Collaboration Between Otolaryngologists and Audiologists Can Benefit Both

Philip Mark Brown, MD’s audiologist coworkers keep him apprised of the current state of the art regarding the available battery of audiologic tests. “If we are considering purchasing or instituting [a product or service],” he said, “we meet as a group practice and our audiologists make an argument for or against it. They are key in keeping us abreast of what is going on in audiology. Everything is done in conjunction with the practice’s audiologists.”

Dr. Brown, who is a principal with Central Park ENT in Arlington, TX, speaks frequently to his audiologist colleagues, who work in the same suite of offices. “Most of the time audiologists are contractors and not part of the practice,” he said. “We felt very strongly that we wanted a totally integrated system where we work together on every single patient. Just today we have already got together four times to discuss patients.”

This is an example of the best kind of audiologist-otolaryngologist partnership, said Maurice H. Miller, PhD, Professor of Audiology in the Department of Speech-Language Pathology and Audiology at the Steinhardt School of Education of New York University. Idiopathic sudden sensorineural hearing loss, Meniere’s disease, tinnitus management, and cochlear implants are among the many disorders where collaborations between the audiologist and the otologist lead to superior and essential patient management.1–3

“I don’t understand [when people get caught up in politics] and this market share thing,” Dr. Miller said, “because sensorineural hearing loss at the present time is not surgically or medically correctable in the overwhelming number of cases. That clearly falls within the province of the audiologist. The audiologist is the specialist in amplification, fitting, dispensing, programming and reprogramming, whereas when we come to disorders of the middle ear or the outer ear, that is clearly within the realm of the surgical otologist. We work together; I see no conflict.”

Dr. Miller, who was the recipient of the 1996 American Academy of Audiology (AAA) career award for outstanding contributions to research, clinical practice, and teaching, routinely refers to surgical otologists those patients with otosclerosis who see him first and have surgically correctable conditions. “My strong preference is for surgical correction when indicated and my referrals through more than a half century of clinical practice confirm this,” Dr. Miller said. “Surgery would be my choice if I had otosclerosis with a large air-bone gap.”

The bottom line is that any political and financial concerns can interfere with patient care, said John K. Niparko, MD, the George T. Nager Professor in the Department of Otolaryngology–Head and Neck Surgery and Director of the Division of Otology, Audiology, Neurotology, and Skull Base Surgery at Johns Hopkins School of Medicine in Baltimore. “Viewing audiology–otology issues from a political perspective is the wrong approach and it only builds barriers between the specialties,” said Dr. Niparko.4 The political issues should be subjugated for the larger issues of patient care. “The issue is not taking patients from one another; literally 80 to 90 percent of the population who could benefit from our interventions don’t access it because of the lack of awareness,” he said. “The key thing is to focus on the patient. …Both specialties need to target ignorance and lack of awareness of [diagnostic and treatment] options, and it is my firm belief that everything else will flow from that.”