Detailed job description and main responsibilities

Clinical:

1. Collaborates with the Audiology Manager in the provision of specific clinical work on a daily basis, ensuring an efficient and effective service within clinical governance guidelines.

• Maintains professional standards and protocols without supervision.
• Responsible for maintaining own workload, prioritising referrals, arranging follow up appointments agreed with patient.
• Contact with clients within hospital clinical settings, community clinical settings, patients own home and nursing homes on domiciliary visits.

2. To perform and analyse diagnostic assessments of hearing on adults and children.

• Using air conduction headphones and bone conduction vibrator to obtain accurate hearing threshold levels (using masking stimuli where appropriate) and following BSA guidelines. Instructing the patient on what is required of them to perform the test including the use of tact and persuasion where barriers to understanding exist e.g., children with special needs, adults with learning disabilities, babies and the patient may be uncooperative. Requiring frequent use of keyboard, mouse and VDU whilst sitting in a restricted position.
• Perform middle ear analysis using tympanometry, including probe microphone insertion to determine the middle ear function; acoustic reflex testing and eustachian tube function tests as part of the test battery for further management of medical conditions.
• Perform examination of the ear using clinical Otoscope to identify healthy and abnormal ear conditions. Recognising contra-indications to performing further procedures and appropriate referral to other professionals (ENT, GP, Specialist ENT Nurse, other specialist audiologist) for management/treatment where required.

3. Selection, Verification and Programming (subjective and objective) of hearing aids.

• Using assessment results to select and programme appropriate hearing aids using specific computer software and hardware tools.
• Assess patient’s individual, physical abilities, and social needs in choice of aid and programmes.
• Verify the hearing aid programming using subjective (free field and verbal assessment) and objective ‘Real Ear Measurement’ or ‘Real Ear to coupler Difference’ (on children) techniques involving insertion of probe tube microphone into the ear canal. Adjusting prescription of hearing aid as appropriate. Involves fine manual dexterity and care, requiring prolonged concentration.

4. Provides comprehensive and complex rehabilitation and counselling:

• Instructing patient on effective use of aid, communicating realistic expectations, advice on the disabling effects of hearing loss. Using basic directive counselling and empathic skills to empower the patient in their rehabilitation and management of hearing loss.
•  Formulating individualised care plans. 
• Using effective communication and persuasion where a poor motivational attitude to hearing loss may exist and barriers to understanding and communication may include hearing loss, visual impairment (including deaf-blind clients), dementia and stroke patients with aphasia.
• Liaise with nursing and residential homes and give advice and presentations to staff and residents to ensure all hearing-impaired residents are given an informed and quality service in regard to their communication needs.

5. Audit and outcome measures:

• Audit the benefit of hearing aid use and patient satisfaction using nationally recognised benefit profiles and questionnaires. Input the information into software packages.
• Using the outcome measures for further rehabilitation measures.
• Take part in clinical audit, and research & development of the activity of the service to improve patient services.

6. To participate in the open access hearing aid repair sessions. This entails:

• Dealing with maintenance and replacement of faulty hearing aids, supply of batteries, re-tubing of ear moulds.
• Dealing with queries and problems presented by patients and carers and referring them to the appropriate professional if required.
• To provide this service to inpatients on wards and at outside clinics where transport of equipment to carry out these duties is required. Occasionally this will require working in less-than-ideal conditions.

7. Modification of ear moulds for patients using appropriate equipment (with training) including dental drill, buffer/grinder and safety equipment, to ensure comfortable and acoustically viable fit.

• For adults and children with all types of hearing aid, requiring skill, dexterity and judgement when working to finer tolerances. Involves the use of noisy and dusty machinery for earmould modification.

8. To take accurate and safe impressions of the ear:

• On adults and children of all ages and special needs clients.
• Taking impression of the ear following professional recommended procedures (BSA) by placing foam otostop into ear canal, then syringing impression material into the canal to form an accurate impression for processing by the earmould manufacturer.
• Determine the type, material and any modifications required for earmoulds, swim moulds and other types of earpieces required (e.g. ear defenders).

9. To take a clinical lead in one or more of the following specialist areas being responsible for generating written, verbal and electronic reports to other professionals, communicating results, prognosis and further actions:

• Direct referral hearing aid clinic: taking accurate clinical history, otoscopic examination of the ears, performing diagnostic assessment and making a clinical decision on the appropriateness of hearing aids and assistive listening devices, formulating a patient management plan. Reporting findings to GP and other medical personnel as required for further management.

• Diagnostic Audiology on adults including: 1. Auditory Brainstem Response assessments using electrodes to detect stimuli from supra-aural/intra aural headphones and bone conductor, and using specific computer software and hardware. 2. Otoacoustic emissions to detect cochlear function using probe microphone and specific computer software and hardware. 3. Speech Audiometry, using taped speech lists and headphones to determine speech discrimination.
• Hearing aid fitting for more complex hearing loss client group.
• Tinnitus management clinics: patients referred from ENT and from existing client base for management of the sometimes-distressing condition of tinnitus awareness.

Assessment of patient using diagnostic tests, handicap questionnaire and tinnitus questionnaire.

Formulating a tinnitus therapy rehabilitation plan including use of sound generators, hearing aids and breathing techniques to aid tinnitus retraining therapy.

Using directive and patient centred counselling skills with emotionally distressed patients.

Arranging tinnitus clinics for individual consultation of up to 1 hour for each patient.

Refer for psychological management where appropriate. Following patient through the therapy for up to 3 years.

• Vestibular clinics: assessment of balance disorders using computer specific software and hardware to inform of Vestibular function. Includes Electronystagmography and caloric irrigation of the ears using water, air or iced water where appropriate.
• Grommet follow-up clinics: postoperative assessment of patients who have had grommet/ventilation tube inserted by surgical methods into tympanic membrane.

Recording any postoperative complications/parental concerns.

Otoscopic examination to assess condition of ear and the grommet position/patency.

Carrying out appropriate tests including age-appropriate hearing assessment and/or tympanometry if required.

Taking clinical decision on further management or discharge from care and reporting finding in medical records for ENT information.

• To act as Clinical Educator or Supervisor for the training of Assistant Audiology Practitioners, Clinical placement students (BSc/MSc) and work experience students. Assess clinical competencies both verbally and practically and update the student logbook. Provide training days for junior and senior medical and non-medical staff.
• Responsible for maintenance and calibration of all Audiology equipment. Ensure annual calibration is carried out, equipment sent for repair to appropriate department/company. Ensure accurate records are maintained for equipment. Train all staff in the care and maintenance of equipment, filling in the risk assessment sheets as required.
• Hearing aid stock control: adult and paediatric hearing aid stock maintenance to ensure adequate levels of stock for new issuing and replacement.
• Teaching and delivering complex rehabilitative and audiological information to groups of patients (up to 20 individuals including patients and carers/relatives) for instruction and rehabilitation with regard to hearing aids.
• Undertakes wax removal using microscope and suction clearance equipment as part of the ENT/Audiology Aural Care program.