Demystifying the roles in Audiology

There is more choice now than ever as to where a person can go to see a hearing specialist. When booking a consultation with your specialist, it can become confusing as to which type of specialist is the best to go and see to meet your needs. During this discussion, we will talk about the different job titles in audiology, what qualifications to look out for, and what this then qualifies them to do in terms of service provision and procedures. I will also discuss what courses I have undertaken and what this qualifies me to do. - Kara Butterworth Snr Audiologist and business owner at K & M Hearing Solutions

Role of an Audiologist

The title audiologist is traditionally referred to as an NHS qualified Audiologist. They may have qualified with BAAT I and II which predates, and is therefore equivalent to, today’s degree. If they took the degree they may have a Bsc in Audiology or Bsc in Healthcare Science (Audiology). This qualifies the audiologist to work within the NHS. In order to work within the private sector and sell hearing aids, an additional qualification is required. However, some universities now include this within the Bsc in Audiology degree, so it will depend on when and where the individual completed their course as to whether they would need to complete any additional training to work privately.
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The role of the NHS audiologist is to:

• Support Ear Nose and Throat clinics, providing hearing diagnostics for the consultants
• Complete Pure Tone Audiograms, taking impressions and explaining results to patients
• Fit NHS hearing aids, using Real Ear Measurements The NHS audiologist may also specialise in:

• Pediatric/children (under the age of 18) providing hearing diagnostics which may include Visual Response Audiometry, Oto Acoustic Emissions and play audiometry
• Balance /vestibular services in providing vestibular assessments, supporting ENT and providing rehabilitation and management options for patients
• Learning Disabilities in providing care plans, hearing assessments, desensitisation programmes, fitting hearing aids and support for carers/care homes
• Tinnitus assessments and management, sometimes in partnership with ENT
• Specialist hearing aids such as Cochlear Implants and BAHAs (bone anchored hearing aid) which involves speech audiometry, auditory training, regular appointments, counselling and advice.

In order to specialise in these fields, further studying may have been undertaken. They may have completed a M.Sc. (masters) in Audiological Science or a PhD whereby the clinician will have completed research in an area of their interest. As such, as part of their career progression, their job title may now be:

• Audiological scientist,
• Healthcare science practitioner in audiology,
• Clinical scientist,
• Audiologist specialising in tinnitus,
• Senior audiologist 

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Hearing Aid Audiologist (HAA)

This refers to an NHS qualified Audiologist who has also completed additional training to dispense and sell hearing aids privately and they are now working within the private sector. They have to adhere to consumer rights and selling goods law, and will have received additional training around this, and must be registered with the HCPC Health and Care Professions Council and have indemnity insurance in place.

The training that the NHS qualified Audiologist has undertaken to add this to their existing qualification may have been completed as a separate course such as the Professional Development Course, APEL route. Or some universities now include this in the Audiology degree, so it will depend on where and when the audiologist completed their degree.
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It must also be noted that some professionals interchange the titles Hearing Aid Audiologist and Hearing Aid Dispenser, so although you may see the title hearing aid audiologist or HAA, you may in fact be receiving treatment from a Hearing Aid Dispenser or HAD. 
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Hearing Aid Dispenser (HAD)

To become a Hearing Aid Dispenser, the individual will work as an apprentice at an existing practice with a mentor, whilst simultaneously attending university. The course takes 14-16 months and qualifies the individual to complete hearing diagnostics and prescribe and fit hearing aids to adults. In order to practice, they must be registered with the HCPC Health and Care Professions Counsel and have indemnity insurance. The dispenser training route is not the equivalent to a degree in audiology, so they will be unable to see children, complex cases or offer advice or further testing for such things like specialist hearing aids like cochlear implants, talk in depth on tinnitus, or treat balance disorders. As such, in order to progress their career, the Hearing Aid Dispenser may opt to continue their training in order to obtain a degree in Audiology.

A hearing aid dispenser therefore primarily sees the older population, treating those with age related hearing loss and dispensing hearing aids to this group.
Other titles you may find a Hearing Aid Dispenser using may be Hearing Aid Audiologist or Hearing Aid Specialist.

You can find out if an individual is registered on HCPC here.

Hearing Therapist

A Hearing Therapist specialises in providing additional support and rehabilitation within audiology. They are trained to use counselling skills to help the patient manage the psychological effects of hearing loss, as well as providing support on a practical level by signposting to support services and products that can help. The role of the hearing therapist is to enable the patient to self manage their condition where possible, by providing them with the necessary skills and knowledge to help them do so.

