Teamwork between otologists and audiologists.

Dear Editor:

As a professor and practitioner of Audiology for more than half a century, I found the Guest Editorial by Dr. Silverstein on "The future of stapes surgery" in the July 2005 issue of the ENT JOURNAL of great interest. However, I must take strong exception to the statement that "if the audiologist becomes the' gatekeeper,' fewer patients [with otosclerosis] will be referred for surgery."

I have always seen the relationship between the otologist and the audiologist as one of cooperative teamwork that ensures quality management of the patient. I have advised my many patients with stapedial otosclerosis to seek surgical evaluation for this condition. Audiologists I have trained through the years and the overwhelming majority of my colleagues approach these patients similarly, although we do indicate that a hearing aid is an alternative. If I suffered from middle ear otosclerosis and had well-preserved cochlear function, I would opt for surgical correction.

We feel that amplification and strong programs of audiologic rehabilitation comprise the appropriate treatment for most patients with sensory hearing losses. There are enough such patients to keep us busy without inappropriately steering those patients with conductive hearing loss away from surgery, which is by far the more appropriate treatment.

Sincerely,

Maurice H. Miller, PhD

Professor of Audiology

New York University

New York, N.Y.

Response:

It is refreshing to hear this type of opinion.

Herbert Silverstein, MD, FACS 

Silverstein Institute

Sarasota, Florida