By Barry A. Freeman, Ali A. Danesh, Kelly Jones, and Farzon Danesh
This article is a part of the March/April 2025, Volume 37, Number 2, Audiology Today issue.
Education and Preparation of Audiologists
Barry A. Freeman (BAF): In the early years of audiology, practitioners depended on physician referrals and often relied on physicians to interpret audiological test results and recommend treatment because audiologists were unable to fit and dispense hearing aids. As audiology evolved into an autonomous profession, we gained recognition for our specialized knowledge and skills. However, since audiologists began dispensing hearing aids under state licensing laws and professional ethical codes, there appears to have been a noticeable shift toward prioritizing product sales over diagnostic proficiency. In my opinion, the future will demand that audiologists refocus on diagnostic capabilities. As consumers gain access to hearing aids and other products through various retail channels, manufacturers may continue to commoditize the profession by encouraging people to purchase their products without differentiating between distribution channels, whether in retail stores, big-box chains, online, or through professional offices. We have seen similar trends in other fields, such as optometry and veterinary medicine, where consumers seek professional expertise for diagnosis but purchase products elsewhere.
Given these changes, audiologists must receive academic and clinical training that provides a strong foundation to adapt to these evolving demands. Emerging treatments will likely require coursework in genetics, pharmacology, and biochemistry, among other areas. In the future, it is possible that audiologists will play an expanded role in dispensing medications, interpreting medical scans, and offering or facilitating genetic counseling. However, these opportunities will be attainable only if audiologists have the appropriate academic foundation and clinical expertise to support them.
Farzon Danesh (FD): Future audiology practices may increasingly incorporate genetic profiles to inform decisions related to the prevention, diagnosis, and treatment of disorders. Audiologists will need to tailor management and treatment plans based on genetic information, predict the risk of developing hearing or balance disorders, address inherited conditions or comorbidities, and anticipate outcomes for patients of all ages. This shift in practice will likely result in professional education primarily delivered at scientific conferences rather than meetings hosted by product manufacturers.
Ali A. Danesh (AAD): Despite these changes, we all seem to agree that the hearing instrument, by itself, is not the sole solution. The impact of audiological rehabilitation—improving the quality of life and communication and enhancing speech perception in difficult listening situations—is only possible with a caring audiologist. I teach courses in genetics for several audiology academic programs. I envision a future where audiologists will be required to take this type of class and, perhaps, have more undergraduate classes in basic sciences. Audiologists possess a unique understanding of the physiology of the auditory and vestibular systems and, in the future, will be a major part of the health-care team managing and treating tinnitus, sensorineural hearing loss, and vestibular disorders through advancements in the areas of hair cell regeneration and gene therapy, combined with advancements in pharmacotherapy.
The audiologic physician is a possible next step for defining future audiologists.
Kelly Jones (KJ): I agree. For example, in cases of sudden sensorineural hearing loss (SSNHL), we can assess the degree and etiology of the loss, but patients still need to be referred to a physician for medical management. While collaboration with physicians is essential in these cases, it adds an extra step and can potentially delay treatment. Reflecting on several recent cases where patients presented with SSNHL, I have noticed instances where patients assumed that our office could provide comprehensive care—evaluating, diagnosing, and prescribing treatment to start their recovery. In addition, some patients have mentioned delays in securing appointments with their primary care physicians or specialists, prompting them to seek help at urgent care facilities. Given these challenges, it seems logical, in the future and with proper education and training, for audiologists to dispense the necessary oral corticosteroids to improve patient outcomes and offer a quicker response for those with SSNHL.
FD: When considering the future education model for audiologists, I hope that there will be a broader use of integrated education with students in other health-care professions. For example, we would take more courses or clinical rotations in interdisciplinary fields. This collaborative approach across professions may be a model for a value-based health-care system that could begin in professional training and be carried through into clinical practice. Some examples may include fall prevention programs with physical therapy, pharmacy, and geriatric medicine or anatomy and physiology classes with students from other health-care professions.
