Guidelines for Graduate Education in Amplification

Introduction

The purpose of this document is to furnish guidelines to which faculty members in audiology training programs can refer when developing and implementing curriculum and practicum experiences in the area of amplification. Specifically, the guidelines are designed to help training programs afford students adequate opportunity to acquire the knowledge and skills necessary for the provision of audiologic services in amplification as delineated in the Standards for Certification, Scope of Practice, and Preferred Practice Patterns for Audiology.

The guidelines, presented in two sections, outline general and specific areas of knowledge and skills that students should acquire in preparation for clinical service to individuals who may benefit from the use of amplification devices and/or other hearing assistive technology systems (HATS) ^[1] . Although a body of knowledge necessarily underlies the comprehension and mastery of skills included herein, there are other areas of knowledge for which specific skills are not associated with, or relevant to, the practice of audiology. Where any question occurs as to acquisition of knowledge versus skill, particularly for the purposes of providing adequate practicum experiences, academicians should consult the ASHA Standards and Implementations for Certificate of Clinical Competence in Audiology (1997), Scope of Practice in Audiology (1996), and Preferred Practice Patterns for the Profession of Audiology (1997) wherein minimal competencies and the requisite knowledge and skills underlying these competencies are outlined. The first section of this document presents areas of general knowledge and skills that students need to acquire. These areas may be prerequisites that provide a foundation on which more specific knowledge and skills can be developed, or they may be ancillary areas of knowledge and skills that complement specific areas of competency. The second section outlines areas of knowledge and skills that are specifically related to amplification.

This document is based on the premise that ASHA certified audiologists who select, fit and dispense amplification devices ^[2] are professionals who are qualified to provide rehabilitation services for individuals with hearing impairment. Moreover, although amplification devices and other HATS are focal, they are but one element in the intervention process. The benefits to be achieved from amplification are contingent on the clinician's ability to maximize the appropriateness of, acceptance of, and adjustment to the use of amplification. Competent clinicians look beyond the audiometric findings in recommending and fitting amplification. They consider the full range of communication and psychosocial implications of hearing difficulties so as to ensure that amplification is recommended within a context that is meaningful to the individual. Training must promote acquisition of the knowledge and skills needed to provide not only appropriate amplification but appropriate expectations and appropriate ancillary coping skills so as to maximize adherence to and benefits from the recommended use of amplification.

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General Knowledge and Skills

The following areas of general knowledge and skills constitute basic and supplemental competencies that are required in addition to the specific knowledge and skills one must have for the provision of audiological services in amplification. Curriculum and practicum requirements should ensure that students have adequate opportunity to acquire and demonstrate mastery of:

• general science areas, including acoustics, anatomy and physiology of the hearing and speech mechanisms, basic electronics, psychophysical measurement, instrumentation, calibration, computer technology, and statistics and research design

• normal auditory and speech-language development

• disorders and pathologies of the peripheral and central auditory systems

• characteristics of speech, language, voice, oral-motor function, and speech perception associated with congenital and acquired hearing impairment

• client/patient management skills, including interpersonal communication, counseling theories and methods, identification of treatment targets and goals, intervention strategies, and follow-up procedures

• fundamentals of professional conduct, including an awareness and understanding of ethical standards in clinical and business practice

• consumer trends and concerns, as well as cultural differences and biases that affect attitudes toward individuals with disabilities and hearing aids

• interview techniques, test interpretation, report writing, and referral procedures

• pure tone audiometry, speech audiometry, immittance measures, and site of lesion testing including electrophysiological measures

• assessment of communication strengths, limitations, and adjustment problems experienced in relation to hearing impairment for pediatric, adult, and geriatric populations, including additional medical, psychosocial, educational, and vocational concerns

• treatment methods for peripheral and central auditory disorders

• assessment of treatment efficacy, outcome measures, program evaluation procedures

• business and management skills, including billing services, personnel management, insurance coverage and reimbursement policies

