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Alabama Hearing Instrument Specialist — Requirements & Free Practice

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Apprentice Permit

One-year supervised training permit, renewable once under the Board examination-attempt condition.

Licensing authority: Alabama Hearing Instrument Dealers Board · Application information

Initial apprentice permit
No examination is required for this applicant pathway.
Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Distance learning
Successfully complete the International Institute for Hearing Instrument Studies distance-learning program before supervised practice; the course is training, not an identified licensing-examination leaf.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Permit term
One year from issuance. No second permit within five years following expiration of the initial permit.
Sponsor
Provide sponsorship by an active Alabama dispenser with an established business address and at least one year of licensure; a dispenser may sponsor no more than four apprentices.
Supervised practice
Practice only under direct supervision and physical observation by the sponsoring dispenser or the dispenser-designated specialist. The supervisor reviews and approves testing, impressions and orders and is present at hearing-aid delivery.

Official no-examination sources

Effective from 2026-09-22.

One additional year after a failed specialist examination attempt
Attempt sequence
The Board authorizes the IHS written examination only after the practical and law tests have been passed; which qualifying-examination attempt can be presented depends on the applicant’s actual progress.
Duration
Renewal is limited to one additional year; the Board form says a permit may not be renewed more than once within a five-year period.
Failed attempt
Rule 445-X-1-.03(2)(b)1 permits one additional year only after the permit holder has sat and failed the specialist examination during the initial permit year. The current renewal application requests proof of at least one attempt during the previous 12 months. The alternative leaves identify the currently offered specialist examinations that the attempted-examination condition can involve; they do not require a passing score for renewal.
Sponsorship
Continue qualified sponsorship and direct supervision; submit the renewal application and $125 renewal fee.

Hearing Aid Dispenser License

License to fit and dispense hearing instruments, including the statutory route for an Alabama-licensed audiologist.

Licensing authority: Alabama Hearing Instrument Dealers Board · Application information

Annual active license renewal
No examination is required for this applicant pathway.
Annual application
Submit the completed renewal application and fee annually on or before January 30; a 30-day grace period, late fees and reinstatement fees apply as specified by Board rule.
Business address
Provide a current permanent business street address on renewal; Rule 445-X-1-.03(5)(e) requires notice of an address change within 15 days.
Continuing education
Satisfy the Board-approved continuing-education requirements: twenty hours every two years, including six directed hours (two medical/hearing-healthcare, two patient care/management, two Alabama jurisprudence and ethics). The directed hours must be in-person or Board-approved live video/virtual instruction.
Continuing status
The 2026 renewal form requires current NBC-HIS certification for a dispenser or a current Alabama audiologist license for its audiologist alternative. Continuing certification or licensure status is an applicant condition; Ala. Code §34-14-6(a) expressly prohibits an examination as a renewal condition within two years.
Disciplinary restriction
Renewal is denied while a Board suspension or revocation has been appealed and remains in litigation (Rule 445-X-1-.03(5)(f)).
Documentation
Maintain continuing-education certificates or IHS transcripts and supporting documents for four years and submit the required originals or official transcripts to the Board. The current Board Testing & CEU page states that an IHS official certificate or transcript is the only permitted proof accepted by the office.

Official no-examination sources

Effective from 2026-09-22.

Issuance to an Alabama licensed audiologist
No examination is required for this applicant pathway.
Alabama audiology license
Hold and provide proof of a current Alabama audiologist license. Examinations of that other profession are applicant qualifications, not leaves here.
Application
Apply to the Hearing Instrument Dealers Board, provide the current audiologist license and submit applicable application and license fees.
Statutory path
Ala. Code §34-14-11(a)(5) independently directs issuance to an Alabama-licensed audiologist; the Board expressly describes this as an alternative to its examination-and-certification dispenser pathway.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure with national board certification

All of the following:

Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Certification
Provide proof of current NBC-HIS certification; the Board application requires it for a dispenser, except the Alabama-audiologist alternative or an individually granted certification exemption.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Written exam selection
Ala. Code §34-14-5(a) allows the Board to revise qualifying-examination standards; Rule 445-X-1-.04(5) permits national examinations. The current Board dispenser-specific statement identifies the NBC-HIS certification written examination together with the practical and state-law examinations. This route therefore references the registered NCE for that written requirement.
Initial licensure with an individual certification exemption appeal

