A licensed hearing instrument specialist shall comply with the following cerumen management principles:

(1) The indications for cerumen management for a licensed hearing instrument specialist include:

Terms Used In Tennessee Code 63-17-223

  • Cerumen: means a wax like secretion from glands in the external auditory canal. See Tennessee Code 63-17-201
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Hearing instrument: means any instrument or device designed for or represented as aiding, improving or correcting defective human hearing and any parts, attachments or accessories of such an instrument or device. See Tennessee Code 63-17-201
  • Licensed hearing instrument specialist: means any person licensed by this part who has passed a council-approved psychometrically-sound examination for hearing instrument specialists. See Tennessee Code 63-17-201
  • Otolaryngologist: means a physician specialist dedicated to the care of patients with disorders of the ears, nose, throat, and related structures of the head and neck, commonly referred to as ENTs. See Tennessee Code 63-17-201
  • signed: includes a mark, the name being written near the mark and witnessed, or any other symbol or methodology executed or adopted by a party with intention to authenticate a writing or record, regardless of being witnessed. See Tennessee Code 1-3-105
(A) Enabling audiometric testing;
(B) Making ear impressions;
(C) Fitting hearing protection or prosthetic devices; and
(D) Monitoring continuous use of hearing aids;
(2) The licensed hearing instrument specialist shall refer a patient who exhibits any of the following contraindications to cerumen removal for medical consultation or medical intervention to an otolaryngologist or a licensed physician:

(A) An age less than twelve (12) years of age;
(B) A perforated tympanic membrane;
(C) History of pain, active drainage, or bleeding from the ear;
(D) Evidence of congenital or traumatic deformity of the ear;
(E) Ear surgery within the last six (6) months;
(F) Tympanostomy tubes, such that irrigation should not be used;
(G) A bleeding disorder;
(H) Actual or suspected foreign body in the ear;
(I) Stenosis or bony exostosis of the ear canal;
(J) Cerumen impaction that totally occludes the ear canal;
(K) Cerumen located medial to the cartilaginous external auditory canal; or
(L) A tympanic membrane that the licensee is unable to see;
(3) In performing cerumen removal, a licensed hearing instrument specialist shall only remove cerumen lateral to the external auditory canal using the following instruments:

(A) Cerumen loop;
(B) Cerumenolytic liquid;
(C) Irrigation, for patients with intact tympanic membranes and a closed mastoid cavity, no tympanostomy tubes, no recent ear surgery, and no recent dizziness; or
(D) Suction used lateral to the bony canal, only for patients with no recent surgery, intact tympanic membranes and no clear otorrhea;
(4) If the patient, while undergoing cerumen management that did not present contraindications, complains of significant pain, exhibits uncontrolled bleeding or a laceration of the external auditory canal, or notices the acute onset of dizziness or vertigo or sudden hearing loss, then the licensed hearing instrument specialist shall immediately stop the procedure and refer the patient to an otolaryngologist or a licensed physician;
(5) The licensed hearing instrument specialist shall maintain the following proper infection control practices:

(A) Universal health precautions;
(B) Decontamination;
(C) Cleaning, disinfection, and sterilization of multiple use equipment; and
(D) Universal precautions for prevention of the transmission of human immunodeficiency virus (HIV), hepatitis B virus, and other bloodborne pathogens, as defined by occupational safety and health standards promulgated pursuant to 29 CFR 1910;
(6) The licensed hearing instrument specialist who performs cerumen management shall maintain a case history for every patient and informed consent signed by the patient as part of the patient’s records;
(7) The licensed hearing instrument specialist shall carry appropriate professional liability insurance before performing cerumen removal; and
(8) The licensed hearing instrument specialist is prohibited from requiring patients to sign any form that eliminates liability if the patient is harmed.
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