If you’re struggling because of your hearing loss, hearing aids, tinnitus, hyperacusis (sensitivity to sound), auditory processing disorder or balance problems, your audiologist may discuss referring you to a Hearing Therapist.
The role of the Hearing Therapist is to support with:

• counselling to help with the psychological and emotional effects of hearing loss
• advising on practical solutions to help you in your work and social life
• Assistive listening devices
• referring you to other support services, such as social services
• details of local support groups and lip-reading classes
• auditory training to make listening easier
• Balance rehabilitation
• Communication tactics

• Tinnitus; advice and management
• Transitioning from pediatrics to adult services
• Teaching relaxation, one-to-one or in groups to manage stress triggers which can
  exacerbate existing conditions such as vestibular balance problems and tinnitus

A Senior Hearing Therapist, is a Hearing Therapist who may specialise in one or more of the following areas:

• Cochlear Implants
• Bone Anchored Hearing Aids
• Single Sided Deafness/Sudden hearing loss
• Adults with Learning Disabilities
• Cognitive Behavioural Therapy
• Tinnitus Retraining Therapy
• Department Lead

​In order to become a Hearing Therapist, the individual may have completed the Diploma in Hearing Therapy, which was the traditional route, whereby the individual had an apprenticeship at an NHS hospital, whilst studying at university. The course took 2 years. This course no longer exists and has since been replaced with the Masters degree in Rehabilitation. However, an Audiologist may opt to do additional training and complete additional courses, or take a specific module at university, such as Tinnitus, to become qualified to offer additional support and rehabilitation to their patients. 

Hearing Care Assistant (HCA)

A HCA role is to support the hearing aid dispenser/audiologist in practice. They will have attended the 3 month HCA course which qualifies the individual to: 

• Carry out Ear Examination
• Take Impressions
• Carry out Ear Wax Removal – micro-suction and water irrigation
• Complete basic hearing tests and identify when to refer for further testing to the
  Hearing Aid Dispenser/Audiologist
• Carry out Tympanometry
• Carry out basic Hearing Aid Fine Tuning
• Carry out Hearing Aid Servicing and Repairs

Find out more here.

ENT Consultant

An ear, nose, and throat (ENT) consultant, also known as an otolaryngologist, is a medical professional who specialises in diagnosing and treating conditions of the head and neck, particularly the ears, nose, and throat:

• Ear conditions such as: Hearing loss, ear infections, dizziness, perforated ear drums, tinnitus.
• Nose conditions: Sinus infections, nasal injuries, tumors, and disorders of the sense of smell
• Throat conditions: Tonsillitis, breathing problems, and cancers of the mouth or throat
• Other conditions: Snoring, vertigo, balance problems, and head and neck cancer
  ENT consultants can perform both nonsurgical and surgical treatments. They may also prescribe medicines, help patients recover from diseases that impair hearing and balance, and perform plastic and reconstructive work on the face. ​

Wax Clinician

A wax clinician will have attended a one- or two-day course in wax removal, usually microsuction. This then qualifies them to remove wax.
Can an Audiologist, Hearing Aid Audiologist or Hearing Aid Dispenser remove wax? Yes, they can. Additional training in wax removal would need to be undertaken in order to qualify them to perform wax removal. They may have completed courses on: 

• Microsuction
• Water irrigation
• Manual extraction
• Endoscopic ear wax removal

For safe wax removal with a professional who has studied ear anatomy and physiology, and ear conditions/ referable conditions, I would recommend that you book with either an:

• Audiologist
• Hearing Aid Audiologist
• Hearing Aid Dispenser
• Hearing Therapist
• Hearing Care Assistant
• Nurse Practitioner specialising in wax removal
• Ear Nose and Throat Consultant (for more complex cases) ​

Who else can do wax removal?

Anyone! And this is where there is growing concern within the audiology community. At present the BSHAA, BAA and AIHHP professional bodies have been working hard to lobby for wax removal to become regulated. Unfortunately, the title of wax removal clinician is not a protected title. At present, an individual need only attend a one or two day course and they can open up a wax removal business the next day. We have seen shop floor staff in pharmacies, beauticians, hairdressers, nail technicians, and many others begin removing ear wax after attending these one-/two-day courses. 

Why is this a problem?

• They are more likely to miss conditions requiring onward referral to the GP or ENT. Some conditions are very serious and require urgent referral. Unfortunately, the wax removal courses cannot possibly cover in-depth teaching on anatomy and physiology of the ear and referable conditions.
• We are seeing many cases of ear drums being perforated or the canals damaged from inexperienced wax removal clinicians
• We are seeing many cases of wax not being removed successfully from the canals despite several visits to the same clinician. This then means the patient has unfortunately had to go elsewhere for wax removal, and essentially pay twice, to have their wax successfully treated.