All of the following:

Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Certification
Provide proof of current NBC-HIS certification; the Board application requires it for a dispenser, except the Alabama-audiologist alternative or an individually granted certification exemption.
Certification exemption
Ala. Code §34-14-11(b) authorizes the Board to review an individual appeal for exemption from required dispenser certification. Approval is case-specific; the identified certification examination remains a leaf because an individual may be excused from it. The provision does not waive the separately identified state practical and law examinations.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Written exam selection
Ala. Code §34-14-5(a) allows the Board to revise qualifying-examination standards; Rule 445-X-1-.04(5) permits national examinations. The current Board dispenser-specific statement identifies the NBC-HIS certification written examination together with the practical and state-law examinations. This route therefore references the registered NCE for that written requirement.
Reinstatement and renewal within two years of expiration
No examination is required for this applicant pathway.
Annual application
Submit the completed renewal application and fee annually on or before January 30; a 30-day grace period, late fees and reinstatement fees apply as specified by Board rule.
Business address
Provide a current permanent business street address on renewal; Rule 445-X-1-.03(5)(e) requires notice of an address change within 15 days.
Continuing education
Satisfy the Board-approved continuing-education requirements: twenty hours every two years, including six directed hours (two medical/hearing-healthcare, two patient care/management, two Alabama jurisprudence and ethics). The directed hours must be in-person or Board-approved live video/virtual instruction.
Continuing status
The 2026 renewal form requires current NBC-HIS certification for a dispenser or a current Alabama audiologist license for its audiologist alternative. Continuing certification or licensure status is an applicant condition; Ala. Code §34-14-6(a) expressly prohibits an examination as a renewal condition within two years.
Disciplinary restriction
Renewal is denied while a Board suspension or revocation has been appealed and remains in litigation (Rule 445-X-1-.03(5)(f)).
Documentation
Maintain continuing-education certificates or IHS transcripts and supporting documents for four years and submit the required originals or official transcripts to the Board. The current Board Testing & CEU page states that an IHS official certificate or transcript is the only permitted proof accepted by the office.
Expiration limit
Apply within two years after expiration; pay both the regular renewal and reinstatement fees. Section 34-14-6(a) expressly requires no examination within this period. Practice is not authorized while the license is expired.

Official no-examination sources

Effective from 2026-09-22.

Licensure by reciprocity

All of the following:

Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Certification
Provide proof of current NBC-HIS certification; the Board application requires it for a dispenser, except the Alabama-audiologist alternative or an individually granted certification exemption.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Equivalent standards
The existing license requirements must be equivalent to or greater than Alabama requirements. The Board must approve acceptable tests at or above the statutory National Institute of Hearing Instrument Studies examination standard. This comparison standard does not identify another currently offered examination required of the applicant.
Existing license
Currently licensed as a hearing aid specialist, dispenser or dealer elsewhere; this is an applicant condition, not a leaf for another jurisdiction’s examination.
Good standing
License must be in good standing and not suspended or revoked; all license verifications must be on file.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Nbchis score window
The current Board Levels of State Licensure statement adds: "(Out-of-State Reciprocity dependent upon having passed the NBC-HIS exam within the previous 12 months.)" This implementing requirement is retained as a condition together with the statute’s approved-test and score-window requirements.
Pending complaints
A pending complaint must be resolved and its resolution validated by the licensing authority before an Alabama license can be granted.
Reciprocity agreement
The issuing licensing authority must have a current reciprocity agreement on file with the Board.
Score delivery and age
The licensing authority must mail examination scores directly to the Board; the examination must have been taken within the preceding 12 months (Ala. Code §34-14-3(c)(2)).
Written exam selection
Ala. Code §34-14-5(a) allows the Board to revise qualifying-examination standards; Rule 445-X-1-.04(5) permits national examinations. The current Board dispenser-specific statement identifies the NBC-HIS certification written examination together with the practical and state-law examinations. This route therefore references the registered NCE for that written requirement.

Certificate of Endorsement

Statutory certificate registered and maintained in the same manner as a license under Ala. Code §34-14-3(f).

