Roles and Responsibilities

Audiologists and speech-language pathologists (SLPs) often collaborate in the aural rehabilitation (AR) process.

Roles and Responsibilities of Audiologists

Audiologists play a central role in the screening, assessment, diagnosis, and treatment of adults with hearing loss and related disorders. The professional roles and activities in audiology include clinical services; prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Audiology (ASHA, 2018).

The following roles and responsibilities are appropriate for audiologists:

Education and Advocacy

• Educate and counsel the person receiving services and their care partners on hearing loss, device use and care, and factors related to tinnitus and hyperacusis.
• Educate the public and other professionals on the needs of people with hearing loss and related disorders (e.g., tinnitus, central auditory processing disorder [CAPD]).
• Educate the public and other professionals on the role of audiologists in the prevention, identification, and management of hearing loss and related disorders.
• Advocate for the communication needs of all people, including for the rights of—and funding of services and devices for—those with hearing loss and related disorders.

Screening and Assessment

• Conduct a comprehensive audiologic assessment.
• Provide evaluation and fitting services for hearing aids, cochlear implants, other sensory aids, and hearing assistive technology.

Intervention and Support

• Develop and implement an AR plan of care in collaboration with the person receiving services, their care partners, and other professionals (e.g., physicians, SLPs), including the establishment of patient-centered communication goals.
• Provide device and technology support, including programming services.
• Provide patient- and family-centered information and training in the areas of
• listening skills and communication strategies;
• managing the listening environment;
• communication with conversational partners;
• strategies for addressing individualized goals on communication, life participation, and community engagement;
• hearing protection and noise hazards; and
• self-advocacy.
• Provide referrals to other professionals as indicated to ensure access to comprehensive services.

As indicated in ASHA’s Code of Ethics (ASHA, 2023), audiologists who serve this population should be specifically educated and appropriately trained to do so.

Roles and Responsibilities of Speech-Language Pathologists

SLPs play a role in the screening, assessment, and rehabilitation of adults with hearing loss and related communication needs. Professional roles and activities in speech-language pathology include clinical services; prevention and advocacy; and education, administration, and research. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

The following roles and responsibilities are appropriate for SLPs:

Education and Advocacy

• Educate and counsel the person receiving services and their care partners on hearing loss, device use and care, and factors related to tinnitus and hyperacusis.
• Educate the public and other professionals on the communication needs of people with hearing loss and related disorders (e.g., tinnitus, CAPD).
• Advocate for the communication needs of all people, including for the rights of—and funding of services and devices for—those with hearing loss and related disorders.

Screening and Assessment

• Conduct a speech and language screening and/or comprehensive assessment as indicated, including a review of functional auditory skills.

Intervention and Support

• Define communication goals for an AR plan of care.
• Develop and implement an AR plan of care in collaboration with the person receiving services as well as with care partners and other professionals (e.g., audiologists).
• Provide patient- and family-centered individual or group training in the areas of
• listening and communication behaviors and strategies (e.g., conversational strategies);
• modifying the listening environment;
• communication with conversational partners;
• strategies for addressing individualized goals on communication, life participation, and community engagement;
• hearing protection and noise hazards; and
• self-advocacy.
• Provide referrals to other professionals to ensure access to comprehensive services.

As indicated in ASHA’s Code of Ethics (ASHA, 2023), SLPs who serve this population should be specifically educated and appropriately trained to do so.

Interprofessional Education/Interprofessional Practice

Interprofessional education (IPE) and interprofessional practice (IPP) are important considerations in the field of AR (Tillery & Rao, 2024). Collaboration between audiologists, SLPs, and other professionals (e.g., psychologists, social workers, physicians) benefits the person receiving services and supports improved outcomes. See ASHA’s page on interprofessional education/interprofessional practice (IPE/IPP) for more information on this topic.

