What Is an Audiologist?
Audiology is the branch of science related to hearing loss and balance disorders. Audiologists are the primary health-care professionals who evaluate, diagnose, treat, and manage hearing loss and balance disorders in adults and children (AAA, 2017). The elderly, adults, teens, tweens, and children may all be treated by an audiologist. Tinnitus (constant noise/ringing in the ears) and central auditory processing disorders are just two conditions that an audiologist may treat. The most common duties of an audiologist are to identify hearing impairments and prescribe treatments for them.
Most types of hearing loss can be treated by an audiologist, although some are irreversible and can just be managed. An audiologist may treat hearing loss due to nerve damage by prescribing a hearing aid or other amplification devices (assistive listening) and hearing assistance technology. Designing and implementing hearing conservation programs or newborn hearing screening programs may also be part of an audiologists’ duties. They may be members of a cochlear implant team, perform ear- or hearing-related surgical monitoring, or provide hearing rehabilitation training such as auditory training and listening skills improvement (AAA, 2017).
An audiologist will not only evaluate and asses hearing loss or balance disorder in a patient, but they also counsel patients and family members to assist them with the prescribed treatment or equipment. They also perform periodic checks of a patient’s hearing to track progress or decline of hearing ability. Educational and research opportunities also exist in the audiologist profession, whether through public education or researching causes or treatments for certain hearing disorders and dysfunctions.
Audiologists work in a variety of settings, such as hospitals, clinics, private practice, Ear, Nose, and Throat (ENT) offices, universities, elementary and secondary schools, government, military, and Veterans’ Administration (VA) hospitals. Most audiologists earn a doctor of audiology (AuD) degree. Some audiologists may earn a doctor of philosophy (PhD) or doctor of science (ScD) degree in the hearing and balance sciences. Audiologists must be licensed or registered for practice in all states, the District of Columbia, and Puerto Rico (AAA, 2017).
Roles of an Audiologist
A practicing audiologist has multiple roles within their professional duties. In addition to the expected roles, an audiologist may be responsible for determining the level of emotional or mental stress hearing loss may be causing a patient and identifying sources to alleviate that stress (Study, 2017). Diagnostician, counselor, audiological care coordinator, audiological researcher and educational audiologist are a few of the different roles an audiologist is involved in. Each of the varying roles requires the special skill set only an audiologist will have.
Within this field, diagnostics are the first step in patient treatment. As a diagnostician, an audiologist will analyze the patient to determine if an audiological problem exists and determine the extent or scope of the diagnosis. Children under 5 are particularly difficult to diagnose, so exceptional skill is required to obtain evidence-based test procedures for hearing assessment in children, while making sure that they are cost-effective for the child’s family (Thomas, 2017). The diagnosis may come as a referral from a physician or from the patient directly, in a private or occupational setting. The audiologist will use different tests and equipment to evaluate the patient, as well as obtain historical information, and provide comfort to the child and the parents and answer all questions they may have.
In the counselor role, the audiologist interacts with the child and family members throughout the diagnosis and treatment process. This audiologist gives them information about the diagnostic tests, the support systems available, possibilities in managing the hearing loss, and is also generally available when needed (Thomas, 2017). Audiological assessment results are communicated to the family in terms they can understand, and intervention options are described and discussed in a sensitive manner.
Audiological Care Coordinator
As an individual case manager for patients, an audiologist may be the central coordinator of all medical examinations and results from different experts and institutions. In the early stages of diagnosis, the audiological care coordinator will assess the issue and recommend the correct intervention. If the patient is a minor, the intervention must be discussed with the parents or guardian to ensure they understand the recommended options.
Many research opportunities exist in the audiological field, as it is relatively new compared to other medical professions so there is much that needs to be discovered in order to fully understand some disorders and dysfunctions associated with hearing and balance. Equipment such as hearing aids and assistive listening devices continue to be improved and more advanced because of audiological research. Audiological researchers continue to improve the quality of life of those with hearing and balance issues, include pediatric research for speech recognition and testing and developing speech-language programs.
Educational audiologists work in home or school settings to provide facts and dispel myths about hearing loss and people who are deaf or have challenges with hearing. They may also evaluate the progress of students with these types of disabilities in school or at home. An educational audiologist facilitates communication and helps students, patients, and families understand the social, emotional and cognitive needs of a child (Thomas, 2017).