Licensing authority: Alabama Board of Hearing Instrument Dealers

Annual active license renewal
No examination is required for this applicant pathway.
Annual application
Submit the completed renewal application and fee annually on or before January 30; a 30-day grace period, late fees and reinstatement fees apply as specified by Board rule.
Business address
Provide a current permanent business street address on renewal; Rule 445-X-1-.03(5)(e) requires notice of an address change within 15 days.
Certificate parity
Section 34-14-3(f) applies the same renewal grounds and fees as a license.
Continuing education
Satisfy the Board-approved continuing-education requirements: twenty hours every two years, including six directed hours (two medical/hearing-healthcare, two patient care/management, two Alabama jurisprudence and ethics). The directed hours must be in-person or Board-approved live video/virtual instruction.
Disciplinary restriction
Renewal is denied while a Board suspension or revocation has been appealed and remains in litigation (Rule 445-X-1-.03(5)(f)).
Documentation
Maintain continuing-education certificates or IHS transcripts and supporting documents for four years and submit the required originals or official transcripts to the Board. The current Board Testing & CEU page states that an IHS official certificate or transcript is the only permitted proof accepted by the office.

Official no-examination sources

Effective from 2026-09-22.

Registration by endorsement

All of the following:

Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Certificate registration
Ala. Code §34-14-3(f) registers a certificate holder in the same manner as a licensee with identical initial fees, renewal grounds and disciplinary procedures.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Equivalent standards
The existing license requirements must be equivalent to or greater than Alabama requirements. The Board must approve acceptable tests at or above the statutory National Institute of Hearing Instrument Studies examination standard. This comparison standard does not identify another currently offered examination required of the applicant.
Existing license
Currently licensed as a hearing aid specialist, dispenser or dealer elsewhere; this is an applicant condition, not a leaf for another jurisdiction’s examination.
Good standing
License must be in good standing and not suspended or revoked; all license verifications must be on file.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Pending complaints
A pending complaint must be resolved and its resolution validated by the licensing authority before an Alabama license can be granted.
Reciprocity agreement
The issuing licensing authority must have a current reciprocity agreement on file with the Board.
Score delivery and age
The licensing authority must mail examination scores directly to the Board; the examination must have been taken within the preceding 12 months (Ala. Code §34-14-3(c)(2)).
Written qualification
The Board must determine the license-equivalent category and acceptable written qualifying evidence. Section 34-14-3(c)(2) names a comparison standard and Board-approved tests, not a separately identified current written examination for this certificate; that unresolved generic slot is an applicant condition.
Reinstatement and renewal within two years of expiration
No examination is required for this applicant pathway.
Annual application
Submit the completed renewal application and fee annually on or before January 30; a 30-day grace period, late fees and reinstatement fees apply as specified by Board rule.
Business address
Provide a current permanent business street address on renewal; Rule 445-X-1-.03(5)(e) requires notice of an address change within 15 days.
Certificate parity
Section 34-14-3(f) applies the same renewal grounds and fees as a license.
Continuing education
Satisfy the Board-approved continuing-education requirements: twenty hours every two years, including six directed hours (two medical/hearing-healthcare, two patient care/management, two Alabama jurisprudence and ethics). The directed hours must be in-person or Board-approved live video/virtual instruction.
Disciplinary restriction
Renewal is denied while a Board suspension or revocation has been appealed and remains in litigation (Rule 445-X-1-.03(5)(f)).
Documentation
Maintain continuing-education certificates or IHS transcripts and supporting documents for four years and submit the required originals or official transcripts to the Board. The current Board Testing & CEU page states that an IHS official certificate or transcript is the only permitted proof accepted by the office.
Expiration limit
Apply within two years after expiration; pay both the regular renewal and reinstatement fees. Section 34-14-6(a) expressly requires no examination within this period. Practice is not authorized while the license is expired.

Official no-examination sources

Effective from 2026-09-22.

Hearing Aid Specialist License

Licensed hearing aid specialist subject to Alabama dispenser supervision.

