California Legislation Would Authorize Hearing Aid Dispensers to Conduct Cerumen Management and Tympanometry

April 4, 2017

SACRAMENTO, CALIFORNIA — If a bill recently introduced into the California state senate by senator Cathleen Galgiani (District 05) becomes law, hearing aid dispensers in the state will be allowed to conduct cerumen management (earwax removal) and tympanometry.

The bill, SB-198, is said to only authorize cerumen management for hearing aid dispensers under physician and/or surgeon supervision. Additionally, the bill authorizes tympanometry to be conducted by hearing aid dispensers only for purposes of further referral to a physician and/or surgeon for diagnosis or treatment.


Amending the Business and Professions Code


Text of the relevant California Business and Professions Code pertaining to hearing dispensers, shown below, has the proposed changes highlighted in red that would be enacted by passage of SB-198.



 (a) “Practice of fitting or selling hearing aids,” as used in this article, means those practices used for the purpose of selection and adaptation of hearing aids, including direct observation of the ear, testing of hearing in connection with the fitting and selling of hearing aids, taking of ear mold impressions, fitting or sale of hearing aids, and any necessary postfitting counseling. This may include cerumen management. For the purposes of this section, cerumen management means the removal of cerumen for the sole purpose of inspecting the ears, making impressions, or fitting and maintaining hearing aids.

(1) Cerumen management shall only be performed by a hearing aid dispenser who has demonstrated proficiency of this skill in his or her licensing examination.
(2) Cerumen management shall only occur under physician and surgeon supervision, which shall be subject to all of the following:
(A) The hearing aid dispenser and physician and surgeon shall collaborate to develop a written standardized protocol. The protocol shall include, but not be limited to, a requirement that the supervised hearing aid dispenser immediately refer to an appropriate physician and surgeon any trauma, including skin tears, bleeding, or other pathology of the ear discovered in the process of cerumen management.
(B) Approval by the supervising physician and surgeon of the written standardized protocol.
(C) The supervising physician and surgeon shall be within the general vicinity, as provided by the written standardized protocol, of the supervised hearing aid dispenser and shall be available by telephone at the time of cerumen management.
(D) A physician and surgeon may not simultaneously supervise more than two hearing aid dispensers for purposes of cerumen management
The practice of fitting or selling hearing aids does not include the act of concluding the transaction by a retail clerk.
When any audiometer or other equipment is used in the practice of fitting or selling hearing aids, it shall be kept properly calibrated and in good working condition, and the calibration of the audiometer or other equipment shall be checked at least annually.
(b) A hearing aid dispenser shall not conduct diagnostic hearing tests when conducting tests in connection with the practice of fitting or selling hearing aids.
(c) Hearing tests conducted pursuant to this article shall include those that are in compliance with the Food and Drug Administration Guidelines for Hearing Aid Devices and those that are specifically covered in the licensing examination prepared and administered by the board. Tympanometry shall be considered an allowable hearing test for purposes of this section and shall only be used for further referral to a physician and surgeon for diagnosis or treatment.


American Academy of Audiology Announces Opposition


The American Academy of Audiology has come out with strong opposition to the proposed bill in California, issuing a statement to California senators in the Business, Professions and Economic Development Committee where the legislation is currently under consideration.


“On behalf of the Academy’s nearly 800 members in the state of California, and the patients they serve, the Academy strongly encourages the California legislature to consider the implications that this proposed legislation may have on consumers of hearing care within the state. We urge you not to advance this legislation to authorize hearing aid dispensers to perform cerumen management and tympanometry.”
Exerpt, March 27th letter to California legislators
After being referred to the Business, Professions and Economic Development Committee in February, the legislation is set for a hearing on April 17th.
  1. The term supervision should be defined as more direct than “within the vicinity” and “available by telephone”. This is not in the patient’s best interest.

    Technically, under the direction of a physician, a nurse or others can perform tympanometry and be billed under the MD NPI. But it is up to the physician to interpret this test correctly. It is irresponsible to allow testing and interpretation of this test to HIS when no specific coursework has been completed for appropriate technique and interpretation (as in more than a weekend course).

    It is likely if this bill passes, billing insurance companies for these services is next. In an era of trying to reduce unnecessary medical costs, it is not in the consumer’s or insurance industry’s best interest.

    1. Mary, I fully agree that some formal training for HAD’s is mandated for tympanometric procedures. But , if nurses are allowed to do them, then HAD’s should be allowed to do so !
      Jay Muhury.

  2. HAD’s and Audiologists should not be allowed to monkey with the external ears for cerumen management. What the ENT surgeon does for cerumen extraction is quite detailed and beyond the scope of HAD’s and AuD’s. The equipment needed is complex, and regularity of practice is necessary for success.

    They should drop this Bill. Tympanometry can be performed by almost anyone, and interpretation is also easy. I have taught tympanometric interpretation to HAD’s and AuD’s for many years and believe that use of this equipment by both professions will help the hard of hearing patients.

  3. Mary is correct. And this topic screams for more input. Stay tuned.

Leave a Reply