But what about smaller practices that can’t justify adding an audiologist to their in-house team? Can otolaryngologists learn to perform audiometry themselves?
Explore This IssueSeptember 2007
“That would be worst direction in which we could go,” said Dr. Miller. It’s really not within their purview and it is counterproductive to quality patient care. “When it comes to audiosurgery, the surgeon who did the procedure should not do the postop audiologic workup,” he said. Pre- and postoperative audiologic evaluation should be performed by an audiologist. “It’s not within the otologist’s scope of practice. But it is within the scope of practice for the audiologist.” A competent audiologist’s objectivity ensures a means of quality assurance, Dr. Miller said. “The independence of the audiologist contributes to objective audiological evaluation and consultation.”
Dr. Miller would advise otolaryngologists in smaller practice settings to refer their patients to a certified licensed audiologist in their own locale or region. Audiologists who are members of the American Academy of Audiology are distributed geographically in most parts of the country. (See Resources at the end of this article.)
Given the new technologies available in the modern era, there has been an evolution of the hearing care specialties. Some hearing devices are now so technical both from the medical/surgical perspective and the audiologic fitting perspective, said Dr. Niparko, that audiology and otology specialists will have to upgrade their collaborations in order to adequately fit these devices.
There are a number of areas in particular that will require this. Early detection of childhood hearing loss is one. “If childhood hearing loss, even in 2007, isn’t aggressively addressed, there are devastating consequences,” said Dr. Niparko. “And that still happens routinely in our society.” There are some very troubling statistics being published now with respect to this issue, he said. It may be that a substantial percentage of kids in their middle school years are already manifesting high-frequency hearing loss. This, again, is an area of really crucial collaboration for otologists and audiologists.
“New semi-implantable hearing devices for patients with moderate to severe hearing loss require that computer-savvy audiologists effectively program and interpret the various sound environments that an individual experiences,” said Dr. Niparko. “This really comes to bear in a situation where you’ve got a challenging environment corrupted by noise.”
Testing is another area in which the field has evolved, said Dr. Niparko, who is also Director of The Listening Center at Johns Hopkins and the past president of the American Otological Society. It starts with an early identification program. Universal newborn screening protocols now mean that clinicians are assessing hearing loss in children who are 24 hours old. “Being able to intelligently tell a family what the risk of their child’s hearing loss might be at that stage requires that we understand these tests and interpret them carefully. Good communication is essential… and is more critical now that the technology of diagnosis and intervention are more complicated, more technical,” said Dr. Niparko.