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UA Clinical ServicesOverview of Services ProvidedA. The Following Diagnostic Audiologic Services are Provided:1. Behavioral, physiologic, electrophysiologic audiologic evaluation of all ages2. Behavioral, physiologic and electrophysiologic site of lesion testing3. Cochlear implant candidacy evaluation4. Auditory function and aural (re)habilitation candidacy assessment5. Hearing aid/assistive device candidacy evaluation6. Auditory processing Disorder evaluationB. The Following Hearing Aid, Cochlear Implant and Other Services are Available (seesection III):1. Hearing aid fitting2. Hearing Aid Bank hearing aid fitting3. Fitting of earmolds, swim plugs, hearing protectors4. Hearing aid repair5. Sale of hearing aid supplies6. Hearing aid orientation/counseling7. Verification and validation of treatment benefit (real ear measurements, etc.)8. Electroacoustic hearing aid analysis9. Loaner hearing aid provision10. Hearing aid repair11. Cochlear implant mapping, fine tuning, and processor repair12. Individual and group aural (re)habilitationC. Other Services Provided Include:1. Counseling2. Consultation3. Referrals4. Follow-up5. Parent and family training6. In-service training and workshopsD. Clinicians Engaged in Patient Services Shall:1. Be licensed by the State of Arizona as Dispensing Audiologists.2. Be certified by the American Speech-Hearing-Language Association3. Maintain strict patient confidentiality in accordance with the department’s privacypolicies4. Refer patients for needed services not available in the program5. Not accept remuneration for referrals6. Have available information regarding other professional resources in the community7. Not discriminate on the basis of sex, race, age, religion, national origin, or sexualpreference.8. Comply with the regulations of legally authorized agenciesUpdated: 12/2019

Communication Screenings- As part of the diagnostic evaluation, the audiologist will screen speech and language skills ofpatients as deemed necessary.A. Procedure1. Adult: Audiologist will attempt to engage patient in conversation. Should patientnot become engaged, the audiologist is to obtain necessary communicationinformation via guardian, spouse/significant other report.2. Child: Audiologist will attempt to engage patient in play or conversation. Shouldpatient not become engaged, the audiologist is to obtain necessary communicationinformation via parent/guardian report.B. Areas of assessment1. Receptive language2. Expressive language3. Articulation4. Voice5. Fluency6. Oral-facial anomaliesC. Screening Instruments:1. Use of the “Communication Screening Guidelines” is recommended for assessingcomprehension, expressive language and articulation2. Voice and fluency are judged by examiner with consideration given to sex and ageappropriateness3. Oral-facial anomalies should be judged by non-invasive observationD. Referral criteria and referral sources:1. A rationale for refer and instances where patient could not be screened needs to beincluded in the audiologic report2. Examples of referral sources for immediate follow-up include but are not restrictedto:(a) Speech-language pathologist for complete speech-language evaluation in casesof: Receptive or expressive language delay Inappropriate speech intelligibility for age Dysfluency(b) Speech language pathologist or Ear, Nose and Throat to assess voice3. Patients managed by their primary care physician, another agency or professionalshould not be directly referred for follow-up. A recommendation for follow-upshould be made in the audiologic report4. No referral should be made if patient is already receiving treatment or therapy for anoted concern.Updated: 12/2019

Note regarding capturing patient contact informationThe following patient identification information must be obtained anytime audiologic servicesare provided. This information includes requirements indicated in Article 2, R9-16-212-C of theArizona rules for Licensing Audiologists and Speech-Language Pathologists.1. Name2. DOB3. Address4. Telephone5. Parent/guardian (if applicable)6. Physician7. Referred by8. Date of evaluationUpdated: 12/2019

