The ASA Professional Standards of Practice for Audiologists

March 1997

These Professional Standards of Practice constitute an official statement of The Audiological Society of Australia Inc. and were approved by the Federal Executive Council in 1996. The Professional Standards of Practice provide guidance for the professional of audiology. They were prepared by the Ethics And Standards Committee in consultation with the members of the ASA.

I. Introduction
II. Acknowledgments
III. Professional Standards of Practice

A. Guiding Principles
B. Fundamental Components of Professional Standards of Practice
C. Professional Standards of Practice: Procedures

1. Hearing Screening.
2. Standard Audiological Assessment.
3. Complex Audiological Assessment
4. Auditory Evoked Potential Assessment
5. Balance System Assessment
6. Electroneurography Assessment
7. Vestibulor Rehabilitation
8. Central Auditory Processing Testing
9. Tinnitus Assessment
10. Audiological Counselling
11. Consultation
12. Hearing Aid Assessment
13. Surgically-implanted Devices
14. Hearing Rehabilitation Assessment
15. Hearing Rehabilitation
16. Assistive Product Dispensing
17. Assistive Listening System/Device Selection
18. Sensory Aids and Surgically-implanted Devices Assessment
19. Device Fitting/Orientation
20. Follow-Up Procedures
21. Product Repair/Modification
22. Neurophysiologic Assessment Intraoperative Monitoring
23. Prevention
24. Student Supervision

IV Glossary of Terms

Appendix 1: ASA Recommended Audiometric Symbols
Appendix 2: ASA Recommendation re: Cerumen Management
Appendix 3: ASA Code of Ethics

Not to be copied except with the permisslon of the FEC Audiological Society of Australia Professional Standards of Practice

II. Acknowledgments

This document is the result of two years of intensive and dedicated work by approximately one hundred ASA members, as well as numerous advisers. The collation and preparation of the Standards was coordinated by Pam Gabriels and Margaret Anderson as part of their FEC portfolio of Ethics and Standards.

B. Fundamental Components of Professional Standards of Practice

Clinical Process

Procedures are conducted m the client's/patient's chosen communication mode and linguistic system. (Including access to interpreters where required).

An essential component of each procedure is client/patient and/or family/carer counselling, which may address the nature of the hearing loss or related disorder and its impact, and outcome of the procedure.

Procedures address client/patient and family/carer preferences, goals, and special needs. Materials and approaches used and products dispensed are appropriate to the client's/patient's chronological and developmental age, medical status, physical and sensory abilities, education, vocation, cognitive status and cultural/ethnic, social, and linguistic background.

Setting/Equipment Specifications

Equipment is maintained according to manufacturer's specifications and recommendations. Instruments are properly calibrated at recommended intervals and calibration records are maintained.

Safety and Health Precautions

All procedures ensure the safety of the client/patient and clinician and adhere to universal health precautions (e g, prevention of bodily injury and transmission of infectious disease).

Decontamination, cleaning, disinfection and sterilisation of multiple-use equipment before reuse is carried out according to facility-specific infection control policies and procedures, and according to manufacturer's instructions.

There is a monitoring procedure to ensure these procedures are followed by all clinical and ancillary staff.

Documentation

Audiologists prepare, sign and maintain, within an established time frame, documentation that reflects the nature of the professional service. When appropriate and with written consent, reports are distributed with all necessary identifyng information.

Except for screenings, documentation addresses the type and degree of hearing loss and associated conditions.

Documentation includes identification information, relevant history, results of previous screening, assessment, and rehabilitation if available.

Results of assessment and proposed management are discussed with the client and reported to the referra1 source when the referrer is another professional. They may also be reported to the client's family/carer or carer (if appropriate).

C. Professional Standards of Practice: Procedures

1. Hearing Screening
Pass-fail procedures to identify individuals who require further audiological assessment

Expected Outcome(s)

Hearing screening identifies those persons most likely to have auditory disorders that may interfere with their education, health, development or communication.

Screening may result in recommendations for rescreening, standard or complex audiological assessment, or in referral for other examinations or services.

Clinical Indications

Individuals of all ages are screened as needed, requested, or mandated, or when they have conditions that place them at risk for hearing loss.

Clinical Process

Neonates at risk for auditory disorders will receive audiological screening by otoacoustic emissions and/or auditory brainstem response (ABR), SSEP and/or other appropriate electrophysiological tests.

Infants at risk are screened no later than three months after being identified. For infants less than six months of age, otoacoustic emissions testing and, if necessary ABR screening is recommended For infants older than six months, either behavioural testing, otoacoustic emissions testing, or ABR is an appropriate screening approach.

For children under three years, the choice of behavioural auditory assessment and/or electrophysiological procedures must be based on the individual and the environment.

Clients/patients who fail the screening are referred for further standard or complex assessment.

Setting/Equipment Specifications

Hearing screening is conducted in a clinical or natural environment conducive to obtaining reliable, valid screening results.

Electroacoustic equipment and ambient noise meet manufacturers specifications and Australian/New Zealand standards for auditory assessment for hearing loss prevention purposes.

Documentation

Documentation contains identifying information, screening results, and recommendations, including the need for rescreening, assessment, or referral.

Related References

American Academy of Audiology. (1988). Position Statement on Early Identification of Hearing Loss in Infants and Children. Washington, DC: Author

Joint Committee on infant hearing (1991). 1990 Position Statement. ASHA 33 (Suppl) 5, 3-6.

National Institutes of Health USA. (1993). Early Identification of Hearing Impairment in Infants and Young Children (NIH Consensus Statement, Vol 11, No 1, pp. 1-24). Washington, DC: U.S. Government Printing Office.

Northern, J.L. & Downs, M.P. (1991). Hearing in Children (4th ed.). Baltimore, MD: Williams and Wilkins.

Standards Association of Australia. (1969). Reference Coupler for the Calibration of Earphones Used in Audiometry. (AS 243.3). Sydney, NSW: Standards House.

Standards Association of Australia. (1983). Audiometers. (AS 2586). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Reference Zero for the Calibration of Pure - Tone Audiometers. (AS 1591.2). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Wide Band Artificial Ear. (AS 1591.5). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Acoustics - Hearing Conservation. (AS 1269). Sydney, NSW: Standards House.

Standards Association of Australia. (1995). Reference Zero for the Calibration of Pure - tone Bone Conduction Audiometers. (AS 1591.1). Sydney, NSW: Standards House.

Standards Association of Australia. (1995). A Mechanical Coupler for Calibration of Bone Vibrators. (AS 1591.4). Sydney, NSW: Standards House.

Swigart, E.T. (Ed.). (1986). Neonatal Hearing Screening. San Diego, CA: College Hill Press.

2. Standard Audiological Assessment
Procedures to assess and monitor the status of the peripheral auditory system, which comprises the outer, middle and inner ear.

Expected Outcomes

Standard audiological assessment is conducted to quantify and qualify, by site of lesion, peripheral hearing loss on the basis of perceptual, physiologic, or electrophysiologic responses to acoustic stimuli.

Assessment may result in recommendations for further audiological assessment, rehabilitative.

Assessment, medical/educational referral, hearing aid/sensory assessment, hearing.

Rehabilitation, speech or language assessment, or counselling.

Clinical Indications

Individuals of all ages are assessed when a hearing loss is suspected.

Standard audiological assessment is prompted by referral, or by failure of a screening (see Standard 1) or by self referral.

Clinical Process

A case history is obtained, otoscopic evaluation performed and, if necessary the patient is referred for cerumen management.

