(a) The purpose of this
section is to set forth standards for the performance of cerumen management by a
licensed audiologist. Cerumen management is within the scope of practice of an
audiologist who meets the requirements of this section.
(b) "Cerumen management," as used in this section,
shall mean the removal of wax like secretions from the cartilaginous portion of the
external ear in otherwise healthy ears.
A licensed audiologist may perform cerumen
management only if he or she:
education pursuant to
, 3.3 or 3.4, which included
instruction in the topics required by (d) below; or
2. Has successfully completed a 12-hour seminar or
workshop in cerumen management, which qualifies for American Speech-Language Hearing
Association (ASHA), American Academy of Audiology (AAA) or Academy of Doctors of
Audiology (ADA) continuing education credit and which includes instruction in the
topics required by (d) below.
Initial education or a course in cerumen
management shall include:
presence of medical preexisting contraindications that warrant referral to a
physician, such as:
i. A patient who has hearing in
only one ear;
ii. A perforated tympanic
iii. Inflammation, tenderness,
open wounds or traces of blood in the external ear canal;
iv. Drainage from the external ear canal or middle
v. Ear surgery within the last six
vi. A patient who has
mellitus, HIV infection or bleeding disorders;
viii. Actual or suspected foreign body in the
ix. Stenosis or bony exostosis of
the ear canal;
x. Cerumen impaction that
totally occludes the ear canal;
Cerumen located beyond the isthmus; or
xii. Inability to see the tympanic
patient distress and appropriate action to take if complications are
i. Universal health
disinfection and sterilization of multiple use equipment; and
iv. Universal precautions for prevention of the
transmission of human immunodeficiency virus, hepatitis B virus and other blood
borne pathogens; and
Methods for removal of cerumen, for example, cerumen loop, gentle water irrigation,
suction and use of material for softening.
In addition to the education requirements of
(c) above, a licensed audiologist shall complete the following prior to performing
1. Observe a minimum of 2
cerumen management procedures using a cerumen loop, 2 cerumen management procedures
using gentle water irrigation and 2 cerumen management procedures using suction
performed by either a licensed audiologist who has met the requirements of this
section, an audiologist authorized to perform cerumen management in another state or
a physician; and
perform, under the supervision of a licensed audiologist who has met the
requirements of this section, an audiologist authorized to perform cerumen
management in another state or a physician, a minimum of 2 cerumen management
procedures using a cerumen loop, 2 cerumen management procedures using gentle water
irrigation and 2 cerumen management procedures using suction.
(f) A licensed audiologist shall perform cerumen
management only in a healthcare facility licensed by the Department of Health and
Senior Services or in his or her office.
(g) A licensed audiologist shall not perform
cerumen management and shall refer a patient to a physician if any of the
pre-existing contraindications listed in (d)1 above occur.
(h) A licensed audiologist shall not perform
cerumen management on a patient who is six years old or younger.
A licensed audiologist shall not perform, or
shall cease performing, cerumen management if patient reports:
1. Tenderness during manipulation of the pinna or
at any time during the cerumen removal procedure; or
2. Dizziness occurring during cerumen
(j) A licensed
audiologist shall refer a patient for immediate treatment from a physician if a
complication arises during the performance of cerumen management.
(k) A licensed audiologist who performs cerumen
management shall maintain a case history for every patient and informed consent
signed by the patient as part of his or her records.