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Specific Knowledge and Skills in Amplification as Part of Audiologic Rehabilitation

The following specific areas of knowledge and skills are those associated with the competencies required in the provision of clinical services related to amplification. Curriculum and practicum requirements in graduate training programs should afford students the opportunities to acquire and demonstrate mastery of the following:

• physical characteristics and function of the various types of hearing aids and other assistive amplification devices, including components, batteries, and user controls

• electroacoustic characteristics of hearing aids and other assistive amplification devices, including analog/digital circuitry, output limiting, and frequency response

• past and current national and international terminology and specification standards

• measurement methods for electroacoustic characteristics in compliance with existing ANSI standards

• cerumen management procedures

• assessment of real ear performance using ear canal probe-tube microphone systems

• anatomical, acoustic, and electroacoustic effects on real ear response

• acoustic effects of style, shape, and venting of earmolds and hearing aid shells

• earmold styles, materials, impression procedures, and modification techniques

• styles of in-the-ear hearing aids, impression procedures for hearing aid shells, and modification techniques of shells to alleviate discomfort and other subjective complaints

• room acoustics, including the effects of noise, reverberation, and distance on speech intelligibility, environmental modifications, and interactions with amplification devices

• determination of candidacy for amplification based on data from case history, interview, hearing disability and handicap assessments, and audiological evaluation

• hearing aid evaluation concepts and procedures including:

  • prescriptive fitting protocols and measurement of real ear performance, programming of hearing aids, and evaluation of aided and unaided performance as appropriate

  • effects of acoustic and electroacoustic modifications on hearing aid performance and user performance

  • electroacoustic modification procedures to alleviate specific residual difficulties or subjective fitting complaints

  • rationale for selection of specific hearing aid configurations and characteristics (e.g., monaural vs. binaural fittings, CROS variations, directional microphones and circuitry to suppress background noise, compression circuitry and other output limiters, and other emergent hearing aid fitting options)

  • appropriate alternatives and supplements to traditional hearing aid fittings, including vibrotactile aids, cochlear implants, implantable hearing aids, personal and sound-field FM systems, frequency transposer hearing aids, and hearing assistive technology systems

  • age-appropriate evaluation procedures as well as alternative or modified evaluation procedures for special populations (e.g., individuals in residential care facilities, individuals for whom English is a second language, non-English speakers, and those with sensory integration dysfunction or other concomitant developmental, physical, or learning disabilities)

  • follow-up procedures, including objective and subjective outcome assessments to establish (a) hearing aid performance, benefit, and satisfaction and (b) postfitting minimization of disabilities and handicap as assessed prefitting

  • interdisciplinary collaboration to verify acceptance of and benefit from amplification in real-life communication situations (e.g., schools and nursing homes)

  • responsibilities and procedures that represent accepted standards for hearing aid delivery systems as outlined in the current ASHA Standards and Implementations for Certificate of Clinical Competence in Audiology (1997), Scope of Practice in Audiology (1996), Preferred Practice Patterns for the Profession of Audiology (1997), Code of Ethics (1994), and state regulatory codes

• rehabilitative/intervention techniques and requirements, including:

  • individual and group hearing aid orientation procedures

  • theory-based approaches to individual, group, family counseling

  • counseling skills, including effective interpersonal communication, conveyance of genuineness, concern, warmth, and empathy, and the ability to establish rapport, ensure realistic expectations, instill motivation, and promote adherence to treatment recommendations

  • facilitation of acceptance of amplification and resolution of communication and adjustment problems related to hearing difficulties

  • early intervention programs and goals for infants, toddlers, and preschool children with impaired hearing

  • participation in multidisciplinary selection of the appropriate communication mode

  • facilitation of speech and language development

  • strategies for management of central auditory processing disorders

  • strategies for selecting alternative educational options for children and integrating students into the appropriate classroom setting

  • access to services that use the client's preferred communication modality

  • promotion of effective communication skills and repair strategies to optimize benefits from amplification in varied listening environments and situations

