Global Audiology/Americas/Canada
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General Information
Canada is the second-largest country in total area; however, most of Canada’s roughly 36 million people reside along the southern border. Modern-day Canada is comprised of ten provinces and three territories, all of which stretch across the northern part of North America. Canada’s eastern and western borders are the Atlantic and Pacific Oceans, respectively. To the north lies the Arctic Ocean, and to the south lies the continental United States of America. The state of Alaska lies to the northwest. Though English and French are the officially recognized languages, many others are spoken throughout the nation. Nearly 98% of citizens speak English and/or French as a native language.
History of Audiology
In Canada, the professions of audiology and speech pathology are relatively young; however, they are not well documented. Services were first recorded in the early portion of the 1930s. This is relatively late compared to the clinical services that were being provided in other countries after World War I. It was not until the 1950s and 1960s that audiology services flourished in Canada. The earliest audiologists were individuals educated in other countries and recruited to provide services in Canada. These audiologists worked for government clinics and the Interprovincial School for the Deaf. Early on, it was common for providers to offer audiology and speech pathology services due to the lack of professionals in both disciplines (Martin, 2007, The History of the Professions of Speech-Language Pathology and Audiology in Canada: Our First Fifty Years. Winnipeg, Manitoba, Canada: Author). Canadian universities began to offer audiology programs in the early 1960s. The first two were the University of Toronto and the University of Montreal. A major issue with tracking the development of services occurred due to a large number of providers that would move between provinces and even their nation of origin. The internationally recruited professionals offered a great amount of influence on audiology; especially those from the United Kingdom and the United States. This influence is still evident today.
Some provinces and territories still do not institute regulations. The federal government did not develop guidelines for the practice of audiology until 1982. The regulation by professional organizations was complicated by the fact that international audiologists typically belonged to an organization in their home country and considered membership in an established institution to be sufficient. Eventually, the Canadian Speech and Hearing Association was founded as a unifying basis for audiology and speech pathology. Since this time, the professions have become somewhat separate while acknowledging the common history that they share.
Hearing loss incidence and prevalence
In 2012 and 2013, the Ministry of Health conducted the Canadian Health Measures Survey (CHMS), which included audiometric assessments of adults and children. The survey results “indicate that 20% of adults aged 19 to 79 years had at least a mild hearing loss in at least one ear" (“Hearing Loss of Canadians,” 2015). Of the adults surveyed, hearing loss was most common in the 60-79 age group at 47%, 16% of adults aged 40-59 years, and 7% of adults aged 19-39 years. The older adults (60–79 years) were also more likely to have bilateral hearing loss. Children between 6 and 18 years old were also included in the survey. The audiometric results indicate that approximately 5% of children had a hearing loss, and most (90%) had a unilateral hearing loss. Male and female children were equally affected. Otoacoustic emissions were completed on children 3-5 years of age, but not audiometry. 7% of children tested with OAEs showed results consistent with conductive hearing loss. The majority of survey participants were unaware of their hearing loss; nor had they been diagnosed with hearing loss by a health care professional (“Hearing Loss of Canadians,” 2015). More recent specific data by age groups are available.[1] [2] [3]
A 2022 study reported that hearing loss is highly prevalent among home care and long-term care residents, with rates ranging from 25% to 29% in home care and dual sensory loss being most prevalent in long-term care at around 25%.[4] About 42% of Canadians report hazardous occupational noise exposure.[5] Approximately 35% of working Canadians, aged 16 to 79 years, had measured hearing loss on the basis of one or more tests, and 43% of participants, representing 11.5 million Canadians, have experienced tinnitus at some point in their lives. Men were significantly more likely to have had tinnitus compared to women.
Information About Audiology
Education
Audiologists in Canada are required to complete a master’s or doctorate degree in audiology in addition to an undergraduate degree. Master’s degree programs are two to three years in duration. Some universities offer doctoral degree programs in audiology (AuD or PhD). The Doctorate of Audiology is considered commensurate with the educational requirements.
Audiology Practice: Public and Private
Audiology services can be accessed in a variety of facilities, which can lead to some confusion about how services are paid for. Publicly funded facilities such as hospitals, community health centers, and schools do not charge patients directly for services that are medically necessary (“Paying for Audiologist Services,” 2016). Cochlear implants can be covered under these terms. To obtain audiological services in public institutions, a physician referral may be required. Many citizens purchase a supplemental health insurance plan to assist with prescriptions, services, and devices that may not be covered by the public program. Many of the supplemental plans assist with the purchase of hearing aids. Audiologic services are covered by public insurance; hearing aids are not covered for adults. Children under the age of sixteen can receive hearing aids at no or reduced cost.[6] Private clinics are also available for Canadian citizens. In order to access private clinics, patients may utilize private health insurance from an employer or pay out of pocket, see Understanding public and private health care By law, private clinics are not supposed to provide services covered under the Canada Health Act; however, many clinics do so at reduced wait times. In these clinics, audiologists can charge for their services in addition to hearing aids (Canadian Health Care, 2004-2007).
