Audiologic Care and the National Academies of Practice

by Brenna Carroll, AuD • Nancy Green, AuD • Carrie Meyer, AuD

What is Audiologic Care?
Audiologic care is the protection, preservation, evaluation and treatment of the hearing and balance functions of the human audio-vestibular system, provided only by audiologists, either individually or as part of a health care team, who use their professional skills to improve the quality of life for each patient. Audiologists also provide programming and patient training in the use of hearing aids, surgically implanted devices such as cochlear implants, and assistive listening devices.

With whom do audiologists collaborate?
Because hearing is an integral part of effective communication as well as health, audiologists collaborate with every health profession represented by the National Academies of Practice. Interprofessional collaboration allows audiologists to provide the most effective, highest quality patient-centered care.

Where do audiologists practice?
Audiologists provide services in a wide range of settings, including private practice, hospitals, clinics, and schools. Additionally, audiologists work as clinicians and faculty in university programs. Audiologists also work as researchers, as clinical support for hearing aid and equipment manufacturers, and as an integral part of hearing conservation programs in industry and the military.

What is the education and training to become an audiologist?
Audiologists must complete a post baccalaureate Doctor of Audiology (AuD) degree program, including a full-time externship during the final year of the AuD program. To be licensed in most states, AuD students must pass the national examination in audiology (PRAXIS).

Audiologic Care and Interprofessional Collaboration
The National Academies of Practice mission includes patient-centeredness. Audiologists provide front-line, often first-contact, comprehensive care when working with other health care professionals to address whole-person health. This article highlights audiologic care and demonstrates the audiologist’s critical and fundamental role in multidisciplinary teams.

Diagnostic Assessment
When performing diagnostic hearing assessments, an audiologist may collaborate with various health care professionals to diagnose the type, degree, and etiology of hearing loss.

• Physicians: Audiologists collaborate with physicians to diagnose medically manageable conditions affecting hearing.
• Nurses: Audiologists coordinate with nurses who assist in patient care, often by providing care coordination in a medical setting, including scheduling for lab work, imaging, genetic testing, and aftercare following medical and surgical treatments.
• Dentists: Audiologists collaborate with dentists to refer patients for evaluation when disorders of the teeth or jaw are impacting ear function, including temporomandibular joint dysfunctions, otalgia, and tinnitus.
• Optometrists: Audiologists partner with optometrists to treat visual impairments, especially dual sensory loss, which affect a patient’s ability to communicate effectively or to use amplification devices.
• Nutritionists and Dietitians: Nutritionists and dietitians can provide audiologists with recommendations for patients with auditory dysfunction that can be improved by changes in diet.
• Multidisciplinary Team: Clinical audiologists often work as members of a multidisciplinary team that may include psychologists, social workers, and occupational therapists. The team approach ensures comprehensive care and addresses all aspects of a patient’s communication and health care needs.

Collaboration among these professionals ensures that patients with hearing loss and other auditory dysfunction receive comprehensive care. From initial evaluation and diagnosis through medical or surgical treatment, fitting with amplification, rehabilitation, and ongoing management, multidisciplinary collaboration results in improved patient outcomes for patients with auditory dysfunction and/or hearing loss.

Balance Disorders
Audiologists treating patients with balance disorders or vestibular dysfunction provide services in collaboration with other professionals to provide comprehensive assessment and to develop a complete treatment plan. Because vestibular dysfunction is a complex, multi-sensory organic disorder, assessment, and management by a multidisciplinary team of professionals is the key to successful recovery for these patients.

