VOLUME 42, ISSUE 11
ISSUE DATE: JUNE 7, 2010
LAW AND PUBLIC SAFETY
DIVISION OF CONSUMER AFFAIRS
AUDIOLOGY AND SPEECH-LANGUAGE PATHOLOGY ADVISORY COMMITTEE
Adopted Amendment: N.J.A.C. 13:44C-7.1
Adopted New Rule: N.J.A.C. 13:44C-7.1A
Scope of Practice - Audiology; Scope of Practice--Cerumen Management
Proposed: May 18, 2009 at 41 N.J.R. 2082(a).
Adopted: April 27, 2010 by Sharon Joyce, Acting Director, Division of Consumer Affairs.
Filed: May 5, 2010 as R.2010 d.081, with substantive changes not requiring additional public notice and comment (see N.J.A.C. 1:30-6.3).
Authority: N.J.S.A. 45:3B-24.
Effective Date: June 7, 2010.
Expiration Date: February 17, 2014.
Federal Standards Statement
A Federal standards analysis is not required because there are no Federal standards or requirements applicable to the subject matter of the adopted amendment or new rule.
Full text of the adoption follows (additions to proposal indicated in boldface with asterisks *thus*; deletions from proposal indicated in brackets with asterisks *[thus]*):
SUBCHAPTER 7. AUTHORIZED PRACTICE
13:44C-7.1 Scope of practice--audiology
(a) The practice of audiology includes the following functions related to hearing, its disorders and related communication impairments:
1.-10. (No change.)
13:44C-7.1A Scope of practice--cerumen management
(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 N.J.A.C. 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;
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.