Licensing authority: Alabama Hearing Instrument Dealers Board · Application information

Annual active license renewal
No examination is required for this applicant pathway.
Annual application
Submit the completed renewal application and fee annually on or before January 30; a 30-day grace period, late fees and reinstatement fees apply as specified by Board rule.
Business address
Provide a current permanent business street address on renewal; Rule 445-X-1-.03(5)(e) requires notice of an address change within 15 days.
Continuing education
Satisfy the Board-approved continuing-education requirements: twenty hours every two years, including six directed hours (two medical/hearing-healthcare, two patient care/management, two Alabama jurisprudence and ethics). The directed hours must be in-person or Board-approved live video/virtual instruction.
Disciplinary restriction
Renewal is denied while a Board suspension or revocation has been appealed and remains in litigation (Rule 445-X-1-.03(5)(f)).
Documentation
Maintain continuing-education certificates or IHS transcripts and supporting documents for four years and submit the required originals or official transcripts to the Board. The current Board Testing & CEU page states that an IHS official certificate or transcript is the only permitted proof accepted by the office.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure by examination
Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Exam sequence
The practical and rules-and-laws examinations must be passed before the Board authorizes the IHS-administered written examination.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Supervision
Ala. Code §34-14-7(c) requires direct supervision by a current Alabama dispenser responsible for all sale and fitting activities. The Board Levels of State Licensure page says a specialist may own or operate an office with a sponsoring Alabama BC-HIS dispenser; the statutory supervision requirement governs.
Training
The Board describes the specialist as having met apprentice requirements, including completion of the IHS distance-learning program. Ala. Code §34-14-7(c) permits an apprentice or applicant to obtain the specialist license after passing the specialist examination.
Reinstatement and renewal within two years of expiration
No examination is required for this applicant pathway.
Annual application
Submit the completed renewal application and fee annually on or before January 30; a 30-day grace period, late fees and reinstatement fees apply as specified by Board rule.
Business address
Provide a current permanent business street address on renewal; Rule 445-X-1-.03(5)(e) requires notice of an address change within 15 days.
Continuing education
Satisfy the Board-approved continuing-education requirements: twenty hours every two years, including six directed hours (two medical/hearing-healthcare, two patient care/management, two Alabama jurisprudence and ethics). The directed hours must be in-person or Board-approved live video/virtual instruction.
Disciplinary restriction
Renewal is denied while a Board suspension or revocation has been appealed and remains in litigation (Rule 445-X-1-.03(5)(f)).
Documentation
Maintain continuing-education certificates or IHS transcripts and supporting documents for four years and submit the required originals or official transcripts to the Board. The current Board Testing & CEU page states that an IHS official certificate or transcript is the only permitted proof accepted by the office.
Expiration limit
Apply within two years after expiration; pay both the regular renewal and reinstatement fees. Section 34-14-6(a) expressly requires no examination within this period. Practice is not authorized while the license is expired.

Official no-examination sources

Effective from 2026-09-22.

Licensure by reciprocity
Application
Complete the Board application and work-history/education form; submit original signatures, lawful-presence documents and applicable fees.
Education
Four-year accredited high-school education or equivalent; Board application requests a high-school diploma or GED.
Equivalent standards
The existing license requirements must be equivalent to or greater than Alabama requirements. The Board must approve acceptable tests at or above the statutory National Institute of Hearing Instrument Studies examination standard. This comparison standard does not identify another currently offered examination required of the applicant.
Existing license
Currently licensed as a hearing aid specialist, dispenser or dealer elsewhere; this is an applicant condition, not a leaf for another jurisdiction’s examination.
Good standing
License must be in good standing and not suspended or revoked; all license verifications must be on file.
Health
Applicant must be free of contagious or infectious disease.
Lawful presence
United States citizenship or lawful presence with federal documentation is required.
License history
Provide official verification of every current or previous license requested by the Board; disclose convictions, suspensions and revocations.
Minimum age
At least 19 years of age (Ala. Code §34-14-4(a)(1)).
Moral character
Good moral character is required (Ala. Code §34-14-4(a)(2)).
Pending complaints
A pending complaint must be resolved and its resolution validated by the licensing authority before an Alabama license can be granted.
Prior written score
Ala. Code §34-14-5(a)(1) recognizes a qualifying written score from a reciprocating licensing authority for 12 months when the Board determines equivalent content. A Board-accepted other-jurisdiction examination score is an applicant condition and may excuse sitting the currently offered ILE; the specialist’s identified current written examination remains a leaf.
Reciprocity agreement
The issuing licensing authority must have a current reciprocity agreement on file with the Board.
Score delivery and age
The licensing authority must mail examination scores directly to the Board; the examination must have been taken within the preceding 12 months (Ala. Code §34-14-3(c)(2)).
Supervision
Ala. Code §34-14-7(c) requires direct supervision by a current Alabama dispenser responsible for all sale and fitting activities. The Board Levels of State Licensure page says a specialist may own or operate an office with a sponsoring Alabama BC-HIS dispenser; the statutory supervision requirement governs.