• Physical Therapists: Audiologists are critical partners with physical therapists in the assessment and treatment of the visual, auditory/vestibular, and somatosensory/musculoskeletal systems and their dysfunction given that the balance system is made up of visual, auditory/vestibular, and somatosensory/musculoskeletal systems.
• Occupational Therapists: Because balance dysfunction impacts a patient’s ability to function at home and on the job, audiologists collaborate closely with occupational therapists to assist the patient to accommodate balance dysfunction in all environments.
• Podiatrists: Somatosensory dysfunction is a common cause of balance disorders. Audiologists collaborate with podiatrists, other professionals, and the patient to treat foot and ankle dysfunctions impacting balance.
• Optometrists: Visual function is critical to balance. An audiologist collaborates with optometrists, other professionals, and the patient to treat vision dysfunction and to integrate improved visual function into the balance treatment program.
• Athletic Trainers: Concussions are a common cause of balance dysfunction. Audiologists provide support and management to athletic trainers as they assist athletes struggling to recover from concussions, TBI, and associated balance disorders.
• Dieticians: Audiologists may consult dieticians to assist with dietary management for some balance disorders, including Meniere’s disease.
• Multidisciplinary Team: Patient care provided by a team of specialists, including audiology, will ensure a more accurate diagnosis and targeted rehabilitation program.

Tinnitus
Tinnitus (noises in the ear(s) or head) is a condition impacting a patient’s hearing and mental health, social and professional relationships, and quality of life. Audiologists are specialists in assessment of the auditory system and management of tinnitus. Successful treatment of tinnitus requires a multidisciplinary approach as it encompasses not only audition, but also emotional and psychological components.

• Psychologists: Most patients with tinnitus can be managed with an audiological assessment and treatment of the underlying auditory dysfunction, though many patients require additional support, which may include cognitive behavioral therapy.
• Physicians: Audiologists refer tinnitus patients to physicians for medical management of their condition, including prescription of medications.
• Pharmacists: Many medications can cause or exacerbate tinnitus. Audiologists collaborate with pharmacists to complete thorough reviews of medications during the management of tinnitus patients.
• Nutritionists/Dietitians: Audiologists collaborate with nutritionists and dietitians in the management of patients with conditions associated with tinnitus (e.g., Meniere’s disease) that are known to respond well to management of diet for potential triggers.
• Multidisciplinary Team: Compassionate and appropriate tinnitus treatment must start with an audiologist, physician, pharmacist, psychologist, nurse case manager, and other professionals as appropriate for the specific patient condition.

Amplification: Hearing Aids, Assistive Listening Devices and Connectivity
Audiologists can uniquely assist their National Academies of Practice colleagues with issues related to electronic and digital forms of amplification and hearing improvement using various technologies.

• Physicians: Audiologists assist physicians with tools that include amplified and Bluetooth stethoscopes that connect and stream to personal hearing aids. Audiologists can also assist in fitting appropriate earmolds to couple with acoustic medical tools.
• Dentists: Audiologists fit custom-filtered hearing protection devices for those in the dental profession for hearing loss prevention.
• Nurses: Audiologists assist nurses with tools that include amplified and Bluetooth stethoscopes that connect and stream to personal hearing aids. Audiologists also assist in fitting appropriate earmolds to couple with acoustic medical tools.
• Veterinarians: Audiologists collaborate with veterinarians in research or specific cases involving animals with hearing-related issues.
• Optometrists: Audiologist can assist optometrists with appropriately fit amplification to assist speech understanding in conditions with limited lighting while performing optic exams.
• Physical Therapists: Audiologists provide amplification and lapel microphones to allow physical therapists to hear patients when a clear line of sight is not available to utilize visual speech cues.
• Occupational Therapists: Audiologists provide amplification and lapel microphones to allow occupational therapists to hear patients when a clear line of sight is not available to utilize visual speech cues.
• Psychologists: In addition to providing amplification for soft-spoken patients, audiologists assist with streaming tools for telehealth visits.

Implantable Devices
Some audiologists specialize in the assessment, programming, and management of implantable hearing devices such as cochlear implants and osseointegrated devices. Common interdisciplinary collaboration includes physicians, psychologists, nurses, and speech-language pathologists. Together, these professionals ensure that patients receive comprehensive care from initial evaluation through surgery, rehabilitation, and long-term management. Collaboration is crucial to achieving optimal outcomes for patients who benefit from implantable devices.

