Action Recommendation 4-2. In order to capture an accurate assessment of an individual’s hearing abilities on a given day, a test battery is recommended. The test battery approach permits a determination of the validity of the claimant’s responses by examining intertest agreement. If SSA continues to use both pure-tone and speech testing, then more than one test in the battery can be used to determine if an individual has met the requirements for a disability based on hearing impairment. A person who may not be able to take a particular test in the battery (e.g., because of a language barrier) may still have a successful claim on the basis of performance on other component tests in the battery. The measures to be assessed in the test battery for adults are:
pure-tone thresholds in each ear presented via air and bone conduction transducers,
speech thresholds using earphones in each ear,
speech recognition performance for signals presented in the sound field at average conversational levels in quiet and in noise,
acoustic reflex thresholds.
The latter two tests are included to rule out conductive pathology, because a conductive component to the hearing loss often can be managed medically with improvement in hearing sensitivity. In addition, acoustic reflex threshold assessment can be useful in identifying cases of feigning a severe or profound hearing loss that would be undetected by other tests in the battery. It is recommended that the entire test battery be completed before a determination of disability is formulated.
Action Recommendation 4-3. The test procedures required for determining a disability based on hearing impairment must be conducted by a clinical audiologist who holds state licensure (if applicable). Audiologists working in states in which no licensure exists should be certified by the American Speech-Language-Hearing Association (Certificate of Clinical Competence in Audiology, or CCC-A) or by the American Board of Audiology.
Audiologists are hearing health care professionals who identify, assess, and manage disorders of the auditory system of individuals across the life span and of individuals from diverse linguistic and cultural backgrounds. They follow a stringent code of ethics (American Speech-