Practical Examination Section

This assessment does not have a question bank.

Examination outline
  • Pretest procedure
  • Pure tone air conduction and masking
  • Pure tone bone conduction and masking
  • Speech audiometry and masking
  • Ear impressions
  • Audiogram interpretation and fitting
  • Troubleshooting hearing aids
Examination sources

State Law Examination

Practice scope

Inferred from the examination name; the authority has not published an examination outline.

  • Code of Alabama, Title 34, Chapter 14 — Hearing Instrument Dealers and Fitters
  • Alabama Administrative Code, Chapter 445-X-1 — Hearing Instrument Dealers
Examination sources

International Licensing Examination for Hearing Healthcare Professionals

Provider
International Hearing Society (IHS); scheduled and paid through the TestWise system at testing centers
Format
Practice-based computer-delivered multiple-choice examination; most questions present a scenario; a few questions require selecting two (or three) correct answers to earn one point; dichotomous right/wrong scoring
Exam questions
105 multiple-choice questions: 80 scored and 25 unscored pilot questions
Time limit
120 minutes (two hours)
Passing score
Pass/Fail on the overall raw score against the IHS-recommended passing score; the licensing agency makes the final decision
Exam fee
$260.00 (USD) per examination appointment, including re-takes, plus applicable taxes
Examination outline
  • Domain 1. Conduct Patient/Client Assessment (21%) (21%)
    • Objective 1.1 Apply infection control protocols (5%). Includes but is not limited to choosing appropriate infection control processes for tools and equipment; observing universal precautions for infection control; distinguishing between single- and multiple-use items; differentiating among sanitization, disinfection and sterilization processes; and identifying personal protective equipment.
    • Objective 1.2 Apply otoscopic inspection protocols (5%). Includes but is not limited to observing safety protocols during otoscopy; identifying anatomical structures; identifying abnormalities through otoscopic inspection; and recognizing the presence of referral criteria. This objective helps provide evidence of the candidate’s ability to perform otoscopy.
    • Objective 1.3 Utilize audiometric testing protocols (11%). Includes but is not limited to performing air and bone conduction threshold and suprathreshold testing; performing speech audiometry; performing effective masking; and applying principles to include interpreting results of tympanometry/immittance audiometry. This objective helps provide evidence of the candidate’s ability to perform audiometric testing and application of tympanometry.
  • Domain 2. Interpret and Apply Assessment Results (22%) (22%)
    • Objective 2.1 Interpret and explain audiometric results (11%). Includes but is not limited to demonstrating an understanding of referral criteria; interpreting pure tone and speech testing results; identifying the need for additional testing; identifying the degree and configuration of hearing loss; and identifying the type of hearing loss.
    • Objective 2.2 Determine candidacy for amplification (11%). Includes but is not limited to interpreting the case history and outlining contraindications to hearing instrument use.
  • Domain 3. Select Hearing Devices (18%) (18%)
    • Objective 3.1 Select style and type of hearing instruments (9%). Includes but is not limited to establishing fitting goals and selecting specific hearing instruments based on test results, case history, and individual patient/client preferences and lifestyle; selecting electroacoustic and physical properties; and evaluating the need for accessory devices.
    • Objective 3.2 Select earmold or other acoustic coupler (9%). Includes but is not limited to assessing physical properties of the outer ear, taking ear impressions, critiquing ear impressions, and selecting coupler based on patient/client needs.
  • Domain 4. Fit and Dispense Hearing Devices (20%) (20%)
    • Objective 4.1 Utilize protocols to fit hearing instruments and other devices (10%). Includes but is not limited to confirming physical and acoustic integrity of hearing devices; programming and adjusting hearing devices; verifying physical fit and acoustic comfort; orienting patient/client to hearing instruments; and orienting patient/client to assistive devices. This objective helps provide evidence of the candidate’s ability to program and dispense hearing instruments and other devices.
    • Objective 4.2 Verify fitting (5%). Includes but is not limited to selecting verification method based on patient/client; assessing physical and acoustic integrity of hearing devices; interpreting and explaining verification results; and modifying physical and acoustic parameters of device. This objective helps provide evidence of the candidate’s ability to perform fitting verification (e.g., speech mapping, REM).
    • Objective 4.3 Validate fitting (5%). Includes but is not limited to selecting validation method based on patient/client; interpreting and explaining validation results; and modifying physical and acoustic parameters of device. This objective helps provide evidence of the candidate’s ability to perform fitting validation (e.g., questionnaire, self-assessment).
  • Domain 5. Provide Continuing Care (19%) (19%)
    • Objective 5.1 Implement aural rehabilitation and counseling (8%). Includes but is not limited to demonstrating an understanding of the psychology of the hearing impaired; defining and managing patient/client expectations for improved communication; defining and managing family/caregiver expectations for improved communication; and identifying communication strategies.
    • Objective 5.2 Apply instrument maintenance and troubleshooting protocols (9%). Includes but is not limited to employing hearing instrument cleaning procedures; performing listening checks on hearing instruments; troubleshooting acoustic properties of hearing instruments; and adjusting based upon changes in patient/client hearing loss and/or listening needs. This objective helps provide evidence of the candidate’s ability to maintain and troubleshoot instrument performance.
    • Objective 5.3 Interpret electroacoustic analysis results (2%). Includes but is not limited to identifying need for electroacoustic analysis and comparing electroacoustic analysis of patient’s/client’s hearing instruments to fitting specifications.
Examination sources