Person- and Family-Centered Care

AR begins during the first contact with the person seeking or receiving services and their care partners. Individualized person- and family-centered care is an approach to the planning, evaluation, and delivery of clinical services based on collaboration among the person receiving services, their care partners, and the clinical provider (B. Johnson et al., 2008). Inclusion and involvement of care partners in the AR process is important and may benefit the person receiving services in a variety of ways (Hull, 2005; Scarinci et al., 2013). Person-centered methods have been found to be cost effective and to provide substantial returns on investment, supporting the feasibility of this approach for clinicians and payers (Gyllensten et al., 2017; Pirhonen et al., 2020).

Person- and family-centered care uses the following integral concepts (B. Johnson et al., 2008):

• Provide dignity and respect in honoring the priorities and choices of the person receiving services and their care partners, including appropriately responding to the influence of their values and cultural background.
• Share information by communicating with the person and their care partners accurately, completely, and in a health-literate format so that the person and their care partners can participate in decision making at the level of their choice.
• Support participation of the person receiving services and their care partners at the level they choose.
• Enable the person receiving services and their care partners to collaborate with health care professionals in a variety of ways.

For more information, see the ASHA pages on focusing care on individuals and their care partners, and health literacy; the ASHA Practice Portal page on Cultural Responsiveness; and the Institute for Patient- and Family-Centered Care.

Assessment for AR

An AR assessment identifies the impact of hearing loss and/or other auditory complaints (e.g., tinnitus, CAPD) on communication, activities, participation, interactions with communication partners, and other individualized aspects of personal well-being. Assessment may be ongoing or periodic depending on (a) the person’s evolving needs and goals and (b) the initiation of device use (e.g., hearing aids, cochlear implants).

Shared decision making is vital to the relationship between the provider and the patient. The assessment process involves informational and personal adjustment counseling and may result in a recommendation for a variety of AR options and/or referral to other professionals. See the ASHA Practice Portal page on Counseling in Audiology and Speech-Language Pathology for more information.

Case History

A detailed and individualized case history is taken with attention to the following details:

• priorities and communication goals of the person receiving services and their care partners
• primary communication modality
• medical history, including medication use (both prescribed and natural/homeopathic)
• history and etiology of hearing loss (e.g., prelingual or postlingual)
• type of hearing loss
• duration of hearing loss
• description of other auditory complaints or diagnoses (e.g., tinnitus, hyperacusis, CAPD)
• history of hearing device use­
• use and type of current hearing device
• challenging communication situations
• cognitive status
• cultural considerations
• available supports
• results from any client and/or family surveys or questionnaires
• expectations of the person receiving services and their care partners regarding hearing technology
• educational/vocational implications

See the ASHA Practice Portal page on Cultural Responsiveness for more information regarding gathering a case history. A variety of hearing-related self-report tools are available (Bentler & Kramer, 2000; Bentler et al., 2016, pp. 437–496; Cox, 2005; Erdman, 2001; Weinstein, 2015). Self-report measures may be completed by the person receiving services, their family members, and/or other care partners. Self-report measures may be used to gather information on one’s perception of their hearing loss and its impact on communication, psychological well-being, and other factors related to quality of life.

Comprehensive Assessment

An AR assessment may include various measures and/or tests, depending on the person’s needs and goals and desired outcomes:

