AAO-HNSF Certificate Program for Otolaryngology Personnel

Hands-on Training Sign-off Students must perform a minimum of 2 tests for the instructor to sign off. Instructors may request students to perform more than the minimum number prior to sign-off.

Participant Name________________________________Date_________

Type of Hearing Cases

Number of Times Performed

Instructors Signature

1 Perform a basic examination of the ear (checklist) a) Evaluate external auditory canal b) Perform tuning fork tests 2 a) Perform basic hearing tests i. Perform air conduction testing ii. Perform air conduction testing with masking iii. Perform bone conduction testing iv. Perform bone conduction testing with masking b) Perform speech audiometry testing i. Speech Recognition Threshold ii. Speech Recognition Threshold with masking iii. Word Recognition iv. Word Recognition with masking c) Perform tympanometry

I have completed the required number of tests for the hands-on training.

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______________________

Signature of Student

Date

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