Read more about what is happening in the background regarding wax removal services here. 

Children and wax removal

Can an Audiologist, Hearing Aid Audiologist or Hearing Aid Dispenser remove wax from a child?
An audiologist with a background of working within pediatrics, who has the correct insurance cover, can remove wax from children aged 5 and above.
A Hearing Aid Dispenser, unless they have worked in the NHS, have experience with pediatrics, and the correct insurance cover, cannot remove wax from anyone below the age of 18.
A CQC registered Nurse specialising in wax removal can also remove wax from children. 

Nurse specialising in wax removal

For a nurse to carry out wax removal privately, they must register with the Care Quality Commission (CQC). This registration is to ensure that high standards of care are maintained and for accountability. It also helps ensure that the public receives safe, effective, compassionate, and high-quality care. They may have completed a one- or two- day course in wax removal in order to be able to carry out wax removal, and then gone through the process of being registered for wax removal specifically under the CQC. They may perform microsuction, water irrigation or manual extraction. 

So what are my qualifications?

I initially qualified as a Hearing Therapist. I specialised in Adults with Learning Disabilities and Mental Health, and therefore progressed to a Senior Hearing Therapist. I studied at Bristol University whilst I had my apprenticeship at the University Hospital of North Staffordshire. I trained via the traditional route and have the Diploma in Hearing Therapy (equivalent of the Masters degree in Rehabilitaion). As part of my role as a Snr Hearing Therapist, I ran the Learning Disability within Audiology service and managed a team to provide services and care to this group. I also specialised in balance/vesitbular rehabilitation, hyperacusis, auditory processing disorder and tinnitus.

I then completed the BAAT I and II to become qualified as a NHS Audiologist. This course predates, and is therefore equivalent to, the Bsc degree in Audiology/ Bsc in Healthcare Science (Audiology). I have worked with both children and adults during my 10 years with the NHS. I also completed the course, via the APEL route, to become qualified as a Hearing Aid Dispenser to qualify me to dispense/sell hearing aids and work within the private sector. I worked within the private sector for over 10 years, and in February 2024, opened my own business to enable me to use all my skills and experience from both the NHS and private sectors, to deliver the best care and advice to my customers.

I have been performing wax removal for over 8 years now. I initially completed a course on water irrigation at De Montfort University, to safely remove wax. Later I completed a course of microsuction to enable me to treat wax using this method. I am fully trained in microsuction, water irrigation and manual extraction. As part of my training, I was required to submit 10 case studies of wax removal for each of these courses, providing before and after video/photograph evidence as well as case notes on the procedure I had performed, before being signed off as fit to practice.

What titles can I therefore use with my qualifications?

• Senior Hearing Therapist
• Audiologist (NHS)
• Hearing Aid Audiologist
• Hearing Aid Dispenser
• Wax Clinician (children and adults)
• Tinnitus Specialist 

Am I insured? Yes I have full indemnity insurance. In addition to this, as a member of BSHAA, I have further insurance to enable me to see children for wax removal (5 and above). 
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Am I part of a regulatory body? Yes I am a member of HCPC and my registration number is HAD 02020 I am also a member of BSHAA, BAA and AIHHP. I strive to deliver excellent service and care, part of which is maintaining my professional practice and adhering to a code of practice. I also support the Duchy Hospital (private) providing hearing diagnostics for ENT. This relationship means I have a direct referral route into ENT. This not only ensures a seamless service of care but has enabled my patients to be seen and treated more quickly. An example of this, was a patient whom I fitted with hearing aids recently. She had been to see another wax clinician just prior to seeing me. This clinician had missed a canal cholesteatoma in the patient’s ear. I was able to send an urgent referral the same day I saw her, and she received urgent care from ENT as a result of this. 
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Conclusion

To sum up, choosing a professional audiologist for your hearing care is essential for ensuring safety, effectiveness, and thorough support. Audiologists and other certified professionals in hearing care go through rigorous training and follow stringent professional guidelines, making sure they are prepared to diagnose, handle, and treat various complex conditions related to hearing and the ears. Opting for a qualified audiologist not only gives you access to their knowledge but also provides you with the assurance that your ear health is being managed with accuracy and attention. Although there are numerous choices for hearing care, choosing an experienced audiologist ensures you get the best, scientifically proven treatments customised to your specific needs, along with trustworthy recommendations for any specialised care you might require. Get in touch with us today to discuss your hearing health.

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