Adult Audiologic EvaluationA.B.C.Prior to appointment1. Check equipment2. Review charts (history, prior reports/records) and SACCase History Informationa) Chief complaint(s)b) History of: (including but not limited to)i. Tinnitusii. Dizzinessiii. Noise exposureiv. Family history of hearing lossv. Head traumavi. Ear pain/infection/drainagevii. History of ear infections/ear surgeryviii. Ototoxic drugsix. Assessment of communication handicapx. Results of previous audiologic evaluationsc) History of hearing aid use (if applicable)i. First aided (i.e., date)ii. Type of aid(s) or other device(s) usediii. Monaural vs. Binauraliv. Which ear fittedv. Present aidvi. Summary of success with hearing aid(s) to datevii. Name of hearing aid dispenser(s)d) Social/work factorsi) Living situation and support systemii) Professional backgroundiii) Goals: Situations in which they would like to hear bettere) Other medical concernsi) History of chemotherapy radiationii) Diabetes or heart diseaseProcedure for a Basic Hearing Evaluation1. Speech Awareness or Reception Threshold (familiarization first)2. Pure Tone Thresholds by air conduction. Whenever possible, the followingfrequencies will routinely be obtained: 250, 500, 1000, 2000, 3000, 4000, 6000,8000 Hz.3. Pure Tone Thresholds by bone conduction4. Word recognition testing in quiet using BYU lists/NU 65. QuickSIN (binaural presentation, under headphones/insert phones using standardprotocol)6. Acoustic immittance, which may include:i. TympanometryUpdated: 12/2019

D.E.ii. Ipsilaterally stimulated acoustic reflexes at varied test frequencies (500,1000, 2000, 4000 Hz)iii. Contralaterally stimulated acoustic reflex thresholds at varied testfrequencies (500, 1000, 2000, 4000Hz)7. Most comfortable loudness levels for speech and/or pure tones8. Tolerance levels for speech and/or pure tonesSite of Lesion Testing: A patient referred with chief complaint of tinnitus, dizziness or auralfullness may undergo a basic audiologic assessment, together with additional site of lesiontesting. Patients demonstrating sensorineural hearing losses, asymmetric hearing loss, orunilateral hearing losses may also undergo additional site of lesion testing. The additionalsite of lesion testing may include one or more of the following:1. Acoustic reflex decay testing at 500 and 1000 Hz (ipsilateral and contralateralstimulation2. Tone decay testing (note method used) at 500, and 2000Hz and/or the impairedfrequency3. PI-PB function (i.e., Performance Intensity Function for Standardized word lists)4. Electrophysiologic evaluation (ABR, etc.)5. Otoacoustic emissions testing6. Tests for non-organic hearing lossReportsUpdated: 12/2019

Audiologic Evaluation for Adults Referred byArizona Disability Determination Service; Tucson, DDSASuch patients are referred for audiologic evaluations for the purpose of determining whether ornot they qualify for disability payments. Given the constraints of the referral and the higherthan normal likelihood of non-organic hearing loss, the following variations on our standardprocedures are required.1) Only pure tone testing (air and bone), and word recognition testing will be done at theinitial appointment. If further testing is indicated, the following two scenarios apply:a) If the testing is needed for routine reasons, like immittance re: middle ear issues, theaudiologist can ask for the office staff to call DDS for authorization and proceed with thetesting assuming that we will receive authorization.b) If the testing is needed because of concerns about reliability, a second appointment isrequired. The audiologist should:i) Finish with the appointment, letting the patient know that further testing is neededat a separate appointment.ii) Write a report that includes specifically what is required at the reevaluation,specifying the relevant CPT Codes.iii) Call DDS (Richardo Chavez) with an update.2) The SRT will be obtained before any other testing is done. However, the patient is NOT tobe oriented to the words through the audiometer. Instead, they are two be given a writtenlist of the words to be used and the following instructions: “You are going to hear thesewords presented in random order; please repeat them back. The level will get very soft, soeven if you are not sure what you heard, take a guess.”3) Vigilance regarding test reliability will be maintained, including but not limited to:a) Assessment of the patients ability to communicate with and without visual cues duringthe case history, to be compared to the test results,b) Stenger test when possible,c) A primarily ascending approach to threshold testing until reliability can be confirmed.d) Random variation of frequencies and ears tested,e) Recheck of thresholds to determine consistency.4) Written reports must include the following:a) Case historyb) Detailed comments about otoscope evaluationc) Description of resultsd) Discussion of reliabilitye) NO comment about degree of disability. This will be determined by DDS based on theresults and other factors.5) DDS Contact as of 7/18/17:Ricardo Chavez Sr.Updated: 12/2019