National Competency Exam

Provider
National Board for Certification in Hearing Instrument Sciences (NBC-HIS); scheduled through Kryterion Webassessor at testing centers
Format
Computer-based multiple-choice board certification examination for holders of a current dispensing license or certificate of registration (where applicable); items from the five competency areas are randomly distributed and scored as a single exam, each item correct or incorrect with no partial credit
Exam questions
100 scored multiple-choice items, sometimes with as many as 30 additional non-scored beta items
Time limit
105 minutes for the 100-question exam; adjusted automatically when beta questions are added
Passing score
Criterion-referenced passing standard set by a modified Angoff methodology; pass or fail reported for the entire exam
Exam fee
$225 (USD) for United States & Canada or $250 (USD) for International, per exam sitting
Examination outline
  • DOMAIN 1: Assess patient presenting problem and needs (25%) (25%)
    • 1) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes a family history of hearing loss.
    • 2) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes childhood hearing-related illnesses.
    • 3) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes hearing loss duration, dizziness, loss of balance, and/or tinnitus.
    • 4) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes hearing loss duration, trauma and/or discomfort.
    • 5) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes past and/or current health conditions and/or medication/drug history.
    • 6) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario that includes occupations or recreational activities that include exposure to noise and acoustic trauma.
    • 7) Identify the most likely type/degree/slope of hearing loss or potential impact to hearing given a patient scenario including history of ear surgeries, diseases and treatments.
    • 8) Identify the potential impact on patient's lifestyle (e.g., family, work, social activities) given a patient scenario of hearing loss type (e.g., SNHL).
    • 9) Identify which patient scenario would most likely require a medical referral based on given symptoms (e.g., impacted cerumen, asymmetric hearing loss, sudden onset hearing loss).
    • 10) Identify the most appropriate type of preventative hearing protection given a patient scenario involving noise exposure.
    • 11) Differentiate between scenarios that indicate a hearing loss vs. lack of understanding (e.g., cognitive decline, retrocochlear).
  • DOMAIN 2: Test and analyze patient hearing (25%) (25%)
    • 1) Identify irregularities/obstructions during an otoscopic examination.
    • 2) Identify when the patient would benefit from cerumen management, removal, and/or precautions in cerumen management.
    • 3) Identify the degree and type of hearing loss based on the pure-tone air and bone-conduction given audiometric results (e.g., mixed hearing loss, SNHL).
    • 4) Identify condition(s) that would cause the tympanogram and/or reflex configuration given tympanogram and/or reflex results.
    • 5) Identify potential methods for managing tinnitus.
    • 6) Identify when to conduct speech awareness vs. speech reception threshold test.
    • 7) Identify how speech discrimination test results would impact the patient's outcome, most appropriate treatment option, or additional testing.
    • 8) Determine whether this was over masked, under masked, effectively masked, masking was not necessary, or a masking anomaly (e.g., interaural attenuation) given audiometric test results showing air- and/or bone-conduction testing and masking levels.
    • 9) Identify the potential impact on fitting given a patient scenario involving Speech Reception Threshold (SRT), Most Comfortable Listening Level (MCL), and/or Uncomfortable Loudness Level (UCL) (e.g., recruitment).
    • 10) Interpret Speech in Noise (SIN) results and impact on treatment plan.
    • 11) Identify signs of irregular test results and/or the potential causes of irregular test results (e.g., malingering, user error, equipment failure).