Services offered by Otolaryngologists, Otologists and Otoneurologists
Otolaryngologists offer a diverse selection of ear-related services. Services may include: diagnosis and management of acute and chronic pathologies, balance disorders, and traumatic injuries; surgical management of congenital malformations, pathologies, tumors, and implantable devices. The most common surgical implants available are cochlear implants and bone-anchored hearing aids. Otolaryngologists are highly trained, and many perform complex microsurgeries to improve hearing. Many are also skilled in plastic surgery, which can be helpful when correcting congenital malformations of the ear (“What is an Otolaryngologist-Head and Neck Surgeon?,” 2013).
Audiological Services
Audiologists practice in several different clinical settings. These include: hospitals, public health clinics, schools, early intervention programs, private practices, hearing instrument manufacturers, research facilities, industrial facilities, and universities. While each setting may require the provision of different services, overall, audiologists are responsible for the identification, diagnosis, and management of individuals with hearing loss, tinnitus, balance disorders, and other ear-related disorders.
Clinical services offered by audiologists include the following:
- Assessment of hearing and balance
- Management of hearing and balance disorders
- Assessment, selection, dispensing, validation and verification of management options including hearing aid and other rehabilitation strategies
- Intraoperative monitoring
- Aural rehabilitation
- Cerumen management
- Screening for communication disorders
Additionally, audiologists are responsible for the education of families regarding identified hearing loss and the community on general hearing health, including hearing protection. Audiologists who work in schools are responsible for optimizing students’ educational experiences related to their hearing. Audiologists are also responsible for educating the next generation of hearing health professionals and advancing the field via research efforts. The efforts of others allow for the continuing practice of the profession through administrative and legal procedures (“Scope of Practice in Audiology,” 2016).
Professionals
The table below shows the professionals who regularly interact with individuals with hearing loss. The ratios are estimates calculated based on the population of 36,155,487 (“Canada,” 2016).
| Professionals | Approximate number | Ratio to the population |
|---|---|---|
| Audiologists | 1,759 ("Canada's Health Care Providers: Provincal Profiles, 2013," 2013) | 1: 20,555 |
| Otolaryngologists | 733 ("Otolaryngology Profile," 2015) | 1: 49,325 |
| Physician Assistants | 308 ("Canada's Health Care Providers: Provincal Profiles, 2013," 2013) | 1: 117,388 |
| Physicians | 82,198 ("Physicians in Canada, 2015," 2016) | 1: 440 |
| Speech-Language Pathologists | 8,973 ("Canada's Health Care Providers: Provincal Profiles, 2013," 2013) | 1: 4029 |
Professional and Regulatory Bodies
The Canadian Academy of Audiology (CAA) aims to exemplify the field of audiology in Canada by supporting audiologists in their endeavor to become the primary providers for hearing health. The organization was established in 1996 and incorporated in 1998. CAA provides a scope of practice, ethical standards, educational materials, and advocacy for the profession of audiology. The Academy also publishes The Canadian Audiologist, a bimonthly electronic journal.
Another professional body for Canadian audiologists is Speech-Language & Audiology Canada (SAC). SAC began in 1964 as the Canadian Speech and Hearing Association. Since the mid-1960s, SAC has been active in developing clinical standards and collecting demographic data relating to communication disorders. In 1998, SAC and the American Speech-Language and Hearing Association collaborated to establish a program for reciprocal certification.
Scope of Practice and Licensing
The Canadian Academy of Audiology published a position paper in 2002 regarding the scope of practice for audiologists as defined below:
“The scope of practice of audiologists is defined by the training and knowledge base of those who are licensed or otherwise regulated to practice audiology. The central focus of the profession of audiology is on human hearing, both normal and impaired, and its relationship to disorders of communication.
The position paper outlines the specific areas in which audiologists are qualified to provide services. These services include, but are not limited to (“Scope of Practice,” 2002):
- Establishing and managing screening programs for patients of all ages
- Assessment and diagnosis
- Habilitation and Rehabilitation
- Hearing Conservation
- Intraoperative Monitoring
- Research
In terms of licensing, each province and territory has its own requirements for licensing audiologists. However, there is a plan to establish a national examination to ensure the commensurate education of audiologists.