  • facilitation of use of visual, auditory, tactile, and combined sensory input to optimize communication performance

  • responsibilities and procedures in audiologic rehabilitation as recommended and described in current ASHA documents (e.g., Standards and Implementations for Certificate of Clinical Competence in Audiology (1997), Scope of Practice in Audiology (1996), Preferred Practice Patterns for the Profession of Audiology (1997), Guidelines for Hearing Aid Fitting for Adults (1998)

• Hearing assistive technology systems (HATS), including large and small space assistive listening devices, classroom amplification, hearing enhancement devices for telephone and TV listening, visual and vibratory signaling and warning devices, text telephone/TTY/TDD, real-time speech captioning, and automatic speech recognition systems

• maintenance, troubleshooting, and repair of hearing aids, earmolds, and hearing assistive devices

• amplification delivery systems, including models for dispensing, interprofessional and interagency relationships, professional certification and licensure, program accreditation, state and federal legislation, and regulations pertaining to the manufacture and sale of hearing aids and related equipment

• specific professional responsibilities and procedures in the provision of amplification devices and HATS, including ethical practices, record keeping and documentation, principles of quality assurance, risk management, professional liability, equipment and facilities selection, financing and reimbursement systems, inter- and intra-institution relations and interprofessional relationships, marketing, personnel management, and billing procedures

The appendix contains recommended readings related to the general and specific knowledge and skills sections of this guideline.

Appendix: Recommended Readings

American Speech-Language-Hearing Association. (1984, May). Definitions of and competencies for aural rehabilitation. Asha, 26, 37–41.

American Speech-Language-Hearing Association. (1991). Amplification as a remediation technique for children with normal peripheral hearing. Asha, 33(Suppl. 3), 22–24.

American Speech-Language-Hearing Association. (1994, March). Guidelines for fitting and monitoring FM systems. Asha, 36(Suppl. 12), 1–9.

American Speech-Language-Hearing Association. (1994, March). Professional liability and risk management for the audiology and speech-language pathology professions. Asha, 36(Suppl. 12), 25–38.

American Speech-Language-Hearing Association. (1994, August). Service provision under the Individuals with Disabilities Education Act-Part H, as Amended (IDEA-Part H) to children who are deaf and hard of hearing ages birth to 36 months. Asha, 36, 117–121.

American Speech-Language-Hearing Association. (1994, December). Joint Committee on Infant Hearing 1994 position statement. Asha, 36, 38–41.

American Speech-Language-Hearing Association. (1995, March). Guidelines for education in audiology practice management. Asha, 37(Suppl. 14), 20.

American Speech-Language Hearing Association. (1995). Hearing loss and hearing aid use in the United States. In Communication facts. Rockville, MD: Author.

American Speech-Language-Hearing Association. (1997, Spring). Guidelines for audiology service delivery in nursing homes. Asha, 39(Suppl. 17), 15–29.

American Speech-Language-Hearing Association. (1998). Maximizing the provision of appropriate technology services and devices for students in schools. Rockville, MD: ASHA.

Bellis, T. J. (1996). Assessment and management of central auditory processing disorders in the educational setting: From science to practice. San Diego: Singular Publishing.

Bess, F. H., Gravel, J. S., & Tharpe, A. M. (Eds.). (1996). Amplification for children with auditory deficits. Nashville, TN: Bill Wilkerson Press.

Brooks, D. N. (1990). Measures for the assessment of hearing aid provision and rehabilitation. British Journal of Audiology, 24, 229–233.

Byrne, D. (1996). Hearing aid selection for the 1990s: Where to? Journal of the American Academy of Audiology, 7, 377–395.

Byrne, D., & Birtles, G. (1994). Hearing impairment and hearing aid use. Medical Journal of Australia, 160(10), 662–663.

Chermak, G. D., & Musiek, F. E. (1997). Central auditory processing disorders: New perspectives. San Diego: Singular Publishing Group.

