What Is an Audiologist?

Audiologists are healthcare specialists who diagnose and treat auditory (hearing) disorders and vestibular (spatial balance) problems related to the inner ear. People are often referred by family physicians, neurologists, ear-nose-throat (ENT) specialists, and speech pathologists to conduct hearing tests and treat a variety often disorders ranging from tinnitus and aging-related dizziness to partial or complete hearing loss. Audiologists provide a variety of treatments, from earwax removal to hearing aids and managing cochlear implants.

The educational pathway for an audiologist is lengthy, requiring no less than four years of postgraduate studies to attain a doctoral degree in audiology (AuD).

Concentrations

An audiologist's practice is focused on identifying, diagnosing, treating, and monitoring disorders of the auditory and vestibular systems.

The auditory system involves not only the ears and their inner structures (known as the outer, middle, and inner ear), but also the neuronic structures that process the digital information en route to the brain.

The vestibular system is confined primarily to the spiral cavity known as the cochlea and the labyrinth of the inner ear, both of which contribute to your sense of balance and spatial orientation.

The types of auditory disorders an audiologist may be called treat include:

• Auditory neuropathy: A nerve-related disorder causing poor speech perception
• Auditory processing disorders: A variety of disorders that affect the ways that the brain processes auditory information
• Autoimmune hearing loss, including granulomatosis with polyangiitis and Cogan's syndrome, both of which can damage the cochlea
• Congenital hearing loss
• Infection-related hearing loss caused by diseases such as measles, mumps, herpes, meningitis, HIV, syphilis, or the Zika virus
• Noise-related hearing loss
• Otosclerosis: Hearing loss caused by the hardening of the stirrups in the middle ear)
• Ototoxicity (ear poisoning)
• Stroke-related hearing loss
• Tinnitus (ringing in the ears)
• Trauma-related hearing loss

Vestibular disorders can occur on their own or overlap with hearing loss. Among some of the vestibular disorders an audiologist may help treat include:

• Acoustic neuroma: A serious but nonmalignant tumor that develops on the vestibulocochlear nerve leading to the brain
• Aging-related dizziness and imbalance, which may result from a combination of vestibular, brain, and visual disorders
• Autoimmune inner ear disease, which can also cause hearing loss
• Benign paroxysmal positional vertigo: A common imbalance disorder typically caused by debris in the inner ear
• Bilateral vestibular hypofunction: Difficulty maintaining balance, especially in the dark, which is often secondary to a wide spectrum of other illnesses or disorders
• Cholesteatoma: An abnormal skin growth in the middle ear that can damage its bones
• Enlarged vestibular aqueduct syndrome: An imbalance in the volume and composition of the fluid in the inner ear
• Labyrinthitis and vestibular neuritis: Injury of the vestibulocochlear nerves resulting from an infection of the inner ear
• Ménière's disease: A vestibular disorder of unknown origin that causes abnormally large amounts of fluid in the inner ear
• Perilymph fistula: A tear or defect in one of the thin membranes that separate the middle ear from the inner ear
• Persistent postural perception dizziness: Chronic dizziness that increases with movement or moving stimuli
• Superior semicircular canal dehiscence syndrome: The displacement of inner ear fluid caused by an opening in the bone covering the inner ear canal
• Vertebrobasilar insufficiency: The restriction of blood to the inner ear, vestibulocochlear nerve, and brainstem (common in the elderly)

Procedural Expertise

An audiologist has the expertise to treat or participate in the treatment of hearing-related problems and disorders involving dizziness, imbalance, or vertigo. Those beyond the scope of the audiologist's practice may be seen by a neurologist (who specializes in nervous system disorder) or ENT surgical specialists.

The functions of an audiologist are far-ranging and include not only the diagnosis and treatment of hearing/balance disorders, but the prevention of hearing loss.