• A needs assessment may be completed, including subjective self-report measures completed by the person receiving services and/or their care partners to gather information on topics such as the functional impact of hearing loss, psychological factors, and quality of life.
• Screening measures may be completed, including
  • cognitive screening (Shen et al., 2016) and
  • speech-language screening on topics such as
    • functional listening skills in everyday environments and situations,
    • noncommunicative and avoidance behaviors (e.g., reduced response to communication partners, avoidance of phone communication), and
    • use of verbal and nonverbal communication strategies.
  • Assessment measures completed may include
    • an audiologic evaluation with measures specific to CAPD and/or tinnitus and hyperacusis as appropriate (see ASHA’s Practice Portal page on Hearing Loss in Adults and Guidelines for the Audiologic Management of Adult Hearing Impairment [American Academy of Audiology, 2006] for more information);
    • a speech-language evaluation;
    • a skills assessment (e.g., detection, discrimination, recognition, comprehension), including
      • the ability to characterize sound presence, duration, and suprasegmental features (e.g., loud vs. soft, high pitch vs. low pitch, vocal inflection) and
      • speech recognition and comprehension at various presentation levels (e.g., words, sentences) with and without competing noise; and
    • a speechreading assessment at perceived, analytic, and synthetic levels (Seal et al., 2013).
  • Device assessments may be completed as appropriate, including
    • assessment of any current hearing device use (e.g., type, regularity of use, personal and care partner satisfaction with the device);
    • evaluation of differential listening abilities with various amplification options, including the use of hearing assistive technology systems; and
    • determination of candidacy for hearing aid(s), cochlear implant(s), other implantable device(s), and/or hearing assistive technology systems.
  • Outcome measures may be established for tracking treatment progress and benefit (Allen et al., 2022), for example, the NOMS Audiology Registry.

AR Plan of Care

A comprehensive AR plan of care is person- and family-centered (Ekberg et al., 2015; Grenness et al., 2014; Laplante-Lévesque et al., 2010; Meyer et al., 2015). A multicomponent AR approach combines various AR approaches and techniques (e.g., informational and personal adjustment counseling, perceptual training) to provide an individualized plan of care.

The International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001) can be used to assist clinicians in establishing goals, developing an AR plan of care, and determining outcomes that can be measured to document progress. See the ASHA page on International Classification of Functioning, Disability, and Health (ICF) for more information.

An AR plan of care may include various approaches, including counseling, use of sensory aids, environmental modifications, training, and/or sound therapy.

Counseling

Effective counseling in AR is a key component (Clark & English, 2018; Sweetow, 2018) and is applicable to hearing loss as well as related disorders (e.g., tinnitus, CAPD). Fundamental skills in counseling are important for the development and implementation of an individualized person- and family-centered AR plan of care (Hull, 2005; Jessen, 2015; C. E. Johnson et al., 2018). “By shifting the focus to our patients and attending to the actual reasons they seek audiologic intervention, the foundation on which to base relevant counseling emerges” (Erdman, 2009, pp. 190–191).

An AR plan of care may include one or more of the following types of counseling:

• Informational counseling focuses on providing education to the person with hearing loss (and/or related disorders) and their care partners about the disorder, associated symptoms, prevention and wellness, and the rationale for specific treatment interventions.
• Personal adjustment counseling focuses on the person’s psychological, social, and emotional acceptance of hearing loss and/or related disorders.
• Support groups provide support from a community, practice with speech in noise, training for conversation partners, work on auditory comprehension, and discussion of other concerns that may arise.

The following topics may be covered during AR counseling:

• the nature and effects of hearing loss, tinnitus, hyperacusis, and/or CAPD
• the care, management, and use of hearing and assistive technology
• expectations for hearing technology use
• adjustment to hearing technology
• use of hearing protection
• the rights of people with hearing loss and/or related disorders
• interpersonal and psychosocial implications of hearing loss and/or related disorders
• self-advocacy
• educational and vocational implications of hearing loss and/or related disorders
• impact on family and other care partners
• issues regarding the use of the telephone, television, and/or other technology
• access and availability of resources and accommodations
• effective coping and compensatory skills
• any other patient and/or care partner concerns

Sensory Aids

The AR provider can help the person receiving services to maximize the use of a current hearing device or guide the process of selection and fitting for a new device. Instruction and demonstration will be provided for the most effective use of the device(s) based on the patient’s individualized needs and goals. Devices may include hearing aids, cochlear implants, other implantable devices, and/or assistive listening devices.

See the ASHA Practice Portal pages on Hearing Aids for Adults and Cochlear Implants for more information.

Environmental Modifications

An AR plan of care may also include individualized environmental modifications to improve access and reduce barriers to communication. The AR provider offers education and support in implementing these changes. Examples of environmental modifications include the following adjustments:

• choosing optimal seating arrangements
• improving room acoustics
• minimizing background noise
• improving lighting for speechreading
• installing visual alerting systems
• using amplified telephones
• using nonwearable masking devices (for tinnitus)

Professionals may assist in defining and implementing specific accommodations and/or modifications for the workplace and educational settings as well as advocating for environmental modifications (e.g., loop systems) in public venues.

