Although the current emergency regulations are an improvement over the original regulations established nearly a year ago, I consider the regulations to be unusually and unnecessarily restrictive.  Specifically:

1. The audiologist conducting cerumen management must obtain informed written consent prior to performing cerumen management limited to the outer third of the external auditory canal.  I am not currently required to obtain informed written consent while placing foam and cotton blocks in the external canal--which regularly extend beyond the first and often the second bend of said canal.  I do seek verbal consent before placing any device, insert, earmold, or equipment in ANY patient's ear. 
2. Cerumen management is currently limited to debris that is located in the outer third or cartilagenous portion of the ear canal.  Yet, if I elect to use irrigation or water to move ear wax from the patient's canal, pressured water will naturally move against the tympanic membrane.  It is permissible for water to pass beyond the outer third of the ear canal but hand held devices such as suction or curettes may not?
3. Manditory referral of patients to other health care professionals for cerumen management has created unneccessary medical and fiscal hardship to at least six of my patients.  One hospitalized patient with severe hearing loss had to wait six weeks for replacement of hearing aids lost while in hospital.  Due to impacted ear canals, I could not make earmold impressions required for hearing aid replacement and (s)he attended  four weeks of inpatient rehabilitation was compromised by her untreated cerumen management (and unremedied hearing loss).  Three other patients had to wait over a month for cerumen removal that I had previously provided.  Two other patients stated that 'my family doctor told his nurse to remove the wax from my ears; she used water to push the wax out and it hurt so much more than when you cleaned my ears.'  Ironically, when the later two patients returned to my office, otoscopic inspection revealed much significant non impacted wax in the lateral portion of each ear canal.    The emergency regulations force me to refer my patients out for cerumen managment to health care professionals who are not 'certified' for cerumen managment.  Does this constitute an improvement protection of the citizens of Virginia?  I think not. 
4. In its present form, the Emergency Regulations require me to send contraindicated patients to health care providers who are less equipped to provide cerumen management than Audiologist licensees.  As noted previously, to mandate referral to other healthcare professional for simple and common conditions is in no way efficient patient care, nor in anyone's best interest.  Increasing numbers of citizens are home bound and cannot be easily transported to outpatient ENT practices because of their debilitated health and limited mobility. 

Access to the ear canal (and professional management of all aspects of complications that interfere with that) is the cornerstone of literally everything we do professionally. I urge the Board of Audiology and Speech Language Pathology to continue to revise these Regulations to be less restrictive to audiologists performing safe cerumen management. 

Thank you.

Lorraine (Lori) Klein Gardner, Au.D.

Doctor of Audiology--Owner, Hear Virginia

Richmond, Virginia