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Audiological Medicine

Audiological Medicine. SALZBURG Sept/Oct 2005 Katherine Harrop-Griffiths London.

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Audiological Medicine

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  1. Audiological Medicine SALZBURG Sept/Oct 2005 Katherine Harrop-Griffiths London

  2. 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.

  3. WHAT IS THE SIZE OF THE PROBLEM? 2002 WHO estimate of the world burden of disabling hearing impairment = 250 million persons

  4. WHO 1995

  5. 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)

  6. 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

  7. Exposure 85dB(A) 86-90dB(A) 91-95dB(A) Workers affected 1 million 0.75 million 0.25 million UK: workers affected by noise

  8. A Specialty ……….. a specialty is established when the subject matter begins to subspecialise. Sir Douglas Black President Royal College of Physicians 1965

  9. Sub-specialties • Adult diagnostic audiology • Adult auditory rehabilitation • Vestibular medicine • Paediatric audiology • Paediatric vestibular medicine • Auditory electrophysiology + Phoniatrics

  10. “A rose by any other name….” • Audiological Medicine • Audiovestibular Medicine • ABC medicine • Medical Audiology • Medical Otology • Neuro-otology • Otoneurology • Medical ENT

  11. Neurology Cardiology Rheumatology Audiological Medicine Neurosurgery Cardiac surgery Orthopaedic surgery Otolaryngology UK Organisation of Medicine MEDICINE SURGERY

  12. 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

  13. 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

  14. Drivers of Health Provision • Costs • EU unification • Clinical governance

  15. 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

  16. Specialty register • Training • Work patterns • Research collaborations • Publications • Professional bodies EU Unification

  17. AM AM Phoniatrics ENT ? New discipline

  18. Medical degree Training 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

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

  20. Training Issues • Knowledge • Competencies / skills & attitude • Exit/entry examinations • Appraisals • Assessments

  21. Specialty Training Needs • Audiological Paediatricians • Audiological Physicians • Super- specialist interests • Academic medicine • Raise awareness of specialty amongst colleagues and lay public

  22. 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

  23. 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."

  24. Future Trends • Occupational health • Public health • Genetics – gene therapy • Neuropharmacology • Neuroscience • Computer/electronic technology

  25. 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.

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