    • 12) Identify the results that indicate recommendation for medical referral given otological or hearing test results (e.g., binaural interference, PTA vs. SRT discrepancy, air-bone gap).
    • 13) Identify when a client is a possible candidate for a surgical solution (e.g., cochlear implant, Bone-anchored Hearing Aid (BAHA), PE tubes).
    • 14) Select the best audiometric transducer given physical considerations of the patient (e.g., supra-aural vs. insert earphones).
  • DOMAIN 3: Prescribe and analyze hearing instruments (25%) (25%)
    • 1) Identify the appropriate hearing instrument (e.g., style, configuration, matrix, rechargeable vs. battery) given a patient scenario that includes physical and/or cognitive limitations.
    • 2) Identify which telephone use options are most appropriate given a patient scenario including physical/cognitive limitations or knowledge of technology.
    • 3) Identify which Assistive Listening Devices (ALDs) are most appropriate given a patient scenario that includes lifestyle, physical/cognitive limitations and/or knowledge of technology.
    • 4) Identify the contraindications for Invisible-in-Canal (IIC) hearing instruments given a patient's ear canal, size, hearing loss and lifestyle (i.e., extended or daily wear use).
    • 5) Identify the most appropriate modification to the procedures and/or materials during an ear impression (e.g., gun vs. syringe, otoblock size/type, mastoid and/or piercings, unusual/missing pinna).
    • 6) Identify the most appropriate tube, tube length, dome size, earmold, or receiver power for over-the-ear (OTE) hearing instruments.
    • 7) Identify the most appropriate wire, wire length, dome size, earmold, or receiver power for receiver-in-canal (RIC) hearing instruments.
    • 8) Identify the most appropriate tube, tube length, dome size, earmold, or receiver power for behind-the-ear (BTE) hearing instruments.
    • 9) Identify advantages and disadvantages of custom hearing instruments versus OTE, RIC, and BTE given a patient scenario.
    • 10) Identify advantages and disadvantages of custom hearing instruments given a patient scenario.
    • 11) Identify possible treatment options for asymmetrical and single-sided deafness (SSD) (e.g., CROS/BICROS).
    • 12) Determine the most appropriate hearing instrument given a patient scenario that includes lifestyle, history, test results, and ear canal characteristics.
  • DOMAIN 4: Fit, adjust, program, and service hearing instruments and equipment (15%) (15%)
    • 1) Identify the appropriate adjustment given objective verification outcome results (e.g., sound field aided/unaided discrimination, sound field aided/unaided warble tones or narrow band noise).
    • 2) Identify potential causes of problems or identify the appropriate modification given results from real ear or speech mapping.
    • 3) Identify the appropriate methodologies for modifying the physical fit of earmolds, custom shells, OTE, BTE, and/or RIC instruments given a patient complaint.
    • 4) Identify the appropriate adjustments given subjective validation of results (e.g., COSI, IOI-HA, APHAB, verbal feedback).
    • 5) Troubleshoot and adjust/modify programming of hearing instrument given a patient complaint.
    • 6) Identify or resolve potential hearing instrument problems caused by obstructions, moisture, or battery performance.
    • 7) Troubleshoot pairing and wireless connectivity between hearing-related devices.
  • DOMAIN 5: Counseling and rehabilitation (10%) (10%)
    • 1) Identify the most appropriate patient explanation given results of otoscopic examination and audiometric examination.
    • 2) Identify potential limitations and benefits of amplification.
    • 3) Identify the most appropriate counseling based on subjective validation results.
    • 4) Identify helpful strategies and information for improved hearing and communication in various situations or environments.
    • 5) Identify appropriate manual hearing instrument adjustments that patients, family members, or caregivers can make.
Examination sources