“What is the difference between an audiologist and a hearing aid dealer (hearing instrument specialist–H.I.S.)?” This is a common question and often comes up in clinical practice when a patient is seeking a second opinion or has obtained services from a dealer which has resulted in dissatisfaction with the hearing aid and/or follow-up service. The problems frequently stem from inappropriate style selection (e.g., fitting a small canal instrument on a severe to profound hearing loss) and incorrect programming settings that have not been properly measured and verified to ensure maximal audibility while maintaining comfort. Typically, this is the result of the very limited training of the dealer whose primary focus is on sales and commission.
A fair and appropriate evaluation of the differences between an audiologist and a hearing aid dealer requires us to look at sections of state law that define the scope of practice and the minimum academic training required for each provider group.
Ohio Definitions of Practice
Audiologists are defined in Chapter 4753 of the Ohio Revised Code (ORC); Hearing aid dealers in Chapter 4747, ORC.
State laws are enacted by the legislature to provide consumer protection.
Boards composed of members including licensed practitioners, a member representing the public and an ex officio representative of the Attorney General’s office, issue licenses. Each practitioner licensed by the board must operate within the standards of care and conduct established in the law (scope of practice). Failure to practice within the law can result in fines and/or revocation of their license to practice within their profession.
Definition of Practice (as written in the Ohio Revised Code)
Hearing Aid Dealers
“Practice of dealing in” or “fitting of” hearing aids means the sale of a hearing aid, and the measurement and testing of human hearing by means of an audiometer or by any other means for the purpose of selecting, adapting and selling a hearing aid to any person, and includes the making of impressions for earmolds.
“Practice of audiology” means the planning, directing, supervising, and conducting of habilitative or rehabilitative counseling programs for individuals or groups of individuals who have (been diagnosed) or are suspected of having disorders of hearing; any service in audiology, including prevention, identification, evaluation, consultation, habilitation or rehabilitation, instruction, and research; participating in hearing conservation, hearing aid and assistive listening device evaluation, selection, preparation, dispensing, and orientation; fabricating ear molds; providing auditory training and speech reading; and administering tests of vestibular function and tests for tinnitus in accordance with section 4753.14 of the Revised Code.
Defining the practice of a health care profession limits areas in which the licensee may practice. For example, Hearing Aid Dealers are limited to testing hearing solely for the purposes of fitting hearing aids. Unlike Audiologists, they may not engage in, nor are they trained to complete diagnostic hearing or balance examinations nor participate in the assessment of patients with tinnitus. Audiologists are uniquely qualified and trained to identify a wide variety of pathology and underlying medical conditions of the hearing and balance systems and to refer these cases for appropriate medical or surgical treatment.
Requirements for License (as written in the Ohio Revised Code)
Hearing Aid Dealers
4747.05. (1-4) & 4747.10 (B)
- 18 yrs old
- good moral character
- free of contagious of infectious disease
- High School diploma or equivalent education (GED)
- pass qualifying examination specified and administered by board which “…shall be a thorough testing of knowledge required for the proper selecting, fitting and sale of hearing aids, but shall not be such that a medical or surgical education is required for successful completion. It shall consist of written and practical portions which shall include, but not be limited to, the following areas: Basic physics of sound, anatomy and physiology of the human ear, the function and purpose of hearing aids, pure tone audiometry, speech reception threshold testing and speech discrimination testing, masking techniques, recording and evaluation of audiograms and speech audiometry to determine proper selection and adaptation of hearing aids, earmold impression techniques.”
- Master’s or Doctoral degree in Audiology
- Minimum of 350 hours of patient care hours obtained in an accredited college or university, in a cooperating program of an accredited college or university, or in another program approved by the board.
- He/she submits to the board evidence that he has passed the examination for licensure to practice
A High School diploma or GED coupled with a correspondence course in hearing aids offered by the International Hearing Society is the basis of academic training for the majority of hearing aid dealers across the country. The academic and clinical preparation of audiologists differs dramatically. Since January 1, 2006 all new graduates applying for a license to practice audiology in Ohio
must have an AuD or other equivalent doctoral degree. For 40 years the primary clinical degree in audiology was a Master’s degree; a one or two-year course of academic and clinical study following the bachelor’s degree.
Over 15 years ago, the leaders and educators in the profession of audiology realized that two years of graduate level coursework was not enough time to cover the expanding body of scientific, engineering, diagnostic and treatment methods needed to meet the needs of the patients being served. The American Academy of Audiology and other related professional organizations developed a four-year, post-bachelors curriculum for the professional doctorate in audiology—the Doctor of Audiology or Au.D. degree. The audiologist is for hearing what the optometrist is for vision.
The result has been an improved profession with well-educated, capable practitioners prepared to handle any hearing or balance problem that comes to their clinics and offices. With extensive training in counseling and rehabilitation, audiologists extend hearing rehabilitation beyond just fitting a hearing aid. They approach their patients with both clinical and technical skills necessary to optimize success with today’s advanced and highly sophisticated hearing instruments. By their knowledge, extensive training and professional integrity, audiologists are best qualified to provide comprehensive solutions to patients in need of hearing rehabilitation.
Doctors of Audiology have by far the most clinical education and evidenced-based skills in diagnosing and rehabilitating hearing and balance related disorders among all professionals; however this fact is not well-publicized or recognized. In fact, many individuals who seek treatment do not differentiate between Audiologists and hearing instrument specialists (licensed hearing aid dealers). To further confuse the issue, some are using the title of “audioprosthologist” after completion of a 30 day course spread over 13 weekends (equivalent of 15 undergraduate credit hours or approximately 1 semester). The state of Oregon prohibited the use of this title in 2006 as it was deemed to be misleading to the general consumer. In fact, years ago dishonest hearing aid dealers attempted to use the title “Certified Hearing Aid Audiologist” but this was subsequently prohibited by states due to the obviously confusing nature this presented to consumers. Clearly, this punctuates the need for heightened consumer awareness and education at both a local and national level.
Citation/Credit: Portions of this page were adapted from writings of Dr. Robert G. Glaser (Ph.D.), past president of the Ohio Academy of Audiology and past president of the American Academy of Audiology.
Full Disclosure Statement: The author began his career as a Hearing Aid Dealer/Hearing Instrument Specialist (BC-H.I.S., training license) for almost 2 years (1998-1999) prior to completing his undergraduate and doctoral degrees. He received a Bachelor of Science (B.S.) degree from Western Michigan University in 2003, majoring in Speech Pathology and Audiology and minoring in Biological Sciences. He earned his Doctor of Audiology (Au.D.) from Ohio State University in 2007.