated
 Word recognition (recorded material) 10 most difficult words first
 Screen auditory processing as indicated
Diagnostic Audiology: Best Practices

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





Historical perspective: Foundations of clinical audiology
Our old and worn out audiologic test battery
Defining “best practices” and “standard of care”
The concept of value added tests (VATs)
Clinical guidelines: Good news and bad news
Summary of current clinical guidelines
A modern audiological test battery
Focusing on the ultimate goal of clinical care
Evidence-Based Practice:
Focusing on the Goal, Not the Process
Identification
•
•
•
•
Screening
History
Self-Referral
Professional
referral
Evidence-Based Practice:
Focusing on the Goal, Not the Process
Diagnosis
Identification
•
•
•
•
Screening
History
Self-Referral
Professional
referral
•
•
•
•
•
Hearing loss
ANSD
APD
Tinnitus
Vestibular
disorder
Evidence-Based Practice:
Focusing on the Goal, Not the Process
Diagnosis
Identification
•
•
•
•
Screening
History
Self-Referral
Professional
referral
•
•
•
•
•
Hearing loss
ANSD
APD
Tinnitus
Vestibular
disorder
Intervention
Hearing aids
Aural Rehab
Counseling
Cochlear
implant (s)
• Vestibular
rehab
• Drugs
• Surgery
•
•
•
•
Evidence-Based Practice:
Focusing on the Goal, Not the Process
Diagnosis
Identification
•
•
•
•
Screening
History
Self-Referral
Professional
referral
•
•
•
•
•
Hearing loss
ANSD
APD
Tinnitus
Vestibular
disorder
Intervention
Hearing aids
Aural Rehab
Counseling
Cochlear
implant (s)
• Vestibular
rehab
• Drugs
• Surgery
•
•
•
•
Outcome
Effective
communication
• Efficient
communication
• Academic
success
• Quality of life
•
Diagnostic Audiology: Best Practices
A Glimpse into the Future of Audiology
A Glimpse at the Future of Audiology:
An Optimistic Perspective
If money is your hope for independence, you will never
have it. The only real security that a man will have in this
world is a reserve of knowledge, experience, and ability.
Henry Ford
A Glimpse at the Future of Audiology:
An Optimistic Perspective
The biggest mistake we
currently make may is an
emphasis on selling
hearing aids when the
focus of our attention,
when the focus should be
…
A Glimpse at the Future of Audiology:
An Optimistic Perspective
Should be not on
products but
…Providing
comprehensive
evidence-based
audiology services to
maximize
communication and
patient outcome!
A Glimpse at the Future of Audiology:
An Optimistic Perspective
 Education Reforms are
Essential and a Top Priority
 Aggressively Market
Audiologists as THE Hearing
Experts
 Relation with Other
Professional Organizations
 Open and constant
communicate
 Tirelessly seek consensus
on core issues
 “Speak with one voice”
A Glimpse at the Future of Audiology:
An Optimistic Perspective
 Broaden Hearing Health Care
Profession
 Bring hearing aid dispensers
into audiology fold
 Support expansion of
audiology assistants and
technicians
 Return to Original Audiology
Missions
 Diagnosis of hearing loss
and related disorders
 Rehabilitation of hearing loss
with optimal outcome
A Glimpse at the Future of Audiology:
Increased Focus on Exclusive Audiology Services
 Evidence-Based Rehabilitation
 With or without hearing aids
 Auditory and cognitive rehabilitation in elderly population
 Enhanced listening skills
 Pediatric Services
 Hearing loss
 Vestibular and balance deficits
 Vestibular Assessment and Rehabilitation in Adults
 Auditory Processing Disorders
 Tinnitus and Hyperacusis
A Glimpse at the Future of Audiology:
Questions to Ask Our Patients
 “Do you want to buy a cheap
hearing aid or with audiology
services do you want to ….
 Communicate effectively
 Enjoy better quality of life
 Live happier and healthier
 Avoid falls and maintain
mobility
 Improve your child’s school
performance
 No longer hear annoying
tinnitus
 Tolerate everyday loud
sounds
Diagnostic Audiology: Best Practices
Thank You! … Questions?
2014
Boston: Pearson Publishers
www.allynbaconmerrill.com