• Physicians: Audiologists work closely with physicians to ensure a patient is a suitable candidate for an implant and provide pre-operative counseling. Physicians (typically an otolaryngologist), medically evaluate a patient's candidacy for implantable devices, perform the surgical implantation, and manage any medical conditions related to the implant. Audiologists also collaborate on post-operative care and adjustments.
• Nurses: Nurses assist during the surgical procedure, provide post-operative care, and educate patients and families on wound care, medications, and any potential complications. They also assist in monitoring patients' overall health during follow-up appointments.
• Speech-Language Pathologists: An audiologist collaborates with a speech-language pathologist to assess the patient's speech and language development pre- and post-implantation. They work together to develop and implement rehabilitation plans, including auditory training and speech therapy to maximize the patient's ability to understand spoken language.
• Multidisciplinary Team: The audiologist is a part of a multidisciplinary team that may include psychologists, social workers, educational professionals, and occupational therapists. This team approach ensures comprehensive care, addressing all aspects of the patient's development and quality of life.

Pediatric Audiology
A pediatric audiologist collaborates with various healthcare professionals to ensure comprehensive care for children with hearing related concerns, and that the care addresses both medical and developmental aspects effectively.

• Physicians: Audiologists collaborate with physicians who may coordinate referrals, imaging, and genetic tests to diagnose underlying conditions affecting hearing. Additionally, physicians treat hearing loss conditions that can be medically managed through medication and surgical intervention.
• Nurses: Audiologists collaborate with nurses who assist in patient care by providing coordination in a medical setting. Examples include coordination for newborn hearing screening, coordination for diagnostic hearing testing post-surgical interventions, and coordination for in-patient assessment when ototoxic medication is administered. Some nurses may conduct hearing screenings in conjunction with well patient visits or conduct screenings in public elementary schools.
• Speech-Language Pathologists: Audiologists work closely with speech-language pathologists to assess and treat speech and language delays associated with hearing loss.
• Occupational Therapists: Audiologists collaborate with occupational therapists on developmental issues related to hearing loss that may impact a child’s motor skills or daily activities.
• Social Workers: Audiologists collaborate with social workers who provide counseling, support, and resources for families coping with hearing loss and connect them with community services.
• Optometrists: Audiologists collaborate with optometrists to treat visual impairments that may affect a child’s learning or development in conjunction with hearing concerns; specifically, syndromes that include hearing and visual co-morbidities.
• Respiratory Therapists: Audiologists collaborate with respiratory therapists to coordinate care when hearing impairments are present alongside respiratory issues.
• Dentists: Audiologists collaborate with dentists to assess and treat oral health issues that can be interlinked with hearing concerns.

Educational Audiology
Educational audiologists provide hearing services to children in an educational setting. In addition to diagnosing, managing, and treating hearing loss, educational audiologists work as part of a school multidisciplinary team and provide specialized hearing assessments focused on improving educational performance. They maintain and update students’ hearing aids, fit and manage assistive technology and provide additional support, advocacy and resources to individual students and the school system. Hearing loss has a significant impact on all aspects of educational achievement. Collaboration among professionals will enable students with hearing loss to function successfully in personal, educational, and work settings.

• Occupational Therapists: Audiologists collaborate with occupational therapists as they work with hard of hearing students to address their physical, cognitive, and psychosocial needs in the educational setting, assisting with academics, social participation, and work skills development.
• Social Workers: Audiologists and social workers assist hard of hearing students and their families in support of the student’s behavioral and emotional health.
• Speech-Language Pathologists: Hearing loss has a significant impact on speech and language development. Audiologists work closely with speech-language pathologists assisting hard of hearing students as they improve their speech production, language, and communication skills.
• Optometrists: Vision is critically important to hard of hearing students’ ability to function in the classroom. Audiologists collaborate with optometrists as they work with students who are hard of hearing to ensure they can see clearly and use their vision to support their oral/aural learning and communication skills.
• Multidisciplinary Team: Because hearing loss affects all aspects of a student’s academic and social life, assessment, and treatment by a multidisciplinary team of professionals is the key to successful management for these patients.

