Audiology began as the study of hearing but has evolved into a healthcare profession focused on diagnosing and treating hearing and balance disorders. Audiologists are trained to identify, assess, diagnose, treat, and manage conditions affecting the auditory and vestibular systems through behavioral, physiologic, and electrophysiologic testing. The profession has developed from roots in speech pathology programs after World War II to a clinical doctorate degree (Au.D.) as the standard for entry-level practice in many countries. Audiologists work in a variety of settings and their scope of practice continues to expand with technological and clinical advances.

2. Introduction and Development of
Profession of audiology (Structure, Types,
Certification)
Dr. Ghulam Saqulain
M.B.B.S., D.L.O., F.C.P.S
Head of Department of ENT
Capital Hospital, Islamabad

3. “Thebest wayto predict thefutureis to createit.”
PeterF. Drucker

4.  In its most basic form, audiology can be regarded as the
science or study of hearing (Katz, 2002; Roeser, Valente &
Hosford-Dunn, 2000).
 The term audiology is a combination of the Latin word
“audire”, to hear, and the Greek word “logia”, meaning the
science or theory of hearing.
 Clinical audiology involves studying hearing as part of the
human communication system (Kidd, Cox & Matthies,
2003).

5. Audiologist
 According to the Professional Board (2005), an
internationally accepted definition of an audiologist is:
“A heath care and educational professional who
assists in the promotion of normal communication as
well as the prevention, identification, assessment,
diagnosis, treatment and management of the following
disorders in a variety of settings ranging from private
practice, private hospitals, government hospitals, rural
clinics, tertiary institutions, schools, pre-schools,
industries, communities and home environments:

6. 􀂃Types and degrees of hearing or balance disorders that arise in the
peripheral and/or central
auditory or vestibular systems;
􀂃Functional hearing disorders;
􀂃Central auditory processing disorders
􀂃Developmental or acquired disorders of language and language
processing caused by a hearing loss…, involving the
subcomponents: phonology, morphology, syntax, semantics and
pragmatics and the modalities concerned with oral, graphic and /or
written modes as well as Sign Language and other manual
communication systems;
􀂃Developmental or acquired speech disorders caused by a hearing
loss: articulation, phonology, and voice disorders (including
respiration, phonation, resonance and disordered prosody).”
(HPCSA Shout, 2005:4)

7.  By virtue of their academic training and clinical experience,
audiologists are the primary healthcare professionals involved in
the identification, prevention and evaluation of auditory and
balance disorders. In addition, audiologists are the single most
important resources for non-medical habilitation or rehabilitation
of hearing loss (Roeser, Valente & Hosford-Dunn, 2000).
 Although the title of audiologist had been used by hearing aid
dealers in the United States (Harford, 2000), Berger (as cited in
Casey & Monley, 2002) credits Canfield (an otologist) for coining
the term audiologist in 1945. Canfield authored “’Audiology, the
Science of Hearing: a Developing Professional Specialty”, which
was published in 1949.

8. INTRODUCTION &
DEVELOPMENT
 Audiology is a young profession with its roots in the
development of aural rehabilitation programs designed
for servicemen re-entering civilian life following World
War II.
 The success of military-based aural rehabilitation
programs quickly spurred the development of similar
programs within the civilian sector because of the
devastating impact of hearing loss on the lives of those
affected.
 The educational preparation of audiologists grew as its
informational and technological bases developed

9.  What began as a bachelor’s degree preparation for entering
the profession expanded into a required master’s degree,
and the field has recently evolved into a doctorate-level
profession.
 As audiology has expanded, so has the variety of specialty
areas in which audiologists may concentrate
 And as the population grows, so does the need for
audiological services.
 In the United States, it has been recognized that the
requisite knowledge base underlying the practice of
audiology has expanded significantly and as a result there
has been a shift from a Masters degree to the Clinical
Doctorate in Audiology (Au.D.) as the minimum entry-level
into the profession.

10.  In South Africa, the field of audiology has also been
recognized and the Professional Board for Speech-
Language and Hearing Professions has recognized speech-
language therapy and audiology as two separate,
independent and autonomous professions (HPCSA, 2005).
 Tertiary institutions have responded by moving away from
the traditional programme that taught speech pathology and
audiology (allowing for dual registration with the Health
Professions Council of South Africa [HPCSA] as both a
speech-language therapist and audiologist) within a four-
year undergraduate degree structure.

11.  Since 1999, some university departments in South Africa
have introduced a split-curriculum and have trained and
graduated students as either speech-language therapists or
audiologists resulting in registration with the HPCSA on the
respective single register.
 At the University of Pretoria, students may choose to train
as speech-language therapists, audiologists or as both.