Assessment may include:

• Air-conduction and bone-conduction pure-tone threshold measures with appropriate masking
• Word recognition and speech recognition/discrimination measures with appropriate masking
• Tympanometry, and reflexometry
• Auditory evoked potentials (when traditional audiometry cannot be employed)
• Evoked otoacoustic emissions
• Recently documented measurement procedures

Clients/patients with identified hearing loss receive follow-up services to monitor audiological status and to enable appropriate management decisions.

Setting/Equipment Specifications

Assessments are conducted with calibrated acoustic stimuli. Refer to AS 1269 Standards.

Electroacoustic equipment and ambient noise meet Australian Standards AS 1269-1989 and manufacturer's specification.

Documentation

Documentation addresses interpretation of test results and the type and severity of the hearing loss and associated conditions or disabilities.

Documentation contains identifying information, pertinent background information, assessment results, interpretation, and specific recommendations. Recommendations may address the need for further assessment, follow-up, or referral.

Related References

Standards Association of Australia. (1969). Reference Coupler for the Calibration of Earphones Used in Audiometry. (AS 1591.1). Sydney, NSW: Standards House.

Standards Association of Australia. (1983). Audiometers (AS 2586). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Reference Zero for the Calibration of Pure - Tone Audiometers. (AS 1591.2). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Wide Band Artificial Ear (AS 1591.5). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Acoustics - Hearing Conservation. (AS 1269). Sydney, NSW: Standards House

Standards Association of Australia. (1995). Reference Zero for the Calibration of Pure - Tone Bone Conduction Audiometers. (AS 1591.1). Sydney, NSW: StandardsHouse.

Standards Association of Australia. (1995). A Mechanical Coupler for Calibration of Bone Vibrators. (AS 1591.4). Sydney, NSW: Standards House.

3. Complex Audiological Assessment
Procedures to assess the status of the peripheral auditory system, the auditory nerve, and the central auditory nervous system or to establish the site of the auditory disorder. Also, procedures to determine the status of the auditory system in individuals whose developmental levels preclude use of a standard audiological assessment (see Standard 2.).

Expected Outcomes

Complex audiological assessment is conducted to quantify and quaIify hearing loss on the basis of perceptual, physiologic, or electrophysiologic response to acoustic stimuli. The assessment may also provide information as to the site of lesion.

Assessment may result in recommendations for further audiological assessment, medical/educational referral, hearing aid/sensory aid assessment, hearing rehabilitation assessment, speech and language assessment, developmental paediatric assessment or counselling.

Clinical Indications

Clients/patients are assessed on the basis of referral, case history, prior audiological assessment, or medical status.

Clients/patients difficult to test by other means.

Clinical Process

Case history is obtained. Otoscopic evaluation will be performed and, if necessary, cerumen management may be advised. Communication behaviours will be observed.

The assessment may include procedures contained in Standard 2.,

Standard Audiological Assessment.

Procedures to assess thresholds in young and/or developmentally delayed client/patients may include:

• developmentally appropriate behavioural procedures (eg. behavioural observation audiometry, visual reinforcement audiometry, play audiometry) using nonspeech and speech stimuli (eg. Kendall Toy Test, Nuchips).
• Reflexometry
• Auditory evoked potentials
• Auropalpebral Reflex Thresholds
• Evoked otoacoustic emissions

Procedures to assess cochlear versus retrocochlear (ie, eighth cranial nerve, brainstem,) auditory disorders may include:

• Reflexometry
• Auditory evoked potentials
• Speech audiornetry
• Evoked otoacoustic emissions

Procedures to assess central auditory nervous system disorders may include:

• Auditory evoked potentials
• Brief tone stimuli
• Distorted speech
• Dichotic stimuli
• Temporal ordering of stimuli
• Masking patterns
• Physiological measures of brain activity, including blood flow, metabolic rate, and electrical activity

Procedures for detecting or quantifying pseudohypoacusis may include:

• Comparing pure-tone averages and speech recognition thresholds
• Bekesy audiometry, including lengthened off-time (LOT) and Bekesy Ascending
• Delayed auditory feedback, including key tap procedures
• Stenger tests
• Reflexometry
• Auditory evoked potentials
• Evoked otoacoustic emissions

Recently documented measurement procedures may supplement assessment.

Clients/patients with identified hearing loss or auditory disorders receive follow-up services to monitor audiological status and to enable appropriate management.

Setting/Equipment Specifications

Assessments are conducted with calibrated acoustic stimuli (e g, pure tones, broadband noise).

Electroacoustic equipment and ambient noise meet ANSI and manufacturer's standards, where applicable.

Instrumentation is available for monitoring, recording, and reinforcing clients' responses.

Documentation

Documentation addresses interpretation of test results and the type and severity of the hearing loss or auditory disorder and associated conditions or disabilities.

Documentation contains identifying information, pertinent background information, assessment results, interpretation, prognosis and specific recommendations. Recommendations may address the need for further assessment, follow-up or referral. When hearing rehabilitation is recommended, information is provided concerning the frequency, estimated duration and type of service (e.g., individual, group, home program) required.

Related References

Standards Association of Australia. (1969). Reference Coupler for the Calibration of Earphones Used in Audiometry. (AS Z43.3). Sydney, NSW: Standards House.

Standards Association of Australia. (1983). Audiometers. (AS 2586). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Reference Zero for the Calibration of Pure - Tone Audiometers. (AS 1591.2). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Wide Band Artificial Ear. (AS 1591.5). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Acoustics - Hearing Conservation. (AS 1269). Sydney, NSW: Standards House.

Standards Association of Australia. (1995). References Zero for the Calibration ofPure - Tone Bone Conduction Audiometers. (AS 1591.1). Sydney, NSW: Standards House.

Standards Association of Australia. (1995). A mechanical Coupler for Calibration of Bone Vibrators. (AS 1591.4). Sydney, NSW: Standards House.

4. Auditory Evoked Potential Assessment
Procedures to assess auditory function using electrophysiologic methods

Expected Outcomes

Auditory evoked potential (AEP) assessment indicates the clinical status of the auditory neural pathway and associated sensory elements.

Neurophysiologic information assists in differential diagnosis and in estimating hearing threshold sensitivity.

Assessment may result in recommendations for treatment, follow-up or in referral for other services.

Clinical Indications

Auditory evoked potential procedures may be indicated for clients/patients of all ages with signs, symptoms or complaints for whom central or peripheral auditory nervous system disease or disorder is suspected.

Auditory evoked potential assessments are indicated for objective evaluation of auditory sensitivity or function. Evaluations are conducted with clients/patients who are difficult to test by conventional behavioural methods to supplement behavioural information or to resolve conflicting information.

Clinical Process

Client/patient is prepared for the procedure using recording electrodes applied with accepted techniques.

Traditional AEP procedures include:

• Electrocochleography (ECochG)
• Auditory brainstem response (ABR)
• Short latency response (SLR)
• Middle latency response (MLR)
• Late/long latency response (LLR)

Meaningful data descriptors are extracted from the electrophysiologic response. These data are compared with normative data.

When testing under sedation relevant guidelines should be followed.

Setting/Equipment Specifications

Power-line-operated instruments conform to minimum ANSI safety requirements.

Recording and stimulating electrodes conform to acceptable sterile conditions.

AEP testing is conducted in an environment that is satisfactorily free of electrical interference so as not to affect the measurement of responses. When determining thresholds with AEP methods, ambient noise levels meet ANSI specifications. Safety and Health Precautions

AC-line-powered equipment is grounded adequately for both equipment and client/patient.

