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The 2003 election ballot soon to be sent to the members of the American Academy of Otolaryngology-Head and Neck Surgery is of great importance to every practicing otolaryngologist. It will contain a referendum of the Academy membership regarding the membership's wishes for or against the establishment of subcertification in the subspecialty of Otology and/or Neurotology by the American Board of Otolaryngology (ABOto). The issues involve the possible consequences of subcertification: restricting the general otolaryngologist from performing ear surgery or allowing third-party payers to avoid paying for ear surgery performed by the general otolaryngologist. In addition, the added cost, protracted education time, and increase in medical malpractice insurance for the board-certified neurotologic surgeon would needlessly add cost to a patient's care.

This matter has generated major concern, and I have received telephone calls and letters to the editor about it (see pages 475ff). Michael M. Paparella, MD, past chairman of the Department of Otolaryngology at the University of Minnesota, alongterm past member of the ABOto, and teacher of more than 25 professors and chairmen of academic departments of otolaryngology, believes in providing benefit both to our patients and to members of the profession. He is not, however, in favor of subcertificatjon in neurotology by the ABOto. Barry E. Hirsh, MD, FACS, a practicing neurotologic surgeon, voices similar concerns and feels that the testing and subcertification of the neurotologist will further divide our small specialty, which needs and requires unity. John J. Shea, Jr., MD, who developed the stapedectomy operation that revitalized the specialty of otolaryngology and who popularized the use of the operation microscope, which today is used for many surgical procedures, opposes the new subcertification by the ABOt o because the additional year of training it would require is not necessary for adequate patient care. He also expresses concern that subcertification might cause universities and hospitals to prevent competent otolaryngologists who lack this new certificate from doing neurotologic surgery.

Your vote concerning your wishes fororagainstthis new category of subspecialization could be the last and only meaningful opportunity you will have to voice your opinion. I urge every academy member to seriously study the issues and be sure to send back your vote on this very important matter.

JACK L. PULEC, MD

Editor-in-Chief

EAR, NOSE & THROAT JOURNAL