Audiological Medicine

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Audiological Medicine

• SALZBURG Sept/Oct 2005
• Katherine Harrop-Griffiths
• London

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Audiological Medicine is the medical
discipline concerned with the investigation,
diagnosis, management and habilitation/rehabilitat
ion of children and adults with hearing, balance
and communication disorders.
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WHAT IS THE SIZE OF THE PROBLEM?
2002 WHO estimate of the world burden of
disabling hearing impairment 250 million
persons
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WHO 1995
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Demographics of deafness

• In developed countries
• 1/1000 children born with hearing loss gt 40 dB
• Aetiology determined in about 50
• 2/1000 PCHI by age of 16 years gt 40 dB
• 4.7 of adults over 50 years and
• 71.1 of adults over 70 years have some hearing
  loss
• (RNID)

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Demographics of dizziness/vertigo

• 1/3 population by age of 65 years
  (Roydhouse,1974)
• 48 women and 37 men by 80 years
  (Pemberton,1956)
• Falls commonest cause of accidental death in over
  75 year olds (Downton,1994)
• Vestibular symptoms after head/whiplash injury
  commonest cause of failure to return to
  work(Luxon,1996)
• 2/3 of patients in tertiary clinic had suffered
  psychiatric symptoms in 3-4 year review period

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UK workers affected by noise

• Exposure
• 85dB(A)
• 86-90dB(A)
• 91-95dB(A)

• Workers affected
• 1 million
• 0.75 million
• 0.25 million

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(No Transcript)
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A Specialty

• .. a specialty is established when the
  subject matter begins to subspecialise.

Sir Douglas Black President
Royal College of
Physicians 1965
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Sub-specialties

• Adult diagnostic audiology
• Adult auditory rehabilitation
• Vestibular medicine
• Paediatric audiology
• Paediatric vestibular medicine
• Auditory electrophysiology
• Phoniatrics

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A rose by any other name.

• Audiological Medicine
• Audiovestibular Medicine
• ABC medicine
• Medical Audiology
• Medical Otology
• Neuro-otology
• Otoneurology
• Medical ENT

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UK Organisation of Medicine

• Neurology
• Cardiology
• Rheumatology
• Audiological Medicine

• Neurosurgery
• Cardiac surgery
• Orthopaedic surgery
• Otolaryngology

MEDICINE
SURGERY
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Medical Links
Rheumatology
Immunology
Orthopaedics
ENT
Public Health
Neurology
Occupational Health
Clinical pharmacology
Audiological Medicine
Ophthalmology
General Medicine
Paediatrics
Psychiatry
Primary care
Genetics
Cardiology
Geriatrics
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Non - medical Colleagues

• Physiotherapists
• Occupational therapists
• Psychologists
• Nurse specialists
• Epidemiologists
• Lawyers
• Neuroscientists

• Audiologists
• Hearing therapists
• Hearing aid dispensers
• Teachers of the deaf
• Speech and language therapists
• Pharmacologists
• Play therapists
• Social workers

A multidisciplinary team approach
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Drivers of Health Provision

• Costs
• EU unification
• Clinical governance

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Costs

• Mergers economy of scale
• More doctors
• New initiatives NHS Direct
• Change of emphasis to primary care
• Tertiary care outpatient v. inpatient
• Technical/scientist led services
• Move away from specialist training

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• Specialty register
• Training
• Work patterns
• Research collaborations
• Publications
• Professional bodies

EU Unification
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AM
AM
Phoniatrics
ENT
? New discipline
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Training
Medical degree
8-9 years
2 Foundation Years
2 3 yr Basic Medical Training higher degree -
MRCP
2 yr Basic Surgical Training in General or ENT
surgery higher degree - MRCS
4-5 yr. Higher specialist training
MSc in Audiological Medicine training in all
subspecialties and linked specialties rotating
through teaching and district general hospitals
CONSULTANT
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Linked specialties

• ENT surgery
• Developmental paediatrics
• Neurology
• Geriatrics
• Psychiatry children and adults
• Ophthalmology children and adults
• Genetics
• Immunology
• Phoniatrics children

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Training Issues

• Knowledge
• Competencies / skills attitude
• Exit/entry examinations
• Appraisals
• Assessments

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Specialty Training Needs

• Audiological Paediatricians
• Audiological Physicians
• Super- specialist interests
• Academic medicine
• Raise awareness of specialty amongst colleagues
  and lay public

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National Specialty Requirements

• Good general internist
• Integration of service needs across disciplines
  ie seamless service
• One stop provision of care
• Cost effective service
• Value added service
• Patient led service

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Clinical Governance
"A framework through which NHS organisations are
accountable for continually improving the quality
of their services and safeguarding high standards
of care by creating an environment in which
excellence in clinical care will flourish."
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Future Trends

• Occupational health
• Public health
• Genetics gene therapy
• Neuropharmacology
• Neuroscience
• Computer/electronic technology

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Audiological Medicine

• much needs to be done
• Depth and breadth of specialty to be defined
• Raise awareness of meaning of specialty amongst
  colleagues, public and politicians
• Promote IAPA
• Thank you.