Auditory Processing Disorder
Auditory processing disorder (APD) is a term used to describe a spectrum of auditory challenges rather than a single distinct disorder. According to the American Speech-Language-Hearing Association (ASHA), “central auditory processing consists of mechanisms that preserve, refine, analyze, modify, organize, and interpret information from the auditory peripheral system. These mechanisms underlie skills such as auditory discrimination, temporal aspects of audition, and binaural processing (ASHA, 1996; Bellis, 2011; Chermak & Musiek, 1997).”  Treatment varies by individual and focuses on managing the acoustic environment, learning to use other skills to compensate for APD, and remediation of the auditory deficit. A multidisciplinary approach is key to assessing and managing APD, however the diagnosis of APD can only be made by an audiologist.

• Occupational Therapists: Audiologists collaborate with occupational therapists to assist patients with APD to develop compensatory strategies for the classroom, strengthen academic skills, improve social function and interactions, and strategize and create work skills.
• Speech Pathologists: Audiologists work with speech pathologists to assist students with APD to use electronic devices that assist listening (FM/DM systems), coordinate with teachers to improve delivery of information, and find other methods of optimizing the classroom and other learning environments to help the student with APD better focus their attention in the classroom. 
• Optometrists: Because patients with APD struggle with processing auditory information, they rely heavily on their vision. Audiologists and optometrists work together to ensure that patients with APD have regular vision exams and up to date prescriptions for glasses or contact lenses.

Industrial Audiology/Hearing Loss Prevention
Industrial audiologists are uniquely qualified to provide services to noise-exposed workers in manufacturing, mining, and transportation, their employers, schools, and individuals. They also provide these individuals and organizations with information, protective devices, noise measurement, and hearing testing designed to minimize the effects of hazardously loud noise exposures.

• Physicians: Audiologists collaborate with physicians in occupational hearing conservation programs in the workplace to help determine the differences between medically manageable hearing loss and noise-induced hearing loss. Physicians provide medical treatment for non-work-related hearing loss.
• Nurses: Nurses, particularly occupational health nurses, are often trained by an industrial audiologist to perform basic audiometric procedures at worksites, local one-stop clinics, or in mobile units.
• Audiologists: Audiologists collaborate with local clinical colleagues to have complete audiologic evaluations performed for workers who may have noise-induced hearing impairment due to workplace noise. Clinical audiologists also provide custom-made hearing protectors for hard-to-fit workers, hunters, and musicians. Schools consult with audiologists in efforts to reduce noise in cafeterias, and metal/wood/auto workshop classes to reduce noise exposures to students and faculty.
• Dentists: Audiologists provide dentists with information on patient hearing loss from noise exposure from the use of dental equipment such as drills, and the cumulative effects of noise on the hearing of dentists themselves.
• Respiratory Therapists/Occupational Therapists/MRI Technicians and others: Audiologists provide information on noise exposure for many types of health care workers who operate equipment on a routine basis that may be hazardous to hearing upon prolonged exposure and provide appropriate hearing protection devices to reduce the exposure.

Ototoxicity (Medications and Chemicals)
Audiologists coordinate closely with pharmacists, physicians, and nurses to monitor ototoxicity, to minimize the potential damage to the auditory system caused by certain medications or chemicals and optimize outcomes.