Training

Training is provided in a variety of areas and in selected modalities to maximize communication skills in environments relevant to the person receiving services. Training includes participation of care partners, as appropriate. There are a variety of commercially available training programs and mobile applications that may be useful in an AR plan of care.

Auditory Training

“Auditory training is a process designed to enhance the ability to interpret auditory experiences by maximally utilizing residual hearing” (Sweetow & Sabes, 2009, p. 267). It can be used as a valid tool to support AR and improve auditory communication skills, especially when used in combination with other tools and approaches (Stropahl et al., 2020). Auditory training may be provided in face-to-face individual or group sessions, in home-based training sessions, and/or with the use of computer programs and mobile applications (Dornhoffer et al., 2022; Han et al., 2024; Olson, 2015; Sweetow & Sabes, 2007). In some cases, auditory training may be part of an intervention plan for people with normal peripheral hearing (e.g., CAPD, tinnitus). The approach to auditory training may be analytic, synthetic, or a combination of both (Sweetow & Sabes, 2009).

The analytic approach can be described with the following characteristics:

• uses the smallest distinguishing linguistic features of acoustic cues (i.e., bottom-up processing)
• uses small segments of speech such as phonemes or syllables
• focuses on how perception (i.e., hearing) influences communication
• follows the auditory skills hierarchy, including
  • sound awareness (i.e., determining if sound is present or absent),
  • auditory discrimination (i.e., distinguishing sounds as the same or different),
  • auditory identification (i.e., labeling sound), and
  • auditory comprehension (i.e., understanding the meaning of the sound)
• uses tasks progressing from easy to difficult and/or from a quiet environment to an environment including background noise

The synthetic approach can be described with the following characteristics:

• focuses on the overall meaning of discourse (i.e., top-down processing)
• uses segments of speech such as words, phrases, sentences, or conversation
• includes all areas of auditory comprehension
• pulls analytic targets into functional practice to address the use of strategies in real-world situations

Communication Skills Training

Communication skills (or strategies) training may include the following areas of focus:

• articulation
• communication strategies (e.g., active listening, angle and distance of communication partners)
• conversational partner training
• conversational repairs
• pragmatics
• prosody
• self-advocacy
• use of communication systems (e.g., augmentative and alternative communication)
• voice (e.g., resonance, loudness)

Tye-Murray (2024) provides detailed information regarding communication breakdowns, repair strategies, and communication partner training. Group AR may also be helpful in communication skills training (Hawkins, 2005).

Speechreading

Speechreading refers to processing speech using visual information, such as movements of articulators, facial cues, and gestures. Including speechreading in an AR plan of care supports the idea that “cross-modal stimulation from optical and acoustic events contribute to multisensory enhancement in speech perception” (Lansing, 2014, p. 253). Training may be provided for both the speech reader (i.e., listener) and the communication partner (i.e., talker). For example, the speech reader may engage in perceptual practice activities while the talker learns to modify speech and use proactive behaviors to reduce miscommunications. Training may use a variety of message types and occur in a range of settings, as these factors may be sources of communication difficulties. See Wickware (2014) for a description of four approaches to speechreading training: analytic, synthetic, pragmatic, and holistic.

Sound Therapy

In a comprehensive AR plan of care, some patients may require additional services from an audiologist, such as sound therapy. Sound therapy is the use of sound to relieve bothersome tinnitus. Strategies and products are used to mask, habituate, or neuromodulate perceived subjective tinnitus. Both wearable and nonwearable devices may be helpful. Tinnitus retraining therapy is an approach to intervention that includes both sound therapy and counseling.

See the ASHA Practice Portal page on Tinnitus and Hyperacusis for more information.