The professional performing the procedures knows facility-specific emergency medical protocols.

Documentation

AEP equipment, electrode types and sites, acoustic transducers, and stimulating and recording parameters are specified in wnting at the time of the procedure.

Clinical events (e.g., client/patient sleep status, sedation, procedural problems, client/patient comments) are recorded at the time of the procedure.

Report includes an interpretation of AEP findings and recommendations.

Related References

National Acoustics Laboratories. (1988). NRB In Specifications for Audiometric Test Rooms. Sydney, NSW.

Standards Association of Australia. (1990). In Service Safety Inspection and Testing of Electrical Equipment. (AS 3760). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Hearing Conservation. (AS 1269). Sydney, NSW: Standards House.

5. Balance System Assessment
Procedures to assess and monitor the status of the peripheral or central vestibular system and the sensory or motor component of balance.

Expected Outcomes

Balance system assessment is conducted to:

• Detect pathology within the vestibular or balance system
• Determine probable site of lesion
• Monitor change in balance function and also to
• Determine the contribution of the visual, vestibular and proprioceptive systems to functional balance
• Determine coordinated recovery from induced sway

Assessment may result in recommendations for rehabilitation.

Clinical Indications

Individuals of all ages are assessed when they complain of balance dysfunction and/or abnormalities of gait or general assessment of cranial nerve function.

Balance system assessment is prompted by referral or by results of an audiological assessment (see Standard 2).

Clinical Process

Electrodes are placed strategically around the eyes and the cornea-retinal potential is used to record nystagmus and other eye movements (Electro-oculography) in response to the presence or absence of stimulation of the vestibular end organs and their central connections. Commonly only the horizontal plane is recorded. The assessment may also be performed using visual observations of eye movement during Electronystagmography.

ENG sub-tests include:

• Gaze test
• Saccade test
• Ocular pursuit test
• Optokinetic test
• Positional tests
• Dynamic positioning (Dix-Hallpike) test
• Bithermal caloric tests (and failure of fixation suppression (FFS) test)
• Torsion swing test
• Posturography

These procedures primarily focus on the horizontal semicircular canals, the superior branch of the vestibular nerves, and the vestibular and occular motor pathways in the brainstem and cerebellum.

Setting/Equipment Specifications

Power-line instruments for recording the corneo-retinal potential (e.g. electronystagmographs) and those for providing the caloric stimulation (either water or air irrigators) should conform to minimum ANSI safety requirements.

As with all potentials measured from the body, the environment should be satisfactorily free of electrical interference so not to adversely affect the measurement of the responses.

Calibration of eye movements prior to the assessment should occur in a standardised manner and calibration be repeated as appropriate during the procedures. Appropriate equipment to perform the sub-tests required should be available, e.g. a tracking/pursuit device, fixed points subtending required angles of eye movement, couch or chair with adjustable back.

A computerised rotary chair is used to measure phase, gain, and symmetry of the VOR and computerised dynamic posturography (CDP) employing computer-induced platform movements may be used with the above conditions.

Safety and Health Precautions

AC powered instruments should be checked regularly for adequate earth leakage in the event of malfunction as the client/patient is directly attached to electrical equipment in electro-oculography and water is employed during the procedures.

Recording electrodes should be single use/disposable or conform to acceptable sterile conditions. Caloric delivery probes should be sterile. If using water irrigation, the tanks should be cleaned and refilled daily.

Given the cardiac stimulation afforded by caloric irrigation, the professional performing the procedures knows appropriate emergency protocols.

Documentation

Equipment, electrode types, calibration values and course of the vestibular assessment should be documented at the time of the procedures.

Clinical events including client/patient comments should be recorded at the appropriate place in the assessment records.

Documentation contains identifying information, pertinent background information, contra-indications checks to caloric assessment, vestibular assessment results, interpretation and specific recommendations. Recommendations may address the need for further assessment, follow-up, referral, or vestibular rehabilitation therapy.

A report detailing the results and Interpretations with suggested recommendations is included.

Related References

Evans, K.M. & Melancon, B.B. (1989). Back to Basics: A discussion of Technique and Equipment. Seminars in Hearing, 10(2), 123-139.

Shepard, N.T. & Telian, S.A. (1996). Practical Management of the BalancedDisordered Patient. San Diego, CA: Singular Publishing.

Standards Association of Australia. (1990). In Service Safety Inspection andTesting of Electrical Equipment. (AS 3760). Sydney, NSW: Standards House.

Teter, D.L. (1983). The Electronystagmography. Test Battery and Interpretation. Seminars in Hearing, 4(1), 11-22.

6. Electroneurography Assessment
Procedures to assess facial nerve function using electrophysiological methods

Expected Outcomes

Electroneurography assessment indicates the clinical status of the facial nerve and associated motor elements.

Neurophysiological information assists in differential diagnosis and in estimating facial nerve function.

Assessment may result in recommendations for treatment, follow-up, or in referral for other services.

Clinical Indications

Electroneurography procedures may be indicated for clients/patients of all ages with signs, symptoms, or complaints for whom facial nerve disorder is suspected.

Electroneurography assessments are indicated for objective evaluation for facial nerve sensitivity or function.

Clinical Process

Client/patient is prepared for the procedure using recording electrodes applied with accepted techniques.

The facial nerve is stimulated using accepted stimulators and stimulating methods.

Meaningful data descriptors are extracted from the electrophysiological response. These data are compared with normative data.

Setting/Equipment Specifications

Power-line-operated instruments conform to minimum ANSI safety requirements.

Recording and stimulating electrodes conform to acceptable sterile conditions.

Testing is conducted in an environment that is satisfactorily free of electrical interference so as not to affect the measurement of the response.

Safety and Health Precautions

All monitoring equipment is grounded adequately for both equipment and client/patient.

The professional performing the procedure knows facility specific emergency medical protocols.

Documentation

Electroneurography equipment, electrode types and sites and stimulating and recording parameters are specified m writing at the time of the procedure.

Clinical events (e g client/patient status, procedural problems, client/patient comments) are recorded at the time of the procedure. - Report includes an interpretation of electroneurography findings and recommendations.

Relevant References

Standards Association of Australia. (1990). In service Safety Inspection and Testing of Electrical Equipment. (AS 3760). Sydney, NSW: Standards House.

9. Tinnitus Assessment
A procedure to identify individuals with tinnitus who require further investigation or treatment

Expected Outcomes

Tinnitus assessment identifies those persons most likely to have tinnitus interfering with their educational, health, developmental or communication needs.

Tinnitus assessment may result in recommendations for referral for other examinations and services.

Counselling of client/patient.

Clinical Indications

Individuals are assessed usually when the tinnitus is perceived to be a problem upon request or by referral.

Clinical Process

Case history is obtained and otoscopic examination performed.

Assessment may include:

• Air conduction (excluding masking)
• Bone conduction (excluding masking)
• Tinnitus pitch and loudness matching
• Testing for residual and partial residual inhibition
• Speech testing
• Impedance audiometry (excluding reflex testing)
• Masking of audiogram if required
• Distortion product otoacoustic emissions (if available)

Patient information.

Counselling.

Follow-up

Referral services if required .

Setting/Equipment Specifications

Assessments are conducted with calibrated acoustic stimuli.

Electro-acoustic equipment meets Standard AS2586-1983 types 1 and 2 only.

Ambient noise meets Clause of 5.1 AS 1269-1989.