Christensen, K. M., & Delgado, G. L. (1993). Multicultural issues in deafness. White Plains, NY: Longman Publishing Group.

Cox, R., & Alexander, G. (1995). Abbreviated Profile of Hearing Aid Benefit. Ear and Hearing, 16, 176–186.

Crandall, C. (1998). Hearing aids: Their effects on functional health status. Hearing Journal, 51(2), 22, 24, 27-28, 30, 32.

Crandall, C., Smaldino, J. J., & Flexer, C. (Eds.). (1995). Sound-field FM systems. San Diego: Singular Publishing.

Crowley, H. J., & Nabelek, I. V. (1996). Estimation of client-assessed hearing aid performance based on unaided variables. Journal of Speech and Hearing Research, 39, 19–27.

Davis, H., Hudgins, C. V., Marquis, R. J., Nichols, R. H., Peterson, G. E., Ross, D. A., & Stevens, S. S. (1946). The selection of hearing aids (part 1 and 2). Laryngoscope, 56(part 1)(part 2), 85–115–163, 135–115–163.

Demorest, M. E., & DeHaven, G. P. (1993). Psychometric adequacy of self-assessment scales. Seminars in Hearing, 14, 314–325.

Demorest, M. E., & Walden, B. E. (1984). Psychometric principles in the selection, interpretation, and evaluation of communication self-assessment inventories. Journal of Speech and Hearing Disorders, 49, 226–240.

Dentler, R. X. (1989). External ear resonance characteristics in children. Journal of Speech and Hearing Disorders, 54, 264–268.

Dillon, H., James, A., & Ginis, J. (1997). Client-Oriented Scale of Improvement and its relationship to several other measures of benefit and satisfaction provided by hearing aids. Journal of the American Academy of Audiology, 8, 27–43.

Elfenbein, J. (1994). Monitoring preschoolers' hearing aids: Issues in program design and implementation. American Journal of Audiology, 3, 65–70.

Erdman, S. A. (1993). Self-assessment in audiology: The clinical rationale. Seminars in Hearing, 14, 303–313.

Erdman, S. A. (1994). Self-assessment: From research focus to research tool (monograph). In J.-P. Gagné & N. Tye-Murray (Eds.), Research in audiological rehabilitation: Current trends and future directions (monograph). In J.-P. Gagné & N. Tye-Murray (Eds.), Journal of the Academy of Rehabilitative Audiology (Vol. 27, pp. 67–90).

Feigin, J. A., Kopun, J. G., Stelmachowicz, P. G., & Gorga, M. P. (1989). Probe-tube microphone measures of ear-canal sound pressure levels in infants and children. Ear and Hearing, 10, 254–258.

Flores, P., Martin, F. N., & Champlin, C. A. (1996). Providing audiological services to Spanish speakers. American Journal of Audiology, 5(1), 69–73.

Gatehouse, S. (1999). Glasgow Hearing Aid Benefit Profile: Derivation and validation of a client-centered outcome measure for hearing aid services. Journal of the American Academy of Audiology, 10(2), 80–103.

Hodgson, W. R., & Montgomery, P. (1994). Hearing impairment and bilingual children: Considerations in assessment and intervention. Seminars in Speech and Language, 15, 174–182.

Kawell, M. E., Kopun, J. G., & Stelmachowicz, P. G. (1998). Loudness discomfort levels in children. Ear and Hearing, 9, 133–136.

Keidser, G. (1996). Selecting different amplification for different listening conditions. Journal of the American Academy of Audiology, 7, 92–104.

Keidser, G., Dillon, H., & Byrne, D. (1996). Guidelines for fitting multiple memory hearing aids. Journal of the American Academy of Audiology, 7, 406–418.

Kochkin, S. (1996). 10-year trends in the hearing aid market: Has anything changed? Hearing Journal, 49(1), 23–34.

Lewis, D. (1994). Assistive devices for classroom listening. American Journal of Audiology, 3, 58–69.