Professional Relations Officer; Arizona Disability Determination Service; Tucson4710 South Palo Verde RoadTucson, Arizona 85714(520) [email protected]: 12/2019

Pediatric EvaluationA.B.C.Case History Information1. Chief complaint2. Referred by and reason for referral3. Parent/guardian observations re: child4. Reported observations of others (i.e., educational personnel or health careprofessionals)5. Pertinent medical history (including ear infection history)6. Family history of hearing loss7. Pertinent birth history8. Summary of communication development, including parent/guardian report ofreceptive/expressive language abilities9. Results from previous audiologic evaluationsHistory of Hearing Aid Use (if applicable)1. Date hearing aid(s) acquired2. Binaural vs. monaural3. Type of aid (make, model)4. When are aids worn?5. Parent/teacher observations of behavior changes when child is aided6. Dispenser7. Impression of degree of success with aidsProcedures for Basic Behavioral Hearing Evaluations of Infants and Toddlers having adevelopmental age level between 6 months- 3 years)1. Speech Awareness Threshold (SAT) in sound field or under insert receiver phones ora Speech Reception Threshold (SRT) using picture identification, objectidentifications or body part identification in the sound field or under insert receiverphones.2. Behavioral thresholds using appropriate stimuli for soundfield or ear specific testingusing visual reinforcement audiometry or conditioned play audiometry.3. SRT/SAT by bone conduction and threshold responses to tonal stimuli by boneconduction (if possible)4. Acoustic immittance testing including: tympanometry, acoustic reflexes withipsilateral stimulation and contralateral stimulation (if possible). For childrenbetween the ages of birth to 6 months, use both a 226 Hz and 1000 Hz probe tone.For older infants and children, use a 226 Hz probe tone.Updated: 12/2019

Soundfield Assessment of Aided Speech Recognition Ability in AdultsA. Assumptions:1. All testing will be done with the chair and patient in the calibrated position2. All levels referred to here result in a presentation of 60 dBA3. All testing is to be done through one, front-facing speaker onlyB. AZ Bio Sentence Recognition Testing1. On the audiometer, select the followingLine inChannel 1: Left Speaker, Source A, 60 dBHL on the dial (results in 60 dBA)Channel 2: Off2. Present stimuli through the ASU Sentence Test SoftwareUse calibration tone to calibrate Channel 1Use the software to present and score the desired test(s)C. CNC Word Recognition Testing1. On the audiometer, select the followingLine inChannel 1: Left Speaker, Source A, 60 dBHL on the dial (results in 60 dBA)Channel 2: Off2. Present stimuli through the ASU Sentence Test SoftwareUse calibration tone to calibrate Channel 1Use the software to present and score the desired test(s)Updated: 12/2019

