About The Book

As the population in the U.S. becomes more diverse, health care professionals have a responsibility to adapt their services to meet the needs of the diverse populations they serve. However, many providers lack access to the appropriate resources to provide high quality care to their Spanish-speaking patients. Audiology Services in Diverse Communities is a professional resource designed to decrease language barriers, improve patient-clinician interactions, and create more culturally competent hearing services.

Written by a clinician for clinicians working on a daily basis with minority communities experiencing existing systemic barriers, this unique text begins with an overview of cultural competence and the barriers that exist in audiology services. The text continues an evidence-based, cross-cultural approach to addressing some of those barriers and generating a discussion of what professionals can do in their own clinical settings. The final, and largest, section of the text is a language tool presented in both English and Spanish to aid clinicians as they communicate and work with Spanish-speaking patients.

Key Features

  • The only book that provides clinicians with a compilation of resources, in English and Spanish, ready to use in clinic
  • More than 25 resources such as clinical history forms, test instructions, standardized questionnaires, self-assessment tools available in English and Spanish to help clinicians provide with language concordance during clinical encounters.
  • Evidence-based ideas that can help clinicians assess, develop, implement, and monitor cultural-competent services
  • A unique format that allows clinicians to visualize English resources on the left-side and Spanish resources on the right-side, facilitating communication between patient and clinician – preview example here


The field of Audiology emerged as a profession during the 1940s, in part, as a response to thousands of men and women returning from the various conflicts in World War II. Many of these returning veterans had developed noise-induced hearing loss and needed help. Although the care of hearing-impaired individuals preceded these events, it was the U.S. government’s hearing rehabilitation programs that led to standardized procedures for aural rehabilitation and hearing aid fitting that set the stage for Audiology today. These days, Audiology is at the forefront of hearing health care. The entry level degree is the Doctorate of Audiology (AuD) and professionals who hold this degree are trained to assess and manage hearing and balance problems across the lifespan. Many aspiring Audiologists come from across the world to train in programs in the U.S. and many bring unique experiences from international efforts to address the hearing health care needs of children worldwide. The advanced diagnostic techniques, rehabilitation strategies, hearing aid technologies, and cochlear implants have had an enormous impact on the lives of millions of people with hearing loss. However, there are still large gaps in both knowledge and access to high-quality hearing health care in both the U.S. and across the world. In the U.S., one area that has lagged significantly is in the test materials, procedures, and management of Spanish-speaking individuals. Population data, as recent as 2019, estimate that about 42 million people in the U.S. speak Spanish at home. An additional 11.6 million are bilingual (Spanish/English). Not surprisingly, Spanish is the most studied language in the U.S. outside of English. To put it in perspective, when monolingual and bilingual Spanish speakers are combined the U.S. has more Spanish speakers than Spain and more Spanish speakers than the entire population of Colombia. The statistics alone suggest that hearing health care management of this population is essential and needs to be prioritized. Untreated hearing loss in this population not only can degrade quality of life, but also has practical implications. In particular, children in our schools are both at a disadvantage at home and in school trying to manage two languages. The first step to addressing this hearing health care need starts with Audiologists. There is a scarcity of bilingual Audiologists to begin to address this critical need and many Audiologists need additional training to work with the Spanish-speaking population and although language is a primary barrier, cultural barriers also exist. Latino and Hispanic individuals can be of any race, and come from many countries that have different customs. Spanish-speaking individuals also span the educational and socioeconomic spectrum. Being aware of the vast diversity within this population is essential in effective patient management. Moreover, the lack of well-normed test material, such as word recognition lists, presents direct practical challenges. None of these barriers are insurmountable, but the solution starts with individuals such as the ones reading this book, to begin to build true momentum to professional solutions aimed at improving access and care. This book is aimed at providing that first step by providing tools and suggestions to make current care more effective and to lay the groundwork for the essential solutions of tomorrow. As a bilingual Audiologist myself, I share the hopeful view with the author that the future will hold better solutions to meet the needs of this population both here in the U.S. and abroad. — Edward Lobarinas, PhD, CCC-A, Associate Professor, The University of Texas at Dallas

About The Author

Alejandra Ullauri, AuD, MPH, is a bilingual, board-certified audiologist. She holds a Master’s degree in Audiology from Flinders University of South Australia, a Doctorate in Audiology from the University of Florida, and Master’s in Public Health form Universidad San Francisco de Quito. She is the Director of Chicago Hearing Care, and the founder of Audiology En Español, an educational platform that teaches medical Spanish for audiologist. 

Table Of Contents


Part I. Audiology Services in Diverse Communities

Chapter 1. Culturally Competent Health Services: An Ongoing Journey

The Role of Culturally Competent Health Care in Reducing Health Disparities
The Characteristics of Culturally Competent Health Systems
Assessing Cultural Competence in Health Care

Chapter 2. Culturally Competent Barriers in Audiology Services: Latino/Hispanic Perspective

Barriers Identified as Systemic
Barriers Identified Within Organizations
Barriers Identified Within the Workforce
Barriers Related to the Health Care User

Chapter 3. Addressing Barriers in Hearing Care: Beyond Provider Training

Building Adaptive Cultural-Competent Hearing Services
Addressing Systemic Barriers
Addressing Barriers Within Organizations
Addressing Barriers Within the Workforce
Addressing Barriers Related to the Health Care User
Embracing Diversity, Avoiding Stereotyping
Further Reading

Part II. Language Tool: Clinical Assessment and Counseling Materials in English and Spanish

Chapter 4. Anatomy Graph

Ear Anatomy

Chapter 5. Clinical History for Pediatric and Adult Cases

Adult Clinical History
Pediatric Clinical History

Chapter 6. Test Description and Instructions for Hearing Tests

Pure Tone Audiometry
Measuring Uncomfortable Loudness Levels
Speech Audiometry Tests and Recommendations
Conditioned Play Audiometry
Visual Reinforcement Audiometry
Acoustic Reflexes
Otoacoustic Emissions
Auditory Evoked Potentials
Hearing Health Questionnaires
Patients’ Education Materials

Chapter 7. Hearing Technology

Hearing Technology Chart
Hearing Technology Description
Hearing Aid Evaluation
Taking Ear Impressions
Hearing Aid Fitting and Verification
Hearing Aid Follow-Up and Validation

Chapter 8. Cochlear Implants

Cochlear Implant Assessment Test Battery
Cochlear Implant Assessment: Clinical History
Patients’ Education Materials
Cochlear Implant Assessment


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