(1) Prior to engaging in cerumen removal, a licensed hearing instrument specialist shall have held a valid, undisciplined license as a licensed hearing instrument specialist for a minimum of two consecutive years and provide the board with evidence of (a) successful completion of a cerumen removal course pursuant to subsection (3) of this section and (b) professional liability insurance pursuant to subsection (5) of this section. If the licensed hearing instrument specialist continues to engage in cerumen removal, the licensee shall annually provide evidence to the board of professional liability insurance.

(2) If the patient exhibits contraindications to cerumen removal requiring medical consultation or medical intervention, a licensed hearing instrument specialist shall refer the patient to an otolaryngologist or another physician licensed to practice medicine and surgery under the Uniform Credentialing Act. If a licensed hearing instrument specialist engaged in routine cerumen removal discovers any trauma, including, but not limited to, continuous uncontrolled bleeding, lacerations, or other traumatic injuries, the licensee shall, as soon as practicable, seek immediate medical attention for the patient.

(3)(a) Prior to engaging in cerumen removal, a licensed hearing instrument specialist shall complete a cerumen removal course recommended by a national medical or audiology organization and approved by the board and provide the board with evidence of such successful completion and attestation of competence. In order to be approved by the board as a cerumen removal course, the course shall be approved by a national medical or audiology organization and shall:

(i) Be overseen by a physician or an audiologist, preferably an otolaryngologist;

(ii) Consist of at least six hours of practice of cerumen removal from an ear canal model using a variety of safe techniques;

(iii) Include in-person practice of cerumen removal techniques;

(iv) Include an infectious control component; and

(v) Result in a certificate of successful completion and attestation of competence signed by such physician or audiologist.

(b) The board may, only after consultation with the Board of Medicine and Surgery and the Board of Audiology and Speech-Language Pathology, adopt rules and regulations as provided in section 38-126 to provide requirements for the initial cerumen removal course.

(4) The licensed hearing instrument specialist shall maintain documentation evidencing the satisfactory completion of the training.

(5) A licensed hearing instrument specialist shall carry appropriate professional liability insurance before engaging in cerumen removal.

(6) A licensed hearing instrument specialist shall perform cerumen removal using the customary removal techniques that are commensurate with the licensee's training and experience. Performance of cerumen removal is limited to the patient's cartilaginous outer one-third portion of the external auditory canal.

(7) A licensed hearing instrument specialist engaged in cerumen removal shall comply with the following requirements:

(a) The indications for cerumen removal for a licensed hearing instrument specialist shall include:

(i) Enabling audiometric testing;

(ii) Making ear impressions;

(iii) Fitting ear protection or prosthetic devices; and

(iv) Monitoring continuous use of hearing aids;

(b) The licensed hearing instrument specialist shall refer a patient to an otolaryngologist or another physician licensed under the Uniform Credentialing Act for medical consultation or medical intervention if the patient exhibits any of the following contraindications to cerumen removal:

(i) The patient is younger than eighteen years of age;

(ii) The patient has a perforated tympanic membrane;

(iii) The patient has a history of pain or active drainage or bleeding from the ear;

(iv) There is evidence of congenital or traumatic deformity of the ear;

(v) The patient has had previous ear surgery;

(vi) The patient has tympanostomy tubes, such that irrigation should not be used;

(vii) The patient has a bleeding disorder;

(viii) The patient has an actual or suspected foreign body in the ear;

(ix) The patient has a stenosis or bony exostosis of the ear canal;

(x) The patient has a tympanic membrane that the licensed hearing instrument specialist is unable to see; or

(xi) There is any other contraindication to cerumen removal that requires medical consultation or medical intervention; and

(c) If the patient, while undergoing cerumen removal that did not present contraindications, complains of significant pain, exhibits uncontrolled bleeding or a laceration of the external auditory canal, or experiences the acute onset of dizziness or vertigo or sudden hearing loss, the licensed hearing instrument specialist shall immediately stop the procedure and refer the patient to an otolaryngologist or another physician licensed under the Uniform Credentialing Act.

(8) The licensed hearing instrument specialist shall maintain the following proper infection control practices:

(a) Universal health precautions;

(b) Decontamination;

(c) Cleaning, disinfection, and sterilization of multiple-use equipment; and

(d) Universal precautions for prevention of the transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens, as defined by occupational safety and health standards promulgated pursuant to 29 C.F.R. 1910, as such regulations existed on January 1, 2025.

(9) The licensed hearing instrument specialist who performs cerumen removal shall maintain a case history for every patient and informed consent signed by the patient as part of the patient's records. A licensed hearing instrument specialist shall include in the patient's record video-otoscopy pictures of the patient's ear canal showing cerumen that must be removed and video-otoscopy pictures after the removal of the cerumen.

(10) The licensed hearing instrument specialist shall carry appropriate professional liability insurance before performing cerumen removal.

(11) The licensed hearing instrument specialist is prohibited from requiring patients to sign any form that eliminates liability if the patient is harmed.

(12) A licensed hearing instrument specialist who passes the initial training in cerumen removal shall take one additional hour of continuing education specific to cerumen removal annually, by any approved means, in addition to the required continuing education requirements for the license as a licensed hearing instrument specialist.