Clinical practice guidelines

Evidence-based clinical practice guidelines provide the framework for best-practice audiology care. The following guidelines are the most widely referenced in US audiology practice:

• AAA Clinical Practice Guidelines: Adult Hearing Aid Fitting (2023): The American Academy of Audiology's comprehensive guidelines covering candidacy, pre-fitting assessment, prescriptive fitting, real-ear measurement, outcome validation, and follow-up care. Available free at audiology.org.
• AAA Pediatric Amplification Guidelines (2013, updated): Guidelines for hearing aid fitting in infants and children, including RECD measurement, DSL targets, and family-centered care. Available at audiology.org.
• ASHA Preferred Practice Patterns for Audiology: ASHA's scope-of-practice and preferred practice documents covering audiologic assessment, hearing aid dispensing, and aural rehabilitation. Available at asha.org.
• JCIH Year 2019 Position Statement: The Joint Committee on Infant Hearing's guidelines for early hearing detection and intervention (EHDI) programs, including newborn hearing screening, diagnostic evaluation, and early amplification.
• AAA Tinnitus Management Guidelines (2021): Evidence-based guidelines for tinnitus assessment and management, including sound therapy, cognitive behavioral therapy, and hearing aid fitting for tinnitus patients.
• AAO-HNS Clinical Practice Guideline: Sudden Hearing Loss (2019): American Academy of Otolaryngology guidelines for the evaluation and management of sudden sensorineural hearing loss, including steroid treatment protocols.

Prescriptive fitting targets and calculators

• NAL-NL2 calculator: The National Acoustic Laboratories provides a free online NAL-NL2 target calculator at nal.gov.au. Useful for verifying fitting software targets or calculating targets for unusual audiogram configurations.
• DSL v5.0: Available through the DSL Method website (dslio.com) and integrated into all major fitting software platforms. The DSL group at Western University also provides clinical resources and training.
• Audioscan Verifit target library: The Verifit REM system includes built-in NAL-NL2, DSL v5.0, and other prescriptive targets. The Audioscan website (audioscan.com) provides fitting guides and clinical resources.

Outcome measures and assessment tools

Validated outcome measures are essential for documenting hearing aid benefit and guiding clinical decisions. Key tools:

• COSI (Client Oriented Scale of Improvement): Free download from the National Acoustic Laboratories (nal.gov.au). Patient-centered outcome measure where patients identify priority listening situations. Highly recommended for routine clinical use.
• IOI-HA (International Outcome Inventory for Hearing Aids): Seven-item questionnaire available in multiple languages. Free download from the IOI-HA website. Provides a standardized outcome profile across seven domains.
• HHIE/HHIA (Hearing Handicap Inventory): 25-item questionnaire measuring social and emotional impact of hearing loss. Widely used for documenting pre- and post-fitting benefit. Available in the public domain.
• APHAB (Abbreviated Profile of Hearing Aid Benefit): 24-item questionnaire measuring benefit across four subscales. Available from the University of Memphis Hearing Aid Research Lab.
• QuickSIN: Speech-in-noise test available from Etymotic Research (etymotic.com). Essential for quantifying SNR loss and setting realistic expectations for noise performance.
• DPOAE and TEOAE normative data: Otoacoustic emissions normative databases are available through equipment manufacturers (Interacoustics, Natus, Maico) and in published literature.

Audiogram interpretation resources

• WHO hearing loss grading: The World Health Organization's classification system (normal, mild, moderate, moderately severe, severe, profound) is the most widely used international standard. Updated in 2021 to include a "slight" category (16–25 dB HL).
• ASHA degree of hearing loss categories: ASHA uses a slightly different classification system (normal, slight, mild, moderate, moderately severe, severe, profound) that is standard in US clinical practice.
• Audiogram of familiar sounds: The "speech banana" audiogram showing where common environmental sounds and speech phonemes fall on the audiogram. Useful for patient counseling. Available free from ASHA and AAA.
• Count-the-dot audiogram: The Killion/Mueller count-the-dot audiogram provides a quick estimate of the Articulation Index (AI) or Speech Intelligibility Index (SII) from a pure-tone audiogram. Useful for counseling and for estimating expected word recognition scores.

Infection control and equipment maintenance

• CDC guidelines for audiologic equipment: The Centers for Disease Control and Prevention provides guidelines for cleaning and disinfecting audiologic equipment, including insert earphones, probe tips, and hearing aid shells.
• OSHA bloodborne pathogen standards: Relevant for audiologists who handle cerumen or perform cerumen management procedures.
• Manufacturer cleaning protocols: Each hearing aid manufacturer provides specific cleaning and disinfection protocols for their devices. These are available through professional portals and should be followed to avoid voiding warranties.

Coding and documentation resources

• AAA coding and reimbursement resources: The AAA provides coding guides, CPT code references, and reimbursement resources for audiologists. Available to AAA members at audiology.org.
• ASHA reimbursement resources: ASHA's reimbursement and coding resources cover Medicare, Medicaid, and private insurance billing for audiology services. Available at asha.org.
• ICD-10-CM codes for hearing loss: The primary ICD-10 codes for hearing loss documentation include H90 (conductive and sensorineural hearing loss), H91 (other and unspecified hearing loss), and H93 (other disorders of ear). Accurate ICD-10 coding is essential for insurance billing and outcomes tracking.
• NOAH system documentation: The HIMSA NOAH system is the industry standard for audiologic record-keeping and fitting data management. Documentation best practices are available through HIMSA (himsa.com).

Telehealth and remote care resources

• AAA telehealth guidance: The AAA has published guidance on telehealth practice in audiology, including appropriate services, technology requirements, and state licensure considerations.
• ASHA telepractice resources: ASHA's telepractice resources cover clinical, ethical, and regulatory considerations for remote audiology services.
• State telehealth laws: Telehealth regulations vary by state. The Center for Connected Health Policy (cchpca.org) maintains a state telehealth law and reimbursement policy database.