Hearing Screenings (Not for Occupational Hearing Conservation)Screenings are provided to individuals at the Hearing Clinic or at contracted offsite locations.The purpose of a screening is to identify those individuals in need of further speech-languageand/or hearing services.All adult screenings will be done in accordance with ASHA's Guidelines for Audiologic Screening:American Speech-Language-Hearing Association. (1997). Guidelines for Audiologic Screening.Washington DC: AuthorCopies may be ordered from:ASHA Fulfillment Operations10801 Rockville PikeRockville, MD 20852-3279(301) 897-5700, x 218Or through their web site: http://www.asha.org/All school screenings will be done in accordance with The Dept. of Health Services, Title 9, Ch.13. The guidelines can be found at: http://www.azsos.gov/public services/Title 09/9-13.htm(Guidelines are for infants and school-age children only)A. Referral1. Hearing Clinic Screenings (Non-occupational)2. An individual may be screened at the Center as the result of or referral from anysource.3. An individual may be screened at the Hearing Clinic when referred alone or as partof a group.4. Individuals are screened at offsite locations when the following requirements aremet:i. no less than 10 children referredii. appropriate space is providedB. Protocol1. Individual: Pure tone hearing screening is conducted under earphones atfrequencies and levels suggested in the current ASHA guidelines for identificationaudiometry. When reliable pure tone responses cannot be obtained or a hearingloss is identified a follow-up audiologic evaluation will be recommended.2. Group School Hearing Screens: Pure tone hearing screening is conducted underearphones at frequencies and levels mandated by the State of AZ. Tympanometrycan also be administered as part of the hearing screening. There are 3 ways to passa school hearing screening:i. Pure tone only: Pass criteria are 500 Hz (25dB HL), Octave frequenciesbetween 1000 and 4000 Hz (20 dB HL).Updated: 12/2019

C.ii. Tympanometry (clear admittance peak between -200daPa and 100 daPacombined with pure tone pass for octave frequencies between 1000-4000 Hz(20 dB HL).3. TEOAEs (if behavioral responses cannot be obtained). A pass is a 3 dB signal to noiseratio and reproducibility greater than 50% in at least 3 frequency bandsDocumentation1. Individual: An appropriate pre-drafted screening result form indicating hearingscreen results and appropriate follow-up is provided to each individual.2. Group: An appropriate pre-drafted screening result form indicating hearing screenresults and appropriate follow-up is provided to school personnel for eachindividual. Summary information regarding results of mass screenings is provided tothe appropriate person at the referring agency. Information regarding screeningresults and recommendations are maintained on the clinic computer for a period ofseven years and discarded thereafter.Updated: 12/2019

Occupational Hearing Conservation Program (HCP)The University of Arizona Hearing Clinic works closely with the UA Occupational HealthDepartment Hearing Conservation Program. Our role is to do complete evaluations for thoseemployees referred to us by Occupational Health, typically because of the possibility of achange in hearing while working around noise.Evaluation and ReportingA. Front office personnel will:a. Schedule the patients for a 2-hour new patient evaluationb. Have the employees complete the following prior to their appointment:i. Hearing Conservation History Form.ii. Release of information giving us permission to send the report to UAOccupational Health.c. Receive and upload into TIMS previous results sent from Occupational HealthB. Clinicians will:a. Complete a full evaluation, including Hearing Protective Device (HPD) Evaluation.The HPD evaluation is done using the Real Ear Attenuation by Threshold (REAT)method:i. Obtain sound field warble tone thresholds for each year. 500, 1000,2000, 3000, & 4000 Hz. Note that masking may be required.ii. Obtain ear specific sound field warble tone thresholds with theemployees ear protection, inserted by the employee. 500, 1000, 2000,3000, & 4000 Hz. Note Note that masking may be required for this.iii. Report the difference between the results as the degree of ear protectionattenuation.b. Insure that the signed report is given to the office manager for sending to UAOccupational Health WITHIN 48 HOURS OF THE COMPLETED APPOINTMENT. Tomeet this requirement, it is typically best for the clinician to write and print thereport themselves rather than having their students draft it first. This timing iscritical given OSHA reporting requirements in the case of a Standard ThresholdShift.c. Use the following report template:Updated: 12/2019