Documentation

Documentation contains identifying information, pertinent background information, type of amplification systems/sensory aid used if applicable, assessment results, specific discussion of recommendations. Recommendations may address the need for further assessment, follow-up, fitting or referral.

Related References

Champlin, C.A., Muller, S.P. & Mitchell, S.A. (1990). Acoustic Measurements ofObjective Tinnitus. Journal of Speech and Hearing Research, 33(4), 16 - 21.

Gabriels, P. (1990). A Practical Guide to Fitting Tinnitus Instruments, The Hearing Journal, 43(2), 25-27.

Tyler, R.S. & Conrad - Armes, D. (1983). The Determination of Tinnitus Loudness Considering the Effects of Recruitment. Journal of Speech and Hearing Research, 26, 59 - 72.

Vernon, J. (1987). Assessment of the Tinnitus Patient. In Hazell, J. (Ed.). Tinnitus. Edinburgh; New York: Churhill Livingston.

10. Audiological Counselling
Procedures to facilitate the client's/patient's understanding, recovery from, or adjustment to, hearing loss, tinnitus and balance disorders. Specific purposes of counselling may be to provide patients and clients with information and support, to discuss appropriate hearing or tinnitus instruments and assistive listening devices, make appropriate referrals to other professionals, and to help clients/patients develop appropriate strategies to enhance communication.

Expected Outcome

Audiologists assist clients/patients and their families/carers to develop appropriate goals and strategies for adjustment to, or prevention of hearing loss.

Recommendations for further follow up, other examinations or referral to more specialised clinics where indicated.

Clinical Indications

Counselling services are offered as part of treatment or habilitation or rehabilitation protocols for hearing loss, tinnitus and balance disorders, for hearing conservation programs or upon request or referral.

Clinical Process

Counselling services for client/patient and their families/carers include:

• Discussion of habilitation and rehabilitation needs
• Provision of information
• Provision of appropriate hearing and tinnitus instruments and assistive listening devices
• Hearing conservation

Professionals are responsible for providing or referring the client/patient and family/carer for adequate counselling. Referrals to and consultation with medical practitioners, Ear Nose and Throat Specialists, and other professionals may be an integral component of counselling.

Setting/Equipment Specifications

Counselling is conducted in appropriately treated sound rooms and in a setting conducive to client/patient and family/carer comfort, confidentiality and uninterrupted privacy.

Documentation

Documentation includes identifying information, pertinent background information, results of tests, clients needs and agreed goals, and recommendations, including the need for further counselling or referral.

Related references

Dillon, H, Kontschoner, E, Battaglia, J., Lovegrove, R, Ginis, J, Mavvias, G, Carnie, L., Ray, P., Forsythe, L., Towers, E., Goulias, H & Macaskill, F. (1991). Rehabilitation Effectiveness - assessing the needs of clients/assessing outcomes for clients. The Australian Journal of Audiology. 13(2), 55-65.

Hodgson, W. R.(1994). Audiologic Counselling. In Katz, J. (Ed), Handbook of Clinical Audiology(4ih Edition). Baltimore, MD: Williams and Wilkins.

Martin, F.N., Abadie, K.T. & Descouzis, D. (1989). Counselling Families of Hearing Impaired Children. The Australian Journal of Audiology, 11(2), 41-54.

Molyneaux, D. (1990). Successful interactive skills for speech - language pathologists and audiologists. Rockville, MD: Aspen Publishing.

11. Consultation
Procedures to provide professional expertise that may include conferring with other professionals during case discussion and team conferences or in individual communication. providing information to business, industry, to the public, private agencies and to educational facilities. Involvement in program development and evaluation, supervisory activities and providing expert testimony may also be provided.

Expected Outcome

Information is provided about hearing and related disorders, and assessment and intervention strategies. Goals and expectations of consultation are variable and are negotiated between the consultant and consultee(s) for client/patient benefit.

Clinical Indications

Consultation services may be provided by arrangement or upon request and address:

• Prevention of hearing disorders
• Identification of persons at risk for hearing disorders
• Assessment, intervention plans, procedures and interpretation of results
• Environmental assessment and modification
• Equipment and material needs and/or modifications
• Program development, evaluation and management
• Quality assessment and improvement
• Education and advocacy
• Second opinion and/or independent educational evaluation
• Expert testimony

Clinical Process

Consulting activities may take many forms. The consultant:

• Gathers information through observations, interviews, assessments or other direct services, and reviews of records and materials
• Assesses the type and extent of assistance required
• Makes recommendations or provides information
• Provides monitoring and follow-up services
• Acts in an advisory capacity to Government agencies

Setting/Equipment Specifications

Consultation services are offered in home. healthcare, education, business and industrial settings and for individuals, families, groups and organisations.

Documentation

The consultant provides written plans or reports to document services rendered as indicated in the agreement made between the parties involved.

12. Hearing Aid Assessment
Procedures to determine the choice of individual amplification systems where appropriate

Expected Outcome

Selection and evaluation of optimal amplification systems for the client to enhance communication ability.

Clinical Indications

Individuals of all ages with a hearing loss.

Clinical Process

Hearing aids are recommended on the basis of the client's/patient's audiological and communicative needs.

Assessment for fitting is based on:

• Client's/patient's communication needs and preferences
• Audiological and/or electrophysiological test outcomes
• Discussions with client/patient re rehabilitation options including hearing aids, ALD's,
• hearing tactics, auditory training
• Consideration of particular hearing aid styles and characteristics and their suitability for the client

Clients/patients suspected of having active medical pathologies of the auditory system are referred for a medical evaluation prior to hearing aid assessment and fitting.

Selection of electroacoustic characteristics of hearing aids to be based on:

• A recognised and validated prescriptive approach
• Application of knowledge regarding acoustic modifications and ear mould technology

Evaluation of aid effectiveness may be based on:

• Appropriate behavioural testing (e g, frequency-specific measures of functional gain, word recognition)
• Real-ear measurements
• Electroacoustic evaluation of hearing aids
• Feedback from client/patient and/or carers
• Determination of earmould characteristics and hearing aid configuration
• Administration of communication inventories or questionnaires

Assessment addresses function in both aided and unaided conditions.

Setting/Equipment Specifications

Assessment uses measurable acoustic stimuli.

Specifications for electroacoustic equipment and environmental ambient noise meet ANSI standards, where applicable.

Instrumentation and test environments are available for free field testing, electroacoustic evaluation of hearing aids. and real-ear measurements.

Documentation

Documentation contains identifying information, pertinent information, assessment results, and specific recommendations. Recommendations may address the need for further assessment, follow-up or referral. When rehabilitation is recommended, information is provided concerning the frequency, estimated duration, and type of service (e g, individual, group, home program) required.

Related References

Mueller, H. G. (1992). Probe Microphone Measurements: Hearing Aid Selection and Assessment. San Diego, CA: Singular Publishing.

Standards Association of Australia. (1971). Reference Coupler for the Measurement of the Electroacoustic Characteristics of Hearing Aid Earphones. (AS 1089). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Measurement of Electroacoustical Characteristics. (AS 1088.0). Sydney. NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aids with Induction Pick - up Coil Input. (AS 1088.1). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aids with Automatic Gain Control Circuits. (AS 1088.2). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aid Equipment Not Entirely Worn on the Listener. (AS 1088.3). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Magnetic Field Strengths in Audiofrequency Induction Loops for Hearing Aid Purposes. (AS 1088.4). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Characteristics of Electrical Input Circuits for Hearing Aids. (AS 1088.6). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Measurement of the Performance Characteristics of Hearing Aids for Quality Inspection for Delivery Purposes. (AS 1988.7). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Method of Measurement of Performance Characteristics of Hearing Aids Under Simulated In - Situ Working Conditions. (AS 1088.8). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Acoustics - Hearing Conservation. (AS 1269). Sydney, NSW: Standards House.