12.  The Universities of Cape Town and KwaZulu-Natal currently
train audiology and speech-language therapy students
together up to the second year level. Students then move
into specific training at a third and final year level.
 In Pakistan?

13.  The development of audiology training programs and the
current position of the profession cannot be appreciated
without considering the progression of the related profession
of speech-language pathology.
 Most audiology programmes started as a subsidiary of one
or two courses in a speech pathology course.

14.  The Route of audiology can be traced back to
speech pathology, which emerged out of
education for the deaf in Europe and America in
the 18th and 19th centuries.
 The developments of Deaf Education in these
continents led to the practice of speech correction
in the education system and by the late 1920’s,

15.  In 1920’s, university speech clinics were created and
various courses in speech pathology materialized.
 These early courses often emerged from within the
departments of psychology, education or speech & drama
and as a result, many programs today remain within the
Faculty of Arts or Science (Aron, 1991).
 The training of the profession in Europe in the 1920’s and
30’s has a somewhat different origin and orientation. The
profession of speech pathology was introduced by
phoneticians and medically trained voice experts who had
studied normal speech and voice.

16.  The profession in Europe thus has a close relationship with
the medical fraternity and indeed many speech-language
pathologists and audiologists first complete medical training.
 As a result, many of the speech-language pathology and
audiology courses were at a postgraduate diploma level
(Aron, 1991).

17.  In the late 1940’s, the first students graduated from
American university programmes with a specialty in
audiology.
◦ The content of these early curriculums was heavily
weighted in speech correction and speech science.
◦ The courses specific to applied audiology were
limited to audiometry and aural rehabilitation, which
included lip-reading, auditory training and hearing
aids (Harford, 2000).

18.  Most of the audiologists that graduated in the 1950’s
held a Ph.D. and joined speech pathology faculties
at other universities to teach a limited number of
courses, develop an audiology curriculum or conduct
research on the auditory system.
 By the end of the 1950’s, it became apparent that
not all graduates with a Ph.D. wanted to pursue an
academic career and that some wanted to be
located in a hospital, clinic or rehabilitation center
(Harford, 2000).

19.  In 1959, ASHA established the American Board of
Examiners in Speech Pathology and Audiology
(ABESPA).
 One of the fundamental missions of ASHA was to
ensure that speech and hearing services to the
public were of the highest quality.
 In the 1950’s, ASHA awarded two levels of
certification to individual audiologists as either
“basic” or “advanced”. These certifications were
based on the speech correctionists' requirements.

20. ◦ Basic certification was relatively easy to obtain and
required a bachelors degree in speech correction or
audiology or both in which case there was dual
certification.
◦ The advanced certification was more stringent and
required a Masters degree, in addition to the
successful completion of a one-day written
examination and an oral examination by external
examiners.
◦ In the 1960’s, the two levels of certification were
collapsed into a single level that required a Masters
degree.
 Following an expected evolutionary path, audiology
developed identifiable specializations, including
diagnostic audiology, pediatric audiology, industrial
audiology, educational audiology, interoprative
monitoring and vestibular assessment and management
(Harford, 2000).

21.  With this increased scope of practice, came a move
towards a professional doctorate in audiology (Au.D.) as
the minimal entry level into the profession.
 David P Goldstein (Ph.D.) spearheaded the move
towards a clinical doctorate and was the first chair of the
Audiology Foundation of America (AFA) a non-profit
organization established in 1989 to promote the
professional doctorate (Bloom, 2000)

22.  The impetus for change in the professional education of
audiologists came from audiologists in private practice
who recognized the need for newly graduated
audiologists to be more competent in certain areas.
 In 1991, the American Academy of Audiology published
a paper strongly endorsing the concept of an Au.D. as
an entry-level degree for the practice of audiology. I
 n 1997, the ASHA Legislative Council passed a
resolution mandating an upgrade in the requirement for
certification effective on 01 January 2007 and an Au.D.
as the basic requirement for certification effective 01
January 2012 (Harford, 2000).