Occupational Health/Hearing Conservation Report TemplateThe University of Arizona, Department of Speech, Language, and Hearing SciencesSpeech-Language and Hearing Clinics1131 E 2nd Street, Tucson, AZ 85721-0071Phone: 520-621-7070 Fax: 520-621-9901Patient Name:DOE:Examiner:DOB:Audiometer:Referred by:UA Risk Management Service &Occupational HealthBackground Information:To include at minimum:1. Patient concerns about hearing loss, tinnitus or dizziness including when they began2. History of UA work related noise exposure: What years? What kind of noise? Hours in noise perweek? Job title & tasks associated with significant noise exposure?3. History of noise exposure outside of work:a. Other noisy work: What years? What kind of noise? Hours in noise per week?b. Recreational and other noise exposure outside of work? What types? How often overhow many years?4. History of otologic disease, heart disease, diabetes and smoking.5. Was the employee exposed to noise within 24 hours prior to testing?Results:Testing to include at minimum speech reception threshold, pure tone air and bone conduction thresholds,word recognition, and QuickSIN, discussed here in the usual manner.Audiometric Thresholds at OSHA-Specified Frequencies:Right Ear:Left Ear:500 HzdBHLdBHL1000 HzdBHLdBHL2000 HzdBHLdBHL3000 HzdBHLdBHL4000 HzdBHLdBHL6000 HzdBHLdBHL8000 HzdBHLdBHLHearing Protection Device (HPD) Evaluation: The effectiveness of Mr. Employee’s own hearingprotection devices (Earmuffs, brand XX) was assessed using the Real Ear Attenuation by ThresholdMethod. (Warble tone ound field thresholds with and without his ear protection.) The attenuation resultsfrom testing are as follows:ConditionRight Ear:Left Ear:500 HzdBdB1000 HzdBdB2000 HzdBdB3000 HzdBdB4000 HzdBdB*For above conditions when a HPD was used, the HPD was adjusted by the patient. NBN masking wasprovided via insert earphone when necessary.Updated: 12/2019

Summary and Recommendations:Average HL (2, 3, & 4 KHz): RIGHTBaseline (Date)xx.x dBHLToday (Date)xx.x dBHLAverage HL (2, 3, & 4 KHz): LEFTBaseline (Date)xx.x dBHLToday (Date)xx.x dBHLSummarize the hearing loss, including the expected impact on communication. Include this language:This is (or is not) the type and configuration often associated with noise exposure.Describe any recommendations in the usual manner.Name, Au.D., CCC-A,Name, B.S.Audiology Clinic InstructorCc:PatientOccupational Health OfficeGraduate Student ClinicianUpdated: 12/2019

Hearing Aid EvaluationA.Case History1. Reason for referral (i.e., chief complaint)2. Date when most recently seen for hearing evaluation3. Location of previous evaluations4. Copy of most recent audiometric test results (See Below for more information)5. If further case history information is not available in the report from the recenthearing evaluation, HAE case history may include review of information listed under“Hearing Evaluation - Case History Information”6. Establishment of goals for amplification (needs assessment). (Example – COSI)7. Previous hearing aid use and benefitB. Hearing Aid Evaluation Information1. Following an initial basic hearing evaluation (See Audiologic Evaluation Section,Subsection B), a hearing aid evaluation may be performed. It is the policy of thisclinic to accept test results from other sources on which to base the HAE if thefollowing requirements are met:i. Previous audiometric testing was conducted by a licensed audiologist (nameand signature of the examiner required), andii. The test data was obtained within the past 12 months (within the past 6months for children under the age of 18)iii. Per Article 3, R9-16-313 the audiometric results used for fitting anddispensing purposes must include information regarding:1. Type, degree and configuration of hearing loss;2. Ability, as measured by the percentage of words the client is ableto repeat correctly, to discriminate speech (Speech recognition inquiet at conversational levels; and3. The client’s most comfortable and uncomfortable loudness levelsin decibels2. In addition to information obtained in a basic hearing evaluation, the followingunaided information should also be obtained for fitting hearing aids:i. Speech recognition ability in noiseii. Formal assessment of function in critical listening situations (COSI, Glasgowor similar)C. Reportsa. Selection of the hearing aid must be completed either during the time of theappointment or after the appointment. Any associated ordering ofearmolds/aids, or HAB repairs must be complete by the student conducting theevaluation appointment.b. Please see Hearing Device Section of this manual for specific instructions onselecting hearing aids for HAB, EPIC, VR, Self-pay appointments.Updated: 12/2019

