Audiological Medicine

Audiological Medicine SALZBURG Sept/Oct 2005 Katherine Harrop-Griffiths London Audiological Medicine… with the investigation, diagnosis, management and habilitation/rehabilitation of children and adults with hearing, balance and communication disorders. … is the medical discipline concerned WHAT IS THE SIZE OF THE PROBLEM? 2002 WHO estimate of the world burden of disabling hearing impairment = 250 million persons WHO 1995 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 2600 2400 2200 2000 Number of patients 1800 1600 1400 1200 1000 800 600 400 200 0 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03 '05 Year 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 UK Organisation of Medicine Neurology Cardiology Rheumatology Audiological Medicine Neurosurgery Cardiac surgery Orthopaedic surgery Otolaryngology MEDICINE SURGERY Medical Links Immunology ENT Public Health Rheumatology Orthopaedics Neurology Occupational Health General Medicine Psychiatry Audiological Medicine Clinical pharmacology Ophthalmology Paediatrics Primary care Genetics Geriatrics Cardiology 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 Drivers of Health Provision • Costs • EU unification • Clinical governance 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 •Specialty register •Training •Work patterns •Research collaborations •Publications • Professional EU Unification bodies AM AM Phoniatrics ENT ? New discipline Training 8-9 years 2 Foundation Years 2 yr Basic Surgical Training in General or ENT surgery + higher degree - MRCS Medical degree 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 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 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.