Since Hearinghealthmatters.org was launched in April, each of our 10 separate blogs has built up a faithful following of repeat visitors, while also attracting a good number of new readers each week.
Many who come to our site visit several or even all of our individual blogs; others focus on ones they find of special relevance to them. A lot of our blogs, such as Hearing Economics, The Better Hearing Consumer, Hearing International, Have You Heard?, Wayne’s World, Hear in Private Practice, and Hearing Views, are quite broad in scope and cover a great range of hearing-related topics.
Others, such as Hear the Music and Dizziness Depot, are generally more narrowly focused. They provide an admirable service to readers who have a particular interest in improving people’s ability to hear music or in vestibular diagnosis and treatment. But people who have not delved into those areas before may tend to skip those blogs.
That’s a shame. When practitioners or consumers do that, they often miss out on information that would be of value to them. As an editor at Hearinghealthmatters.org, I often notice posts on my colleagues’ blogs that I know would be of interest to far more people than read them when they were first published.
For that reason, I will occasionally re-publish an outstanding blog on Hearing Views, where I hope it will be seen by many people who missed it when it was originally posted. This week, I am featuring an article by Alan Desmond, AuD, which was published September 11 on Dizziness Depot.
Entitled “An Open Letter to Dispensing Audiologists,” the post makes a convincing case for why audiologists who have never seriously thought about adding vestibular care to their practice should think again. If you didn’t catch it the first time around, I suspect you’ll be glad you had a second chance.
Just one more point before I turn this page over to Dr. Desmond. I should advise you that his next three blog posts were devoted to “The Pitfalls of Adding Vestibular Services to Your Practice.” So, if you find yourself getting carried away by the following, you’d better check out those other posts at Dizziness Depot.
David H. Kirkwood, Editor, Hearing Views
Adding vestibular services provides benefits to all involved
Alan Desmond, AuD
By Alan Desmond
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 web site: “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 a person to seek treatment, patients with dizziness are often desperate for immediate relief. Most often, they seek treatment from a primary-care physician (PCP); fewer than 10% ever see a specialist, such as an audiologist, neurologist, 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’s approach to hearing loss versus dizziness is 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. But, in most communities, the options for vestibular management are sparse. Despite the fact that there are many more patients complaining of dizziness than of 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 he or she truly wants to do what is best for the patient. If there is no one locally who can educate primary-care physicians and help manage them their dizzy patients, they must do the best they can with minimal diagnostic information.
The regional specialty balance clinic benefits because you, the audiologist, will understand which patients require more sensitive diagnostic and treatment options than you offer, and will refer these patients on to such a clinic.
Finally, you will benefit for the many reasons discussed in the next paragraphs.
BENEFITS FOR THE AUDIOLOGIST
First, you distinguish your practice from a retail hearing aid office. 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 for a standard ENG/VNG battery.
Third, it brings many patients into 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 who have not taken the step to seek help. They give you 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.
Alan Desmond, AuD, is the author of two textbooks, several book chapters, and two educational booklets for primary-care physicians, all related to dizziness and vertigo. He is a co-author of the Clinical Practice Guideline for Benign Paroxysmal Positional Vertigo, and represents the American Academy of Audiology at the American Medical Association. He is the founder/director of Blue Ridge Hearing and Balance Clinic in Bluefield and Princeton, WV. He blogs weekly at Dizziness Depot.