23. A brief history of the Au.D.
 The Au.D. is a four-year postgraduate course of full-time
study including both academic and practicum
components.
◦ It is different to the research focused Ph.D. in that it
requires a minimum of 12 months full-time supervised
clinical practicum (approximately 2000 hours) and at
least 75 semester credit hours of graduate level course
work (ASHA, 2006 ).
◦ In the United States, the movement to a doctoral entry–
level entry for the clinical practice of audiology has been
fraught with controversy between audiologists, non-
audiologists, students and associations.
◦ The pros and cons of the Au.D have been disputed; the
rationale, implementation and outcomes have been
debated; and importantly, the wisdom of the decision has

24.  The Scope of Practice describes the range of interests,
capabilities and professional activities of audiologists.
 It defines audiologists as independent practitioners and
provides examples of settings in which they are
engaged.
 The principle is that members of the Academy will
provide only those services for which they are
adequately prepared through their academic and clinical
training and their experience, and that their practice is
consistent with the Code of Ethics of the American
Academy of Audiology.
Scope of Practice:Scope of Practice:

25.  The scope of practice should be kept relevant and
updated (Bergen, 2003).
 Changes within the profession (due to emerging clinical,
technological and scientific developments), changes in
related professions and changes in the larger healthcare
arena results in changes to the scope of practice.
 When challenged, a profession must be prepared to
defend itself with evidence of qualifications and
competencies through documentation of adequate
academic preparation and experience.

26.  Due to the expanding scope of practice of
audiology, academic preparation must
constantly be evaluated
 Interestingly, the scope of practice makes no
mention of cerumen management, which is
included in the scope of practice for audiologists
in the United States.
 The minimum competencies laid out by the
HPCSA require that newly qualified audiologists
have practice management skills.

28.  According to the Professional Board, the following
professional tasks should be excluded from the minimum
competencies of a newly qualified audiologist:
􀂃the mapping of clients with cochlear implants;
􀂃the management of balance and other vestibular
disorders;
􀂃language and speech disorder due to some cause
other then hearing loss;
􀂃fluency disorders;
􀂃dysphagia;
􀂃neuromotor disorders;
􀂃voice disorders and
􀂃communicative disorders that require augmentative
and alternative communication using high level
technological devices.

29.  According to the Standards Generating Body, the
proposed four-year qualification exit competencies
compares favourably to similar qualification in the United
Kingdom, Australia and New Zealand and is thus
internationally recognized.
 This appears contradictory in that a Masters degree is
the minimum entry-level into practice in Australia.

30.  Are as o f practice include the audio lo g ic ide ntificatio n,
asse ssm e nt, diag no sis and tre atm e nt o f individuals with
im pairm e nt o f audito ry and ve stibular functio n,
pre ve ntio n o f he aring lo ss, and re se arch in no rm aland
diso rde re d audito ry and ve stibular functio n.
 The practice o f audio lo g y include s:
Identification
Audio lo g ists de ve lo p and o ve rse e he aring scre e ning
pro g ram s fo r pe rso ns o f allag e s to de te ct individuals
with he aring lo ss. Audio lo g ists m ay pe rfo rm spe e ch o r
lang uag e scre e ning , o r o the r scre e ning m e asure s, fo r
the purpo se o f initialide ntificatio n and re fe rralo f pe rso ns
with o the r co m m unicatio n diso rde rs.
.

31.  Assessment andDiagnosis
Asse ssm e nt o f he aring include s the adm inistratio n and
inte rpre tatio n o f be havio ral, physio aco ustic, and
e le ctro physio lo g ic m e asure s o f the pe riphe raland
ce ntralaudito ry syste m s. Asse ssm e nt o f the ve stibular
syste m include s adm inistratio n and inte rpre tatio n o f
be havio raland e le ctro physio lo g ic te sts o f e q uilibrium .
Asse ssm e nt is acco m plishe d using standardiz e d te sting
pro ce dure s and appro priate ly calibrate d instrum e ntatio n
and le ads to the diag no sis o f he aring and/o r ve stibular
abno rm ality

32.  Treatment
◦ The audiologist is the professional who provides the full
range of audiologic treatment services for persons with
impairment of hearing and vestibular function.
◦ The audiologist is responsible for the evaluation, fitting,
and verification of amplification devices, including
assistive listening devices.
◦ The audiologist determines the appropriateness of
amplification systems for persons with hearing
impairment, evaluates benefit, and provides counselling
and training regarding their use.
◦ Audiologists conduct otoscopic examinations, clean ear
canals and remove cerumen, take ear canal impressions,
select, fit, evaluate, and dispense hearing aids and other
amplification systems.
◦ Audiologists assess and provide audiologic treatment for
persons with tinnitus using techniques that include, but
are not limited to, biofeedback, masking, hearing aids,
education, and counselling.

33. ◦ Audiologists also are involved in the treatment of
persons with vestibular disorders. They participate as
full members of balance treatment teams to
recommend and carry out treatment and rehabilitation
of impairments of vestibular function.
◦ Audiologists provide audiologic treatment services for
infants and children with hearing impairment and their
families. These services may include clinical treatment,
home intervention, family support, and case
management.

