User:Forsakendaemon/Audiology

Audiology (from Latin audīre, "to hear"; and from Greek -λογία, -logia) is a branch of science that studies hearing, balance, and related disorders. In a clinical setting, audiology is concerned with the diagnosis, assessment, and rehabilitation of disorders of the auditory and vestibular systems.

The practitioners of audiology are called audiologists. Audiologists may specialise in diagnostics, rehabilitation, or research, and may focus on hearing or balance. Some audiologists specialise in working with newborns, young children, patients with additional disabilities, or those with implantable devices such as cochlear implants and bone conduction hearing implants.

Auditory Audiology
Auditory audiology is that part of audiology concerned with the measurement of hearing, diagnosis of hearing disorders, and the rehabilitation of hearing loss. It is often associated with the provision of hearing aids, cochlear implants, or other hearing devices. It may be practiced by audiologists or audiometrists (a profession concerned with the measurement of hearing and the rehabilitation of hearing loss).

Diagnostics
A variety of tests may be used to assess hearing function. These tests may be subjective, requiring a behavioural response from the patient under investigation, or objective, measuring an automatic physiological response in the auditory system.

A full and accurate case history should be taken, which may inform which diagnostic tests are to be undertaken, explain the results of these tests, or suggest medical referral.

Common subjective tests used to assess hearing function are pure tone audiometry (and its variants play audiometry, visual response orientation audiometry, and behavioural observation audiometry), and speech audiometry, including both word and sentence tests. These tests present a stimulus to the patient (such as a pure tone, noise burst or speech) and require the patient to respond to the presence or content of the stimulus. Behavioural tests test the function of the auditory system as a whole, as they rely on the patient hearing and processing a sound before responding to it.

Objective tests used to assess auditory system function include impedance tests and electroacoustic tests. Impedance tests measure the movement of the tympanic membrane, and include tympanometry, acoustic reflex testing, and otoacoustic emmission measurements. Electroacoustic tests measure the electrcal signals in the auditory system elicited by acoustic stimuli, and include electrocochleography, auditory brainstem response, auditory steady-state response, and cortical acoustic evoked potentials. These tests may be able to identify the location of problems within the auditory system, as they do not require the entire auditory pathway to function to elicit a response.

Diagnostic information obtained through testing may suggest one of various disorders of the auditory system, including sensorineural hearing loss, conductive hearing loss, cholesteatoma, vestibular schwannoma (acoustic neuroma), or auditory neuropathy. If a medically relevant diagnosis is suspected, the patient should be referred to an otolaryngologist, neurologist or other medical specialist.

Rehabilitation
Rehabilitative auditory audiology focuses on the rehabilitation of a diagnosed hearing loss and associated disorders, including tinnitus.

A programme of auditory rehabilitation is generally designed to achieve one or more goals, which are set by the clinician and the patient. Once goals have been identified, and expectations discussed, options for rehabilitation will be presented to the patient. This may include fitting and verification of hearing aids, cochlear implants, or other hearing devices, communication training, and counselling to come to terms with the hearing loss or tinnitus.

Hearing aids are programmed by connecting them to a computer, and adjusted to provide a prescribed amount of sound output. Several prescription formulae exist. The amount of gain can be verified against the prescription through Real Ear Measures or in a hearing aid test chamber.

Cochlear implants are fitted in a similar way, although as the output is not sound the fitting cannot be verified in the same way. The procedure of setting up the voltage output of a cochlear implant processor is called mapping.

Communication training refers to activities designed to equip the patient and their communication partners with skills necessary to cope effectively with the hearing loss. It addresses functional issues with hearing that are not solved through the provision of hearing devices, such as residual difficulty hearing in background noise or on the telephone. It may involve various activities, including discussing good communication practice with communication partners, practicing the identification of strateges to deal with intrusive background noise in social situations, or training a patient to use a telephone effectively.