According to the World Health Organization, hearing loss is one of the six leading contributors to the global burden of disease (Zahnert, 2011). An aging population and an increase in hobbies and activities that involve exposure to excessive noise have contributed to the increase in cases of hearing loss. Fortunately, advances in treatment of hearing loss have been made, including hearing aids, cochlear implants, and surgical treatments. The proper diagnosis of the type of hearing loss and early detection are essential in determining the appropriate treatment or rehabilitation.
Conductive hearing loss is a condition which interferes with the transmission of sound to the cochlea. It is typically reversible with medical treatment, and may be caused by wax in the auditory canal, fluid in the middle ear, or blockage of the eustachian tube (AIHA, 2000). Typically, with conductive hearing loss, the extent of the loss of hearing remains constant. Occupational conductive hearing loss is not common.
Sensorineural hearing loss occurs within the ear when the hair, sensory cells, and auditory nerve endings begin to degrade. This type of hearing loss caused primarily by excessive noise but also can be attributed to presbycusis, some viruses, congenital defects (heredity), and drug toxicity (AIHA, 2000). Most occupational hearing loss is sensorineural, and it is not reversible. Sudden sensorineural hearing loss can be caused by systemic infection, (e.g., meningitis, syphilis, or HIV infection), diseases of the ear, (e.g., cholesteatoma), trauma, (e.g., blast trauma, skull-base fracture), cardiovascular disease, and paraneoplastic involvement of the inner ear (Zahnert, 2011).
An audiologist evaluates and treats the following disorders:
Hearing Disability – The severity of hearing disorders or disability varies greatly. An audiologist uses an audiometer to measure the measure to degree and extent of the severity of the damage to the patient’s hearing. In most cases, an audiologist can identify the cause of the hearing loss and prescribe a solution or treatment based on the examination.
Amplification – Hearing aids and assistive listening devises amplify noise to the level of hearing of the person using it. An audiologist will prescribe the correct device based on the patient’s level and extent of hearing loss.
Auditory Processing Disorders occur when there is dysfunction between the brain and the signals it receives from the inner ear. The brain uses these signals to interpret and translate noises. An audiologist will measure the sounds a patient can hear and determine the frequency at which those sounds are heard (normal human hearing range is from 20-20,000 Hz (Hertz). The function of the cerebral cortex, which interprets noises and sounds, can also be measured by an audiologist to diagnose the disorder and determine the proper treatment.
Tinnitus refers to a constant noise or ringing sound in the ear, described in most cases as a low intensity buzzing or whistling sound. Firefighters, military personnel, and construction workers are among some of the groups commonly afflicted with tinnitus. Although not all tinnitus can be cured, an audiologist can help reduce the effects on the patient.
Hyperacusis and Misophonia are hearing disorders related to amplification issues. Hyperacusis refers to increased sensitivity to everyday sounds in the typical environment, and Misophonia refers to selective sensitivity to small, repetitive sounds (Thomas, 2017). Those who experience these disorders typically have symptoms similar to that of a tv turned up too loud when exposed to certain sounds or noises.
Balance Disorders – Balance disturbances typically caused by inner-ear issues can cause imbalance, dizziness, vertigo and other balance disorders. Imbalance disturbances can be caused by infection or trauma to the inner ear.
Speech Language Pathology
An audiologist may specialize in speech language pathology. These specialists are able to diagnose, assess, treat, and prevent speech-language related disorders and disabilities in children and adults (Thomas, 2017). Some of the most common speech language disorders an audiologist may treat are described below.
Speech Disorders occur when a child or adult has difficulty forming the appropriate speech sounds due to genetics, trauma, or unknown causes. Stuttering and voice box problems are just two examples of speech disorders.
Language Disorders refer to the inability to understand or interpret others or the inability to express thoughts or feelings through speech and/or written language.
Social Communication Disorders are common with autism or traumatic brain injuries. Difficulty with communicating in verbal and non-verbal manners to express one’s feelings in social settings are typical of social communication disorders.
Cognitive Communication Disorders – Issues with organizing thoughts, paying attention to others, or remembering things when speaking are symptoms of cognitive communication disorder, which can be caused by traumatic brain injury, stroke or the onset of dementia (Thomas, 2017).