Outcomes

A person’s progress in the AR process may be measured in several ways and may require documentation by more than one professional (e.g., audiologist and SLP). Outcomes may be tied to the ICF framework and may include measures related to functional progress, activities, and participation. Outcomes may be defined as hearing-specific or may be more generally related to health and quality of life.

Examples of outcome measures include

• functional listening skills,
• clarity of speech,
• use of communication strategies in daily activities,
• reduction of self-perceived hearing handicap,
• use of self-advocacy skills, and
• health-related and overall quality of life.

Outcomes and treatment progress may be described with the following types of documentation:

• a periodic review of short- and long-term functional treatment goals and objectives as determined by collaborative decision making
• a description of (and reasons for) appropriate modifications to the treatment plan
• patient-reported outcome measures and self-assessment questionnaires
• surveys or questionnaires completed by family or other care partners

Service Delivery

In addition to determining the optimal treatment options for each person receiving AR services, a personalized AR plan utilizes a patient-centered approach when considering service delivery variables. Examples of variables that may affect treatment outcomes include format, provider(s), dosage, timing, and setting. For example, the AR plan could include individual and/or group sessions and could be provided utilizing in-person sessions and/or telehealth options (Ferguson et al., 2019; Malmberg et al., 2018). See the ASHA Evidence Maps on Hearing Loss (Adults) and the ASHA Practice Portal page on Telepractice for more information about telepractice in AR. Inclusion of the patient and their care partners and communication partners in decisions about service delivery variables may support participation in AR activities and carryover of strategies to multiple environments.

See the ASHA Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology for information on this topic.

Reimbursement

Coverage for AR services may vary depending upon the provider, the state where services are provided, the insurance source, and individual health plans. For questions related to reimbursement, contact reimbursement@asha.org and check out ASHA’s page on billing and reimbursement.

ASHA Resources

• American Speech-Language-Hearing Association Clinical Practice Guideline on Aural Rehabilitation for Adults With Hearing Loss
• Billing and Reimbursement
• Coding for Evaluation of Auditory Rehabilitation Status
• Focusing Care on Individuals and Their Care Partners
• Health Literacy
• Hearing-Related Topics: Terminology Guidance
• Infection Control Resources for Audiologists and Speech-Language Pathologists
• International Classification of Functioning, Disability, and Health (ICF)
• Interprofessional Education/Interprofessional Practice (IPE/IPP)
• Medicare Frequently Asked Questions: Audiology
• NOMS Audiology Registry

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

• American Academy of Audiology: Guidelines for the Audiologic Management of Adult Hearing Impairment
• Association of Late-Deafened Adults
• Hearing Health & Technology Matters
• Hearing Loss Association of America
• Institute for Patient- and Family-Centered Care
• The Picker Principles of Person Centred Care
• World Health Organization: International Classification of Functioning, Disability and Health (ICF)

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Acknowledgments

Content for ASHA’s Practice Portal is developed through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Aural Rehabilitation for Adults page.

Primary Version

• Diane Brewer, MA, CCC-A (2018)
• Kathy Cienkowski, PhD, CCC-A (2018)
• Deborah Culbertson, PhD, CCC-A (2018)
• Rachel Glade, MS, CCC-SLP (2018)
• Andrea Gregg, MS, CCC-SLP (2018)
• Dusty Jessen, AuD, CCC-A (2018)
• Mary Ann Kinsella-Meier, AuD, CCC-A (2018)
• Saneta Thurmon, MA, CCC-A/SLP (2018)
• Michele Wilson, MA, PhD, CCC-A/SLP (2018)

Secondary Versions

• Laura Gaeta, PhD (2025)
• Sharon Williams, PhD, CCC-A (2025)

ASHA seeks input from subject matter experts representing differing perspectives and backgrounds. At times a subject matter expert may request to have their name removed from our acknowledgment. We continue to appreciate their work.

Citing Practice Portal Pages

The recommended citation for the Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Aural rehabilitation for adults [Practice portal]. www.asha.org/practice-portal/professional-issues/aural-rehabilitation-for-adults/