The rehabilitation programme may also be functionally assessed, by performing speech audiometry or through self-report questionnaires. These measurements are intended to ensure that any auditory rehabilitation programme achieves the goals identified by the patient and clinician, improving the patient's quality of life.

Vestibular Audiology
Vestibular audiology refers to the diagnosis, measurement, and mangement of vestibular disorders and related disorders of balance function. Due to the connected nature of the cochlea and vestibulum, as well as the similarities in function of their sensory cells, vestibular testing is often performed in concert with auditory testing.

Diagnostics
A variety of tests may be used to measure the fuction of the various components of the vestibular system, including the semicircular canals, otolithic organs (utricle and saccule), vestibular nerve, and vestibular nuclei.

Vestibular tests generally induce a change in one or more of the semicircular canals or otolithic organs, and then measure the effect of his change via the eyes (vestibulo-ocular reflex) or sternocleidomastoid (SCM) muscle (vestibulo-collic reflex). Ocular effects may be seen as nystagmus, and detected by electronystagmography or videonystagmography. Effects in the SCM may be detected using electrodes that record the electrical activity of the muscle.

Changes may be induced by the introduction of heat or cold to the ear canal (as in caloric reflex testing), using a loud sound (as in cervical vestibular evoked myogenic potential (cVEMP) testing), using a mechanical tap on the head (as in ocular vestibular evoked myogenic potential (oVEMP) testing), or by mechanically rotating the body as in the Dix-Hallpike test.

As much vestibular testing relies on proper function of the oculomotor system, tests of eye movement may also be undertaken, including a horizontal gaze nystagmus test, and tests of smooth pursuit and saccade ability.

Vestibular testing may assist with the diagnosis of particular kinds of disease, such as benign paroxysmal positional vertigo, Meniere's disease, vestibular neuronitis, labyrinthitis, or perilymph fistula.

If a disorder is suspected, referral will generally be made to an otolaryngologist or neurologist for further investigation (such as an MRI or CT scan) or drug treatment.

Rehabilitation
Treatments prescribed by an audiologist vary due to the different locations and severities of vestibular insufficiency. They may include head and eye movements, postural changes, and walking exercises aimed at alleviating symptoms and training the vestibular system to compensate for the insufficiency.

Actvities may include keeping the eyes fixated on a specific target while moving the head or walking, moving the head right to left to shift eye focus between two targets a significant distance apart, and walking while keeping eyes fixated on a specific target while also turning the head in different directions.

By repeating a combination of head and eye movements, postural changes and walking, the central vestibular system (brainstem and cerebellum) will strengthen pathways associated with weaker peripheral function, restoring overall vestibular function and redcing symptoms.

Disorders of the vestibular system may present with auditory symptoms, such as hearing loss and tinnitus, and so rehabilitation of the vestibular symptoms may not be sufficient to improve quality of life. In these cases, auditory reabiltation should be pursued concurrently.

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Audiologist
An audiologist is a health-care professional specializing in identifying, diagnosing, treating and monitoring disorders of the auditory and vestibular system portions of the ear. Audiologists are trained to diagnose, manage and/or treat hearing, tinnitus, or balance problems. They dispense, manage, and rehabilitate hearing aids and assess candidacy for and map cochlear implants. They counsel families through a new diagnosis of hearing loss in infants, and help teach coping and compensation skills to late-deafened adults. They also help design and implement personal and industrial hearing safety programs, newborn hearing screening programs, school hearing screening programs, and provide special fitting ear plugs and other hearing protection devices to help prevent hearing loss. Audiologists are trained to evaluate peripheral vestibular disorders originating from inner ear pathologies. They also provide treatment for certain vestibular and balance disorders such as Benign Paroxysmal Positional Vertigo (BPPV). In addition, many audiologists work as auditory scientists in a research capacity.

Audiologists have training in anatomy and physiology, hearing aids, cochlear implants, electrophysiology, acoustics, psychophysics, neurology, vestibular function and assessment, balance disorders, counseling and sign language. An Audiologist usually graduates with one of the following qualifications: MSc(Audiology), Au.D., STI, PhD, or ScD, depending the program and country attended.