Hearing Aid FittingAudiometric test results are to be used for a hearing aid fitting only if they meet the followingconditions:1.2.3.4.5.6.Were obtained within the previous 12 months (6 months for a child).Were obtained by or under the supervision of a licensed audiologist.The results were obtained by a licensed hearing aid dispenser ANDThe results are supported by similar results obtained by an audiologist.There is a signature and name of the licensed professional on the test resultsAre deemed by the U of A audiologist to contain adequate information needed for thefitting and include the necessary results cited in R9-16-313.Please see Hearing Device Section of this manual for specific instructions on fitting hearingaids for HAB, EPIC, VR, Self-pay appointments.A. Hearing Aid Pre-fitting Preparationa. Hearing Aid Bank:i. Custom aids:1. A thorough listening check and electroacoustic evaluation are to be doneto ensure proper hearing aid function.2. The instrument is to be connected to the fitting system to insure that itcan be programmed.3. A note is to be entered into Lytec indicating the make, model and serialnumber and the outcome of the listening and connection check.4. The aid is placed in a tray with the client’s name on it, in the hearing aidworkroom.5. The aid is to be quick-fit and pre-programmed appropriately for thepatient.6. ALL STEPS ARE TO BE DONE BY THE FITTING STUDENT.ii. Non-custom aids:1. A thorough listening check and electroacoustic evaluation are to be doneto ensure proper hearing aid function.2. The instrument is to be connected to the fitting system to insure that itcan be programmed.3. A note is to be entered into Lytec indicating the make, model and serialnumber and the outcome of the listening and connection check.4. The aid and earmold (when received) is placed in a tray with the client’sname on it, in the hearing aid workroom.5. The aid is to be quick-fit and pre-programmed appropriately for thepatient.6. ALL STEPS ARE TO BE DONE BY THE FITTING STUDENT. Typically this isdone at the time of the hearing aid order, but must be done at least 24hours prior to the fitting.Updated: 12/2019

b. New Hearing Instruments:i. Ensure a note is entered into Lytec indicating their make, model & serialnumbers and that they have been received. Check the color.ii. Insure the instruments’ date-received, invoice number, and serial numbers areto be entered into the Hearing Instrument Log.iii. The aids and earmolds (when received) are placed in a tray with the client’sname on it, in the hearing aid workroom.iv. The aids are color coded and any accessories are checked in and charged inpreparation for the fitting appointment.v. The aids are to be quick-fit and pre-programmed appropriately for the patient.vi. Steps ii-iv are often done by the hearing clinic assistant. STEP v and vi MUST BEDONE BY THE FITTING STUDENT AT LEAST 24 HOURS PRIOR TO THE FITTING.B. Hearing Aid Fitting Appointmenta. The physical fit of the hearing aid/earmold will be checked.b. Adjustments will be made to the fit, venting and/or electroacoustics of the instrumentto minimize the risk of feedback.c. Testing will be done to verify the appropriateness of fit in the following areas:i. AUDIBILITY:1. Hearing instruments are to be fit to an appropriate target using real earmeasures, typically with an input level of 60 dBSPL. Place each client’sPROBE TUBE in a plastic bag with their name on it and attach it securelyin their chart for future use.2. Per Article 2, R9-16-313 (A)(7) This verification must be documented inthe patient’s chart and maintained for at least 36 months.ii. COMFORT & TOLERANCE:1. Normal conversational level speech is to be deemed “comfortable” bythe patient.2. Loud conversational level speech is to be deemed “loud but not painful.”d. The patient and/or family is instructed regarding hearing aid use, including thefollowing:i. Battery management and safetyii. Instrument features and landmarksiii. Working knowledge of hearing aid componentsiv. Insertion and removal (practiced until successful)v. Expectation of performancevi. Tips regarding acclimation to hearing aid usevii. Instruction on cleaning, care, and maintenanceviii. Warranty informationix. The clinic’s hearing aid information brochure will be providedx. Patient’s permission to receive a 1-week phone call will be obtained and thestudent clinician will contact the patient in one week and administer theinterview. A copy of the interview questions is given to the patient.e. The hearing aid Bill of Sale will be reviewed and signed by the patient andUpdated: 12/2019

