audiological medicine salzburg sept/oct 2005 katherine harrop-griffiths london
TRANSCRIPT
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?
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
er o
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
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
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