Audiology's Threatened Autonomy May Be Self-Inflicted: Opinion Editorial

Audiology's Threatened Autonomy May Be Self-Inflicted: Opinion Editorial

May 13, 2019 / By John Greer Clark Editorials

In March of this year, New Mexico Governor Michelle Lujan Grisham signed into law a consumer protection bill for people with hearing loss ensuring that those who purchase hearing aids in her state will be counseled on the benefits and availability of telecoil technology. A handful of other states have done the same with legislation in more states pending. Audiologists frequently have been among the opponents to these legislative initiatives.

Are We Failing Our Patients?

The value of telecoils (or audiocoils as Mark Ross once had advocated they be dubbed [Ross, 2002]) for improved listening within various venues has long been widely recognized. Many public places in Europe have loops installed to permit those with hearing loss who use hearing aids or cochlear implants with telecoils to hear better at train and subway ticket kiosks, pharmacy windows, reception desks, grocery stores, courtrooms, theaters, houses of worship, auditoriums, and in taxicabs and buses and other environments that present challenges of distance, noise or reverberation.

The consumer group Hearing Loss Association of America (HLAA) has long advocated for greater use of telecoils and hearing loops in a variety of venues (HLAA, 2018). A joint initiative began in 2010 between the American Academy of Audiology and HLAA to expand the number of venues that have telecoil-compatible electromagnetic listening loops, pads or shields in an effort to increase hearing aid and cochlear implant utility. While the United States is still far behind Europe in the installation of electromagnetic listening systems, we continue to make strides.

Seventy percent of hearing aids on today's market have telecoils or can be fit to interface with electromagnetic loops. Yet, hearing care professionals, audiologists included, often fail to share information about the benefits of the telecoil. In fact, one survey has found that 66 percent of first-time hearing aid purchasers are not told about telecoils and the value they could add to the consumer's quality of life (Frazier, 2016).

Are We Doing What We Should?

Audiologists are caring and dedicated professionals who often find themselves in highly competitive markets. However, as a profession we have a history of not providing optimal services to those we serve (See Table). While all major audiology associations have included within their best-practice guidelines the administration of pre- and post-self-assessment measures, speech-in-noise testing, probe-mic hearing aid fitting verification, communication management training and the provision of augmentative hearing assistance technologies (aka: ALDs), large numbers of audiologists fail to include these within their practices (Clark et al, 2017).

Where We Fall Short: Percent of Audiologists Who Fail to Routinely Engage in Best Practice

Recommended Practice Percent performing less
than one-half the time
Percent performing
seldom or never
Pre-Treatment Self-Assessment 73 57
Post-Treatment Self-Assessment 67 56
Speech-in-Noise Testing 72 55
Probe-Mic Verification 37 25
Hearing Assistance Technologies Discussion 49 13
Engage Communication Partner 35 11
Provide Communication Strategies 29 6

From: Clark, Huff, and Earl (2017) Clinical Practice Report Card

Earlier in the same month that Governor Grisham signed the telecoil advising bill in New Mexico, the Academy, along with the American Speech-Language-Hearing Association and the Academy of Doctors of Audiology agreed to work toward joint legislative initiatives to expand access to and coverage of audiology services under Medicare (Hearing Review, 2019). These organizations note that it is critical that audiology's full scope of practice be appropriately recognized. Nevertheless, through the years, audiologists have failed to provide this "full scope of practice" to those they serve.

Are We Willing to Do What Is Necessary to Control Our Own Destiny?

Audiologists were among the opponents of the New Mexico telecoil legislation because we view ourselves as autonomous professionals and we balk at the prospect of having the manner in which we practice our profession dictated by outsiders. If we cannot police ourselves better by ensuring that we provide the care we have been charged to provide, we can expect more legislation to dictate what we do. And until we provide our full scope of practice to our patients, we will have many opponents to our legislative efforts to gain greater access to, and increased coverage of, our services.

If the profession of audiology is ever to reach its full potential, we must change the code of ethics statements of our licensing boards, our professional associations, and our certification bodies to ensure that we all practice audiology as it was intended by the profession's founders to be practiced. Recent legislation to dictate professional practice should serve as a clarion call to action by all audiologists. If we do not make these changes ourselves, others are willing to do it for us.

John Greer Clark, PhD, is a professor and director of audiology education at University of Cincinnati.


Clark JG, Huff C, Earl BR. (2017) Clinical practice report card: Are we meeting best practice standards for adult hearing rehabilitation. Audiology Today 17:14-25.

Frazier SO. (2016) Hearing loops get the vote: Hearing-impaired individuals prefer this assistance system. Sound & Communication October:32-33

Hearing Loss Association of America (2018). Position paper: Telecoils and hearing loops. Retrieved April 27, 2019.

Hearing Loss Association of America (2019). Consumer protection bill for people with hearing loss signed by New Mexico Governor. Retrieved April 27, 2019.

The Hearing Review (2019). ASHA, AAA, and ADA agree to joint legislative initiative on Medicare legislation. Retrieved April 27, 2019.

Ross M. (2002) Telecoils: The powerful assistive listening device. Hearing Review 9:22-26.

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