Swallowing Disorders - When the patient has a problem swallowing or feeding themselves after a stroke, possible injury, surgery or simply following a severe illness that they have recovered from, they may have a swallowing disorder (Thomas, 2017).
Newborn Hearing Screening
An audiologist may also manage and coordinate a newborn hearing screening program. Newborns are screened shortly after birth to detect profound or severe hearing loss. In 1964, audiologist Marion Downs determined the incidence rate of newborn hearing loss was 1 in 1,000, which indicated a need for early assessment of newborn hearing (Thomas, 2017). With further research, she discovered that when including partial deafness and lower levels of hearing loss, the incidence rate was actually three times as high as her initial determination (Thomas, 2017).
Marion Downs continued to research newborn hearing loss, and she developed non-invasive testing procedures that even those not trained in audiology can use for detection of hearing loss. Soon after, the National Institutes of Health (NIH) developed universal screening programs which are now required in nearly every state for newborns.
Development of communications pathways in the brain is fundamental to speech, whether it be verbal or non-verbal, such as sign-language. Early understand and practice of spoken, signed or written language is critical to proper development of the language, auditory and speech areas of the brain (Thomas, 2017). The NIH established two types of testing for newborn hearing loss: Automated Auditory Brainstem Response (ABR) and Otoacoustic Emission (OAE) testing.
The ABR and OAE can be used individually or together to diagnose infant hearing loss. Automated auditory brainstem response measures the average response registered by a neuron in response to a repeated auditory signal, and otoacoustic emission testing detects stimulation of the cochlear cells in response to sound. When only one method of testing is used, it may be possible for an audiologist to overlook certain issues so it most cases, they are used in tandem for a more comprehensive evaluation.
Due to the advances in newborn hearing screening, severe and profound hearing loss is now detected with failure rate of 0.5 percent, with the average age of hearing loss detection now at 2-3 months (Thomas, 2017). This has led to a striking improvement in language and social skills as well as emotional development in these children to normal levels, because of the early commencement of remedial training and treatment, before the age of 6 months (Thomas, 2017).
A Brief History of Audiology
The roots of clinical audiology can be traced to the early years of the 20th century when ‘psychoacoustics’ emerged as a branch of experimental psychology aimed at the study of auditory perception (UNC, 2016). After World War II in the 1940’s, audiology emerged as an essential profession to treat many soldiers who returned with noise-induced hearing loss. The U.S. government established hearing rehabilitation programs at the nation’s military hospitals where hearing aid fitting and aural rehabilitation procedures were standardized and implemented across the country (UNC, 2016). College and university training programs were established shortly after.
The field of audiology began to expand throughout the 1950’s and 1960’s with rehabilitation programs in community speech and hearing programs emerging. Audiologists in ear, nose, and throat clinics began performing hearing assessments. Specialty and subspecialty areas of the audiology field began to develop in the 1970’s and 80’s. These specialized areas include pediatric audiology, educational audiology, industrial audiology, cochlear implants, and assessment of balance function (UNC, 2016). Over the past 20 years private practice has been the fastest growing employment sector (UNC, 2016).
From its beginnings in the 20th century, the concept of audiology has been based on the measurement of hearing and the impact of hearing loss on communication and social function and interaction. Hearing aids have greatly improved since the first models that had low fidelity, high batter consumption and excessive size (UNC, 2016). Cochlear implants have provided a great benefit to many patients who did not benefit from a hearing aid. A cochlear implant provides electrical stimulation to the auditory nerve to induce the signal needed to interpret sound and noise.
Technological advances have also allowed for development of hearing loss assessment tools. Behavioral hearing tests and physiological measures that assess auditory function have led to implementation of newborn hearing loss testing and programs.
A Brief History of Speech Language Pathology
Speech-language pathology has its roots in elocution (speech perfection) stemming from the 18th century in England (UNC, 2017). In the 1800’s several books were published describing speech and language defects, particularly in reference to stuttering or stammering. In 1926, the American Academy of Speech Correction was established.
As with audiology, speech language pathology developed into a profession after WWII. Due to medical advances, more soldiers were surviving their injuries, and they now needed medical assistance to accommodate their injuries. An increase in traumatic brain injuries led to an increase in brain damage that caused the loss of ability to understand or express speech (aphasia), and the demand for speech language pathologists to identify, research, and treat this condition led to the development of speech language pathology as a profession.
