PURPOSE: This rule determines when a hearing aid specialist shall make a medical referral. On February 15, 1977 the Food and Drug Administration’s rules governing the hearing aid industry became effective and the department made a portion of the Food and Drug rules a Administration’s medical referral part of the Missouri rules.

1. (1) Any licensee under Chapter 346, RSMo shall advise a prospective hearing aid user to promptly consult with a licensed physician (preferably an ear specialist) before dispensing a hearing aid if the hearing aid dispenser determines, through inquiry, actual observation or review of any other available information concerning the prospective user, that the prospective user has any of the following conditions:

   1. (A) Visible congenital or traumatic deformity of the ear;
   2. (B) History of active drainage from the ear within the previous ninety (90) days; (C), History of sudden or rapjdly progressive lr;r loss wrthm the previous mnety (90)
   3. (D) Acute or chronic dizziness;
   4. (E) Unilateral hearing loss of sudden or recent onset within the previous ninety (90) days;
   5. (F) Audiometric air-bone gap equal to or greater than fifteen (15) decibels at five hundred hertz (500 Hz), one thousand (1000 Hz) and two thousand (2000 Hz);
   6. (G) Visible evidence of significant cerumen accumulation or a foreign body in the ear canal; and
   7. (H) Pain or discomfort in the ear.

2. (2) Special care should be exercised in selecting and fitting a hearing aid whose maximum sound pressure level exceeds one hundred thirty-two (132) decibels because there may be risk of impairing the remaining hearing of the hearing aid user. (This provision is required only for those hearing aids with a maximum sound pressure capability greater than one hundred thirty-two (132) decibels.)

   Auth: section 346.115.1(E), RSMo (1986).* Original rule filed Dec. 19,1975, effective Dee. 29, 1975. Refiled: Jan. 2, 1976. Rescinded and readopted: Filed April 4, 1978, effective Aug. 11, 1978. Amended: Filed March 1, 1984, effectiue July 12, 1984.

   *Original authority 1973, amended 198i.