13. Surgically-Implanted Devices Assessment
Procedures to determine the appropriateness of a cochlear implant, for an individual with a profound or severe to profound sensori-neural hearing loss

Expected Outcomes

Assessment is conducted to determine the appropriateness of a cochlear implant in the management of profoundly or severely to profoundly deaf individuals.

Client/patient or legal guardian fully understands the implications and appropriateness of the rehabilitation, and gives informed comment to the process.

Clinical Indications

Individuals who demonstrate no significant benefit using optimally fitted conventional amplification, as shown following an appropriate trial and training period with the optimal amplification, are considered candidates "Significant benefit' with conventional amplification is classified as follows: ·

• Adults
  For profound losses (40% or less correct) and for severe to profound losses30% or less correct), on open set sentence material, audition only, or less than chance scores on closed set tests, audition only;
• Children
  As for adults, using age appropriate speech perception materials and language assessment techniques.

Clinical Process

Occurs within a multidisciplinary setting.

Assessment includes:

• Full diagnostic audiological assessment.
• Balance tests if applicable.
• Optimisation of hearing aid fitting and/or tactile aid fitting. Evaluation of hearing aid fitting should be based on real ear and insertion gain measurements and/or free field warble tone measurements.
• Appropriate trial with optimised conventional amplification to determine benefit. Trial includes regular, intensive auditory training with formal, age appropriate speech perception and communication assessments before and after training. Training period should be at least eight weeks for adults and at least twelve weeks for children. If indicated, the training period will be extended.
• Administration of appropriate communication inventories.
• Regular and close liaison with appropriate education facilities when indicated (e g, paediatric populations). · Assessment of social/family dynamics by appropriate professionals - social worker,psychologist, family/carer therapist.
• Counselling by appropriate cochlear implant team members regarding expectations ofoutcome of device use and appropriate understanding of required commitment to training.
• Speech and language assessment by speech language pathologists when indicated.
• Electrical assessment of the integrity of the auditory nerve using Promontory Stimulationwhen indicated (e.g. adult population).
• Appropriate medical, radiological assessments.

Setting/Equipment Specifications

Assessment is conducted in an appropriately structured physical, acoustic and visual environment.

Instrumentation is available to:

• Select and/or evaluate optimal hearing aids (may be referred to another clinic)
• Perform sound field testing
• Test correct and appropriate function of hearing aids and/or tactile aids
• Maintain adequate loan devices and availability supplies based on client/patient caseload

Age appropriate speech and language tests are available to assess speech perception abilities for all age groups.

Specifications for electro-acoustic equipment and ambient noise meet ANSI standards, where applicable.

Documentation

Documentation contains identifying information, pertinent background information, assessment results, prognosis, and specific recommendations. Recommendations may address the need for further assessment, follow-up, or referral. When intervention is recommended, information is provided concerning the frequency, estimated duration, and type of service (e g, individual, group, home program) required.

Related References

Boothrod, A. (1986). Issues of Pre - and Post Implant Evaluation Regarding CochlearImplants in Children. Seminars in Hearing, 7(4), 349-360.

Lea, A. R. (1991). Cochlear Implants. Canberra, ACT: A.G.P.S. (Health Care Technology series, No. 6).

14. Hearing Rehabilitation Assessment
Procedures to assess the impact of hearing loss on communication

Expected Outcomes

Hearing rehabilitation assessment evaluates and describes the communication needs and skills of individuals with hearing loss.

Assessment may result in recommendations for therapy and/or further follow-up, or in referral for other examinations or services.

Clinical Indications

Individuals of all ages with a hearing loss or auditory impairment.

Clinical Process

Assessment may include evaluation of:

• communication ability by appropriate personnel
• evaluation of oral, signed, or written modalities
• perception of speech and nonspeech stimuli in multiple modalities
• listening/auditory skills
• speech reading
• communication strategies, used ability to participate
• communication skills of the person's frequent communication partners

Performance in both clinical and natural environments is considered.

Hearing rehabilitation assessment may be part of an interdisciplinary process.

Assessment of client's/patient's ability to participate in and benefit from process.

Setting/Equipment Specifications

Hearing rehabilitation assessment is conducted in clinical or natural environments with consideration for physical, acoustic and visual characteristics.

The functioning of hearing aids, assistive listening systems/devices and sensory aids is checked prior to assessment (see Standards 14. and 15.).

Documentation

Documentation contains identifying information, pertinent background information, type of amplification system/sensory aid used, communication modality used, assessment results, prognosis and specific recommendations. Recommendations may address the need for further assessment, follow-up or referral When therapy is recommended, information should be provided concerning the frequency, estimated duration, and type of service (e.g. individual group, home program) required.

Related References

Byrne, D. (1987). A Post - (Hearing Aid) Fitting Evaluation Procedure Using Speech Intelligibility and Pleasantness Judgement. Canberra, ACT: A.G.P.S. (NAL Report No. 112).

15. Hearing Rehabilitation
Procedures to improve the communication abilities of an individual with a hearing loss.

Expected Outcomes

Hearing rehabilitation facilitates communication of individuals with a hearing loss.

Hearing rehabilitation results in enhancement of the communication processes.

Clinical Indications

Hearing rehabilitation may be provided to individuals of all ages with any degree or type of hearing loss, on the basis of the results of a hearing rehabilitation assessment.

Clinical Process

Hearing rehabilitation is an interdisciplinary process, requiring the input of a communication disability specialist (speech pathologist or specialist Audiologist).

Hearing rehabilitation consists of therapy that focuses on:

• comprehension of language in oral, signed, or written modalities
• speech and voice production
• auditory training
• speechreading
• multimodal (e g, auditory and visual, visual and tactile) training communication strategies
• education and counselling
• communication partner/s training and counselling.

Performance in both clinical and natural environments is considered.

Short and long-term functional communication goals and specific objectives are determined from assessment and represent the framework for treatment. They are reviewed periodically to determine appropriateness.

All individuals involved in the implementation of the hearing rehabilitation plan (e g, client/patient, family/carer, staff) are instructed regarding the components of the plan and their role(s) in its implementation.

Clients/patients and families/carers are provided with informative and supportive counselling regarding the potential communication impact of the hearing loss upon the client/patient and family/carer. and other likely outcomes of therapy.

Dismissal/discharge planning occurs continually throughout the therapy.

Follow-up services may include re-evaluation of the client's/patient's status, referrals, and provision for continuing therapy. (see Standard 9).

The quality of care, utilisation of services and outcomes of hearing rehabilitation are assessed, prior to discharge.

Setting/Equipment Specifications

Hearing rehabilitation is conducted in planned physical, acoustic and visual environments.

Functioning of hearing aids, assistive listening systems/devices, and sensory aids is checked prior to treatment (see Standards 15, 16 and 17).

Maintain adequate loan devices and supplies based on the client/patient caseload.

Documentation

Documentation contains identifying information, pertinent background information, treatment goals, results, prognosis, and specific recommendations. Recommendations may address the need for further assessment, follow-up or referral. When treatment is recommended, information should be provided concerning the frequency, estimated duration and type of service (e g., individual, group, home program) required.

Related References

Macrae, J.H. (1995). Safety Aspects of Amplification for Severe/Profound Hearing Loss. The Australian Journal of Audiology, 17(1), 27-37.

