Otology and audiology in the UK: isolated or integrated
EDITORIAL
practice?
The relationship between the disciplines of audiology and
otology is in an interesting and potentially troubled state.
Recent developments such as the Universal Neonatal
Hearing Screening Programme and the Modernising
Hearing Aid Services programme are revolutionising the
services available and delivered to patients with hearing
and balance disorders in the UK. These have had minimal
input however, from the otological community, which is
suboptimal given that patients within these programmes
may well require otological management. Additionally,
there are significant changes in the political landscape.
Specifically, it is interesting to note the formation of the
British Academy of Audiology (http://www.baaudiology.
org) with a vision of drawing all UK audiologists into
one group with strategic vision and purpose, and of the
British Otology, Hearing and Balance Group (http://
www.entuk.org.uk), which aims at providing a forum for
interdisciplinary exchange of views.
This Editorial reviews the present situation, and delin-
eates opportunities and threats facing otology and audiol-
ogy. It will be argued that the disciplines becoming
clinically and professionally isolated from one another, as
is being observed in the USA, would be to the benefit of
no-one. Rather, the future lies in renewed collaboration
between the disciplines, delivering sophisticated and high
quality care to hearing and balance impaired patients in
multi-disciplinary teams characterized by respect and
integration of purpose.
Historical insights
Whilst the discipline of otology can be said1 to have
adopted a separate and clear identity with the work of Sir
William Wilde (1815–1866) and Joseph Toynbee (1815–
1866), it is less apparent when audiology became a dis-
crete discipline. Determining the hearing thresholds of
hearing impaired patients with scientific precision had
long been an aspiration for those involved with treating
such patients, but it was in 1898 that Sir James Dundas-
Grant proposed a standardized protocol and reporting
format for audiometry.2,3 Dundas-Grant2 stated that an
audiogram ‘can be done by any ordinarily intelligent per-
son possessed of good hearing, conscientiousness and
goodwill’. The development of rehabilitative audiology
can be traced to the demand for rehabilitation following
the return of now hearing impaired servicemen to their
4 Ó 2006 The Authors. Journal compilation Ó 2006 Blackwell Publishing Limited, Clinical Otolaryngology, 31, 4–5
homelands following World Wars One and Two, a driver
also for the development of hearing aid technology.4 The
use of increasingly more sophisticated procedures and a
test battery in diagnostic audiology, particularly the use
of auditory brainstem responses and electronystagmo-
graphy, fed demand for audiology services. The combina-
tion of these factors led to the new profession of
audiologist in both the UK and USA, with a scope of
practice including adult and paediatric diagnostic testing
and rehabilitation. In some European countries, this
explicit division of roles between the disciplines did not
occur however, with some otolaryngologists specializing
in audiological practice. Further, in some nations in Eur-
ope (e.g. Holland), there exists a network of Audiology
Centres, staffed with multi-disciplinary teams including
Physicists, Hearing and Speech Therapists, Hearing and
Speech Scientists Audiometricians and Psychologists. In
some of these, especially those sited in University settings,
there is evidence of integration with otology services,
whereas others work independently of otology, with a
potential risk of isolation.
The traditional relationship between Otology and
Audiology Departments in the UK was, however, often
characterized by audiology being seen as a service depart-
ment for otology. This led to underfunded and demoral-
ized services.5 Advances in audiology (including clinical
developments in Tinnitus Clinics, Paediatric Audiology
and Vestibular Assessment and Rehabilitation), and pro-
grammes of direct access to audiology services, have pro-
voked a move away from this model into one of
autonomous Audiology Departments in recent years. It is
therefore timely to consider relationships between these
two disciplines.
Present USA situation
In recent years, there has been increasing disharmony
between the otological and audiological communities in
the US. The American Academy of Audiology [(http://
www.audiology.org) of which DB is an International
Fellow] have been driving the concept of audiology as
a truly autonomous profession, sponsoring proposed
legislation to that end. The American Academy of Otolar-
yngology, Head and Neck Surgery, however, has taken a
different stance, and does not perceive audiology to be an
appropriate gateway to diagnosis and treatment for

patients with hearing symptoms. While there potentially
are some pecuniary motivations underlying both these
positions, the implication is that both believe themselves
to be pivotal in managing patients with hearing and bal-
ance disorders, and are not entirely respectful of the con-
tribution of the other. The situation is apparently moving
steadily towards professional isolation from each other,
with potential major disadvantages for the patient.
Integrated practice rather than isolation: a clinical
example
One of many potential examples of the disadvantage of
an isolationist approach is that of the prescription of
devices to hearing impaired individuals. Until relatively
recently the options were few. They now include digital
hearing aids, implantable middle ear devices, bone
anchored hearing aids, cochlear implants and auditory
brainstem implants. The more flexible and now often
overlapping criteria for such interventions means that
management decisions would optimally be made by a
multidisciplinary team, characterized by a patient-centred
and mutually respectful approach. Other examples from
tinnitus, vestibular and paediatric practice could easily be
made. It is our belief that such non-hierarchical teams
provide the basis for the effective and efficient delivery of
care for patients with hearing and balance disorders. This
builds upon an earlier call for physician and scientific
audiologists to work in collaboration,6 widening that
challenge to otology and audiologists of all kinds. Fur-
ther, such collaborative practice would be beneficial at a
strategic level, lobbying government with unified voice
for resources and services for individuals with hearing
and balance impairment.
Ó 2006 The Authors. Journal compilation Ó 2006 Blackwell Publishing Limited, Clinical Otolaryngology, 31, 4–5
Editorial 5
In conclusion, we believe that any drift towards isola-
tion on the part of otology or audiology should be coun-
tered. The future of both disciplines lies in formulating a
joint vision, in a context of mutual professional respect,
and patient centred and collaborative practice at clinical
and strategic levels.
Acknowledgements
Dr Lucien Anteuinis, Head of the Maastricht Audiology
Centre, is thanked for helpful discussion about the situ-
ation of audiology in the Netherlands.
Baguley, D.M.,* Moffat, D.A.,  & Ramsden R.T.à
*Department of Audiology, Addenbrooke’s Hospital, Cambridge,
UK. E-mail dmb29@cam.ac.uk,  Department of Otolaryngology,
Addenbrooke’s Hospital, Cambridge, and àDepartment of
Otolaryngology, Manchester Royal Infirmary, Manchester, UK
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5 RNID (2001) Waiting to Hear: Audiology in Crisis. London,
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6 Baguley D.M. & Luxon L.M. (2000) The future of audiological
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