34. ◦ The audiologist is the member of the implant team (e.g.,
cochlear implants, middle ear implantable hearing aids,
fully implantable hearing aids, bone anchored hearing
aids, and all other amplification/signal processing
devices) who determines audiologic candidacy based on
hearing and communication information. The audiologist
provides pre and post surgical assessment, counseling,
and all aspects of audiologic treatment including auditory
training, rehabilitation, implant programming, and
maintenance of implant hardware and software.
◦
The audiologist provides audiologic treatment to persons
with hearing impairment, and is a source of information
for family members, other professionals and the general
public. Counseling regarding hearing loss, the use of
amplification systems and strategies for improving
speech recognition is within the expertise of the
audiologist. Additionally, the audiologist provides
counseling regarding the effects of hearing loss on
communication and psycho-social status in personal,
social, and vocational arenas.

35. ◦ The audiologist administers audiologic identification,
assessment, diagnosis, and treatment programs to
children of all ages with hearing impairment from birth
and preschool through school age. The audiologist is an
integral part of the team within the school system that
manages students with hearing impairments and
students with central auditory processing disorders. The
audiologist participates in the development of Individual
Family Service Plans (IFSPs) and Individualized
Educational Programs (IEPs), serves as a consultant in
matters pertaining to classroom acoustics, assistive
listening systems, hearing aids, communication, and
psycho-social effects of hearing loss, and maintains both
classroom assistive systems as well as students'
personal hearing aids. The audiologist administers
hearing screening programs in schools, and trains and
supervises non audiologists performing hearing
screening in the educational setting.

36.  Hearing Conservation
The audiologist designs, implements and coordinates
industrial and community hearing conservation
programs. This includes identification and amelioration
of noise-hazardous conditions, identification of hearing
loss, recommendation and counseling on use of hearing
protection, employee education, and the training and
supervision of non audiologists performing hearing
screening in the industrial setting.
 Intraoperative Neurophysiologic Monitoring
Audiologists administer and interpret electrophysiologic
measurements of neural function including, but not
limited to, sensory and motor evoked potentials, tests of
nerve conduction velocity, and electromyography. These
measurements are used in differential diagnosis, pre-
and postoperative evaluation of neural function, and
neurophysiologic intraoperative monitoring of central
nervous system, spinal cord, and cranial nerve function.

37.  Research
Audiologists design, implement, analyze and interpret
the results of research related to auditory and balance
systems.
 Additional Expertise
Some audiologists, by virtue of education, experience
and personal choice choose to specialize in an area of
practice not otherwise defined in this document. Nothing
in this document shall be construed to limit individual
freedom of choice in this regard provided that the activity
is consistent with the American Academy of Audiology
Code of Ethics.

39.  Recent
 surveys indicate 21% of audiologists report their full-
time
 primary work setting as “private practice”, and 14% list
 themselves as practice owners.4,5 This means that as
much
 as 80 – 85% of audiology services in the United States
are
 owned and controlled by non-audiologists.

40.  Audiology and healthcare are continually impacted by internal
 and external forces, including government regulations,
 industry consolidation, corporate buyouts, educational
 requirements, and changing scopes of practice. Therefore,
 constant adaptation is necessitated by the dynamic forces
 which exist within our professional environment. Since the
 late 1980s, audiology has continued to transition in an
 effort to achieve several goals. These goals include: effecting
 changes in the Standard Occupational Classification
 Code; becoming an autonomous profession; becoming a
 doctoring profession; obtaining Limited Licensure
 Practitioner status; developing an enriched curriculum with
 the Au.D degree; and acquiring Direct Access to audiology
 services by Medicare recipients. Significant progress has
 occurred towards accomplishing these goals.

41. Types: Self Employment
 The Small Business Administration (SBA) makes a
distinction between “self-employment” versus “wage-
employment”. Self-employment is synonymous with
practice ownership. Practice ownership represents a
broad description of how audiology doctors practice, now
and in the future. Individual practices may vary in type
and scope of services, ranging from a general practice
covering a range of diagnostic and therapeutic services
for a large patient demographic, to a more specific
specialty practice. Practice ownership takes many
business forms, such as:
◦ solo practice,
◦ partnerships or
◦ group practice models that may involve other
audiologists or interdisciplinary partners (e.g. ENT
physicians, optometrists, and physical therapists), as
well as various corporate structures.