16. Assistive Product Dispensing
Procedures by which a prosthetic or assistive device (e.g., hearing aid, assistive listening or alerting system/device, sensory aid) is prepared and dispensed.

Expected Outcomes

The client is satisfied that the device improves communication abilities.

The device functions reliably and the client understands its operation and uses it effectively.

Clinical Indications

Products are dispensed to individuals of all ages following assessment, consistent with specific recommendations.

Clinical Process

The client and family/carer are informed about cost considerations and the safety and health implications of product use.

Professionals may customise products, using available equipment and materials, or may obtain customised products through a manufacturer.

Product dispensing may be part of a multidisciplinary process.

Training is provided in the use and evaluation of effectiveness.

Setting/Equipment Specifications

Dispensing of some products may require an acoustic environment for precise measurement and for objective assessment of benefit.

Documentation

Documentation includes identifying information, pertinent background information, results, and recommendations, including the basis for selecting a particular system/device, counselling provided in issuing the system/device, procedures involved in the assessment of the system/device, consultation with other disciplines, as appropriate, and final disposition/reassessment plans.

Related References

Beck, L.B. & Nance, G.C. (1989). Hearing aids, Assistive Listening Devices, and Telephone Issues to Consider. Seminars in Hearing, 10(1), 66 - 77.

Killingsworth, C.A. (1989). Using Assistive Devices in the Hearing Health Care Practice. Seminars in Hearing, 10(1), 90 - 103.

17. Assistive Listening System/Device Selection
Procedures to assess the effectiveness and appropriateness of assistive listening systems/devices (ALD's) for individual clients/patients or facilities, often involving the dispensing of systems/devices and monitoring their use over time.

Expected Outcomes

Use of an assistive listening system/device reduces the impact of hearing loss on the client/patient life or facilitates listening in acoustic environments.

Clinical Indications

Individuals of all ages are assessed on the basis of their communication, educational, vocational and social needs.

Clinical Process

Need for product is demonstrated.

Use of the device in both clinical and natural environments is considered and evaluated.

Because many ALD's are used with hearing aids, the selection process addresses system/device compatibility.

Because there are no standards that specify sound level and other characteristics, care must be taken to control output levels to minimise adverse effects.

The client is informed about safety concerns.

Setting/Equipment Specifications

The professional has the equipment and materials required to evaluate and customise the system/devices.

Documentation

Documentation specifies the rationale for system/device selection, counselling provided, procedures involved in the assessment of the system/device, the client/patient response to use, prognosis for benefit, plan for monitoring and orientation, and final disposition/reassessment plans.

Related References

Beaulac, D.A. Pehringer, J.L. & Shough, L.F. (1989). Assistive Listening Devices: Available Options. Seminars in Hearing, 10(1), 11-30.

Brandt, F.D. (1989). Microphones and Assistive Listening Devices: A Tutorial. Seminars in Hearing, 10(1), Pg. 31 - 41.

Ross, M. (Ed.). (1992). FM Auditory Training Systems, characteristics, selection, and use. Timonium, Md: York Press.

18. Sensory Aids and Surgically-implanted Device Assessment
Procedures to determine the appropriateness of a sensory prosthetic device, other than a hearing aid or an assistive listening System/device, for an individual with a hearing loss.

Expected Outcome

Recommendations will be formulated regarding the appropriateness, type and configuration of sensory prosthetic devices (e g, tactile aids, cochlear implants, and other implantable devices) other than conventional amplification (i.e. hearing aids or assistive listening systems/devices).

Client/patient or legal guardian filly understands the implications and appropriateness of the assessment and the habilitation/rehabilitation and gives informed consent to the process.

Clinical Indications

Clients/patients who do not demonstrate satisfactory benefit from conventional amplification or to augment benefits of conventional amplification.

Clinical Process

Assessment may include:

• Communicational needs
• Additional trials or training with conventional amplification to determine benefit
• Counselling (e g, regarding expectations of outcome of device use)
• Assessment of pre and post device performance on speech and nonspeech tasks
• Assessment of speechreading performance with and without the sensory device
• Administration of communication inventories

Assessment includes regular review with electrical and acoustic stimuli for cochlear implants, and with vibrotactile and acoustic stimuli for tactile aids.

Setting/Equipment Specifications

Assessment is conducted in a structured physical, acoustic and visual environment.

Assessment uses measurable acoustic (e g, pure tones, broadband noise), electrical, or tactile stimuli.

Specifications for electroacoustic equipment and ambient noise meet ANSI standards where applicable.

Instrumentation is available for sound field testing, and for testing the output and configuration of sensory aids such as cochlear implants.

Documentation

Documentation contains identifying information, pertinent background information, assessment results, prognosis, and specific recommendations. Recommendations may address the need for further assessment, follow-up or referral. When treatment is recommended, information is provided concerning the frequency, estimated duration, and type of service (e g, individual, group, home program) required.

Where required documentation includes a record of compliance with State and Federal guidelines/laws/regulations.

Related References

Standards Association of Australia. (1971). Reference Coupler for the Measurement of the Electroacoustic Characteristics of Hearing Aid Earphones. (AS 1089). Sydney, NSW: Standards House.

Standards Association of Australia. (1983). Acoustics - Hearing Conservation. (AS 1269). Sydney, NSW:Standards House.

Standards Association of Australia. (1987). Measurement of Electroacoustical Characteristics. (AS 1088.0). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aids with Induction Pick - up Coil Input. (AS 1088.1). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aids with Automatic Gain Control Circuits. (AS 1088. 2). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Equipment Not Entirely Worn on the Listener. (AS 1088.3). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Magnetic Field Strengths in Audiofrequency Induction Loops for Hearing Aid Purposes. (AS 1088.4)

Standards Association of Australia. (1987). Method of Measurement of Performances Characteristics of Hearing Aids under Simulated In - Situ Working Conditions. (AS 1088.8). Sydney, Standards House.

19. Device Fitting/Orientation
Procedures to assist individuals to understand and use their assistive device. This may include a hearing aid, assistive listening device, sensory aid, tinnitus instrument and surgically implanted aids.

Expected Outcome

Individuals will be able to demonstrate suitable understanding and use of, and performance with, their device.

Fitting/orientation may result in recommendation for hearing rehabilitation assessment or therapy or assessment for additional devices.

Clinical Indications

Fitting/orientation is conducted for individuals of all ages as a result of an audiological assessment and/or assessment for a hearing aid or assistive device.

Clinical Process

Assistive devices are recommended on the basis of the client/patient audiological and communication needs.

Client/patient suspected of having active medical pathologies of the auditory system or those for whom medical/surgical remediation may be appropriate are referred for a medical evaluation prior to fitting.

Fitting orientation may include:

• Real-ear measurements
• Electroacoustic evaluation of hearing aids
• Earmould impression and modification
• Evaluation of hearing aid use with other listening devices if applicable
• Administration of communication inventories, or other recognised outcomes assessment procedures
• Counselling
• Discussion of communication strategies
• Developing a device use and communication plan
• Feedback for client/patient and family/carer
• Speech assessment

Setting/Equipment Specifications

Fitting/orientation is conducted in a structured environment physically, acoustically, and visually appropriate.

These procedures use measurable acoustic stimuli (e g, pure tones, broadband noise).

Specifications for electroacoustic equipment and ambient noise meet ANSI standards where applicable.