audiologist. The U of A hearing aid contract forms have been constructed to beconsistent with the requirements covered in ARS 36-1909:“B. A bill of sale shall contain the hearing aid dispenser's or the dispensing audiologist's signature andshall show the address of that person's regular place of practice and the number of that person'slicense, a description of the make and model of the hearing aid and the amount charged. The bill ofsale shall also state the serial number and the condition of the hearing aid as to whether it is new,used or rebuilt.C. A bill of sale shall contain language that verifies that the client has been informed about audioswitch technology, including benefits such as increased access to telephones and assistive listeningdevices. If the hearing device purchased by the client has audio switch technology, the client shall beinformed of the proper use of the technology. The client shall be informed that an audio switch is alsoreferred to as a telecoil, t-coil or t-switch.D. A bill of sale shall contain language that informs the client about the Arizona telecommunicationsequipment distribution program established by section 36-1947 that provides assistivetelecommunications devices to residents of this state who have hearing loss. “i.This form should be documented in the patient’s chart and the patient mustreceive a copy for their own records.f. A follow-up appointment is made for 1-2 weeks as deemed appropriate.Updated: 12/2019

Real Ear Verification Using REARSpeech mapping can be completed either after measuring a patient’s RECD or allowing thesystem to use age-related normative data. In order to determine the impact of using normativerather than measured RECD, we measured RECD on college-aged students. Then we asked thesystem to generate NAL-NL1 targets assuming a flat 60 dBHL SNHL and a binaural fitting. Wethen compared the targets obtained using a measured RECD to those using an average RECD.The data were as 2-2-2-1-2-1.18182 -0.27273-0.2 -0.72727 -0.57143 0.7272730 -0.54545-2.22.979267 1.710444 2.039608 1.656442 1.498298 1.354515 1.128152 1.304791 1.989975Based on these data, the following protocol is recommended:1. With adults: Although RECD measurement is always preferred,a. RECD measurement can be skipped in favor of use of normative data if thepatient’s ear canal is of a typical size.b. RECD measurement must be done if the patient’s ear canal is unusually large orunusually small.2. With children: Because of the greater degree of variability and the more significantUpdated: 12/2019

potential error in gain and MPO that might be caused by an exceptionally small earcanal, RECD measurement must always be done prior to speech mapping with children.Updated: 12/2019

Hearing Aid Follow-UpScheduling: All patients fit with hearing aids are to be scheduled for at least one follow upappointment.A. Components:a. All patient concerns are to be identified and, when possible, addressed.b. Patients are to be questioned, at a minimum, regarding:i. Hours of useii. Communication function in goal situationsiii. Physical comfortiv. Loudness discomfortB. Validation: In order to be sure that the selected instrument(s) is making a satisfactoryimpact on the patient’s life, a formal validation measure is to be completed within the firsttwo months after fitting. This might include one of the following:a. Client O

5. Hearing aid/assistive device candidacy evaluation 6. Auditory processing Disorder evaluation B. The Following Hearing Aid, Cochlear Implant and Other Services are Available (see section III): 1. Hearing aid fitting 2. Hearing Aid Bank hearing aid fitting 3. Fitting of earmolds, swim plugs, hearing