Diagnosis

An audiologist may work with patients of varying ages to diagnose a concern. In this role, he or she may:

• Perform otoscopic examinations of the ear canals and eardrum
• Perform acoustic reflex testing using a tympanometer to measure the response of the eardrum
• Perform auditory brainstem response testing using electrodes to evaluate nerve signals sent to the brain in response to sounds
• Interpret the physical, audiological, radiological, and lab findings
• Supervise and conduct newborn hearing screenings
• Conduct behavioral tests to see how children respond to different sounds
• Screen speech-language and sign language to assess the severity of hearing loss
• Assess the candidacy of people with hearing loss for hearing aids, cochlear implants, or audiologic rehabilitation
• Counsel patients on their condition and the available treatment options

Treatment

Audiologists often work in conjunction with other providers and therapists. For their part, audiologists may:

• Remove excess cerumen (ear wax)
• Make ear impressions for hearing devices
• Recommend, provide, fit, and program hearing aids
• Recommend and provide hearing assistive technology systems (HATS) for the hard of hearing
• Provide audiologic rehabilitation, including lip reading, language development, and auditory skills development 
• Perform the non-medical management of tinnitus
• Regularly evaluate and record patient progress
• Work with physical therapists, occupational therapists, speech therapists, and other allied health professionals in providing coordinated care of hearing or balance disorders
• Help patients and families better deal with the psychological and social stresses of hearing loss
• Advocate for treatments, such as hearing aids and cochlear implants, from insurers and other healthcare providers

Prevention

While most people only see an audiologist after a problem is suspected, those with known risk factors may seek such help in advance. Audiologists can:

• Provide counseling and noise-reduction devices to people at risk of occupational hearing loss
• Provided digital earplugs to musicians exposed to high-amplification sounds
• Provide decibel-reducing ear muffs to hunters, recreational shooters, and law enforcement officers
• Consult with senior home living staff to prevent falls, ear infections, and the misuse of medications that can affect balance in the elderly

Subspecialties

Some audiologists choose to specialize in specific aspects of the practice. In some cases, an audiologist may choose to open a balance clinic devoted solely to vestibular disorders. Others choose to work exclusively in pediatrics or start a group practice devoted to hearing implants (including not only cochlear implants, but bone conduction implants, middle ear implants, and auditory brain stem implants).

Specializing in these fields often require additional training.

According to the Bureau of Labor Statistics (BLS), over 70 percent of audiologists work in healthcare facilities, including private or group practices, audiology clinics, and hospitals. Around 10 percent work in schools or for school districts or government departments. The remainder find employment in health and personal care stores.

Training and Certification

A doctoral degree in audiology (AuD) is a graduate program that typically takes four years to complete. A bachelor's degree is needed to enter the program.

Although candidates don't necessarily need a science degree to enroll in an AuD program, they do need to have completed certain pre-requisite coursework at the bachelor level.

Graduate coursework includes anatomy, physiology, physics, genetics, communication development, diagnosis, treatment, pharmacology, and ethics. Programs also include supervised, hands-on clinical practice.

Graduation from a program accredited by the Council on Academic Accreditation (CAA) is required to get a license in most states. Licensing is required in all states, but the requirements can vary significantly. For specific details, contact your state's licensing board for audiologists.

Graduates from an AuD program can be credentialed through the American Board of Audiology (ABD) after passing a standardized exam. Certification may be required by some states or employers. Audiologists can also earn the Certificate of Clinical Competence in Audiology (CCC-A) offered by the American Speech-Language-Hearing Association (ASHA).

Appointment Tips

It helps to be prepared when meeting an audiologist for the first time. Although you may have been referred by another doctor who has already treated you, the audiologist is trained to look for clues that other doctors don't. The more information you are able to provide, the easier it will be to reach a diagnosis.

In advance of your appointment, ask your primary health provider to forward all relevant medical files to the audiologist. Upon arrival, you will be asked to fill out a general questionnaire; be sure to include all medical conditions you have (or have been treated for) and any medications you are currently taking. It often helps to write these things down before you arrive.

Think ahead so that you can clearly communicate your symptoms, including when they started, when they occur, and when they are especially severe. Write down questions in advance so that you fully understand what to expect moving forward. They may include:

• What does a typical examination involve?
• What is the current state of my hearing?
• What are my treatment options?
• Can I do anything to prevent further hearing loss?
• What will happen if I don't get treated?
• Are there financial aid programs that can assist with costs?

Generally speaking, the best way to find an audiologist is through a professional referral. If you can't get one (or are provided a general list from your insurer), you can check their ABA credentials by emailing a request to aba@audiology.org. CCC-A certification can be confirmed on the ASHA credential verification webpage.