AAD: Speaking of which, currently, the majority of audiology programs are tied to schools of education, communication, and humanities, but not health care. Audiologists have more synergies with health-care providers, and, in the future, AuD students should graduate from schools with other health-care professionals, especially since hearing and balance disorders can be associated with many health
conditions and almost every organ of the body. The current model is too restrictive administratively and academically. Future AuD applicants will search for programs and schools that are associated with other health-care and healing professions. After all, healing is not limited to devices, medications, or surgical interventions. A healer, like an audiologist, will have increasing responsibilities and capabilities associated with retraining the brain and generating neuroplastic modifications through proper stimulation and support.
BAF: Before we leave this topic, I just want to add another prediction. In the future, doctors of audiology will be referred to as audiologic physicians, similar to other health-care providers, such as optometric physicians, podiatric physicians, and chiropractic physicians. These health-care providers diagnose, manage, and treat their patients, and they are trained in the art of healing with a focus on patient care. The audiologic physician is a possible next step for defining future audiologists.
Technological Advancements
BAF: There is no doubt that advancements in diagnostic and treatment tools, hearing instruments, and implantable technology will continue to evolve, but these areas will likely expand the role of the audiologist in the future. About eight years ago, there was a predicted shift in consumer electronics from wearables to hearables, with the recognition that audiologists were best positioned to manage these changes due to their expertise in the auditory system (Hunn, 2020).
AAD: I totally agree. This remains a significant opportunity for audiologists, particularly as more microprocessors and sensors—such as accelerometers, gyroscopes, optical coherence tomography of the middle ear, heart rate sensors, global positioning systems, microphones, and environmental sensors—are integrated into devices. To stay ahead, audiologists will need to remain current on these technological advancements.
BAF: I suspect that we may also see a shift away from dependence on a single manufacturer for continuing education. There could be a return to a more unified approach to educational programs at meetings hosted by national and state organizations and even the Consumer Electronics Show. Moreover, the audiologists of the future will not be solely focused on the sale of products such as hearing aids. They must develop expertise in related fields such as genomics and personalized health care. As audiologists increasingly integrate genetic profiles into their practice, they will guide decisions about preventing, diagnosing, and treating various disorders. This will involve selecting appropriate management or treatment plans, predicting the risk of hearing and balance disorders, addressing inherited conditions and comorbidities, and forecasting outcomes for adults and children. This information will be delivered at professional scientific meetings rather than through educational programs sponsored by product manufacturers.
KJ: Historically, health care in the United States, particularly in audiology, has focused on “sick care,” where patients seek treatment when they are experiencing a hearing or balance issue. However, audiologists have a unique opportunity to shift this mindset to preventive care through ongoing patient education. By sharing our knowledge with prospective and existing patients, we can encourage a greater interest in preventive care. I have already noticed a change in the younger generation, with many adults in their 20s taking proactive steps, such as annual hearing tests, with a clear purpose of establishing a baseline for their hearing health. If the interest in hearing-health care ignites at a younger age, we will be able to follow these individuals throughout all stages of their lives. Other health-care professionals, including physicians, dentists, and optometrists, have already embraced this model. Moving forward, our goal should be to ensure that audiology services are prioritized earlier in a patient’s lifetime, ideally before any issues arise. One goal should be having most people know the name of their audiologist at a young age and not for them to wait until they are in their 70s for their first visit.
FD: I want to move the conversation to artificial intelligence (AI), which is growing and expanding and may improve the efficiencies of clinical practice. For example, in our practice, we are looking at one AI tool that captures our conversations with patients, converts them into notes personalized to my writing style, and sends an auto-generated report and patient instructions to the patient’s file, referral source, or the patient. Undoubtedly, AI and machine learning can revolutionize diagnosis, management, and treatment of our patients and will be used to enhance audiological assessment, fitting, and rehabilitation. In the future, I envision AI software in our audiometers, phones, tablets, or wearables to make suggestions to the audiologist about the best practice evaluation or management protocols. This could lead to better patient outcomes and more efficiencies in our practices.
KJ: I agree. Today, AI is incorporated within wearables, including hearing instruments, and I can envision an increased use of wearables to send real-time biometric or other information to health-care providers, including audiologists. Imagine if instruments could notify users if they were in a high-risk noise environment, similar to a noise dosimeter. That information would be shared with the audiologist who would inform the patient of the need for an evaluation or counseling to possibly prevent further hearing loss. The additional information provided to patients through wearables fit by audiologists is almost unlimited.