The 1980’s led to advances in linguistic studies, which further enhanced the understanding and ability to treat language delays and disorders in children and adults. Still today, speech language pathology is researching and treating the pragmatic use of language along with other communication disorders. Where applicable, employers are required to implement and follow hearing loss conservation programs to ensure their employees are not affected by noise-induced hearing loss.
How to Become an Audiologist
To become a practicing audiologist, a minimum of a master’s degree is required, and they must be licensed by the state they choose to practice in. Many states require a doctorate in order to obtain licensure. Certification opportunities are not required, but they are available and recommended for professional advancement. Educational requirements include classroom coursework, research, skills labs and supervised clinical experiences (Study, 2017). Bilingual audiology candidates or those with a working knowledge of sign language are considered more employable (Study, 2017).
A bachelor’s degree may be obtained in any field, although science or medical fields are recommended. In an audiology master’s program, students learn the anatomy of the ear in addition to common hearing and balance disorders and communication disorders. They learn the skills needed to assess and treat patients of various ages and mental states. Course topics may include auditory neuroscience, central auditory function, clinical practicum, basic diagnostic audiology and physics and acoustics for audiology (Study, 2017). A master’s degree in audiology typically requires 2-3 years to complete.
An audiologist may be licensed with a Master’s degree, but they may also choose to obtain their Au.D., or Doctorate of Audiology. The doctorate program allows for further education and knowledge in audiological skills and specializations, including acoustics, pharmacology, psychology and physiology. Students receive hands-on skills in hearing aid fittings, adjustments and rehabilitation techniques. Specialization may also be explored in areas such as pediatric audiology. A Doctorate of Audiology program may require course work in psychoacoustics, auditory diagnostics, rehabilitative audiology and hearing conservation (Study, 2017). It typically takes 4 years to obtain an Au.D.
The American Speech-Language Hearing Association (ASHA) offers a Certificate of Clinical Competence in Audiology, and the American Board of Audiology (ABA) also offers this certification as voluntary options for licensed audiologists. Requirements for certification include education and supervised work experience in addition to passing an exam. Continuing education is also required and may be obtained by attending conferences and conventions.
The Bureau of Labor Statistics (BLS) lists a mean annual wage of $77,420 with an expected employment growth from 20147-2024 of almost 30%, which is much faster than average (Study, 2017). The BLS also states the following skills are needed in order to be a successful audiologist: excellent bedside manner, ability to communicate well with their patients, despite potential hearing issues, compassion and patience to make a patient feel comfortable, critical-thinking and problem-solving skills, and a detailed personality with excellent record keeping skills (Study, 2017).
Audiology is a profession that continues to grow and develop as the population ages and continues to be exposed to excessive noise, whether at home or at work. An audiologist has multiple roles and responsibilities regardless of their specialized or sub-specialized field. Most licensed audiologists obtain a Doctorate of Audiology degree, and they must be licensed by the state they choose to practice in. A career as an audiologist will be demanding and rewarding, and will allow for a variety of experiences and flexibility of career path choices. An audiologist may work with children and adults, or they may specialize in pediatric patients only.
American Academy of Audiology (AAA). What is an Audiologist? Retrieved September 8, 2017 from: https://www.audiology.org/sites/default/files/publications/resources/WhatIsAnAuD.pdf
Thomas, Liji. What Does an Audiologist Do? News Medical Life Science, 2017. Retrieved September 9, 2017 from: https://www.news-medical.net/health/What-Does-an-Audiologist-Do.aspx
Zahnert, Thomas. The Differential Diagnosis of Hearing Loss, Deutsch Arztebl Int. 2011 Jun; 108(25): 433–444.
(AIHA, 2000) The Noise Manual – 5th Edition. Berger, E.H., editor. American Industrial Hygiene Association, 2000.
Study.com. Audiologist, 2017. Retrieved September 9, 2017 from: http://study.com/audiology_training.html
University of North Carolina (UNC). A Brief History of Audiology, December 2016. Retrieved September 9, 2017 from: https://hsl.lib.unc.edu/speechandhearing/professionshistory.