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

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

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

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

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

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

13. 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

14. 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

15. Drivers of Health Provision Costs EU unification Clinical governance

16. 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

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

18. AM Phoniatrics ENT AM ? New discipline

19. 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

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

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

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

23. 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

24. 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."

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

26. 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.