AAD: We recently expanded our hearing and balance services to reduce the dependence on product sales and increase our patient services to our full scope of practice. In the process, we have been looking at many new AI tools to improve patient outcomes and audiologist efficiency. The future appears to be already here. We have been impressed, for example, by the role of AI in auditory as well as cognitive screening tools. Using AI, we can analyze data from vestibular tests, allowing for a more precise diagnosis and personalization of rehabilitation exercises through advanced tracking and adaptation capabilities. Some tools utilize virtual reality to create immersive training environments. We anticipate that these advancements will continue well into the future and may be coupled with remote hearing assessments, eye recording evaluations with smartphones, and the use of AI to manage patients with dizziness.
KJ: Due to our rapid practice growth, we employ assistants to improve our practice efficiencies and to ensure that the audiologists have time to meet the critical needs of our patients. Currently, college students can join our practice and receive training as receptionists. This position allows them to gain insight into daily business operations, develop organizational and time-management skills, and learn more about the profession and their future career. If a student expresses interest in taking on a more hands-on role within our practice, we encourage and support the necessary training to become an audiology assistant. This model has worked well in our practice because it helps us improve our efficiencies and provides the assistants with valuable experiences. In the future, we believe that there will be expanded educational and training opportunities to prepare audiology assistants.
BAF: I was pleased that the American Academy of Audiology now recognizes this need and has added a continuing education program for assistants at their conference. Several years ago, in anticipation of increased demand for hearing and balance services without a growth in the number of graduating audiologists, I was involved in starting one of the first online training programs for audiology assistants. The demand for audiology services will not decrease in the foreseeable future, so the need for audiology assistants will increase. However, I believe the number of individuals available for training will remain limited. Looking at alternatives, I am intrigued by the use of robots and collaborative robots (cobots) in health care; I predict that they will become an integral part of audiology practices in the future. These AudBots are not designed to replace the professional but to enhance and improve the efficiency of the practice by, for example, monitoring patients, performing routine tasks, cleaning workspaces, and assisting patient mobility, all while reducing personnel costs.
Demographic Shifts
BAF: Today, when we think about an aging population, we often focus on baby boomers. However, the future is more about longevity. Remarkably, two-thirds of all people who have ever lived past the age of 65 years are alive today (Dychtwald, 2022). Currently, there are 1 billion people over the age of 60 worldwide (80 million in the United States), and this number is expected to grow to about 2.1 billion people by 2050 (World Health Organization, 2024). We are entering a longevity revolution, where people born today may live well past 100. Audiologists are not going to run out of patients in the future.
As audiologists increasingly integrate genetic profiles into their practice, they will guide decisions about preventing, diagnosing, and treating various disorders.
In addition, audiologists must be prepared to meet the needs of a growing pediatric population. Given the demographic shifts tied to longevity, many children and aging adults will have life-long needs that require ongoing audiological services. In the future, the audiology patient population will be diverse, and audiologists will follow these individuals throughout their lifespan, providing essential care at every stage of life.
AAD:To your point, the advancements in cochlear and vestibular implants, along with cortically-
implanted hearing devices, will be available in the future and will require an AuD, who will have the advanced knowledge and expertise to provide a proper management plan following surgical intervention.
BAF: I understand that the 50-plus generation of U.S. consumers now control almost 80 percent of the net worth in this country and have the most disposable income (AARP Press Room, 2022). This is important because many of our products and services are not covered by third parties and must be paid for by discretionary income. It is this population that purchases the majority of health-care services and products. Hearing loss and fall-related problems are among the leading health-care problems of this aging population. The audiology community and academic programs must address preparation in the management of this aging population. Audiologists will need to meet the demands of these populations across their lifespans.
KJ: There is no doubt the future of audiology will be transformed by advancements in technology, with a strong emphasis on personalized and preventive health care. This will be coupled with the integration of tele-audiology and remote monitoring that will expand access to care, especially in underserved areas. For audiologists and our patients, I foresee a shift from product-centered care to a greater emphasis on patient-centered care and patient empowerment with the diagnostic, treatment, management, and preventive information audiologists provide.
Conclusion
The future of audiology is incredibly promising, driven by the rapid evolution of technology and a growing emphasis on hearing and balance health. As AI continues to transform diagnostic and treatment options, audiologists will be better equipped to meet the diverse needs of their patients. The changes in audiology will happen sooner or later, so we need to be prepared for the future.