Documentation

Documentation contains identifying information, pertinent background information, fitting/orientation results, prognosis and specific recommendations. Recommendations may address the need for further fitting/orientation, follow-up or referral. When treatment is recommended, information is provided concerning the frequency, estimated duration, and type of service (e g, individual, group, home program) required.

Related References

Brandt, F.D. (1989). Microphones and Assistive Listening Devices: A tutorial. Seminars in Hearing, 10(1), 31-41.

Standards Association of Australia. (1971). References Coupler for the Measurement of the Electro-Acoustic Characteristics of Hearing Aid Earphones. (AS 1089). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Measurement of Electroacoustical Characteristics. (AS 1088.0). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aids with Induction Pick - Up Coil Input. (AS 1088.1). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aids with Automatic Gain Control Circuits. (AS 1088.2). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Hearing Aid Equipment Not Entirely Worn on the Listener. (AS 1088.3). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Magnetic Field Strengths in Audiofrequency Induction Loops for Hearing Aid Purposes. (AS 108.4). Sydney, NSW: Standards House.

Standards Association of Australia. (1987). Method of Measurement of Performances Characteristics of Hearing Aids under Simulated In - Situ Working Conditions. (AS 1088.8). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Acoustics - Hearing Conservation (AS 1269). Sydney, NSW: Standards House.

20. Follow-Up Procedures
Procedures needed to complete or supplement an assessment, and/or monitor progress made throughout the course of Intervention, and to determine status after screening, assessment, intervention discharge, and long term after care

Expected Outcomes

Follow-up procedures determine reassessment needs, efficacy of intervention, and appropriateness of clinical decisions and clinical recommendations.

Follow-up procedures complete an assessment and determine whether the client/patient is satisfied with the intervention, has attained the desired level of function and achieved expected outcomes at the end of intervention.

Follow-up procedures may result in recommendations for continued intervention or in referral for other examinations or services.

Clinical Indications

Follow-up services are provided for individuals of all ages following screening, assessment, or intervention.

Clinical Process

Standardised and/or nonstandardised methods are used to determine the client/patient current status and level of satisfaction with services.

Follow-up procedures are conducted either in person (e g, interview, reassessment) or indirectly (e g, phone or mail surveys), and may involve the client/patient, family/carer members, professionals, and/or others associated with the client/patient.

Services may include:

• Supplemental evaluations and/or interventions
• Re-evaluations and re-checks
• Telephone contacts to clients and/or referral agencies
• Verbal or written consultation with other health professionals to monitor a clients functional communication

Setting/Equipment Specifications

Follow-up procedures are conducted in an appropriate clinical or natural environment.

21. Product Repair/Modification
Procedures to restore or adjust a product used to improve or facilitate an individual's communication and/or listening abilities. Products include hearing aids, assistive listening systems/devices, cochlear implants, tactile aids, alerting systems/devices and related accessories.

Expected Outcome

Product repair/modification may restore the product to functional status (according to manufacturer's specifications), relieve discomfort, affect the products capacity to improve some aspect of communication and respond to the users concerns about the product.

Clinical Indications

Discomfort

Malfunction or reduced benefit of a product is reported

Device evaluation may indicated the need for modification or repair

Clinical Process

Professionals establish procedures to facilitate the repair, maintenance or modification of products and verification of the changes made.

Clients and families are informed about cost, warranty and how to obtain the repair or modification of their products.

Setting/Equipment Specifications

For some products, precision measurement equipment is required to identify and repair malfunctions, they may need to be sent to an authorized repair source.

Documentation

Documentation includes information about the complaint or problem and its resolution.

22. Neurophysiologic Assessment/Intraoperative Monitoring
Procedures to evaluate and document changes in the functional status of neural tissue or structures during operative procedures that carry risk for neurologic compromise to the central or peripheral nervous system.

Expected Outcomes

Continuous assessment of electrophysiological function optimises post operative functioning by reducing the client's/patient's risk of injury to neural tissues/structures.

The use of stimulus-response monitoring techniques can allow the confirmation of the location of surgically identified neural structures at risk for injury during surgery.

Early identification of neural dysfunction may enable corrective actions to reverse the identified dysfunction and may avoid permanent neurofunctional deficits.

Immediate postoperative functional status of monitored structures is determined.

Clinical Indications

Monitoring is indicated when there is risk of neurologic complication due to surgery involving any portion of the central and/or peripheral nervous systems.

Monitoring is indicated when intervention by the surgeon or anaesthesiologist in response to intraoperative neurophysiologic changes can help preserve function, reverse damage, and reduce possible adverse neurofunctional consequences.

Clinical Process

A referral is obtained from the client's/patient's surgeon.

A preoperative neurodiagnostic examination may be conducted.

Client/patient is prepared for the procedure, using recording electrodes and, where applicable, stimulators or stimulus transducers, applied with accepted techniques.

Pertinent neurophysiologic responses are recorded before and/or after the induction of anaesthesia to establish an intraoperative baseline.

Neurophysiologic responses are monitored and collected recurrently during the surgical procedure Data are tabulated in a permanent intraoperative record Continuous on-line interpretation of the neurophysiologic responses is carried out and communicated to the surgical and anaesthesia teams.

At the completion of the procedure, stimulating and recording devices are removed from the client/patient using acceptable techniques.

The client/patient may be assessed postoperatively using neurophysiologic techniques to confirm status.

Setting/Equipment Specifications

All test equipment meets ANSI and manufactures standards, where applicable.

Power-operated instruments conform to minimum ANSI safety requirements.

Invasive recording or stimulating devices (electrodes) conform to sterile conditions within the operating room.

Assessments are conducted in an environment that is satisfactory free of electrical interference so as not to affect the measurement of responses.

Safety and Health Precautions

All monitoring equipment is grounded adequately for equipment and patient.

The professional performing the procedures knows facility-specific medical emergency protocol.

Documentation

The written intraoperative record includes demographic and medical information (e.g, diagnosis, surgical procedure, preoperative neurophysiologic and/or audiological findings).

Type of monitoring performed and the monitoring equipment used are specified.

A written chronological record of intraoperative events and communications in the operating room relevant to the monitoring is maintained.

Client/patient-related oral communication between the monitoring team and the surgical team (e g, surgeon, anaesthesiologist, nurse anesthetist) are documented in writing.

Pertinent physiologic parameters (e g, body temperature) and the administration of pertinent anaesthetic agents may be periodically recorded.

Changes in the client's/patient's neurophysiologic state measurable via the monitoring are documented in writing.

Related References

Beck, D.L. (1994). Handbook of Intraoperative Monitoring. San Diego, CA: Singular Publishing.

Dennis, M.J. (Ed). (1988). Intraoperative Monitoring with evoked Responses. Seminars in Hearing, 9(2), 89 - 153.

Standards Association of Australia. (1990). In Service Safety Inspection and Testing of Electrical Equipment. (AS 3760). Sydney, NSW: Standards House.

23. Prevention
Procedures and programs to avoid or minimise the onset and progression of a hearing impairment

Expected Outcomes

Primary prevention eliminates, inhibits, or delays the onset and progression of a hearing impairment and/or tinnitus by minimising risk or reducing exposure for persons at risk.

(For secondary prevention, see Standard 1. For tertiary prevention, see Standards 12 and 17).

In particular, occupational hearing conservation programs (OHCP) are designed to reduce or prevent occupational noise-induced hearing loss and educate employees and management about health hazards associated with noise exposure within and outside the workplace.

Clinical Indications

Prevention services are provided for individuals of all ages at risk for hearing loss and tinnitus.

OHCPs are indicated when employees are considered at risk for occupational noise-induced hearing loss.

