Audiologist or Hearing Instrument Specialist? Know The Facts
November 16, 2021
Selecting a hearing care provider is an important decision. Why? Because finding the most qualified and dependable professional can mean the difference between being successful and satisfied with your hearing aids…or not.
No doubt, you choose other health care professionals—your general practitioner, ophthalmologist, cardiologist, podiatrist, just to name a few—very carefully. Your hearing care professional is no different. Perhaps what makes the process most challenging are the many choices—from types of care providers to brands, levels and styles of hearing technology. Information can be confusing, even contradictory. Being educated about modern hearing healthcare and hearing aids allows you to make the most informed decision for your best outcome.
Here’s what you need to know about the two kinds of professionals—audiologists and hearing instrument specialists—who are licensed to sell and fit hearing aids in the states Johnson Audiology serves—Tennessee and Georgia.
TWO TYPES OF HEARING CARE PROVIDERS: VERY DIFFERENT CREDENTIALS
An Audiologist’s credentials
Audiologists complete extensive university coursework to receive a clinical doctor-ate in audiology, earning their bachelor’s, master’s, and doctorate degrees over the course of eight years.
Through extensive graduate level coursework, what do they learn:
- The neural pathways for transmission of sound from the inner ear to the cortex of the brain
- Diagnostic testing for hearing loss, tinnitus, hyperacusis and other hearing-related disorders
- The circuitry and components of a hearing aid and how to choose brand, style, and fit tailored to the individual patient
- Assistive technology devices and how those can dovetail with a patient’s hearing aids and elevate the hearing experience
- Theories of tinnitus and sound perception
- Ear and hearing dysfunction and appropriate treatment options
- Hearing conservation programs
- Acoustic and digital modification strategies for hearing instruments
- Inner ear balance disorders
- Counseling techniques for patients and their family members regarding hearing loss and intervention.
- How to cultivate critical thinking skills and lifelong learning related to hearing function, amplification strategies, and tinnitus management
- How to concentrate on superior patient care with compassionate counseling
Throughout their graduate-level study, Audiologists are supervised in clinical rotations for all age levels in the following settings:
- University clinic
- Hospital
- Public school system
- Otolaryngology/ENT practices
- Veteran’s Administration
- Private practice
During each semester of the four-year graduate school enrollment, a student will:
- Participate in 12 hours of coursework in addition to six hours of clinical work with patients
- Routinely participate in clinical work with aural rehabilitation therapy to gain a better understanding of the work performed by their speech-language pathology colleagues
- Log nearly 2,000 patient contact hours during their fourth year of graduate study, in addition to their previous hours acquired during their first three years of graduate study
Applicants for licensure as an Audiologist in Tennessee must:
- Earn a doctoral degree with an emphasis in audiology from an accredited institution
- Have a current certificate of clinical competence (CCC-A) from American Speech-Language Hearing Association (ASHA) and/or complete 1,820 clock hours of supervised clinical practicum by a licensed or certified audiologist and pass the Praxis exam for audiology.
- Complete ten hours of continuing education every year to maintain their license.
A hearing Instrument specialist’s training
A dispenser/hearing instrument specialist (HIS) is the second professional permitted to sell and issue hearing aids in Tennessee and Georgia.
For initial apprentice licensure, an HIS must:
- Be at least 18 years old
- Have two years of college coursework in any subject (does not have to be in audiology or a related subject)
- Pass a written exam
Upon apprenticeship completion, an HIS must:
- function under the direct supervision of a sponsoring, licensed hearing instrument specialist (HIS) for at least three months
- Complete 60 hours of classroom coursework
A HIS must:
- Complete 20 hours of continuing education during the two calendar years that precede the licensure renewal year with two hours of the 20-hour requirement pertaining to state statutes and rules concerning hearing instrument specialists.
As you consider who you want to trust as your lifelong partner on your journey to healthier hearing. ask yourself these questions:
- Which hearing provider—an Audiologist or a HIS—has the highest level of education?
- Which provider has shown the greatest evidence of commitment to his or her field through time and personal resources invested in honing knowledge and skills?
- Which provider spends the most time working with patients in a supervised, training setting before being credentialed to work with those with hearing loss solo?
- Which type of provider routinely verifies and files your insurance benefits for hearing health care?
- Which provider conducts a full diagnostic hearing test in a rated, sound-proof booth?
Misconceptions and Facts
Misconception
- An Audiologist’s education concentrates on the diagnostic procedures rather than hearing aid fitting.
Fact
- Audiologists formally study hearing aid technologies from multiple manufacturers while in graduate school and continue to do so throughout their careers. Notably, most of the professionals from the hearing aid manufacturers that lead trainings are degreed audiologists not hearing instrument specialists.
