Current through Register Vol. 56, No. 18, September 16, 2024
(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.
(c) A licensed audiologist may perform
cerumen management only if he or she:
1.
Completed initial education pursuant to
13:44C-3.2, 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.
(d) Initial education or a course in cerumen
management shall include:
1. Recognizing the
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 membrane;
iii.
Inflammation, tenderness, open wounds or traces of blood in the external ear
canal;
iv. Drainage from the
external ear canal or middle ear;
v. Ear surgery within the last six
months;
vi. A patient who has
tympanostomy tubes;
vii. Diabetes
mellitus, HIV infection or bleeding disorders;
viii. Actual or suspected foreign body in the
ear;
ix. Stenosis or bony exostosis
of the ear canal;
x. Cerumen
impaction that totally occludes the ear canal;
xi. Cerumen located beyond the isthmus;
or
xii. Inability to see the
tympanic membrane;
2.
Recognizing patient distress and appropriate action to take if complications
are encountered;
3. Infection
control practices, including:
i. Universal
health precautions;
ii.
Decontamination;
iii. Cleaning,
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
4. Methods for removal of cerumen, for
example, cerumen loop, gentle water irrigation, suction and use of material for
softening.
(e) In
addition to the education requirements of (c) above, a licensed audiologist
shall complete the following prior to performing cerumen management:
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
2. Successfully
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.
(i) 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
removal.
(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.