Research in Audiology
Audiology research is fairly active around the nation. Much of the current work focuses on the pediatric population, aural rehabilitation, and signal processing. The university research laboratories continue to explore outcome measurements for amplification users of all ages. Researchers’ interests in aural rehabilitation extend beyond individuals and often center on the family as a whole.
The University of Western Ontario has also contributed a significant amount of research regarding hearing science in the clinical setting. Researchers for the University of Western Ontario are responsible for developing the Real-Ear to Coupler Difference (RECD) procedure, used for improving the accuracy of hearing aid fittings, and the Desired Sensation Level algorithm.[7] These are merely two examples of the major contributions that Canadian researchers have provided to the field of audiology, but these advancements have had international implications on clinical procedures.
Audiology Charities
There are several philanthropic organizations to assist families and individuals with hearing loss. A few are listed below:
Challenges, Opportunities and Notes
Challenges
A major challenge faced by the profession is the lack of consistency within and between the provinces and territories regarding the practice of audiology. Each province or territory has different regulations for the practice of audiology. Additionally, the funding for audiology programs (e.g., newborn hearing screenings) can fluctuate and is not guaranteed for hospitals.
Another challenge that Canada faces is sifting through the complex healthcare system to determine insurance eligibility and coverage. The public health insurance system can cause patients to experience lengthy waiting periods to obtain hearing healthcare.
References
- ↑ Feder, Katya; Michaud, David; Ramage-Morin, Pamela; McNamee, James; Beauregard, Yves (2015-07). "Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013 Canadian Health Measures Survey". Health Reports 26 (7): 18–25. ISSN 1209-1367. PMID 26177043. https://pubmed.ncbi.nlm.nih.gov/26177043.
- ↑ Mick, Paul Thomas; Hämäläinen, Anni; Kolisang, Lebo; Pichora-Fuller, M. Kathleen; Phillips, Natalie; Guthrie, Dawn; Wittich, Walter (2021-03). "The Prevalence of Hearing, Vision, and Dual Sensory Loss in Older Canadians: An Analysis of Data from the Canadian Longitudinal Study on Aging". Canadian Journal on Aging / La Revue canadienne du vieillissement 40 (1): 1–22. doi:10.1017/S0714980820000070. ISSN 0714-9808. https://www.cambridge.org/core/product/identifier/S0714980820000070/type/journal_article.
- ↑ Feder, Katya Polena; Michaud, David; McNamee, James; Fitzpatrick, Elizabeth; Ramage-Morin, Pamela; Beauregard, Yves (2017-01). "Prevalence of Hearing Loss Among a Representative Sample of Canadian Children and Adolescents, 3 to 19 Years of Age". Ear & Hearing 38 (1): 7–20. doi:10.1097/AUD.0000000000000345. ISSN 0196-0202. https://journals.lww.com/00003446-201701000-00002.
- ↑ Guthrie, Dawn M.; Williams, Nicole; Jaiswal, Atul; Mick, Paul; O’Rourke, Hannah M.; Pichora-Fuller, M. Kathleen; Wittich, Walter; Sutradhar, Rinku (2022-12-08). "Prevalence of sensory impairments in home care and long-term care using interRAI data from across Canada". BMC Geriatrics 22 (1). doi:10.1186/s12877-022-03671-7. ISSN 1471-2318. PMID 36482317. PMC 9733010. https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-022-03671-7.
- ↑ Feder, Katya; Michaud, David; McNamee, James; Fitzpatrick, Elizabeth; Davies, Hugh; Leroux, Tony (2017-01). "Prevalence of Hazardous Occupational Noise Exposure, Hearing Loss, and Hearing Protection Usage Among a Representative Sample of Working Canadians". Journal of Occupational & Environmental Medicine 59 (1): 92–113. doi:10.1097/JOM.0000000000000920. ISSN 1076-2752. https://journals.lww.com/00043764-201701000-00015.
- ↑ Mencher, George T. (2008-12). "Universal Hearing Health Care: Canada". The ASHA Leader 13 (17): 17–17. doi:10.1044/leader.WB5.13172008.17. ISSN 1085-9586. http://pubs.asha.org/doi/10.1044/leader.WB5.13172008.17.
- ↑ Bagatto, Marlene; Moodie, Sheila; Scollie, Susan; Seewald, Richard; Moodie, Shane; Pumford, John; Liu, K. P. Rachel (2005-01). "Clinical Protocols for Hearing Instrument Fitting in the Desired Sensation Level Method". Trends in Amplification 9 (4): 199–226. doi:10.1177/108471380500900404. ISSN 1084-7138. https://journals.sagepub.com/doi/10.1177/108471380500900404.
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 Contributor to the original text | |
| Ross Roeser | ||
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Edited in part by Joyce Rodvie Sagun