Misconception
- Hearing instrument specialists offer the same type of hearing tests as an audiologist
Fact
- Hearing instrument specialists are not licensed to perform audiological exams. Therefore, their assessments are not considered diagnostic hearing tests but rather basic hearing screenings. Audiologists, however, do full audiologic testing in a rated, sound-proof booth. Audiologists are also trained and licensed to conduct diagnostic testing specifically for those with tinnitus and for patients who are candidates for cochlear implantation, testing which hearing instruments specialists cannot legally perform.
Misconception
- Hearing instrument specialists offer free hearing tests because they care more about their customers
Fact
- Most audiologists offer patients the benefit and convenience of filing the patient’s diagnostic hearing test to Medicare, which covers testing. Notably, it is insurance fraud for an Audiologist to bill Medicare for one patient and then provide a free evaluation for another patient. Therefore, audiologists cannot legally provide free hearing testing if they are a Medicare provider. Since most hearing dispensers offer “free” testing this automatically means they are not working with Medicare so customers lose out on that benefit.
Here are some tips when searching for your hearing care professional:
- Ask for the provider’s credentials. A doctor of audiology has the credentials Au.D. following his or her name. If you see HIS following the person’s name, you know that person is a minimally trained hearing instrument specialist.
- Look for an Audiologist who works with several hearing aid manufacturers so that your technology can be tailored to your unique hearing loss.
- Ask if you are entitled to a trial period. Each patient is a unique individual. You deserve to work with a professional who spends times assessing and addressing your personal hearing concerns, goals, desires and budget.
- Do not buy hearing aids by mail or internet that claim patients do not need direct contact with their hearing health-care professional.
Chipper Gocke, 28, has had many poignant moments in the last six weeks since his cochlear implant surgery. “A workmate commented recently that my speaking voice is the appropriate volume now. Not being able to hear myself, I probably often talked too loud before. It seems like a small thing, but it is a way to be more normalized in my professional and other settings.” His mother, Amy Gocke, also has noticed the changes. “Chipper has never called me on the phone before. With his profound lifelong hearing loss and even using powerful hearing aids, he simply couldn’t communicate by phone. Now I look forward to his calls every day after he gets off work.” These daily experiences that people often take for granted—communicating with a workmate or calling a family member to say hello—are now possible for Chipper because of his cochlear implant. Hearing loss has been a part of Chipper’s life since he was a small child. Chipper’s father, Ted Gocke, relates, “From the time he was 18 months old, Chipper had ear infections that had us in and out of the hospital. That led to tubes in his ears and the diagnosis that he had a significant hearing loss.” As a youngster, Chipper received early intervention services before he even reached school age. He also got established with local audiologist, Darnell Scafe, and they reconnected recently when Chipper sought out Darnell for hearing health care services as an adult. Darnell, who joined the Johnson Audiology team in 2018, says, “I remember Chipper as a sweet little boy who didn’t let his hearing loss slow him down. It’s wonderful to get to know the fine, capable young man he has grown into.” Last year, Darnell encouraged Chipper to consider a cochlear implant, and she referred him to Johnson Audiology’s Cochlear Implant Program Director, Dr. Hannah Dearth. Dr. Dearth then was able to complete cochlear implant candidacy testing. In November of last year, Chipper’s surgery was performed at Murfreesboro Medical Clinic (MMC) in Middle Tennessee by an otolaryngologist (ENT). A native of Chattanooga, Chipper traveled for the initial surgery since there is not currently an ENT in Chattanooga who performs CI surgeries. However, Chipper then had his cochlear implant activated at Johnson Audiology (JA) by Dr. Dearth in early January. Also, there to celebrate activation day was Darnell. “It felt like a full circle moment when Dr. Dearth activated Chipper’s cochlear implant, and he began to have those first sound perceptions.” Dr. Dearth explains, “People often wonder how a hearing aid and a cochlear implant are different. Cochlear implants are designed for patients whose hearing aids are no longer assisting them in understanding in both quiet and noisy environments. A hearing aid is designed to provide amplification for speech sounds that are unintelligible without said amplification. Cochlear implants are a surgical option for those who are no longer able to achieve meaningful understanding with a traditional hearing aid. Hearing aids rely on the ear’s natural pathway for hearing to accomplish this and so may not work well for someone with severe damage to the inner ear. A cochlear implant, on the other hand, bypasses the damaged parts of the ear by stimulating the auditory nerve directly with a mild electrical current that sends the sound signal to the brain.” Chipper is committed to his own success with his cochlear implant and in addition to listening to the speech of those around him, he is also tuning in to podcasts and audiobooks that give him even more speech exposure. Dr. Dearth says that is a huge factor in any patient’s ability to thrive with the device. “The patients who are committed to the aural rehabilitation as prescribed experience faster progress and higher success rates long term.” Chipper will continue regular follow-up appointments for the rest of his life to maintain successful progress with his CI. He gets emotional talking about the social isolation that can be a common side effect of profound hearing loss and, also, mentions the spatial awareness that better hearing offers. “Being able to pinpoint sound and localize stimuli from both sides of the head has positive effects for living a safe life,” Dr. Dearth says. Dr. Megan Johnson, audiologist, founder, and owner of JA, says, “Johnson Audiology has provided support for cochlear implant patients since 2017 with care offered through the practice’s location on Lee Highway in the East Brainerd area. After implantation, every other part of a CI patient’s hearing journey can be accomplished at Johnson Audiology—from initial activation to routine mapping.” Chipper and his parents encourage people to explore the possibility of cochlear implants since it can make such a difference in a person’s daily life and function. Johnson Audiology is accepting new patients who currently wear hearing aids but would like to pursue cochlear implant candidacy as well as those who already have a cochlear implant. Call Johnson Audiology at 423.556.7185 or visit www.johnsonaudiology.com/schedule for more information or to schedule an appointment.
