An Open Letter to Dispensing Audiologists

 Adding vestibular services to your practice provides benefits to all involved  

 Most of you are familiar with the frequently quoted statistics regarding hearing loss and hearing aid use.  This quote comes directly from the Better Hearing Institute website:  “The last MarkeTrak survey (2004) estimated that 31.5 million people report a hearing difficulty; that is around 10% of the U.S. population.”

What might surprise you is that these statistics pale when compared to the estimates on the prevalence of dizziness.  The Vestibular Disorders Association reports that 4 out of 10 people will seek medical care for the complaint of “dizziness” at some point in their life.  In the elderly population (75 and over), it is the most common reason for a doctor visit. 

Unlike hearing loss, which typically requires prolonged, repeated negative experiences to prompt seeking treatment, patients with dizziness are often desperate for immediate relief.  Most often, they seek treatment from a primary care physician (PCP), with less than 10% ever seeing a specialist such as Audiology, Neurology or ENT for these complaints.   The treatments historically provided at the PCP level (imaging, medication and observation) are notoriously ineffective.

A striking difference between the PCP approach to hearing loss versus dizziness is the fact that the PCP usually refers to a specialist for treatment of hearing loss, but most choose to treat the dizzy patient themselves. Keep in mind that there are typically numerous options for the PCP when considering where to send a hearing impaired patient.  Currently, in most communities, the options for vestibular management are sparse.  Despite the fact that there are MANY more patients complaining of dizziness when compared to hearing loss, there are FAR fewer diagnostic and treatment options available to them.

Offering competent vestibular services is a win/win for everyone involved.  The patient benefits from access to evidence based diagnostic and treatment procedures, which have been proven to be more effective and more cost effective than the historical PCP approach.  The PCP benefits because they truly do want to do what is best for their patient.  If there is no one locally that can educate them and help manage their dizzy patients, they must do the best they can with minimal diagnostic information. The regional specialty balance clinic benefits because you will understand which patients require more sensitive diagnostic and treatment options than you offer, and you will refer these patients on.  And finally, you will benefit for the many reasons discussed in the next paragraphs.

First, you distinguish your practice from retail hearing aid offices. It has been established that patients are, on average, significantly more satisfied with services obtained from audiologists than hearing instrument specialists{{1}}[[1]]As found at[[1]]. You know the difference in education, standards and professional commitment between audiologists and hearing instrument dispensers.  The general public and even many PCPs may not be aware of or appreciate these differences. Vestibular management is clearly and obviously not within the scope of practice for hearing instrument specialists, so offering these services is an indication of your additional training and expertise. 

Second, fees generated from vestibular testing are not subject to a return policy.  Say what you will about the benefits of a return policy on hearing aids; one can’t deny that they leave a certain level of uncertainty to financial planning.  Currently, Medicare approves approximately $200.00 for a standard ENG/VNG battery.

Third, it brings many patients in to your office that you might otherwise never see.  A common denominator for nearly all patients coming to your office is that they have some concern about their hearing.  In a vestibular practice, you regularly see people with significant hearing loss that have not taken the step to seek help.  You get a glimpse into some of the reasons that 77% of people with hearing loss do not use hearing aids.  Many have unsuccessfully tried amplification in the past, and have determined that “hearing aids don’t work.”  Even more have heard this comment from their friends and have decided not to waste their money on hearing aids.  Once you have helped them through their vestibular issues and established a trusting relationship, you can comfortably approach their hearing problems. 

Is there a downside to this proposition? Tune in next week.

About Alan Desmond

Dr. Alan Desmond is the director of the Balance Disorders Program at Wake Forest Baptist Health Center, and holds an adjunct assistant professor faculty position at the Wake Forest School of Medicine. In 2015, he received the Presidents Award from the American Academy of Audiology.