Position

It is the position of the California Speech-Language-Hearing Association that the practice of audiology includes the management of cerumen in the external auditory canal.

Background

Clinical Audiology is a rapidly changing and evolving profession. The development of new technologies enables us to serve patients better and mandates expansion of the repertoire of clinical skills.

Rationale

The responsible practice of audiology requires inspection of the external auditory canal and verification of the integrity of the tympanic membrane. Obstructive or excessive cerumen interferes with audiologists' ability to view the ear canal and tympanic membrane and prevents adequate access to the ear canal for virtually all routine aspects of audiologic practice.

• Cerumen is produced in glands located in the outer 1/3 to 1/2 of the ear canal. Excessive accumulation or impaction of cerumen is a problem for a significant portion of the population, especially the elderly and persons who wear hearing aids.
  
• The presence of excessive cerumen frequently results in misleading and inaccurate test results. This, in turn, may lead to erroneous conclusions, inappropriate treatment, and repeated tests or ear impressions resulting in unnecessary increased time and cost to the patient and the provider.
  
• Current standard audiologic procedures already require entering the ear canal with the otoscope, immittance probe tips, insert earphones, probe microphone tips, otoacoustic emission probe tips, and ear canal impression material. Many audiologists perform electrocochleography and caloric irrigations for ENG. Cerumen removal is often necessary prior to proper performance of these procedures and is no more invasive than the procedures themselves which audiologists have been performing safely for years.
  
• Audiologists, by training and experience, are adept at identifying abnormal ear canal or tympanic membrane conditions that require medical attention and they are ethically bound to refer to physicians promptly when referral is indicated.
  
• Many physicians, general practitioners and otolaryngologists alike, support the practice of cerumen management by audiologists. Often, when patients are referred to physicians' offices the cerumen management is performed by a nurse or other personnel. Very few professionals, aside from otolaryngologists, are as well trained and familiar with the anatomy and physiology of the outer ear as audiologists.
  
• The position of CSHA that cerumen management is within the scope of practice of appropriately trained audiologists is consistent with the positions of the American-Speech-Language-Hearing Association, the American Academy of Audiologists and the Academy of Dispensing Audiologists.
  
• Cerumen management training courses have been conducted around the country for several years and are routinely available to meet continuing professional education needs of audiologists who practice in California. Not all audiologists want to perform cerumen management, but for those with the training and experience, the decision to do so is integral to clinical management.
  
• Audiologists in other states, particularly those in private practice and hearing aid dispensing, have been ethically and legally managing their patients' cerumen problems without complications. Patients generally appreciate efficient comprehensive care. There have been no published reports or studies documenting harm resulting from audiologists' management of cerumen.
  
• Therefore, because audiologists have a vested interest in securing the best and most expedient and cost-effective hearing services for their patients and because they possess the necessary educational preparation, training and experience, audiologists should be among the professionals providing cerumen management services to their patients.