Research reveals that hearing loss actually rewires your neural pathways Your Amazing Brain Your brain is an amazing organ! This wrinkly, reddish-pink mass weighs about the same as your two-slice toaster, tipping the scales at about three pounds. Acting as a master control center, your brain enables every thought, breath, eye blink, heartbeat, movement—everything—that happens in your body. Rivaling the world’s most powerful supercomputer, your brain can download, process, and react in milliseconds to the tidal wave of information coming from your eyes, skin, nose, tongue, and ears. Neuroplasticity and Your Sense of Hearing Researchers have discovered that the human nervous system—made up of the brain, spinal cord, and a complex network of nerves—has incredible capacity to modify itself, both in function and physical structure. This is called neural plasticity . Dr. Megan Johnson, audiologist and owner of Johnson Audiology explains, “Neural plasticity is going gangbusters in a child’s brain as the child develops and matures into adulthood. Based on years of brain research, we also know that the adult brain is far from being fixed. It, too, changes and adapts when you learn new information or skills or as a response to stress, hormonal fluctuations, drug interactions, injury, and much more.” Dr. Johnson also relates that “your brain displays neuroplasticity when you experience hearing loss.” By measuring brain waves using an electroencephalograph, or EEG, scientists have studied how the brain of a person with hearing loss functions compared to a person with normal hearing. The results are both fascinating and sobering as studies reveal that, in those with hearing loss, the portion of the brain devoted to hearing becomes reorganized. This can be true even with early-stage, mild hearing loss, and the process happens quickly, often in months rather than years. The Hearing Center of Your Brain and Beyond What is actually happening when this takes place? Your brain has a right and a left hemisphere and six major lobes. Think of your frontal lobe as your brain’s boss, where executive functions like decision making, emotion and impulse control, and planning occur. Your temporal lobe, which contains the auditory cortex, is doing the heavy lifting when it comes to interpreting sounds and assigning those sounds meaning. The temporal lobe processes speech and language, and it is where initial learning of new information takes place, which is the first step for logging that information into memory. Dr. Johnson goes on to relate, “When the delicate infrastructure of your ear has become damaged through noise exposure, infection, etc. leading to hearing loss, your auditory cortex cries out to your frontal lobe, saying ‘Help! Help! I’m not receiving any sound to process, so I feel lost.’ The frontal lobe ‘boss’ jumps to attention, and your occipital lobe, responsible for processing vision and touch, takes over the areas in which hearing is normally processed. In other words, your other senses seek to compensate for the deficit due to the loss of your sense of hearing.” Amazing, right? So, where’s the rub? Picture a car assembly line; each worker has an assigned task. One day, the worker who installs the windshields is absent, and the worker who attaches the rearview mirrors is assigned double duty, and a duty that was not part of job training. It is easy to see how the worker left juggling both jobs is compromised, and a car might slip through minus a rear view mirror. Similarly, the areas of your brain that are being taxed to make up for a lack of hearing are overloaded and less able to do their assigned responsibilities. “This explains why so many of my patients with hearing loss relate feeling exhausted and frustrated after a big family gathering—where multiple talkers and sounds must be interpreted—rather than happy and invigorated by the experience. We call this listening fatigue ,” states Dr. Johnson. Additionally, when left untreated long enough, researchers point to the brain’s reorganization due to hearing loss as a significant correlation with dementia. Hearing Technology and Your Brain “But here's the great news!” Dr. Johnson says. When a person is fit with hearing aids or a cochlear implant and sound is restored, the brain has the ability to adjust back—partially or completely—to proper function. How swiftly that happens often depends on how long the hearing loss went untreated and is why she encourages patients to treat hearing loss sooner rather than later. “Here is what I tell patients who are downplaying the importance of hearing: If you won’t treat your hearing loss for the sake of your ears, do it for your brain!”