• Pharmacists: Pharmacists play a crucial role in identifying medications that have potentially ototoxic effects. They provide information to audiologists and physicians about the drugs prescribed to patients that may affect hearing or balance. Pharmacists also help monitor medication adherence and any adverse effects reported by patients.
• Physicians: Physicians, especially oncologists and hospitalists, prescribe medications that can impact hearing and balance and consult with audiologists to assess the risk of ototoxicity based on the patient's medical history, current medications, and the need for ongoing monitoring. Physicians may adjust medication dosages or adjust medications if ototoxic effects are suspected or confirmed.
• Collaborative Practices: Audiologists coordinate with these healthcare professionals through several practices:
• Medication Review: Regular review of medications by audiologists in collaboration with pharmacists and physicians to identify potential ototoxic medications and assess the risk for each patient.
• Baseline and Ongoing Testing: Conducting baseline hearing tests before ototoxic medications are administered and regular monitoring thereafter to detect any changes in hearing acuity or balance.
• Patient Education: Educating patients and caregivers about the signs and symptoms of ototoxicity, emphasizing the importance of reporting any changes in hearing, tinnitus, and/or balance promptly.
• Reporting and Documentation: Audiologists communicate findings to physicians and nurses through detailed reports, ensuring all healthcare team members are informed of any concerns regarding ototoxicity.
• Multidisciplinary Communication: Regular meetings and discussions among audiologists, pharmacists, and physicians to review cases, discuss treatment plans, and address any issues related to ototoxic monitoring.

End of Life/Hospice
When working with patients in hospice care, audiologists improve communication to assist patients when they have important conversations with their family, loved ones, and medical care providers. Hearing aids and assistive listening devices can be used so patients can participate in their care and connect them with their families and friends in their final days.

• Physicians: Physicians working in hospice care need to be aware that hearing loss impacts quality of care and that most elderly patients and other patients in hospice care will have some degree of hearing loss. Audiologists collaborate with physicians by improving communication techniques and utilizing assistive listening devices that markedly improve bedside hearing and communication with caregivers.
• Nurses: Nurses working in hospices can facilitate communication by acquiring and maintaining assistive listening devices and, with the assistance of an audiologist, learning the basics of hearing aid use and maintenance to assist their patients.
• Social Workers: Social workers provide emotional, spiritual, and practical support to patients and their families at the end of life. Working with an audiologist, social workers assist families with hearing aids and assistive listening devices to improve communication and support the patient in their medical and legal decisions.
• Multidisciplinary Team: Care coordination with a multidisciplinary team creates an environment of support and encouragement for patients in hospice care. Using services provided by audiologists, all members of the patient care team can improve communication and relieve the isolation and frustration hearing loss can cause.

Emerging Trends in Audiology
Emerging trends in both hearing medicine and veterinary medicine are evolving rapidly due to advancements in technology and a deeper understanding of how hearing impacts overall health and well-being in both humans and animals. These emerging trends indicate exciting developments in both hearing medicine and veterinary medicine, driven by technological innovations, interdisciplinary collaboration, and a deeper understanding of the impact of overall hearing health on overall well-being.

Emerging Trends in Hearing Medicine

• Regenerative Medicine: Research in regenerative medicine aims to restore hearing through the regeneration of sensory hair cells in the inner ear and holds promise for future treatments for sensorineural hearing loss. Avian and piscine research has been very promising in this area.
• Assistive Technology: Innovations in hearing aids and communication devices for pets with hearing impairments are emerging, improving the quality of life for animals affected by deafness or hearing loss.
• Veterinary Audiology Specialists: The recognition of veterinary audiology as a specialized field is growing, with more veterinarians pursuing advanced training in audiology to better diagnose and manage hearing-related conditions in animals.
• Animal Audiology Certification: Audiologists can obtain additional education to become certified in the assessment of animal hearing. These audiologists can work in conjunction with veterinarians and other researchers to expand the treatment of audiologic pathologies. This can serve to raise awareness and clinical solutions for hearing loss in both animals and humans.

Conclusion
Hearing, hearing loss and balance dysfunction can impact all aspects of health throughout the human lifespan. Audiologists, as primary hearing care providers, work with professionals throughout the health care system to improve outcomes for patients affected by disorders of the auditory system. As research continues to demonstrate the importance of hearing and balance in whole person health, healthy aging, and prevention of injury, audiologists will remain a critical part of any interdisciplinary health team.