42.  Practice activities may involve part-time or full-time work.
 Practice owners may also provide services to hospitals
and clinics.
 Even public schools can be served by practice owners
through contractual relationships rather than by wage-
employed audiologists.
 Practice owners are autonomous, practice
independently, and have an equity position in the
practice.

43. Wage-employment
 Wage employment means working for a
wage and without an equity position in the
practice setting.
 Clinical rotations refer to the experience of
earning academic credit and receiving
clinical training in varied types of clinical
settings, internships and externships by
an Au.D. student.
Clinical Rotation

44. Professional Socialization:
 Professional socialization is the
process by which individuals acquire,
through the educational and the post-
graduate professional environments,
specific characteristics, knowledge,
skills, attitudes, values and norms
regarding their professional roles.

45.  The Profession
◦ Increased public rcognition of audiology
◦ Improved inter-professional relationships with other
healthcare providers
◦ Maintenance of indendepndent clinical decisio making
and responsibility for the audiology care provided to
patients
◦ Better positioning to complete for strong pre-
professional students
 Au.D programs/ Faculty
◦ Better positioning to complete for strong pre-
profesional students
◦ Increased alumini support
◦ Higher availability of preceptors for audilogy owned
practice rotations

46.  Practitioners
◦ Increased lifetime earning potential
◦ Independence
◦ Decision-making
◦ Increased Earnings
◦ Autonomy
 Students
◦ Audiology students will benefit from an enhanced
curiculum to include practice development and
management course work as well as clinical rotation
experiences in aduiologist owned practices.

47. Audiologist Certification
 The audiology field is regulated by a range of
certification bodies. Audiology education programs,
professional licensing and certification based on
academic and professional excellence are governed by
state bodies, as well as by professional organizations.
Certain forms of certification are mandatory, while others
are voluntary.
Read more
http://www.ehow.com/info_8072714_audiologist-certification.h

48.  Certified Training
All audiologists are required to have a doctorate degree to
practice. Doctorate degrees in audiology, often
abbreviated Au.D., must be approved by the American
Speech-Language-Hearing Association's, or ASHA's,
Council on Academic Accreditation. If the doctorate
degree isn't certified, it's not possible to become an
ASHA-certified audiologist. Two types of doctorate
programs are approved: A clinical doctorate is focused
more on clinical practice; the research doctorate is more
academically oriented. For those who wish to work in a
doctor-patient setting, the clinical doctorate is needed.
 Audiologist Licensing
All 50 states regulate audiology licensing. The
requirements for licensing vary by state; however; states
usually require audiologists to periodically renew their
licenses through continuing education. In New York
State, for example, audiologists must renew their
licenses every three years. Certain states require
audiologists to hold a hearing-aid dispenser license.
Audiologist licenses may be verified with each state's
department of licensure.

49.  The Certificate of Clinical Competence in Audiology
Audiologists may wish to apply for a Certificate of Clinical
Competence in Audiology, or CCC-A, from the American
Speech-Language-Hearing Association, which signifies a
certain level of academic and professional excellence.
Holders of a CCC-A typically have skills and experience
that go beyond state licensure requirements. In addition
to completing an ASHA-certified program, applicants
must demonstrate their academic worth by supplying
academic transcripts. A letter of reference from the
program's director must signify that the applicant has a
superior knowledge of the skills needed to become CCC-
A certified.
 American Board of Audiology Certification
Obtaining certification from the American Board of
Audiology, or ABA, signifies a lifelong achievement in the
field. Unlike the CCC-A, ABA certification is based on an
individual's employment history. In addition to a
doctorate degree, more than 2,000 hours of mentored
professional practice must be completed. Audiologists
must recertify every three years. Recertification requires
at least 60 hours of continuing education and adherence
to the ABA code of ethics.

50.  American Speech-Language-Hearing Association
Certification
The ASLHA is one of two audiologist certification boards in
the U.S. Their certification requires at least 75 hours of
study in a program that will culminate in a doctoral
degree; as of 2012, it will require a doctorate. A score of
600 or higher on the Praxis exam in Speech Pathology
and Audiology is also required.
The ASHLA's certification is good for three years, after
which it must be renewed.
 American Board of Audiology Certification
The ABA is the U.S.'s other audiology certification board.
They require at least a doctoral degree in audiology, a
Praxis exam score of 600 or higher and, according to
their site, "a minimum of 2,000 hours of mentored
professional practice in a two-year period. The mentor
must be a state licensed or ABA certified audiologist."
Like the ASHLA, the ABA requires certification-holders to
renew every three years.
ABA certification is good for three years, after which it
must be renewed.