History
The use of the terms "Audiology" and "Audiologist" in publications has been traced back only as far as 1946. The original creator of the term remains unknown, but Berger identified possible originators as Mayer BA Schier, Willard B Hargrave, Stanley Nowak, Norman Canfield, or Raymond Carhart. In a biographical profile by Robert Galambos, Hallowell Davis is credited with coining the term in the 1940s, saying the then-prevalent term "auricular training" sounded like a method of teaching people how to wiggle their ears.

The first US university course for audiologists was offered by Carhart at Northwestern University, in 1946. Audiology was born of hearing aid dispensers to address the hearing damage from World War II veterans.

Australia
In Australia Audiologists must hold a Masters in Audiology, alternatively Bachelor's degree from overseas certified by the VETASSESS. As per the law of the land currently to practise as an Audiologist one doesn't need to be a member of any professional body. But to dispense hearing aids to eligible pensioners and eligible war veterans one must have 2 years clinical experience and be registered with an approved body such as Audiology Australia (ASA) or the Australian College of Audiology (ACAud). In Australia, by general definition an 'Audiologist' - is a University graduate with postgraduate qualifications in Audiology or equivalent training. Audiologists have broad responsibilities and expertise in all non-medical areas of hearing services including complex hearing assessment and rehabilitation of hearing impairment (which includes hearing aid prescription, fitting and management). An 'Audiometrist' - has completed a TAFE Certificate Course in hearing aid audiometry and/or received in-house training from the hearing aid industry.

The Audiological Society of Australia (ASA) trading as Audiology Australia via The Code of Ethics and the Practice Standards, governs the professional practice of audiology for members of the ASA. To meet these high standards Members undertake professional development to enable them to maintain appropriate skills and learning in their areas of professional practice. The purpose of the Continuing Professional Development Program is to provide a structure that enables members to formally document the ways in which they manage and extend their professional skills and knowledge. The ASA Continuing Professional Development (CPD) program provides recognition and encouragement for the continuing participation of ASA members in high quality professional development. The CPD program enable members of ASA to demonstrate to external stakeholders (clients, employers, government, the community and other professional groups) their commitment to the highest standards of professional competence for Audiologists. The CPD program is focused on maintaining a high quality practice of audiology and is tied to the Certificate of Clinical Practice (CCP). Members of the ASA who are not engaged in clinical practice are not required to formally document their CPD and will not be issued with a Certificate of Clinical Practice. ACAud Members are required to demonstrate their professional competence and are assessed against ACAud’s Professional Competency Standards. Recognised Competencies are shown on a Member’s Certificate of Competency that is prominently displayed in the Member’s clinic and renewed annually.

There are 5 Universities in Australia that offer graduate programmes (via course work and/or research degrees) in Audiology for local and overseas students. All programmes offered are recognised as eligible for membership of the Society - Audiology Australia and the International Society of Audiology (ISA).
 * University of Western Australia
 * University of Melbourne
 * Flinders University
 * Macquarie University
 * University of Queensland

Canada
In Canada, a Masters of Science (M.Sc.) is the minimum requirement to practice Audiology in the country. The profession is regulated in certain provinces: New Brunswick, Quebec, Ontario, Manitoba, Saskatchewan, Alberta and British Columbia, where it is illegal to practice without being registered as a full member in the appropriate provincial regulatory body.

There are currently five universities in Canada which offer graduate programs in Audiology. Entry requirements typically include specific prerequisite course work in undergraduate studies (usually in phonetics, phonology, acoustics, developmental psychology, perception, anatomy, statistics, physics and research methods) or an additional preparatory year prior to entry into the program and a competitive GPA in the bachelor's degree. The following universities offer the MSc in audiology:
 * University of British Columbia (BC)
 * Université de Montréal (QC) - French instruction
 * University of Western Ontario (ON)
 * University of Ottawa (ON) - French instruction
 * Dalhousie University (NS)

India
The Government of India established the All India Institute of Speech and Hearing, which has become the country's leading Institute in the field of communication disorders in 1966. The second Audiology & Speech Language Therapy program was started in the same year, at T.N.Medical College and BYL Nair Ch.Hospital in Mumbai. There are currently 20 Universities in India which provide Speech Pathology and Audiology programs. These programs are accredited by Rehabilitation council of.