Implementation of OHCPs may be mandated by federal and state regulations.

Clinical Process

Target groups are identified and contacted.

Professional relationships are established.

Consultation and educational strategies are selected. Consultation may be provided to natural support systems, such as family/carer, or to direct service personnel, organisations, or policy making groups. Education may provide general information about communication processes, hearing loss, tinnitus and therapeutic management, specific information to help target groups identify and eliminate the risk factors for the onset, development, or maintenance of these disorders, or to improve target groups' abilities to cope with their hearing loss and tinnitus.

In the workplace, as OHCP program managers or consultants, Audiologists may provide services m the following areas:

• Noise exposure monitoring
• Engineering and administrative controls
• Communication devices
• Auditory assessment including evaluation with respect to job requirements, use of hearing protection and monitoring changes in hearing benefits
• Audiogram review and referral
• Recommendation, demonstrating and/or supply personal hearing protection and training in its use
• Employee and manager education and motivation
• Record keeping
• Training and supervision of occupational hearing conservation technicians
• Development of criteria for disposition and referraI of employees for whom follow-up is required Expert witness consultation
• Evaluation of risk factors and effectiveness of hearing protection

Audiologists work in collaboration with other professionals (i.e., industrial hygienists, occupational nurses, physicians, and environmental, safety and acoustical engineers).

Setting/Equipment Specifications

Prevention services are offered in home, healthcare, education, business, and industrial settings for individuals, families, groups, and organisations.

Equipment specifications used in occupational hearing conservation programs must, at a minimum, meet state regulations.

Related References

Berger, E.H. Ward, W.D., Morill, J.C. & Royster, L.H. (1986). Noise and Hearing Conservation Manual. (4th Edition). Akron, OH: American Industrial Hygiene Association.

Berger, E.H. (1988). Selection and Use of Hearing Protectors. Seminars in Hearing, 9(4), 309 - 324.

Feldman A.S., & Grimes C.T., (1985). Hearing Conservation; A Practical Manual and Guide. Englewood Cliffs, NJ: Prentice Hall.

Macrae, J.H., (1995). Hearing Conservation Standards for Occupational Noise Exposure of Workers from Headphones or Insert Earphones. 107- 115.

National Acoustic Laboratories. (1988 January). Improved Procedure for Determining Percentage Loss of Hearing. (NAL Report No. 118). Sydney, NSW: National Acoustic Laboratory.

Relevant State / Territory Government Legislation on Noise and Hearing Conservation.

Standards Association of Australia. (1988). Hearing Protection. (AS 1270). Sydney, NSW: Standards House.

Standards Association of Australia. (1989). Hearing Conservation. (AS 1269). Sydney, NSW: Standards House.

US House of Representatives Select Committee on Children, Youth and Families. (1991). Turn it Down:. Effects of Noise on Hearing Loss in Children and Youth. Washington, DC: U.S. Government Printing House.

Waugh, R.L. & Macrae, J.H. (1980). Criteria for Assessing Hearing Conservation Audiograms. (NAL Report No. 80). Sydney, NSW: National Acoustic Laboratory.

24. Student Supervision
Procedures and programs to provide quality training for professionals in the field of audiology.

Expected Outcomes

Supervision ensures that post-graduate audiology students receive professional support and a high quality learning experience in their clinical placements.

Supervision enables students to acquire competence in practical skills in the core procedures in 1-23 of this standards document and a theoretical understanding of procedures 1-23 of this standards document.

Preparation for Supervision

Supervisory services are provided, where possible, when negotiated with university audiology programs accredited by the Audiological Society of Australia.

Supervisory processes are negotiated among clinical supervisors and university audiology programs. They are designed to facilitate student, supervisor and university feedback on student performance.

Supervision is provided by Full Members of the Audiological Society of Australia, or audiologists with equivalent professional qualifications.

The Process

University programs establish formal links with potential supervisors and provide guidelines on the supervisory role.

Formal acceptance of a supervisory role is made by the clinical supervisor.

Feedback mechanisms are established to facilitate student, supervisor and university feedback on student performance.

Clients are made aware of the student's status prior to audiological assessment or management.

The supervisor is responsible for all student activities undertaken in his/her clinical setting.

All final review of assessment results, documentation, referral and recommendations is carried out by the supervisor. All written documentation is signed by the supervisor.

Documentation

The parties to the supervisory agreement provide written reports to document the students' activities and educational outcomes as negotiated by the clinician, university program and students.

Related References

Kelly, B.R., Davis, D. & Hedge, M.N. (1994). Clinical Methods and Practicum in Audiology. San Diego, CA: Singular Publishing.

Rassi, Judith (1983). Supervision in Audiology. University Park Press.

IV Glossary of Terms

Assessment
• Procedures to identify and/or monitor a client’s/patient’s hearing and related abilities and to assist with diagnosis of auditory and related disorders.
• Procedures to identify and determine the appropriateness and/or design of assistive hearing and related devices and systems.

At Risk
Susceptible to disease, disorder or injury because of biological, environmental or behavioural factors.

Audiologist
Professionals who identify, assess and provide management for hearing, balance and related disorders of individuals of all ages. They manage and supervise programs and services related to hearing and its disorders. Audiologists counsel individuals with hearing, balance and related disorders, their families, carers and other service providers about the disability and its management. They provide preventative services and consultation and make referrals. Facilitating hearing, balance and related functions is the goal of Audiologists.

In Australia, an Audiologist is a university graduate who has completed a post graduate specialist training in audiology approved by the Federal Executive Council of the Audiological Society of Australia, or has passed such undergraduate or graduate courses in audiology which, in the opinion of the Council constitutes the equivalent of such specialist training.

Auditory Training
The process of teaching the child or adult who is hard of hearing to take full advantage of the sound clues which are still available to him/her.

Cerumen
Earwax

Client/Patient
Recipients of audiological care in various settings (e.g., hospitals, schools, clinics, industry).

Family
Individuals with a common affiliation with the client/patient. Family/carer is defined broadly and may include carers, significant others, and spousal equivalents.

Functional Communication
Ability to convey or receive a message, regardless of the mode, to communicate effectively and independently in natural environments.

At Risk
Susceptible to disease, disorder or injury because of biological, environmental or behavioural factors.

Hearing and Related Disorders
Disorders of the auditory system.

Hearing Rehabilitation
Therapy which is aimed at improving communication abilities of an individual with a hearing loss.

Identifying Information
Records of assessments or recommendation should individually show name and identifying information for the client/patient, date and location of intervention, and name of Audiologist responsible for the intervention. When circumstances warrant, identification of equipment used may also be shown.

Natural Environments
Actual real life environments in which client’s/patient’s function (e.g., home, school, work).

Neonates
Newborn infants up to the age of 28 days.

Products
Prosthetics or assistive systems/devices (e.g., hearing aids, assistive listening systems/devices, sensory aids and related accessories such as batteries, battery testers, cords, tubing and hooks).

Referral
The act of sending or recommending for screening, assessment, or intervention. Referral sources may include self, family/carers and other professionals

Screening
A pass-fail procedure to identify clients who require further assessment.

Therapy
A professional intervention program based on an individual plan of care.

Appendix 1: ASA Recommended Audiometric Symbols

Appendix 2: ASA Recommendation re: Cerumen Management
At the ASA Federal Executive Council meeting on September 8th, 1994, the following motion was passed concerning cerumen management:

"In general, the removal of wax and foreign bodies from the ear canal is best left to medical practitioners unless the Audiologist has secured sufficient additional training to be competent to do so."