Audiological Medicine

SALZBURG Sept/Oct 2005

Katherine Harrop-GriffithsLondon

Audiological Medicine…

… is the medical discipline concerned with the investigation,

diagnosis, management and habilitation/rehabilitation of children and adults with hearing, balance and

communication disorders.

2002 WHO estimate of the world burden of disabling hearing impairment

= 250 million persons

WHAT IS THE SIZE OF THE PROBLEM?

WHO 1995

Demographics of deafness

In developed countries:

• 1/1000 children born with hearing loss > 40 dB– Aetiology determined in about 50%

• 2/1000 PCHI by age of 16 years > 40 dB

• 4.7% of adults over 50 years and

• 71.1% of adults over 70 years have some hearing loss

(RNID)

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

UK: workers affected by noise

Exposure

85dB(A)

86-90dB(A)

91-95dB(A)

Workers affected

1 million

0.75 million

0.25 million

Cochlear Implants (UK) Children

Year

'85 '87 '89 '91 '93 '95 '97 '99 '01 '03 '050

200

400

600

800

1000

1200

1400

1600

1800

2000

2200

2400

2600

Nu

mb

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f p

atie

nts

A Specialty

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

Sir Douglas Black President Royal College of Physicians 1965

Sub-specialties

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

“A rose by any other name….”

• Audiological Medicine• Audiovestibular

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

NeurologyCardiology

RheumatologyAudiological Medicine

NeurosurgeryCardiac surgeryOrthopaedic surgeryOtolaryngology

UK Organisation of Medicine

MEDICINE SURGERY

Audiological

Medicine

Rheumatology

Orthopaedics

Neurology

Paediatrics

Ophthalmology

Cardiology

ENT

Public Health

Occupational Health

Genetics

Psychiatry

Geriatrics

Primary care

General Medicine

Clinical pharmacology

Immunology

Medical Links

Non - medical Colleagues

• Audiologists• Hearing therapists• Hearing aid dispensers• Teachers of the deaf• Speech and language

therapists• Pharmacologists• Play therapists• Social workers

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

A multidisciplinary team approach

Drivers of Health Provision

• Costs• EU unification • Clinical

governance

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

EU Unification

•Specialty register

•Training

•Work patterns

•Research

collaborations

•Publications

• Professional bodies

AMPhoniatrics

ENT

AM

? New discipline

Training Medical degree

2 Foundation Years

2 yr Basic Surgical Training in General or ENT surgery + higher degree - MRCS

2 –3 yr Basic Medical Training + higher degree - MRCP

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

8-9 years

Linked specialties

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

Training Issues

• Knowledge• Competencies / skills &

attitude• Exit/entry examinations• Appraisals• Assessments

Specialty Training Needs

• Audiological Paediatricians• Audiological Physicians• Super- specialist interests• Academic medicine• Raise awareness of

specialty amongst colleagues and lay public

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

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."

Future Trends

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

technology

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.