To practice audiology, professionals need to have either Bachelors/Masters degree in Audiology and be registered with Indian Speech and Hearing Association (ISHA) or the Rehabilitation Council of India (RCI). There are nearly 1000 or more private clinics in India providing speech and hearing services.

An internationally recognized degree, unique multilingual/multicultural background, excellent communication in English has increased the global demand of Indian Audiologists considering the shortage of these graduates especially in western countries.However in recent times, the profession has been plagued by introduction of short term diploma programs which has resulted in dilution of services particularly in hearing aid dispensing and there have been mass protests by speech and hearing fraternity to stop such courses and curb malpractices.{http://articles.timesofindia.indiatimes.com/2012-03-13/mysore/31159074_1_rci-short-term-courses-speech-and-hearing}

Malaysia
There are only 3 Malaysian educational institutions offering degrees in Audiology:
 * University Kebangsaan Malaysia
 * University Science Malaysia
 * International Islamic University Malaysia

United Kingdom
There are currently three routes to becoming a Registered Audiologist:
 * BSc in Audiology
 * MSc in Audiology
 * Fast track conversion Diploma for those with a BSc in other relevant science subject, available at Southampton, Manchester, UCL, London and Edinburgh

There are 10 United Kingdom educational institutions offering degrees in Audiology:
 * Anglia Ruskin University
 * De Montfort University
 * University of Manchester
 * University of Leeds
 * Aston University
 * Queen Margaret University
 * University of Southampton
 * Swansea University
 * Middlesex University
 * University College London

United States
In the United States, audiologists are regulated by state licensure or registration in all 50 states and the District of Columbia. Starting in 2007, the Doctor of Audiology (Au.D.) became the entry level degree for clinical practice for some states, with most states expected to follow this requirement very soon, as there are no longer any professional programs in audiology which offer the master's degree. Minimum requirements for the Au.D. degree include a minimum of 75 semester hours of post-baccalaureate study, meeting prescribed competencies, passing a national exam offered by Praxis Series of the Educational Testing Service, and practicum experience that is equivalent to a minimum of 12 months of full-time, supervised experience. Most states have continuing education renewal requirements that must be met to stay licensed. Audiologists can also earn a certificate from the American Speech-Language-Hearing Association or seek board certification through the American Board of Audiology (ABA). Most states also require a Hearing Aid Dispenser License to enable the Audiologist to dispense hearing aids, though legislation is currently underway in many states which would not require this extra step. It would allow Audiologists to dispense under their Audiology license. Currently there are over 70 Au.D. programs in the United States:

Distance Au.D. Programs:
 * A.T. Still University through Arizona School of Health Sciences
 * University of Florida

Residential Au.D. Programs:

In the past, audiologists have typically held a master's degree and the appropriate healthcare license. However, in the 1990s the profession began to transition to a doctoral level as a minimal requirement. In the United States, starting in 2007, audiologists were required to receive a doctoral degree (Au.D. or Ph.D.) in audiology from an accredited university graduate or professional program before practicing. All states require licensing, and audiologists may also carry national board certification from the American Board of Audiology or a certificate of clinical competence in audiology (CCC-A) from the American Speech-Language-Hearing Association.

Audiologists are autonomous practitioners and do not need physician orders or supervision. However, many audiologists work in doctor's office and hospitals. The median salary for an audiologist in the United States is approximately $65,500 in 2008 according to the Bureau of Labor Statistics. Audiologists who earn over $98,880 (top ten percentile) per annum typically have their own private practice.