Lewis, D. (1994). Assistive devices for classroom listening: FM systems. American Journal of Audiology, 3, 70–83.

Macpherson, B. J., Elfenbein, J., Schum, R. L., & Bentler, R. (1991). Thresholds of discomfort in young children. Ear and Hearing, 12, 190–194.

Masters, M. G., Stecker, N. A., & Katz, J. (1998). Central auditory processing disorders: Mostly management. Needham Heights, MA: Allyn & Bacon.

Meichenbaum, D., & Turk, D. C. (1987). Facilitating treatment adherence: A practitioner's guidebook. New York: Plenum.

Moodie, K. S., Seewald, R. C., & Sinclair, S. T. (1994). Procedure for predicting real-ear hearing aid performance in young children. American Journal of Audiology, 3, 23–31.

Moore, B. (1996). Perceptual consequences of cochlear hearing loss and their implications for the design of hearing aids. Ear and Hearing, 17, 133–161.

Mueller, H. G., Hawkins, D. B., & Northern, J. L. (Eds.). (1994). Probe microphone measurements. San Diego, CA: Singular.

Newman, C., & Sandridge, S. (1998). Benefit from, satisfaction with, and cost-effectiveness of three different hearing aid technologies. American Journal of Audiology, 7, 115–128.

Palmer, C., Killion, M. C., Wilber, L. A., & Ballard, W. J. (1995). Comparison of two hearing aid receiver-amplifier combinations using sound quality judgments. Ear and Hearing, 16, 587–598.

Palmer, C., & Mormer, E. (1997). A systematic program for hearing aid instruction and orientation. High Performance Hearing Solutions, 1, 10, 12, 14-16, 19.

Ross, M. (1992). FM auditory training systems: Characteristics, selection, and use. Timonium, MD: York Press.

Ross, M. (1994). Communication access for persons with hearing loss. Timonium, MD: York Press.

Ross, M. (1996). Pediatric amplification: Use and adjustment. In F. N. Martin & J. G. Clark (Eds.), Hearing care for children (pp. 233–248). Boston: Allyn & Bacon.

Seewald, R. C. (1992). The desired sensation level method for fitting children: Version 3.0. Hearing Journal, 45(4), 36–41.

Stelmachowicz, P. G., Mace, A. L., Kopun, J. G., & Carney, E. (1993). Long-term and short-term characteristics of speech: Implications for hearing aid selection for young children. Journal of Speech and Hearing Research, 36, 609–620.

Stelmachowicz, P. G., & Seewald, R. C. (1991). Probe-tube microphone measures in children. Seminars in Hearing, 12, 62–72.

Swan, I. R. C., & Gatehouse, S. (1990). Factors influencing consultation for management of hearing disability. British Journal of Audiology, 24, 155–160.

The Pediatric Working Group of the Conference on Amplification for Children with Auditory Deficits. (1996). Amplification for infants and children with hearing loss. American Journal of Audiology, 5(1), 53–68.

Turner, C. W., Humes, L. E., Bentler, R. A., & Cox, R. M. (1996). A review of past research on changes in hearing aid benefit over time. Ear and Hearing, 17(Suppl. 3), 14S–28S.

Tyler, R. S. (Ed.). (1993). Cochlear implants: Audiological foundations. San Diego: Singular Publishing Group.

Tyler, R. S., & Schum, D. J. (1995). Assistive devices for persons with hearing impairment. Boston: Allyn & Bacon.

Valente, M. (Ed.). (1994). Strategies for selecting and verifying hearing aid fittings. New York: Thieme.

Valente, M. (Ed.). (1996). Hearing aids: Standards, options, and limitations. New York: Thieme.

Valente, M., Potts, L. G., & Valente, M. (1997). Development of a clinical protocol in attempt to improve user satisfaction with hearing aids. Seminars in Hearing, 18(1), 19–28.

Outcomes with hearing aids: State of the art. In B. E. Weinstein (Ed.), Seminars in Hearing. New York: Thieme.

Notes